Questions

[BryanB]

I have purchased a ResMed S9 Autoset, I went last friday and purchased a full face mask, Quattro FX, and I have been trying to get used to this and I have a few concerns/questions, that I am just not sure about. I have no insurance, so I had to do all this on my own money.

I did have a sleep study that was done years ago, however, I was only able to do half the study, as then my insurance changed, and I couldnt afford the high deductible that then applied. So I went for the first night, was diagnosed with OSA, but did not go back for the second night where they would have done the CPAP and gotten settings for me.

What I am experiencing, when it first turns on, it blows very hard, I guess checking for mask air leaks? Then it 'calms' down, and seems to run at the minimum setting of 4. This seems to be comfortable to start. I've worn the machine for the last few nights, although I can only take it for about an hour or two, I am in the process of getting some climateline tubing so I can use the humidifier, it is just drying me out so bad I cant take more than an hour or two at this point. But, i'm not sure if I have drifted to sleep and not noticed it, or what, but it starts to get much higher pressure, last night, after about an hour and a half, I noticed, it was blowing so hard into the mask, I was getting significant air leaks, that I was not getting at lower pressures, and when I pushed the button on the machine, it showed at that point, it was at 10.4. With it blowing that hard, I found, it was feeling like it was 'blowing' my mouth open, as though I had my head sticking out a car window going down the highway. Obviously, this is not going to be comfortable. Is this 'normal'?

Is there a 'normal' range of pressure? Since we did not have settings, we basically had the unit set for full auto mode, with full range from 4 to 20, this was only at 10.4, I cant imagine what 20 is like?! I do not have ramping turned on currently, so I don't believe that had anything to do with it either.

Thank you for any insight you can give me.

[HoseHead58]

We'd need some more info to provide some information. If you do not already have the S9 Autoset Combined Clinician Manual, I recommend you search this site on how to get it. You'll need that to make any needed adjustments.
What mode is the S9 set to? CPAP or APAP?
What pressure (CPAP) or pressure range (APAP) is it set to?
I have my ramp set to 5 minutes so it starts off at 4 and ramps up to the minimal APAP level (6 for me) over a 5 minute span.
I started off with a CPAP pressure of 10 and yes, it was difficult to avoid the leaks when it got above 8 or so. There are many posts here dealing with leaks and how to avoid them. You'll have to keep trying until you find the correct formula for you.
Are you a side sleeper or back sleeper? As a side sleeper, I had trouble with the mask and leaks until I went with the nasal pillows mask type. Your experiences will likely differ.
You will have to check the data frequently and figure out how things are progressing. If the # of events are going down, then you're heading in the right direction. I am not a doctor but I like the APAP mode better as it seems to be doing a better job. With CPAP, the machine did well. Now that I am on APAP, the 6-14 range does fine. Rarely do I get above 12 during the night, and seldom does it drift below 8. Since 8-12 seems to be my "normal" range, which is why, maybe, that a CPAP of 10 worked well enough for me. Your values are likely to be different.
Read the various postings here. There is a lot of good information to be gleamed from them. Some of it will apply, others may not.
Good Luck.

[jgjones1972]

What I am experiencing, when it first turns on, it blows very hard, I guess checking for mask air leaks? Then it 'calms' down, and seems to run at the minimum setting of 4.

Are you turning it on using "mask fit" (holding the knob button down for 3 seconds) or are you turning it on straight to therapy (tapping power button)? If you are turning it on using the "mask fit" feature, then what you are describing makes sense. With "mask fit" the machine delivers 95% pressure from its last use. 95% pressure is the pressure the machine ran at or below 95% of the time. So if it is getting to 10.4 or above, then your 95% pressure would probably be somewhere at the high end of the range 4 through 10.

Masks need to be adusted for the pressure range they will be used at. So if you adjust your mask at 4 and then your pressure gets up to 10, you'll likely get a lot of leaks. The Quattro FX is pretty sensitive to wide swings in pressure. This is why you have the "mask fit" feature. Adjust the mask at the higher pressure delivered during the "mask fit" period. Then when the pressure goes down the mask may feel tight, but the pressure will probably get back up there as soon as you fall asleep anyway.

This seems to be comfortable to start. I've worn the machine for the last few nights, although I can only take it for about an hour or two, I am in the process of getting some climateline tubing so I can use the humidifier, it is just drying me out so bad I cant take more than an hour or two at this point.

I highly recommend good humidification. What do you have your humidity set to? If you aren't already having issues with rain-out (condensation in hose), you can try raising the humidity level a little at a time (humidity setting is the water drop icon. Sets off and 1 - 5, 5 is max) until you start getting condensation. When getting condensation in hose, you can either back off humidity level or find a way to insulate the hose from cooler air - hose cover, hose snuggy etc. I do recommend going ahead and getting the ClimateLine though. It really helps eliminate rain-out while providing high humidity.

