Airsense 10 faulty machine?

[papa-bear]

Hi all,

I just started with my very first machine (airsense s10) a month ago and am using a nasal pillow.

I've come to the point where I think I'm getting used to the machine but the last 3 nights have left me confused. My machine is set to auto from 4 to 20 psi. Up till 3 nights ago, I've had no big issues waking up once I got used the mask and machine but the last three nights, I've awoken to the machine on a higher psi (9 and change in my case). While I understand that it's correcting my apnea, the pressure doesn't seem to go down and I have to turn the machine off and turn back on. The added head scratcher seems to be that it ramps up even after turning the machine back on while I'm still awake! This has happened a few times in the last 3 nights and I end up taking the thing off.

The question now stands as, is this normal? I've been told the apap machine with a nasal pillow takes a longer time to figure out if you're breathing or not but for longer than 5 minutes (how long i wait to turn the machine off)?

Any insights to those with more experience would be much appreciated.

[chunkyfrog]

When a machine is "set from 4-20", it is essentially not set at all.
This is the default, and I assume you did not have a titration study--is that correct?

[papa-bear]

Thanks for your quick response. Yes, the machine is set on the default 4-20/not set at all (semantics...). Also, I have not had a titration study, didn't even know what that was until i just googled it. My original sleep study was a "take home test", which basically just calculated my ahi after the night.

But again, is it normal for an apap that is supposed to sense between apnea vs breathing to not respond over 5 minutes and to even ramp up pressure even while the person is awake and breathing?

[palerider]

Thanks for your quick response. Yes, the machine is set on the default 4-20/not set at all (semantics...). Also, I have not had a titration study, didn't even know what that was until i just googled it. My original sleep study was a "take home test", which basically just calculated my ahi after the night.

But again, is it normal for an apap that is supposed to sense between apnea vs breathing to not respond over 5 minutes and to even ramp up pressure even while the person is awake and breathing?

it would be in your best interests to download sleepyhead software (see link in my sig) and examine what is happening during the night, then adjust your machine settings to better fit your needs.

it's fine to run a machine wide open like that for a night or two, so that you can find out "do I just need a little bit of pressure?" most people need more than the minimum, some much more, and leaving the machine set on defaults delays it's ability to effectively treat you.

imagine you're in a car, and you're doing 10 mph, and pull onto the freeway, then you see that there's a truck coming up fast behind you, so you mash the gas... you just might get run over if you can't get up to speed fast enough. or, in cpap terms, if you start at 4cm, you'll likely have some events before the machine gets up in the neighborhood of the pressure you need. contrast that to getting up to 50mph before getting on the freeway, now you can much more easily avoid getting squished.

the machine doesn't KNOW when you're awake, it figures "I'm on, so there must be a sleeping person on the other end" so if you're breathing in a way that makes it think there's a problem, it will respond.

as to it not responding, it all depends on what's happening, and how that fits into it's programming. if you're holding your breath to 'test' it, then it's going to ignore you, because it doesn't respond to breath holding tricks, it sees those as central apneas, and it does not respond to those.

[papa-bear]

Thanks for the feedback and recommending the software you mentioned, I think I'll be doing that tonight.

As for "testing" the machine, no, I was not holding my breath or anything like that. I woke up to it being 9 psi, turned it off, turned it on, was breathing normally trying to fall asleep, machine ramps up to 7 psi while I'm awake, waited 5 minutes for it to (hopefully) detect that I'm breathing but no luck so shut it off, turned it back on, was breathing normally trying to fall asleep again, machine ramps up again to about 7 psi while I'm still awake, waited 5 minutes again breathing normally, machine didn't lower pressure, turned it off, took mask off, went to sleep within seconds.... (well, we all know it wasn't good sleep tho...)

Another thing that's coming to mind is.... was I actually awake or was I thinking I was still awake since the events were so close together... hm.. Anyway, I do have a question in to my equipment rep so hopefully he has some insight. If anyone else had similar experiences, I'd appreciate any additional info.

