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Resmed A10 flapper valve driving me crazy
#1
Last night was day 8 of therapy. During the first six nights, I did not experience any issues related to the flapper valve.

THe last two nights, around the last two hours I was to remain asleep, the flapper valve started closing on exhale, making a loud, suction, closing noise, kind of like when you put your hand over the end of a vacuum cleaner's wand. This would happen at random, but often. It got to the point where I was so aware of it possibly happening, I could not get back to sleep.

Any ideas as to what is causing this? I called ResMed and they said to get a new mask. My question was why is not happening until very late in the evening's sleep cycle....like 5-6 hours in? Guess what the response was....still, get a new mask.
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#2
(06-23-2015, 11:28 AM)masbirdies Wrote: Last night was day 8 of therapy. During the first six nights, I did not experience any issues related to the flapper valve.

THe last two nights, around the last two hours I was to remain asleep, the flapper valve started closing on exhale, making a loud, suction, closing noise, kind of like when you put your hand over the end of a vacuum cleaner's wand. This would happen at random, but often. It got to the point where I was so aware of it possibly happening, I could not get back to sleep.

Any ideas as to what is causing this? I called ResMed and they said to get a new mask. My question was why is not happening until very late in the evening's sleep cycle....like 5-6 hours in? Guess what the response was....still, get a new mask.

The valve you are referring to is the Anti-Asphyxia valve in the mask. A full face mask must have one because the mask covers your mouth and nose at the same time. Should you have a power failure during the night when you are sleeping you would possibly suffocate in your sleep if you did not have the Anti-Asphyxia valve. Its a very, very simple and reliable design, just a simple flapper valve so nice to know that they are almost fool proof.

What pressures are you running on your machine? I suspect that you may be running such a low starting pressure, or ramp pressure that your flapper valve is not staying in the therapy position. Try raising either your ramp start pressure, and, or your lower therapy pressure by 1 cm to start with and see if the increased pressure coming through the hose and your mask connection will be enough to hold the Anti-Asphyxia valve so it is not flapping open and closed with your breathing cycle.

The Airsense machine comes from the factory with the ramp starting pressure set at the lowest possible pressure (4cm) and the factory default for pressure range if it's the auto machine also starts at 4cm. I am guessing that is your issue because it is possible that 4cm is not enough pressure under certain breathing circumstances to keep the valve from flapping closed and open on your breathing cycle. You'll have to go into the clinical menu and set the ramp start pressure up from 4cm to a higher value like 5 or 6.......my suggestion is 6cm. Also if your machine is the autoset model and it is still in factory default of wide open pressure range 4 -- 20cm then you need to also raise that lower pressure above the default 4cm.

Once you have titrated or used a machine that is wide open on the pressure range you should begin to raise that lower setting up closer to your 95% pressure...........not very efficient for proper therapy to leave these machines in the default wide open setting of 4 to 20.

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#3
This sums it up. Probably need a different mask. I have never noticed my machine making any noise at all, if any noise is heard most likely it is due to mask design. I use a p10 nose pillow and it is as quiet as can be. I would ask the folks at ResMed to suggest a mask that would be quieter.
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#4
I can almost guarantee you that there is nothing wrong with your mask. Do this little test, which by the way is a good way to verify that your flapper valve is functioning, put your mask on but do not turn on your machine, disconnect the mask from the hose if you have your autostart activated so the machine does not run........now breath normally and you'll most likely feel and hear the little silicone anti-asphyxia valve flapping open and closed as you breath, that means its working properly and will keep you from suffocating during a power failure, that's its sole purpose.

Now with the machine running there should be enough air flow through the hose to simply hold the flapper valve in the therapy position and it should not cycle open and closed......it should stay in the normal therapy position unlike when you were breathing through the mask without the machine running.

So if during the night you feel or hear the valve that means you are in an awake state, when awake we tend to breath more deeply/heavily and this stronger breathing pattern may produce enough negative pressure during the breathing cycle that the flapper valve will begin to cycle. This is probably because you still have your lower pressure or ramp set at 4 cm which is not enough to hold the flapper valve in the therapy position if your are awake and breathing more deeply than you do when you are asleep. So it's a simple increase in pressure setting on the machine, or don't take such huge breaths when your awake on the machine. Also, always be sure there is nothing blocking the exhaust ports/vents on your mask at night......like a pillow or bedding.......you never want to let those exhaust ports become obstructed as they are allowing your exhaled co2 to vent overboard so you don't re-breath too much co2.

