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Resmed S9 user -- autoset or not
#1
ISSUE: Is there any reason to prefer fixed air pressure over autoset on the following facts:

I've used a Resmed Autoset S9 for almost exactly one year. Average AHI has gone from 51.3 to .6. Leakage is high, average 26 -- Swift FX pillow and facial hair -- but with the low AHI I'm not that bothered. I have never been a mouth breather, but air does leak from my mouth in small "burps" between tightly sealed lips using my CPAP machine.

Sleep doc and myself are now at odds over the autoset function. It started life on a fixed pressure which I changed to autoset within a week, and five months ago on a followup, the doc took it off autoset and put it on a fixed setting of 12. Hate the sometimes bloated feeling in my gut, a non-factor on autoset.

Also since, the fixed pressure I now have dry mouth. On autoset where I also had very low AHI averages -- don't recall the number precisely, but around 1.2-1.5 -- I had no experience with dry mouth. Fixed pressure is like living with the Gobi desert, and bad as the discomfort is, I'm concerned with the side effect of dental caries.

I just had a follow up visit on the dry mouth and his best suggestion was to go to a full face mask, which is a non-starter. Tried that, realized I had the potential to become a serial killer, the amount of rage it generated in an otherwise pleasant disposition.

Between the doc and the techs from an associated sleep clinic, I get varying rationales for the fixed preference. One, it takes too long for the machine to ramp up on autoset after an apnea event, two, on autoset your brain is not being trained to adapt to the machine, ie, the machine is doing your thinking. I may have mis-described reason one, but the doctor is death on autoset and to my layman's mind and language, that seemed to be the essence of his objection. MY GP says other sleep docs are fine with autoset and there seems to be no consensus.

Adding to my lengthy preamble, which I hope will assist the smarter minds in responding and eliminate some of the guesswork, I use a chin strap, which I typically adjust once or more in the night. It is almost a reflex action which I do without fully wakening and am off again in a flash. I sleep on average seven hours but now wake up two to three times in the night to a dry mouth.

So, my preference is a return to autoset. Any thoughts?





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#2
Welcome to the forum.

Seems to me that you've already answered your question. If the Auto-titration works better for you, then that's what you should do.

What were the pressures when you were on Auto-titration?

I can't answer why some docs are against auto adjusting machines, but it's more prevalent than you think.
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#3
the cynic in me, and having been exposed to the back office activities of a few doctors (my ex worked for a real beaut... she got more money for psychiatric diagnoses, and you'd be AMAZED at how many people came in that ended up with a diagnosis of depression and a rx for anti-depressants.... "I see you have a broken ankle, that must make you sad, here, take these pills".) might think there are possible reasons.

you put your machine on auto, you feel good, you just might stop going to the sleep doc as much.
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#4
Hi Island Sleeper,
WELCOME! to the forum.!
You say you felt better when your machine was on auto, that's probably what you should use if it's more comfortable.
Hang in there for more responses to your post and best of luck to you with your CPAP therapy.
trish6hundred
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#5
Thanks for the responses. I'm hoping someone here might have a more coherent explanation than I'm capable of regarding the bias against autoset. It's a bit of Catch 22, because there is no denying the astonishing turnaround in my sleep nutrition, but I'm willing to trade off the absolute best AHI number for a moist mouth. Don't like second guessing the doc, who's really a pretty good guy. He only wants to see once a year now that my apnea is under control, so there is no monetary upside on his part. And he told me from the outset he has no monetary interest in the tech side of the clinic; gave me a prescription without question when I wanted it to buy my equipment from a U.S. online supplier.

I don't recall the pressures on autoset, but think they were eight to 14 or 15, and the data showed I wasn't going above 12. I've been too passive in this process, unlike many of you here, not carefully tracking my data or having an easy familiarity with my ResMed. I looked at some posted software for downloading data but it didn't play nice with Apple, and I haven't looked beyond that one try..

I check the hours slept and AHI each morning and wash my mask daily and do all the recommended housekeeping, but nothing more. Wish I could tolerate a full mask but it was a hard fight even with the pillow -- bit claustrophobic -- but one thing I won't do, is sleep without the CPAP. World of difference in my life. Before I do make a change I will try taping my mouth and seeing what that does. Thanks again for you advice.
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#6
(05-19-2014, 02:55 PM)Island Sleeper Wrote: Between the doc and the techs from an associated sleep clinic, I get varying rationales for the fixed preference. One, it takes too long for the machine to ramp up on autoset after an apnea event, two, on autoset your brain is not being trained to adapt to the machine, ie, the machine is doing your thinking. I may have mis-described reason one, but the doctor is death on autoset and to my layman's mind and language, that seemed to be the essence of his objection. MY GP says other sleep docs are fine with autoset and there seems to be no consensus.