Thanks.

[palerider]

Another thing that's coming to mind is.... was I actually awake or was I thinking I was still awake since the events were so close together... hm.. Anyway, I do have a question in to my equipment rep so hopefully he has some insight. If anyone else had similar experiences, I'd appreciate any additional info..

you may very well have been dozing on and off during those times when the pressure increased. you might find the answers in sleepyhead, and zooming in on your data.

[Jay Aitchsee]

Papa, I think you have two things going on.

1st, as mentioned above, the machine doesn't "know" whether you are awake or asleep. If the machine is on, it assumes you are asleep and reacts according. If you stop breathing (hold your breath while turning over, say) while awake, the machine will see that as an apnea and respond accordingly as dictated by its algorithm.

2nd, by having your minimum pressure set at 4, you have effectively eliminated Ramp. The Ramp setting is the "time" to raise the pressure from the start (4) to the "min" Autoset pressure. Since in your case, the Ramp start pressure and the Min pressure are the same, the Ramp setting is meaningless.

Now, I don't use Ramp, but this is my understanding of how it works. Others may offer more or different insight.

[palerider]

2nd, by having your minimum pressure set at 4, you have effectively eliminated Ramp. The Ramp setting is the "time" to raise the pressure from the start (4) to the "min" Autoset pressure. Since in your case, the Ramp start pressure and the Min pressure are the same, the Ramp setting is meaningless.

Now, I don't use Ramp, but this is my understanding of how it works. Others may offer more or different insight.

you're pretty much spot on.

[TangledHose]

Thanks for the feedback and recommending the software you mentioned, I think I'll be doing that tonight.

As for "testing" the machine, no, I was not holding my breath or anything like that. I woke up to it being 9 psi, turned it off, turned it on, was breathing normally trying to fall asleep, machine ramps up to 7 psi while I'm awake, waited 5 minutes for it to (hopefully) detect that I'm breathing but no luck so shut it off, turned it back on, was breathing normally trying to fall asleep again, machine ramps up again to about 7 psi while I'm still awake, waited 5 minutes again breathing normally, machine didn't lower pressure, turned it off, took mask off, went to sleep within seconds.... (well, we all know it wasn't good sleep tho...)

Another thing that's coming to mind is.... was I actually awake or was I thinking I was still awake since the events were so close together... hm.. Anyway, I do have a question in to my equipment rep so hopefully he has some insight. If anyone else had similar experiences, I'd appreciate any additional info.

Thanks.

Papa,

The machine is simply doing what's it's programmed to do.......when you put on your mask and turn the machine on it begins to do its work. If you say the pressure rises to 7cmh2o and then won't go back down its not really supposed to magically go back down. It senses the flow rate from you breathing on the other end and proceeds to the pressure that the on board algorithm tells it to go to. As you are lying or sitting there breathing it may be sensing that the flow rate is somewhat restricted, or in more correct terminology it may be sensing a "Flow Limited" breathing pattern so it automatically increases the pressure to eliminate the Flow Limitations it is sensing and then it will tend to stay at that pressure to eliminate any more flow restrictions, so in your case it is rising to 7cm, which is not very much pressure at all, believe it or not. You might feel like 7 cm is a lot of pressure, but as you adapt to using your machine you will soon feel that 7cm is very comfortable if not a little low. I don't feel comfortable breathing on a cpap until I get up around 10 to 12 cm pressure, anything below that and I feel like it's not enough.

If you left your machine on and went to sleep chances are the pressure will go even higher overnight as the machine does its work. As the other highly knowledgable posters have mentioned up above your machine is currently at its default wide open pressure range from 4cm up to 20cm. If you download and use the Sleepyhead software you'll be able to fine tune your pressure setting to get closer to your average pressure requirements as determined by the auto function of your machine. As an example you might find from the software that most of the night your machine is using say 8cm pressure so you could begin to raise that lower setting of 4cm up closer to your average maybe like 6cm as an example. Then your machine would work more efficiently for you as Pale Rider explained with his merging car example......hey we don't want you to get "squished" when you merge onto the pressure freeway!

