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S9 autoset problem
#1
I've been using my S9 in the autoset mode for over a year now, and routinely have a problem with too much pressure... Once the machine increases the pressure to restore the airway, it doesn't decrease again until it is turned off and restarted. The issue usually results in my being woke up by a leaking mask around my lower lip. Last night i finally got fed up and changed to a straight CPAP mode which helped, but I prefer to use the autoset mode if possible... I used low 12 and high 20 Auto setting, for a prescribed CPAP setting of 16. Anyone else had this issue?
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#2
Hi Shamus54!

It sounds like your basic problem may be that your mask is not adjusted properly to prevent leakage throughout the night. If you use the Mask Fit feature of the S9, and considering that your settings are 12/20, as you have listed, the test will be conducted at 20 cm H2O. If you pass that test, it would imply that you are good to go, even when the pressure increases, as it will when a flow limitation takes place.

There are some things to try that may be helpful. First recheck your mask for proper adjustment and positioning. Then be sure your mask cushion is in good condition. I find that using Pampers Natural Wipes to clean the mask leaves a film of aloe on the cushion that makes it less likely to slip out of position. Then consider using a mask liner since that can reduce the effects of the leakage so it won't wake you. Sleeping on your sides as opposed to your back will normally reduce the pressure necessary for therapy so consider trying that if applicable.

I use a ho-made mask liner in the area of my nose to diffuse the leaks into my eyes that I can't entirely eliminate. I make it by cutting a small patch from an old tee shirt. It works very well on my Mirage Quattro.

You could increase the minimum pressure and reduce the maximum so that you have a tighter range but that isn't addressing the real issue, which is mask leakage.

Consider trying a different mask if all of the above fails. What works for one may not for another. I consider the Mirage Quattro to be a fine mask but you must be sure you have the right size so that the cushion rests in the depression between your lower lip and your chin while landing on the area of your nose bridge that prevents leaks into the eyes. As stated before, mask liners can be of help in moderating the effects of a certain amount of unavoidable leakage, so long as they aren't massive.

Dude
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#3
I forgot to mention the possibility that a chin strap may help if you are opening your mouth while asleep and causing the leak in that area around the bottom.

Dude
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#4
The machine programming causes it to increase pressure in response to flow limitations, snores and volume reductions. Some people have a fairly high flow limitation rate that will cause an auto machine to increase in pressure and stay there. The trick is to review your data and determine what pressure is needed to extinguish OA, and set this a a maximum. You will accept the flow limitation as less disruptive than the higher pressure.

One approach might be to use the pressure you selected for CPAP as the maximum pressure. This will allow your machine to remain in autoset mode, but chances are it will remain at the top of the range you allow. Observe whether this provides adequate treatment of events and comfort, and make small adjustment to the max pressure. It is a bit unusual that a machine will provide pressures in excess of what is necessary, but if you carefully look at your data, you will probably see the cause of the pressure increases.
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#5
(05-09-2016, 10:08 AM)surferdude2 Wrote: Hi Shamus54!

It sounds like your basic problem may be that your mask is not adjusted properly to prevent leakage throughout the night. If you use the Mask Fit feature of the S9, and considering that your settings are 12/20, as you have listed, the test will be conducted at 20 cm H2O. If you pass that test, it would imply that you are good to go, even when the pressure increases, as it will when a flow limitation takes place.

There are some things to try that may be helpful. First recheck your mask for proper adjustment and positioning. Then be sure your mask cushion is in good condition. I find that using Pampers Natural Wipes to clean the mask leaves a film of aloe on the cushion that makes it less likely to slip out of position. Then consider using a mask liner since that can reduce the effects of the leakage so it won't wake you. Sleeping on your sides as opposed to your back will normally reduce the pressure necessary for therapy so consider trying that if applicable.

I use a ho-made mask liner in the area of my nose to diffuse the leaks into my eyes that I can't entirely eliminate. I make it by cutting a small patch from an old tee shirt. It works very well on my Mirage Quattro.

You could increase the minimum pressure and reduce the maximum so that you have a tighter range but that isn't addressing the real issue, which is mask leakage.

Consider trying a different mask if all of the above fails. What works for one may not for another. I consider the Mirage Quattro to be a fine mask but you must be sure you have the right size so that the cushion rests in the depression between your lower lip and your chin while landing on the area of your nose bridge that prevents leaks into the eyes. As stated before, mask liners can be of help in moderating the effects of a certain amount of unavoidable leakage, so long as they aren't massive.

Dude

My main question is why the S9 is not dropping the pressure back automatically, and if others had this same problem... I'm an old hand at using the Quattro mask after using it for several years, and never needed a chin strap in the past. Thanks
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#6
(05-09-2016, 10:29 AM)Sleeprider Wrote: The machine programming causes it to increase pressure in response to flow limitations, snores and volume reductions. Some people have a fairly high flow limitation rate that will cause an auto machine to increase in pressure and stay there. The trick is to review your data and determine what pressure is needed to extinguish OA, and set this a a maximum. You will accept the flow limitation as less disruptive than the higher pressure.

One approach might be to use the pressure you selected for CPAP as the maximum pressure. This will allow your machine to remain in autoset mode, but chances are it will remain at the top of the range you allow. Observe whether this provides adequate treatment of events and comfort, and make small adjustment to the max pressure. It is a bit unusual that a machine will provide pressures in excess of what is necessary, but if you carefully look at your data, you will probably see the cause of the pressure increases.

From everything I've read in the past, the S9 autoset is supposed to auto titrate changing/delivering the pressure you need... Mine just seems to go to the max setting and stay there after I fall asleep, (which is a malfunction in my thinking?).
Dont-know
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#7
(05-09-2016, 10:40 AM)Shamus54 Wrote: From everything I've read in the past, the S9 autoset is supposed to auto titrate changing/delivering the pressure you need... Mine just seems to go to the max setting and stay there after I fall asleep, (which is a malfunction in my thinking?).

I have the same problem with my S9. My breathing patterns give it a false positive and cause the S9 to go to the highest setting. I've found that a straight pressure works the best for me. Some people (like me) just weren't built for auto titration.
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#8
You'll have to looks at the data using software, Sleepyhead or ResScan, to determine if the machine may be at fault. Generally that's not the case. Mask leakage is a common issue that plagues most of us to a degree.

Dude
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#9
I agree with Surferdude. Often leakage is the root of all evil. Two things to consider:
1. you are having an event and the s9 is attempting to deal with it by increasing pressure....which is good.
2. often we encounter leaks. Someone correct me if i am wrong, but what i see in my data, is when leaks occur the s9 also increases pressure, which does not solve a problem, in fact, makes it worse. I see this frequently and is not accompanied by any event. So, the severe leak wakes you up, or it leaks so long that the s9 shuts itself off.

FIRST i am NOT recommending that you change your pressures. BUT i did. I lowered my top end just to see what happened. My leakage went way down. I sort of expected my AHI to rise, but it actually went down a bit also.

Some say don't change what the sleep doctors recommended. My data improved so much that i have left my pressure at 5-10. I was 5-15. I realize some people with severe apnea require high pressures, but i think in milder cases, like mine, the higher pressures just make leaks worse.

That said, if anyone disagrees with my findings, i'm ok with that. Few of us are experts, and learn by doing and sometimes making mistakes.

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#10
Are you sure that the S9 increased pressure due to leaks or might it be the other way around. The leaks started because the pressure was increased.

The S9 is programmed to maintain the set pressure. If it encounters leaks it increases the flow in an attempt to *maintain* the pressure setting.

Best Regards,

PaytonA
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