Just a little post script............sometimes when I first start my machine with the mask on and my pressure has not come up all the way to my 11 cm minimum I'll do a BIG breath, huge inhale and exhale, and it will be enough of a huge breath that I can make my anti-asphyxia valve cycle open and closed a few times just because my deep breathing caused enough negative pressure that it was more than the machine was producing at the time and the valve will cycle.
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#5
(06-23-2015, 12:15 PM)under pressure Wrote:
(06-23-2015, 11:28 AM)masbirdies Wrote: Last night was day 8 of therapy. During the first six nights, I did not experience any issues related to the flapper valve.

THe last two nights, around the last two hours I was to remain asleep, the flapper valve started closing on exhale, making a loud, suction, closing noise, kind of like when you put your hand over the end of a vacuum cleaner's wand. This would happen at random, but often. It got to the point where I was so aware of it possibly happening, I could not get back to sleep.

Any ideas as to what is causing this? I called ResMed and they said to get a new mask. My question was why is not happening until very late in the evening's sleep cycle....like 5-6 hours in? Guess what the response was....still, get a new mask.

The valve you are referring to is the Anti-Asphyxia valve in the mask. A full face mask must have one because the mask covers your mouth and nose at the same time. Should you have a power failure during the night when you are sleeping you would possibly suffocate in your sleep if you did not have the Anti-Asphyxia valve. Its a very, very simple and reliable design, just a simple flapper valve so nice to know that they are almost fool proof.

What pressures are you running on your machine? I suspect that you may be running such a low starting pressure, or ramp pressure that your flapper valve is not staying in the therapy position. Try raising either your ramp start pressure, and, or your lower therapy pressure by 1 cm to start with and see if the increased pressure coming through the hose and your mask connection will be enough to hold the Anti-Asphyxia valve so it is not flapping open and closed with your breathing cycle.

The Airsense machine comes from the factory with the ramp starting pressure set at the lowest possible pressure (4cm) and the factory default for pressure range if it's the auto machine also starts at 4cm. I am guessing that is your issue because it is possible that 4cm is not enough pressure under certain breathing circumstances to keep the valve from flapping closed and open on your breathing cycle. You'll have to go into the clinical menu and set the ramp start pressure up from 4cm to a higher value like 5 or 6.......my suggestion is 6cm. Also if your machine is the autoset model and it is still in factory default of wide open pressure range 4 -- 20cm then you need to also raise that lower pressure above the default 4cm.

Once you have titrated or used a machine that is wide open on the pressure range you should begin to raise that lower setting up closer to your 95% pressure...........not very efficient for proper therapy to leave these machines in the default wide open setting of 4 to 20.

That would defeat the purpose of having an auto. Some people lower the max pressure to the 95% pressure found while running wide open in "Magpie Mode." The minimum pressure is generally raised such that the machine does not have to increment pressure multiple times to squelch obstructive events. Moving the minimum toward the median pressure is better advice.

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JustMongo passed away in August 2017
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~ Rest in Peace ~
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#6
Thanks for all of the responses!

I am currently running in CPAP mode at 10. Ramp has been turned off since day 2 (these events are day 8 and 9). ERP is OFF

This flapper noise does not happen until the last two hours of the night...both days.
The first time it happened, when the flap made the sound, it was like a flutter. Last night, it only did it once per exhale (randomly but at least 50% of the exhales).

To me, if the mask was faulty, it would flutter all the time.
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#7
OK, birdies

Your last post is starting to sound more like a case of rain out in you cpap hose rather than a mask problem.

You may be building up condensation in the hose and the water pools in the hose which can give you that flutter noise. If it happens again take the mask of and see if you can drain water out of your hose. If that is it, which makes sense since its later in the night that it's happening, get the heated hose for your machine. If you already have heated hose try increasing the hose temp or lowering your humidity setting. If it is rain out it will make a gurgling sound as you breathe and the air passes through the accumulated moisture in the hose. If that's what's going on the heated hose or cloth hose cover should fix it.
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#8
(06-23-2015, 01:59 PM)under pressure Wrote: OK, birdies

Your last post is starting to sound more like a case of rain out in you cpap hose rather than a mask problem.

