Resmed S9 Autoset pulsing and disturbing my sleep

[markdunavant]

I was just diagnosed with OSA back in the summer and am still trying to get things right. At first, I borrowed a machine (Remstar cpap)from a friend who wasn't using it. It worked great I hadn't felt this good in quite a while. Once my deductible was met from other things, my dr prescribed and sold me a Resmed S9 autoset with HMi humidifier, climate lined tubing and Resmed swift FX nasal pillow. (I had been using the mask all along). Now, I'm not resting very well. It seems as though I'm not breathing fast enough for this machine as I'm drifting off to sleep. I've had that pulsing air wake me several times when I'm almost asleep. I've also felt it many times when I'm just laying there trying to go to sleep. I can make it happen by either holding my breath or intentionally slowing my breathing. My dr said this was probably partially waking me during the night and disturbing my sleep. She said she thought she turned it off but, it still does this. I'm also still not sleeping very well. They had the machine swapped out with a new one from the factory and there is still no change. I took the machine in 3 days ago and the dr basically told me its all in my head and gave me some "nuvigil". Yesterday, I went back to my friend and got the old cpap back from him so I can sleep.
I know the pulsing means that the machine is sensing an obstruction and thus operating correctly but, is there any way to turn it off? The older Remstar doesn't do this.
Anyone have experience with a similar issue?

[nanwilson]

I was just diagnosed with OSA back in the summer and am still trying to get things right. At first, I borrowed a machine (Remstar cpap)from a friend who wasn't using it. It worked great I hadn't felt this good in quite a while. Once my deductible was met from other things, my dr prescribed and sold me a Resmed S9 autoset with HMi humidifier, climate lined tubing and Resmed swift FX nasal pillow. (I had been using the mask all along). Now, I'm not resting very well. It seems as though I'm not breathing fast enough for this machine as I'm drifting off to sleep. I've had that pulsing air wake me several times when I'm almost asleep. I've also felt it many times when I'm just laying there trying to go to sleep. I can make it happen by either holding my breath or intentionally slowing my breathing. My dr said this was probably partially waking me during the night and disturbing my sleep. She said she thought she turned it off but, it still does this. I'm also still not sleeping very well. They had the machine swapped out with a new one from the factory and there is still no change. I took the machine in 3 days ago and the dr basically told me its all in my head and gave me some "nuvigil". Yesterday, I went back to my friend and got the old cpap back from him so I can sleep.
I know the pulsing means that the machine is sensing an obstruction and thus operating correctly but, is there any way to turn it off? The older Remstar doesn't do this.
Anyone have experience with a similar issue?

Morning Mark and welcome to the forum.

Yes you can turn off the pulsing in two ways...
1: you can turn off the exhale/inhale by going into the clinicians menu and turn it to off.
2: you can set the machine from auto to fixed pressure by also going into the clinicians menu.
The instructions can be had free of charge from appneaboard.com, just find the one you want for your machine and download it.
If the machine you borrowed is a straight cpap and you were doing fine on it you can easily set your machine from auto to straight cpap, that is one of the great things about owning an auto it can be used in both therapy methods.
Good luck
Nan

[robysue]

Imy dr prescribed and sold me a Resmed S9 autoset with HMi humidifier, climate lined tubing and Resmed swift FX nasal pillow. (I had been using the mask all along). Now, I'm not resting very well. It seems as though I'm not breathing fast enough for this machine as I'm drifting off to sleep. I've had that pulsing air wake me several times when I'm almost asleep. I've also felt it many times when I'm just laying there trying to go to sleep. I can make it happen by either holding my breath or intentionally slowing my breathing.
...
I know the pulsing means that the machine is sensing an obstruction and thus operating correctly but, is there any way to turn it off? The older Remstar doesn't do this.

Since it only happens when you are doing extra long exhalations rather than on every breath, it sounds like you are feeling the so-called FOT oscillations that the S9 uses to distinguish between OAs and CAs. The FOTs start about 4-5 seconds after the end of the most active part of the exhalation. In other words, when the machine can detect little or no airflow into or out of the lungs for about 4-5 seconds, it sends a series of small pressure oscillations in order to determine whether the airway is clear (open) or obstructed (blocked). If there is little or no airflow for 10 seconds, the machine will score an OA or a CA depending on the data gathered from the FOT oscillations. There is no way to turn that FOT algorithm off as far as I know.

And when you hold your breath or intentionally slow your breathing down by increasing the pause between breaths, your machine is seeing "very little air going into or out of the lungs." If this goes on for 4-5 seconds, the machine's FOT algorithm will kick in because the machine has no idea that you are awake. If you hold your breath long enough or increase the pause between breaths to 10 seconds, not only will you trigger the FOT algorithm, but also the machine is likely to score a CA or an OA.

The older Respironics REMstar you were using either does not try to distinguish between OAs and CAs OR it uses a very different algorithm called a PP algorithm. Which depends on exactly what REMstar you were using. If you were using an old M-Series REMstar or an even older Legacy REMstar of some sort, it would not have an algorithm for distinguishing between OAs and CAs. If you were using a System One REMstar, it would use the PP algorithm for distinguishing between CAs and OAs.

