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The Dangers of Being Lazy - LJA - 05-13-2017
Howdy all - been a few years since I posted in this wonderful forum. I've been using CPAP and APAP for 20 years more or less, and have owned a long line of machines. A couple of years ago I switched from a ResMed S9 Autoset Spirit to the DeVilbilss Intellipap DV54 APAP - and thought everything was great! AHI always less than 3 - usually 1, with very little pressure increase. The 90% and 95% numbers were usually the same - and the same as the initial pressure setting almost all the time. So, I got lazy and stopped checking the SmartCodes and sleep data - probably for a year or more. Big mistake! What I missed was that the DeVilbiss was not picking-up and proactively dealing with apneas even though it was set to be more sensitive than the factory default settings. I discovered that the hard way - just for grins, I turned off the exhale pressure relief - and woke up at 4am with the machine blowing at 17 (my base pressure is 9) - actually woke me up! So, I was lulled into complacency by actually believing that the DeVilbiss was doing its job - my bad.
So, with the seeds of doubt now firmly planted in my brain - I hauled-out my S9 Resmed from it's two year slumber and set it up. Last night, my 90% number was 11.8 (never saw that on the DeVilbiss until it went nuts night before last) with a starting pressure of 9 and EPR of 1 (same as DeVilbiss). AHI was .3. The ResScan report showed a high pressure of 14 - but I don't think that was during sleep - I think that happened when I was setting-up the machine. I'll know more tomorrow - but in the subjective world, I felt a whole lot better this morning than I've felt for a long time - and that was before looking at the sleep report. My "frog in the cauldron" complacency was costing me quality sleep - for a couple of years - and I have a used DeVilbiss for sale to be used in CPAP mode only. I now totally agree that the often-repeated critique of the DeVilbiss being insufficiently proactive as compared to the S9 Autoset is accurate - and that the S9 is a superior machine for auto-titration. Thus, one of the dangers of relying on an APAP to deal with changed pressure needs over time has become manifestly clear - don't do it unless (a) you have a known, high quality APAP, and (b) read the sleep reports and become suspicious if the numbers don't show variability from night-to-night. I interpreted the lack of variation as a good thing, when, in fact, it was the opposite.
RE: The Dangers of Being Lazy - AlanE - 05-13-2017
It's possible the devilbiss is defective and in need of repair. I've never used it and I don't recall others experiencing the same issues. Good that you are getting good results now though.
RE: The Dangers of Being Lazy - LJA - 05-13-2017
(05-13-2017, 05:16 PM)AlanE Wrote: It's possible the devilbiss is defective and in need of repair. I've never used it and I don't recall others experiencing the same issues. Good that you are getting good results now though.
It could be - but DeVilbiss uses a different kind of apnea detection and prediction that relates more to snoring - whereas ResMed uses flow measurement in the S9 Autoset. It could easily be the case that the ResMed algorithms and flow measurement are better for my kind of apnea. I have another DeVilbiss at our other home in Texas, and have yet to check it - but I plan to when we are there next. Worst case, I can use it as a CPAP fixed at the 90% pressure indicated by the S9.
The bigger problem is that unless you are a serious sleep technician, you wouldn't know the DeVilbiss is defective - everything works fine, the SmartCode reports don't indicate any abnormalities or error codes, but having such a drastic change after turning off the EPR (which was just for grins) tells me that something clearly isn't right - and I don't believe it is a defect - I think it is a matter of design and that design not fitting my kind of apnea - or the S9 just being a better machine - most reviewers rate the S9 as the gold standard of APAP.
RE: The Dangers of Being Lazy - trish6hundred - 05-13-2017
Hi LJA,
WELCOME back! to the forum.
It’s good you brought your S9AutoSet out of storage and that you are getting much better sleep.
Good luck to you as you continue CPAP therapy.
RE: The Dangers of Being Lazy - LJA - 05-13-2017
Thanks Trish!
RE: The Dangers of Being Lazy - LJA - 05-14-2017
(05-13-2017, 06:45 PM)Gtrish6hundred Wrote: Hi LJA,
WELCOME back! to the forum.
It’s good you brought your S9AutoSet out of storage and that you are getting much better sleep.
Good luck to you as you continue CPAP therapy.
Trish - I noticed that my S9 has 6,000 +/- hours on it - how long do you think these things will last? Any experience with the longevity of the S9 or anecdotal data?
RE: The Dangers of Being Lazy - dwd1249 - 05-14-2017
(05-14-2017, 01:21 AM)LJA Wrote:(05-13-2017, 06:45 PM)Gtrish6hundred Wrote: Hi LJA,
WELCOME back! to the forum.
It’s good you brought your S9AutoSet out of storage and that you are getting much better sleep.
Good luck to you as you continue CPAP therapy.
Trish - I noticed that my S9 has 6,000 +/- hours on it - how long do you think these things will last? Any experience with the longevity of the S9 or anecdotal data?
6000 hours = 750 days at 8 hours use or a bit over 2 years. I believe they should last 5 + years.
RE: The Dangers of Being Lazy - LJA - 05-14-2017
(05-14-2017, 03:27 AM)dwd1249 Wrote:(05-14-2017, 01:21 AM)LJA Wrote:(05-13-2017, 06:45 PM)Gtrish6hundred Wrote: Hi LJA,
WELCOME back! to the forum.
It’s good you brought your S9AutoSet out of storage and that you are getting much better sleep.
Good luck to you as you continue CPAP therapy.
Trish - I noticed that my S9 has 6,000 +/- hours on it - how long do you think these things will last? Any experience with the longevity of the S9 or anecdotal data?
6000 hours = 750 days at 8 hours use or a bit over 2 years. I believe they should last 5 + years.
Good news! Thanks!
RE: The Dangers of Being Lazy - LJA - 05-19-2017
A very strange turn of events. I increased the EPR on my S9 to 2, and the 95% pressure went down - and I had my first 0.0 night ever last night! When I turned the EPR off on my Devilbiss DV54 APAP, the pressure went crazy and my AHI'S went up! That's what inspired me to take the S9 out of storage and use it. I don't know what to make of this - since conventional wisdom seems to be that EPR has a tendency to increase auto titrated pressure and AHI numbers.
My range is set from 9 to 15 - and the 95% number went from 11.8 to 10.8 when I increased the EPR on the S9 from 1 to 2, and an AHI of 0.0, not to mention feeling GREAT when I woke up! I wish one of the smart folks on this forum could explain how increasing EPR can cause a reduction in auto-titrated pressure and AHI - and how turning EPR off caused the opposite result. Obviously, I'm thrilled and think I've found the sweet spot for me, but this is so counter-intuitive and counter to conventional thinking, it must have something to do with my unique apnea characteristics.
My next experiment is to reconnect the DeVilbiss and increase the EPR (or whatever DV calls it) to 2 with the same pressure range and see what happens - both in terms of results and subjective feelings.
RE: The Dangers of Being Lazy - AlanE - 05-19-2017
My guess - the 95% number is an average of the total session. Since EPR lowers pressure for every exhale, all other things being equal, increasing EPR should lower the average pressure.