But, i'm not sure if I have drifted to sleep and not noticed it, or what, but it starts to get much higher pressure, last night, after about an hour and a half, I noticed, it was blowing so hard into the mask, I was getting significant air leaks, that I was not getting at lower pressures, and when I pushed the button on the machine, it showed at that point, it was at 10.4. With it blowing that hard, I found, it was feeling like it was 'blowing' my mouth open, as though I had my head sticking out a car window going down the highway. Obviously, this is not going to be comfortable. Is this 'normal'?

Yes, it's "normal", but not desirable. The pressure feels much worse when the mask doesn't have a good seal on your face. Things will get much better when you get the mask adjusted to withstand the higher pressure so it doesn't leak like that.

Is there a 'normal' range of pressure? Since we did not have settings, we basically had the unit set for full auto mode, with full range from 4 to 20, this was only at 10.4, I cant imagine what 20 is like?! I do not have ramping turned on currently, so I don't believe that had anything to do with it either.

There isn't really any "normal" pressure. Under these circumstances it would probably be a good idea to let the machine find the right pressure. I recommend downloading ResScan (software you can use to download the ResMed SD card data to your computer and review details of treatment) and keeping track of what's happening. You could download Sleepy Head also/instead, but it has gotten awful "buggy" lately and probably wouldn't be good to start out with. Then as you start to see what's happening through the night, you can start closing in on a tighter pressure range. Tighter pressure ranges help eliminate leaks a lot - especially with the Quattro FX.

10.4 isn't an unusual pressure and doesn't feel near as bad when the mask is sealed; but, it will feel like pressure. Keep at it and you will get used to it. Especially once you get those leaks under control. I know it seems like a lot of pressure, but after a while (when leaks are under control and the humidity level is set right) you will likely wake up one day and not be able to tell the machine is on. You may even start to like the pressure.

Like you, I started out with a machine set to wide-open (4-20).

After weeks of keeping an eye on average and 95% pressure the machine was using to prevent apneas and hypopneas in order to narrow my pressure range down, I now have it set to 17 - 20. I know it may sound hard for you to believe, but I barely notice the pressure when I put my mask on now and when I wake up in the morning I have to put my hand in front of the mask vent in order to verify that the machine is still on.

Just hang in there and don't hesitate to come back to this forum with any other questions.

[GreginColo]

Hi Bryan; I have the same equipment (machine and mask) as you do and also bought mine out of pocket to avoid dealing with insurance. I have not yet got myself set up with the monitoring software so am kind of in the same place as you even though I have been using it a bit longer. I started with a constant pressure, on an older machine, of 6 as was prescribed by my sleep study last summer. When I got the s-9 auto-set, I set it for a variable pressure between 7 and 10, and that seems to work pretty well. I am able to leave the mask on most nights though some nights find myself adjusting more than other nights. Some nights I get a pretty good seal and others I have more leakage, and have't figured out what the ddiff is, whther my sleeping position, usually on my right side, or what. Being a mouth breather, the Quatro Fx is the best mask I have found. What size do you have? I usually use the large, but also have a medium that I use when I travel, which is not often, so really don;t know how the leakage compares between the two. Sorry I don't have many answers but maybe we can learn from one another. regards, Greg.

[Shastzi]

try washing the cushion with dish soap, Dawn (not concentrated)
and wash your face with the same stuff before bed.
That always gets a good seal for me.

(sealing surfaces should be clean and free of grease!)
If the plastic squeaks when you rub your damp fingers across it, it is properly de-greased!

Cheers!

=^.^=

[PaulaO2]

I think you need to do a few things. One, increase that bottom pressure from 4. That is so low, that when the machine goes to treatment pressure (whatever you body needs), it will seem like a wind tunnel. If you are waking with it at 10, raise the bottom number to 6.

The next thing is to sit up in the evening (or whenever) with the mask and machine on. Watch TV, read a book, whatever. This gets you used to the sensations. It won't help with mask placement since you'll be sitting up vs laying down. If you do want to do it laying down, use the couch, not your bed.

After that, download ResScan and/or SleepyHead to start viewing your data. Not much of it will make sense just yet but you want to start looking at it, to find what your "normal" night is like. No two nights are the same so the data will at first seem to be all over the place. Eventually, though, you'll notice trends.

During this time, you can view the leak rate. You want that less than 24. If it goes higher, look at the data. How often did it go over that line? How long did each leak last?

And the last thing is why are you using a full face mask (FFM)? Do you breathe with your mouth open while you sleep? Consider trying another mask combined with a chin strap. The mask is THE most important part of this fun. You can have the best machine in the world but it is useless if you hate the mask or it leaks or whatever.