Struggling on new machine (DeVilbiss): high HI and tired

[Greendirt]

Thanks for the update on warranty, pterg. Also, as Emilia suggested, I've been using Sleepyhead and found it great and well suited to the individual user compared to DeVilbiss' software which seems designed for a clinic.

For me, I have a new doctor who seems fantastic! She's part of a research group not an OSA 'service' as my last guy was. They were wanting to do everything and provide everything for a big fee. This one recognisees my high level of engagement and just offers medical advice for me to act on as I see fit. Fantastic!

I had an overnight titration study last night and sleep was perfect at 6-7 cm (0.0 AHI!). So, as archangle suggested, I'm going to set myself up for CPAP only at 6cm an see how that goes. I'm lucky to only need low pressures.

Thanks again to all, GD

[peterg]

Thanks for the update on warranty, pterg. Also, as Emilia suggested, I've been using Sleepyhead and found it great and well suited to the individual user compared to DeVilbiss' software which seems designed for a clinic.

For me, I have a new doctor who seems fantastic! She's part of a research group not an OSA 'service' as my last guy was. They were wanting to do everything and provide everything for a big fee. This one recognisees my high level of engagement and just offers medical advice for me to act on as I see fit. Fantastic!

I had an overnight titration study last night and sleep was perfect at 6-7 cm (0.0 AHI!). So, as archangle suggested, I'm going to set myself up for CPAP only at 6cm an see how that goes. I'm lucky to only need low pressures.

Thanks again to all, GD

good for you, I am similarly hitting new lows at 1.5.

update: I took my fired but not toasted intellipap into DB Sydney yesterday, they did a free quote, Ive damaged the board as well as the motor, and the cost is more than a new machine, even by australian standards. better news, I purchased the smartlink module without software for LESS than I could get online in the US, even without postage. good to see the module has a port for an oximeter, Ill need to get a cable for it and try it out. (I know sleepyhead will also import the oximeter data from a file location).

I just connected sleephead to the new card, and it recorded only 1 minute of last nights sleep. so either Sleepyhead is buggy, Ive got settings wrong, a loose connection on the module or, heaven forbid, the damaged board is not going to write out the data to the module properly (it did recognisethe card and it does give smartcode data that does change over time).

ive just started on it so I will hack away. it could even be one of those DB buggy thingies that need another night to sleep on to get sense out of.

even more important now to get good data given a compromised machine.

[Greendirt]

Gee, peterg … you've had it all happen!

Mine is going back too - APAP and SmartLink. But with a reported failure rate of under 1%, I wanted to be more thorough in identifying issues than just “it seems noisy, I'll send it back” but now I think there is a solid basis to say it does not do what it is supposed to. It is either not generating the right pressure or is reporting spurious sleep data, or both.

I have swapped from APAP to CPAP (at 6cm H2O as my titration study this week indicated was 100% effective and gave an AHI of 0.0 with not a single sleep event of any kind what-so-ever, about the same result as I had on the S9 at 6.2cmH2O) and cut out all the comfort features to eliminate as many variables as possible. But it still reports a terrible HI of about 7 to 10 per hour with lower AIs, NRIs etc. My question is why the different outcomes to what should be the same therapy.

Last night I thought the pressure (6cm) felt low and put the manometer on – it read about 5cm. So I put the machine up to 7cm and the manometer read 6cm and the pressure felt right. And I feel OK this morning (despite the machine telling me I had an AHI of 9). So, it may no longer be putting out the pressure it's meant to.

So, are the terrible data reports accurate for bad therapy at the wrong pressure, or is the data spurious as a result of whatever is causing the pressure issue and noise? Or is it both. (Or the titration study and the S9 are both wrong and the DeVilbiss is right – possible I suppose, but not plausible). I am feeling better at 6cm rather than on APAP which varied between 6 and 12 cm.

Whatever, it is not good enough. What I'm wrestling with now is how to go about fixing this.

I can rent a local machine in the interim while the warrant gets sorted out one way or another, however long that takes.

Or I can order a new machine, and then send the DeVilbiss back. With prices so much lower in the US, as peterg points out, it still works out better to buy two machines online than one locally. It's only warranty that's a pain.