If it takes too long for the machine to ramp up after an apnea, the range needs to be set more carefully. I don't know about Respironics, but the Resmed algorithm is rather aggressive, it will begin raising the pressure immediately after an apnea event. Looking from my logs when I was on auto, it took under a minute for the pressure to go up. Considering your AHI was ~1 on auto, I don't see what the problem is.

As for your brain adapting to the machine, I have no clue what that is supposed to mean. Obstructive sleep apnea is not a brain problem.

I would definitely recommend looking at the software, so you can confirm all of this for yourself. Did you try Sleepyhead? I'm not on a Mac, but it works on my oddball Linux computer, I can't imagine it wouldn't work on a Mac.

If I were you, I'd just change it back myself. If your AHI is under 5 and you are getting good sleep, there is no reason to optimize it further especially if it causes side effects.
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#7
By all means set the machine to Autoset. My sleep doc told prescribed a pressure of 15 and recommended that I try the Autoset and EPR features. I like the Autoset feature (and set the range to see how high I ever reach) and can't stand the EPR. Thankfully, my sleep doc doesn't care how I set my machines, as long as I'm sleeping well.
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#8
IMHO, the sleep lab generates more visits (and dollars) by tweaking the pressure and rechecking the results with yet another sleep test. The autoset feature eliminates the need for all that and empowers the patient to monitor his or her own therapy.
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#9
What's the problem? Change to autoset. If it works for you then that's what u should be using. It's easy to make changes in the settings on an S9 so go ahead. If I listened to my sleep doc I'd still be on bipap. With my S9 and Airfit pillows my AHIs are less than 1. Cpap therapy is tough enough to get used to so stick with something u know works for you.
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#10
(05-19-2014, 02:55 PM)Island Sleeper Wrote: I've used a Resmed Autoset S9 for almost exactly one year. Average AHI has gone from 51.3 to .6. Leakage is high, average 26
Leak (if that's the average leak rather than the 95%) could be better. But like you say, with the results you are/were getting it ain't broke so why fix it. Just continue to work on the mouth leaks. That's where your dry mouth is coming from.

(05-19-2014, 02:55 PM)Island Sleeper Wrote: Sleep doc and myself are now at odds over the autoset function. It started life on a fixed pressure which I changed to autoset within a week, and five months ago on a followup, the doc took it off autoset and put it on a fixed setting of 12. Hate the sometimes bloated feeling in my gut, a non-factor on autoset.

A lot of sleep docs prefer fixed pressure because they feel that gives them the best control over what the patient is doing. Never mind the Autoset is the industry standard anymore. It's very much as if a Radiologist stayed with an enclosed MRI machine rather than the newer open models because he thinks that way the patient is less likely to escape. It doesn't make them bad guys, or even bad docs. It just means they are more comfortable when they pidgeonhole everyone into the same narrow treatment plan.

(05-19-2014, 02:55 PM)Island Sleeper Wrote: I just had a follow up visit on the dry mouth and his best suggestion was to go to a full face mask, which is a non-starter. Tried that, realized I had the potential to become a serial killer, the amount of rage it generated in an otherwise pleasant disposition.

You have already demonstrated the pillows mask can work well for you. The ffm will not solve the dry mouth thing if you simply breath through your mouth when using that mask. Many people feel they need the ffm because they are "mouth breathers." I know, because I was one. But with the chinstrap and a little practice there is no reason why the pillows mask, or at least a nasal mask would not work for most people. Even those whose nose doesn't stay clear all that well, like mine. The air pressure will establish the nasal airway and keep it open all night.

(05-19-2014, 02:55 PM)Island Sleeper Wrote: Between the doc and the techs from an associated sleep clinic, I get varying rationales for the fixed preference. One, it takes too long for the machine to ramp up on autoset after an apnea event, two, on autoset your brain is not being trained to adapt to the machine, ie, the machine is doing your thinking. I may have mis-described reason one, but the doctor is death on autoset and to my layman's mind and language, that seemed to be the essence of his objection. MY GP says other sleep docs are fine with autoset and there seems to be no consensus.

The idea that your brain is not being trained to adapt to the machine is nonsense. The idea that it takes too long to ramp up is a minor machine adjustment when required. The default starting pressure on these machines is 4. If you ask it to ramp up from that to an operating pressure over a 1/2 hour period, that is probably too long. So we don't do that. I no longer use a ramp at all. I start at I believe about 11 and let the machine have it's way with me up to a max of about 14. I say I believe that's what I do because it's been so long since I've tweeked the settings that I forgot what they're on. My stats on the left side are pretty accurate though.


(05-19-2014, 02:55 PM)Island Sleeper Wrote: So, my preference is a return to autoset. Any thoughts?

If it was my body we were talking about, absolutely. No question, no hesitation whatsoever.
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