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[Symptoms] Resmed S9 VPAP air pressure discomfort
#1
This is the second night I have used my new Resmed S9 machine and I'm having an awful time with air pressure problems. I experience periodic strange "snoring" or something flapping in my throat, sensations of pockets of air caught in my throat, air escaping from the sides of my mouth (even when my mouth is shut) and occasional "hiccup" sensations (stomach sphincter?). Some of this isn't new. I used to get the "hiccup" on an old CPAP machine and seemed related to sleep position. I believe most of these symptoms are happening when the new machine is responding to my central sleep apneas with increased pressure. These same reactions interrupted my sleep during the titration, but the tech didn't have anything to say regarding my complaint. Does any of this sound familiar to anyone? Is it common to expect to have to take a new machine in for additional adjustments? Or am I out of luck? Thanks.
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#2
SQ,

Your profile says you're using an ASV (Adaptive Servo Ventilation). This machine is typically prescribed to people with Central Apneas, severe Obstructive Apneas, or Combination Apneas (Mix of central and obstructive). This treatment is different from what we refer to as xPAP therapy in that the pressures, pressure control, and the machine response to apnea events, while similar to xPAP therapy in concept, is also very different.

Sorry, my long way of saying you really cannot compare your xPAP experience with ASV treatment. The treatment, and side effects, are fairly different.

We don't have a lot of members on ASV therapy, but I hope someone can give you some good advice.
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#3
Hi SleepQuest,
WELCOME! to the forum.!
I don't know much about ASV machines but hang in there and someone will help you soon as we have a few who use them.
Best of luck to you.
trish6hundred
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#4
(09-11-2013, 01:04 PM)jdireton Wrote: SQ,

Your profile says you're using an ASV (Adaptive Servo Ventilation). This machine is typically prescribed to people with Central Apneas, severe Obstructive Apneas, or Combination Apneas (Mix of central and obstructive). This treatment is different from what we refer to as xPAP therapy in that the pressures, pressure control, and the machine response to apnea events, while similar to xPAP therapy in concept, is also very different.

Sorry, my long way of saying you really cannot compare your xPAP experience with ASV treatment. The treatment, and side effects, are fairly different.

We don't have a lot of members on ASV therapy, but I hope someone can give you some good advice.

Thanks for responding. My ResMed S9 is a VPAP Adapt. Yes, I have combination of apnea types. My sleep doc said this new machine is state of the art. Also expensive. Hopefully, others with this condition will respond.
(09-11-2013, 01:52 PM)trish6hundred Wrote: Hi SleepQuest,
WELCOME! to the forum.!
I don't know much about ASV machines but hang in there and someone will help you soon as we have a few who use them.
Best of luck to you.

Thanks, Trish.
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#5
I updated your subject line so those familiar with that machine can chime in.

The pressure does not increase with central apnea events the same as it does for obstructive events.

The flapping you mention is common with any CPAP. If it continues, you may have to go to a full face mask so your mouth is covered. A chin strap won't help if it is happening with your mouth closed.
PaulaO2
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#6
I've been using my VPAP Adapt for about 10 days now. Although I have not had the specific problems you indicated, I was having trouble adjusting to the extreme pressure changes. I switched to ASV mode, changed Min PS to 0 and Max PS to 5 and it helped a lot. I have recently been gradually increasing both PS settings.
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#7
I have just received the results of my titration study for ASV. I am waiting for my new machine.
There were definitly some interesting variations in pressure during the lab test. I hope to be joining the ranks of ASV users soon and have been reading about how to tweek the settings. I doubt the prescribed settings will last more than a week.

You might want to download the Sleepyhead software so can read the details of what your new manchine is doing for you. Then you may be able to fine tune things and get more comfortable and better sleep. Not all doctors will give you adaquate attention and follow up.
Good luck getting used to your new machIne.
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#8
(09-11-2013, 05:05 AM)SleepQuest Wrote: This is the second night I have used my new Resmed S9 machine and I'm having an awful time with air pressure problems. I experience periodic strange "snoring" or something flapping in my throat, sensations of pockets of air caught in my throat...


Hi SQ, welcome to the forum!

All ASV machines are bi-level (BiPAP or VPAP) but not all BiPAP or VPAP machines are ASV.

For ASV bi-level machines like yours (and unlike machines which are not ASV, such as CPAP, APAP, standard BiPAP and standard VPAP machines), the pressure tends to increase with central apnea events the same as it does for obstructive events, which is to say the pressure increases immediately, perhaps zooming up to full pressure in a few seconds (to whatever pressures it needs to go to, to reestablish your normal rate of "tidal" airflow in and out of your lungs). This is what takes time to get used to, when switching to an ASV machine.

So if you pause to swallow or anything, the machine will jump on top of that. Eventually we become accustomed to the machine. For example we learn to time our swallows to occur (mostly) between breaths, and it does not surprise or annoy us as much when the machine does its thing.

Regarding the flapping you mention, I think it appears that the EPAP pressure is too low.

My ASV titration results pointed to an EPAP pressure which actually was far loo low, so my first ASV prescription set the EPAP pressure far too low.

The technician who performed my ASV titration (before I got my machine) never raised my EPAP above 7. This was even though, before the titration started, I had shown him a ResScan report that showed my auto machine was automatically adjusting my EPAP up to 13 or higher in order to prevent obstructive events. Nonetheless, the technician followed the standard procedure, which is to start with EPAP of 6 or lower and increase the EPAP only when actual apneas or hypopneas occurred. I think this is the standard procedure used in many sleep labs, and it is a faulty procedure, since it is a carryover from earlier, non-ASV titration procedures. The sleep lab's standard ASV titration procedure ignored the difference between ASV and non-ASV treatment, which is that ASV treatment will prevent hypopneas even when the EPAP is too low.

The standard procedure allows for the referring doctor to specify a higher starting EPAP which has been determined from earlier CPAP/APAP therapy results, but the doctor didn't bother to do this, so the ASV titration was started at a very low EPAP pressure.

ASV tends to prevent obstructive apneas and obstructive hypopneas even if the EPAP pressure is way too low. If an ASV machine's EPAP pressure is too low it can cause the flapping you describe (the flapping which occurs in the throat, not in the mouth or lip area). This occurs because the airway is intermittently closing during exhalation, yet the ASV treatment is able to force enough airflow to avoid actual apnea or hypopnea. This intermittent obstruction is bothersome and I think it may prevent us from reaching deep, restorative stages of sleep.

If the technician is keeping an eye on the Flow curves and increases the EPAP pressure high enough to prevent Flow Limitation and Snore, then all will be well. But I wasn't lucky enough to have used a competent technician and sleep lab.

After I got my machine, when I looked closely at the Flow waveforms (using ResScan), I was able to see immediately that the EPAP was way too low. Instead of smooth inhale and exhale curves, there were times when my exhale curves were ratty, rough, intermittently jumping back and forth between zero (no air being exhaled) and more air being exhaled. (On a Flow plot, positive values represent inhalation, and negative values represent exhalation.)

After I adjusted my EPAP pressure to 13 or above, like my APAP had determined was sometimes needed to prevent Flow Limitation and Snore, the Flow curves stayed nice and smooth all night, indicating that my airway was remaining unobstructed and air was able to pass through my airway freely.

Take care,
--- Vaughn



Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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