Since the FOT oscillations seem to be bothering you, you may be happier with a Philips Respironics System One REMStar 60 Series Auto CPAP Machine. It does everything your S9 does, but its PP algorithm for distinguishing between CAs and OAs will probably bother you a lot less because it only involves one short puff and it occurs a bit later in a very, very long exhalation/possible even.

It is worth asking the doctor/DME who sold you the Resmed S9 if it would be possible to swap it for a PR System One Auto CPAP that does NOT have the FOT algorithm.

Finally you say "She (the doc) said she thought she turned it off but, it still does this," my guess is that the doc thought you were noticing the EPR algorithm kicking in. EPR lowers the pressure at the start of the exhalation and raises it back up towards the end of the exhalation. EPR is supposed to make it easier to exhale against the pressure and thus make breathing feel more normal. But a minority of people find that EPR seems to "rush" their breathing---i.e. with EPR turned on, they detect that small increase in pressure while they are still barely exhaling, and psychologically they react by thinking the machine is trying to make them inhale before they're ready to. That did happen to me when I was using a Resmed S9 AutoSet when I first started PAP therapy 3 1/3 years ago.

[Lazer1234]

I was just diagnosed with OSA back in the summer and am still trying to get things right. At first, I borrowed a machine (Remstar cpap)from a friend who wasn't using it. It worked great I hadn't felt this good in quite a while. Once my deductible was met from other things, my dr prescribed and sold me a Resmed S9 autoset with HMi humidifier, climate lined tubing and Resmed swift FX nasal pillow. (I had been using the mask all along). Now, I'm not resting very well. It seems as though I'm not breathing fast enough for this machine as I'm drifting off to sleep. I've had that pulsing air wake me several times when I'm almost asleep. I've also felt it many times when I'm just laying there trying to go to sleep. I can make it happen by either holding my breath or intentionally slowing my breathing. My dr said this was probably partially waking me during the night and disturbing my sleep. She said she thought she turned it off but, it still does this. I'm also still not sleeping very well. They had the machine swapped out with a new one from the factory and there is still no change. I took the machine in 3 days ago and the dr basically told me its all in my head and gave me some "nuvigil". Yesterday, I went back to my friend and got the old cpap back from him so I can sleep.
I know the pulsing means that the machine is sensing an obstruction and thus operating correctly but, is there any way to turn it off? The older Remstar doesn't do this.
Anyone have experience with a similar issue?

I have used both models now and prefer PR 560. And it is mainly because of the way it senses apner. ResMed sends a series of air puffs too fast in my opinion. Respironics sends a larger air puff but waiting a little longer before sending it. As I breathe very slowly so disturbed me by ResMed's puffs.

[Vader]

I was just diagnosed with OSA back in the summer and am still trying to get things right. At first, I borrowed a machine (Remstar cpap)from a friend who wasn't using it. It worked great I hadn't felt this good in quite a while. Once my deductible was met from other things, my dr prescribed and sold me a Resmed S9 autoset with HMi humidifier, climate lined tubing and Resmed swift FX nasal pillow. (I had been using the mask all along). Now, I'm not resting very well. It seems as though I'm not breathing fast enough for this machine as I'm drifting off to sleep. I've had that pulsing air wake me several times when I'm almost asleep. I've also felt it many times when I'm just laying there trying to go to sleep. I can make it happen by either holding my breath or intentionally slowing my breathing. My dr said this was probably partially waking me during the night and disturbing my sleep. She said she thought she turned it off but, it still does this. I'm also still not sleeping very well. They had the machine swapped out with a new one from the factory and there is still no change. I took the machine in 3 days ago and the dr basically told me its all in my head and gave me some "nuvigil". Yesterday, I went back to my friend and got the old cpap back from him so I can sleep.
I know the pulsing means that the machine is sensing an obstruction and thus operating correctly but, is there any way to turn it off? The older Remstar doesn't do this.
Anyone have experience with a similar issue?

I had the same problem but with my PRS1. I even had the unit replaced with a new one but it still bothers me. DME told me that they "hadn't heard of this problem before" and I "might be hypersensitive" so I wound up switching back to one of my old Remstar Auto machines. Problem solved ( for now)

[robysue]

Vader,

Some people are bothered by the PP's the System Ones send out to distinguish between OAs and CAs. The older Remstar machines did not try to distinguish between OAs and CAs and did not have the PP algorithm.

As for which is more noticeable, the Remed FOT algorithm or the PR PP algorithm, I think that's in the airway of the person using the machine and how sensitive it is. Some people notice the FOTs more because they kick in a bit sooner and last a lot longer. Some people notice the PPs more because they're larger puffs of pressure.

[Vader]

Vader,

Some people are bothered by the PP's the System Ones send out to distinguish between OAs and CAs. The older Remstar machines did not try to distinguish between OAs and CAs and did not have the PP algorithm.

That's what I figured. Are you aware of any solution to the problem, other than using an older style machine like I'm doing? I do like my old machines, but it would be nice to have a new unit. The one I'm using is eight years old.