Bottom line is don't expect that if your machine goes up to 7cm pressure that it will go back down within five minutes to a lower pressure, it just doesn't necessarily work that way. Sounds like it wants to use the 7cm in your case and might even go higher rather than lower over the course of a night long sleep session. That's how it's supposed to work. It would only go lower over time if it was sensing no flow limitations or lack of other triggers that it senses.

[GeoffD]

My A10 machine is set at 14-17 AutoSet with no ramp and 3 cm-h20 EPR. It would occasionally go nuts and blast me. For months, I've been power cycling it every night before going to sleep and the problem went away. I just did a trip to Korea and the power brick heated up molten hot and kept quitting with what I presume was a high temperature shutdown in the power supply. It's rated for 110-240v/50-60hz so it shouldn't have that problem. I went online in Korea and ordered a spare power brick that was sitting at my door when I got home. With that new power supply, the machine is happy. So far, I have not needed to power cycle it. I'm going to continue collecting data on it but I suspect that if you have a funky power supply, the machine can go nuts in all kinds of strange ways. The humidifier quits working and I wake with massive cotton mouth. I get a ClimateLine fault code. This issue where it blasts me with high pressure and no sense of EPR.

[papa-bear]

Thanks for all the feedback everyone.

I juuuuuuuuuust checked out Sleepyhead and WOW, that's like a statistician's nirvana right there. Just amazing. So the bottom line is this, it wasn't faulty hardware but a faulty user.

So by looking at the data, it looks like I normally range anywhere from 6 to 10 with a few outliers in the 5 and 11 range. Also looking at the data shows that the last 3 nights and the previous few weeks are very similar in terms of general pressure trends throughout the night and the only difference is that I may just have been more sensitive to the pressure the last 3 nights with events. On top of that, the 2 additional times I mentioned as being awake shows one hour intervals... meaning I was apparently asleep!

In any case, I do have a follow up next week with the sleep doctor and he told me to bring the machine so perhaps I'll ask him about upping the starting pressure as many of you mentioned. And yes, thanks for the examples!

Thanks again to everyone and here's to having a less sensitive night, g'nite all!

[TangledHose]

That's great that you got SleepyHead up and running, it should provide lots of useful information for you.

You might take notice of your 95% pressure reading which means the pressure your machine was operating at, or below for 95% of the night. That figure can give you an idea of where to set your pressure range. The most important pressure is actually the lower pressure setting on your range, if you set your lower pressure around one or two cm below that 95% figure your machine has a better chance to fend off any events as it is up closer to that 95% pressure where the machine has determined it needs to be. With your lower pressure up closer to your 95% figure you won't have as many large pressure swings, which by themselves can possibly disturb your sleep, so by eliminating the need for a big pressure increase you may find that you'll have a more comfortable, more restful sleep.

Sounds like you are well on your way, hope you're appointment goes well, and give us an update if you are so inclined. There are lots of folks on here than can give you some good feedback on your therapy and machine settings based on the data you get from SleepyHead. You might want to look at the top of the announcement section where you see "Pugsy's Pointers" you'll find information there about how to post your Sleepyhead graphs so the other forum members can give you some valuable feedback.

[papa-bear]

Thanks for the added pointers. I'm still figuring this all out and didn't want to get ahead of myself (not to be confused with not doing research) but I will definitely bring all this up with the doc if he does not. And for sure, I'll post updates and possibly success stories!

[chunkyfrog]

Print out data. Good doctors are scientists.
Mine geeks out over data.

[TangledHose]

Print out data. Good doctors are scientists.
Mine geeks out over data.

I think your Doctor is just amazed that a Frog can breathe so deeply