If I get a new machine, then do I get a DeVilbss CPAP (cheap and works with humidifier and data unit etc) or do I break out and get an S9 (and reward a market domineer at great expense to my self). Mmmm. I am undecided.

One of the things that really reflects badly on the DeVibliss software is the daily reports. The header of the report reports the machines settings (pressure etc) as of the day the report is viewed, not the day reported on. Thus, when the settings are changed, the header of all the daily reports that precede it change to the new setting and become inaccurate for the day reported on. That is bad, in my view, as it is misleading for post-analysis.

As an aside, I visited my friendly local CPAP supplier the other day – the DeVilbiss IntelliPAP Auto with humidifier was $1895! The same machine is ~$425 in the US. How is that disparity possible in an open and free global market (as if!)? The S9 AutoSet is $2448 with the humidifier! I might just get the Elite though – at such low pressures that's all I really need. And if I do get ResMed, I won't pay local prices. Sorry ResMed. No, I'm not sorry. Why does a Sydney company charge double in Australia compared to the US after trying to limit free trade via their exclusive dealer arrangements both domestically and internationally? Not good.

Sad, as I like the DeVilbiss in many ways. But it’s just not working right. We'll see.

[DaveLP]

I went from a Resmed M100 (fixed pressure) to the Devilbiss Intellipap Auto last August and have have to experiment with settings, also. I didn't feel that the algorithm was keeping me "open" due to the exhale pressure release being so free. I was used to breathing in and out against a full pressure of 10 cm/h20 all night. I experimented with various settings of IPR and EPR and finally turned off the pressure release feature and tried it that way.

I experience 0 obstructive apnea in a typical night, although I'm prone to hypopnea and that runs my AHI up and down from 4 to 12 or 15. Last night, I awoke with a pounding, rapid pulse, and a full bladder. After getting up and returning to bed, I breathed deeply and finally quieted down and slept the rest of the night with no awakenings. I never had this type of hypopnea symptoms on constant pressure and wonder if the heavier inhale and exhale of the manual machine was better for me. Even with pressure release off, my titrated pressure seems light on exhale. There's something different going on. My daytime energy and general feeling of well being don't seem to match the numbers I see for a particular day.

I, too, wonder if the intellipap is the right machine for me. In almost two years with the fixed pressure Resmed, I don't remember any events like last night. There were no reported leaks or AHI and no leaks, just lots of hypopneas and 3 brief exhale puffs that didn't correspond with the awakening.

[peterg]

Gee, peterg … you've had it all happen!

Mine is going back too -.

I'd recommend getting an oximeter, cause that's the bottom line, and will allow for independent data to test against any suspects.
and Id recommend using Sleapyhead, it works with my Intellipap and it takes the oximeter data to compare to the Intellipap data. (and it's free/donation).
(http://sourceforge.net/projects/sleepyhead/).
as far as Im concerned my compromised machine is working ok, though when the weather gets warmer that burnt plastic smell comes back a little (doing it on the cheep what do I expect?).
I will put in for the disable NSW CPAP machine, 18 month wait and $100 contribuion and only CPAP for me, cause, like Fukushima, my Intellipap feels like she's gonna blow at any time (my fault entirely - most DC inputs have centre positive I now understand and I see a lot of those symbols on appliances with the upper solid line, lower dash, which apparently means the same thing to the electronic pros).

[Greendirt]

In almost two years with the fixed pressure Resmed, I don't remember any events like last night. There were no reported leaks or AHI and no leaks, just lots of hypopneas and 3 brief exhale puffs that didn't correspond with the awakening.

I swapped to CPAP from APAP and that made all the difference to my sleep; maybe it's worth returning tothe pressure you were on before as a fixed pressure? I think the data about hypopnea and puffs and NRIs my IntelliPAP is generating is so grossly exagerated (or entierly spurious) as to be useless. I like a lot of the design features of the DeVilbiss, but my experience of it has been poor in so far as the data, the software and the noise it makes. I will be interested when it is assessed under warranty whether it is considered to be functioning normally, or if it is faulty. If it's functioning normally, I'd be very disapointed.