You may be building up condensation in the hose and the water pools in the hose which can give you that flutter noise. If it happens again take the mask of and see if you can drain water out of your hose. If that is it, which makes sense since its later in the night that it's happening, get the heated hose for your machine. If you already have heated hose try increasing the hose temp or lowering your humidity setting. If it is rain out it will make a gurgling sound as you breathe and the air passes through the accumulated moisture in the hose. If that's what's going on the heated hose or cloth hose cover should fix it.

Thanks for brain-storming with me on this! The sound I am hearing is definitely the flap shutting. I had rain out one time early, like the 2nd day. I had turned the humidity up too high and heard the gurgling.

This sound is the same sound as if you placed a cap on a vacuum line. It's definitely the valve thumping closed. It only happens on exhale.

I just took the hose off and tried to recreate. If you have a mask with a flapper valve, leave it in the hose and disconnect from the mask. The disconnect the opposite end of the hose from the CPAP device. Plug the CPAP device end with your finger and blow into the hose. You will hear the flapper valve shut. This is EXACTLTY what I am hearing.

A thought is coming to mind...in another thread, there is a discussion about CPAP pressure feeling like it;s changing through the night when it's supposed to be constant (meaning not on auto). It was said in the thread that mostly that was the body getting used to the pressure after x hours so that it seemed like it was weaker.

I have felt my pressure was weaker as well. I'm wondering if it really is, in my case, and this is leading to this valve issue after running for several hours straight?????

For it to be rain-out, I'd have to have so much water in the hose that it was blocking the airflow, similar to my finger. If that was the case, there'd be a mess when I pulled of the hose. My hose has been dry both of the nights this has been experienced.
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#9
well, it's a little confusing, but I guess it may be possible that the little silicone anti-asphyxia (flapper valve) may have gotten dislodged or is other wise not functioning as it should be, so maybe this is something to look into with your mask. I have been on cpap for eleven years and mostly used full face masks for the bulk of that time, several Resmed models and my current mask the F&P Simplus and I have never seen a malfunctioning valve and I will often use the same mask for well over a year before replacing.

So you have experience with rainout.......so we can eliminate that as the source of your problem, and the cpap pressure of 10cm is plenty high enough to hold the valve in the therapy position. So, I guess it really may be time to try a new mask, or at least buy the replacement part that has a new anti-asphyxia valve in it..........otherwise I am a little stumped at this point.
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#10
(06-23-2015, 01:08 PM)justMongo Wrote: That would defeat the purpose of having an auto. Some people lower the max pressure to the 95% pressure found while running wide open in "Magpie Mode." The minimum pressure is generally raised such that the machine does not have to increment pressure multiple times to squelch obstructive events. Moving the minimum toward the median pressure is better advice.

Mongo,

I may have not expressed myself very well, but I think we are saying basically the same thing here.

It turns out for Birdies (original poster) that it's not an issue for him because he is running straight cpap.

But what I was trying to point out is that often times someone that is new to cpap will have an Auto machine that is running in the default wide-open as in 4 cmh20 to 20 cmh20, this way of running the machine might be ok for a few nights to self-titrate your pressure, but after you have a good idea of the pressure your Auto machine is settling on for most of the night, then thereafter you should not continue to run in the wide-open pressure settings, it's very inefficient and will not result in optimum therapy for the patient.

The upper pressure setting for most people is not really all that important because if it's set at 20 cm the machine will only raise the pressure as much as it needs, usually won't be as high as 20 cm for most people with standard OSA.

The more important pressure is the lower setting, if you leave it at 4 cm the machine takes much longer to reach optimal therapy pressure and the patient experiences much wider pressure swings in the process, which can, on it's own, cause unnecessary arousals. Setting your lower pressure up from default of 4 cm in the case of the Airsense to a pressure that is closer, but still lower than the 95% pressure will result in much more efficient therapy from your machine and will maintain better airway patency overall. The machine will not be constantly behind the pressure curve, so to speak. In the example I am stating lets say the 95% pressure is 12 cm...........what I would do is then set your lower pressure somewhat below that figure, say around 9 cm or 10 cm so that the machine has a better chance to maintain your airway in the first place. As opposed to leaving the lower pressure down way low like the default of 4 cm where the machine takes a long time to get up to optimal pressure, and in the process may be letting more Apneas/Hypopneas needlessly occur. Having the lower pressure set too low simply leaves the door open for events to occur that otherwise could be eliminated by raising the lower pressure closer to where it needs to be to maintain the airway.

I think that is the point that both of us are getting at in terms of the most efficient way to run an Auto machine.
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