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Resmed S9 Autoset pulsing and disturbing my sleep
#1
I was just diagnosed with OSA back in the summer and am still trying to get things right. At first, I borrowed a machine (Remstar cpap)from a friend who wasn't using it. It worked great I hadn't felt this good in quite a while. Once my deductible was met from other things, my dr prescribed and sold me a Resmed S9 autoset with HMi humidifier, climate lined tubing and Resmed swift FX nasal pillow. (I had been using the mask all along). Now, I'm not resting very well. It seems as though I'm not breathing fast enough for this machine as I'm drifting off to sleep. I've had that pulsing air wake me several times when I'm almost asleep. I've also felt it many times when I'm just laying there trying to go to sleep. I can make it happen by either holding my breath or intentionally slowing my breathing. My dr said this was probably partially waking me during the night and disturbing my sleep. She said she thought she turned it off but, it still does this. I'm also still not sleeping very well. They had the machine swapped out with a new one from the factory and there is still no change. I took the machine in 3 days ago and the dr basically told me its all in my head and gave me some "nuvigil". Yesterday, I went back to my friend and got the old cpap back from him so I can sleep.
I know the pulsing means that the machine is sensing an obstruction and thus operating correctly but, is there any way to turn it off? The older Remstar doesn't do this.
Anyone have experience with a similar issue?
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#2
It sounds like you are feeling the so-called FOT oscillations that the S9 uses to distinguish between OAs and CAs. The FOTs start about 4-5 seconds after the end of the most active part of the exhalation. In other words, when the machine can detect little or no airflow into or out of the lungs for about 4-5 seconds, it sends a series of small pressure oscillations in order to determine whether the airway is clear (open) or obstructed (blocked). If there is little or no airflow for 10 seconds, the machine will score an OA or a CA depending on the data gathered from the FOT oscillations. There is no way to turn that FOT algorithm off as far as I know.

And when you hold your breath or intentionally slow your breathing down by increasing the pause between breaths, your machine is seeing "very little air going into or out of the lungs." If this goes on for 4-5 seconds, the machine's FOT algorithm will kick in because the machine has no idea that you are awake. If you hold your breath long enough or increase the pause between breaths to 10 seconds, not only will you trigger the FOT algorithm, but also the machine is likely to score a CA or an OA.

The older Respironics REMstar you were using either does not try to distinguish between OAs and CAs OR it uses a very different algorithm called a PP algorithm. Which depends on exactly what REMstar you were using. If you were using an old M-Series REMstar or an even older Legacy REMstar of some sort, it would not have an algorithm for distinguishing between OAs and CAs. If you were using a System One REMstar, it would use the PP algorithm for distinguishing between CAs and OAs.

Since the FOT oscillations seem to be bothering you, you may be happier with a Philips Respironics System One REMStar 60 Series Auto CPAP Machine. It does everything your S9 does, but its PP algorithm for distinguishing between CAs and OAs will probably bother you a lot less because it only involves one short puff and it occurs a bit later in a very, very long exhalation/possible even.

It is worth asking the doctor/DME who sold you the Resmed S9 if it would be possible to swap it for a PR System One Auto CPAP that does NOT have the FOT algorithm.

Finally you say "She (the doc) said she thought she turned it off but, it still does this," my guess is that the doc thought you were noticing the EPR algorithm kicking in. EPR lowers the pressure at the start of the exhalation and raises it back up towards the end of the exhalation. EPR is supposed to make it easier to exhale against the pressure and thus make breathing feel more normal. But a minority of people find that EPR seems to "rush" their breathing---i.e. with EPR turned on, they detect that small increase in pressure while they are still barely exhaling, and psychologically they react by thinking the machine is trying to make them inhale before they're ready to. That did happen to me when I was using a Resmed S9 AutoSet when I first started PAP therapy 3 1/3 years ago.
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#3
Hi mark,
WELCOME! TO THE FORUM.!
What robysue said.
Hang in there for more responses to your post and best of luck to you.
trish6hundred
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#4
(01-06-2014, 10:23 AM)markdunavant Wrote: Anyone have experience with a similar issue?
Hi markdunavant, Welcome to Apnea Board
EPR was my issue, felt like the machine trying to interfere with breathing pattern. Tuning EPR off, resolve the issue but your mileage may vary




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#5
(01-06-2014, 11:21 AM)robysue Wrote: It sounds like you are feeling the so-called FOT oscillations that the S9 uses to distinguish between OAs and CAs.
I have been using S9 Autoset for more than 3 years and have not noticed or bothered by FOT, maybe I,m not so sensitive oldman
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#6
(01-06-2014, 03:52 PM)zonk Wrote:
(01-06-2014, 11:21 AM)robysue Wrote: It sounds like you are feeling the so-called FOT oscillations that the S9 uses to distinguish between OAs and CAs.
I have been using S9 Autoset for more than 3 years and have not noticed or bothered by FOT, maybe I,m not so sensitive oldman
Most people are NOT sensitive enough to feel the FOTs on the S9 or the PPs on the System Ones.
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#7
I mostly feel those pulses when falling asleep; right about the time my body is making the transition from awake to asleep and I'm semi conscious. Sometimes they wake me up; sometimes I can continue to fall asleep through them. I can have sleep stage transition apneas though.

I have taken advil pm and Tylenol pm in the past (not at the same time) and they seem to help me go through that transition quicker. Not advocating drug use by any means but it helps me.

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#8
Maybe you need to set a longer ramp time so that you're fully asleep before the machine starts doing its thing. As far as I know (please correct me if I'm wrong) the Resmed machines don't actively start treating apneas or hypopneas and don't start doing the FOT thing during the ramp period. (I'm sure this is the case on the VPAP Adapt, not so sure about the Autoset).
DeepBreathing
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#9
(01-06-2014, 10:23 AM)markdunavant Wrote: I can make it happen by either holding my breath or intentionally slowing my breathing.
Sorry I've missed it earlier. No, its not in your head as your doctor say.
The noise on exhalation is common complaint with the S9 and often talked about



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#10
(01-06-2014, 08:51 PM)zonk Wrote:
(01-06-2014, 10:23 AM)markdunavant Wrote: I can make it happen by either holding my breath or intentionally slowing my breathing.
Sorry I've missed it earlier. No, its not in your head as your doctor say.
The noise on exhalation is common complaint with the S9 and often talked about
Actually the opposite is true, I don,t hear the noise if hold my breath and less evident if slowing my breathing so maybe we,re not talking about the same thing



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