Sierra

My experience with a ResMed is that if you run the humidifier dry it gets pretty hot before it shuts itself down, and stinks pretty bad. Cleaning with vinegar and rinsing out with soap and water, and just water on the final rinse corrects it.

BUG, one limitation of the F&P Icon that you should be aware of its that it lacks central apnea detection, and it just assumes a central apnea is an obstructive apnea, and increases pressure in response to a central apnea. If you do not suffer from central apnea that is not a problem. Your ResMed S9 did detect centrals and flags them. So, you should know where you stand based on results from the S9. For those that suffer from central apnea the F&P Icon is not a good machine to have. Because increased pressure can cause more centrals it can aggravate overall AHI rather improve it in those individuals sensitive to pressure.

When I was diagnosed and given a trial machine it was the F&P SleepStyle which had just come on to the market to replace the Icon. I don't believe it detects central apnea either. I returned it because of the price, but that was a fortunate thing, as now I know it really would not have worked well for me, as I have issues with pressure and central apnea.

In any case, I know you like to read those real technical articles. You can find this information buried in this report. See figure 4. The machine designated as D6 is the Icon, and D8 is the ResMed S9. The right hand column of graphs shows how the machines respond to central (open airway) apnea events. The Icon significantly steps up pressure, while the S9 maintains pressure constant. Full paper at this link:

All APAPs are not Equivalent

Acceptance of the CPAP therapy varies with each person. My wife was diagnosed with an AHI of 80+. While in retrospect, she did not get an ideal machine setup and mask she immediately loved the CPAP due to the improvement in the quality of her sleep. She had near zero adaptation time.

On the other hand I was a reluctant adopter of the CPAP and if truth be known mainly did it to keep my record clean so I could get travel insurance. I was diagnosed at 37 AHI but believed I did not have a sleeping problem. I could get lots of sleep, but I did snore. I found the CPAP uncomfortable and it really disturbed my sleep. I recall considering getting up on one of the first few nights and chucking the whole thing out the window. In any case there was no doubt that it reduced the quality of my sleep until I got things sorted out.

So, you may have two extremes in acceptance there. I believe the overall statistics are that from 1/3 to 1/2 of all those prescribed a CPAP end up not using it, or using it so little that it has no benefit. In the end it depends on perseverance and willingness to experiment with things to find out what works. While I did not initially like the thing, I do have 100% compliance with a bit of 8 hours per night on average since day one.

This all said, I think there is no reason why anyone in the low to moderate AHI range cannot get used to using a CPAP. It just may not happen from night one!

I use the ClimateLine heated hose, with the humidity control in Auto. I almost use the whole reservoir every night. I forgot to fill it one night and ran out of water fairly early in the night. The reservoir got very hot and stunk so much I thought we had a fire in the house. Then I thought the machine was on fire. But I finally woke up and figured it out.

What you might want to try first is turning the humidity up higher, and see if it makes a difference. If it is too high you can get condensation in the hose.

Mine is about 10 months old. I recall once I did not have the water tank fully inserted and it acted weird. I can't remember now exactly what it did, but after I pushed the tank all the way in, it was fine. If you have a look at pages 24 to 27 in the technical manual at the link below, you will find some inspection instructions for the seals. In any case, it sounds like you have it figured out now.

Technical Manual

My suggestion for pressure would be 6 min to 10 max for the first night. With an AHI as low as yours it is unlikely you will need more than 10 cm of pressure. If it is not enough then just increase it for the second night. Your first night with a CPAP is likely to be the worst night you will have with it, so my thoughts are to go in at the shallow end. For comfort I would also set it up for an AutoRamp with a start pressure of 6 cm, EPR at 3, but for Ramp Only. If it is a used machine, make sure you do a data reset and restore all factory defaults first. Otherwise you could mix your data with that of the previous owner.

According to the news article the test costs $300, and the device $2,000. It is available here in Canada at least in Calgary, Alberta where it was developed. Not sure how far they have expanded beyond that. I saw some information at the website that said they got FDA approval for it in the US.

Have a look at the display and report back what you see when you start the machine up. It should look something like this if it is the AirSense 10 model. The pressure(s) in the top right are you min and max, or if a single number a fixed pressure. The one in the middle is the current starting pressure for the ramp. The symbol in the bottom left is the type of ramp.

I suspect you mean 4 millibar, not 4 bar. Millibar convert almost exactly to the cm of water commonly used in North America. That said a pressure of 4 is very low and could feel suffocating. But, it should not leak. I presume you are using a full face mask? Perhaps provide the model name and others may be able to provide some suggestions. My preference is to use a nasal pillow mask like the ResMed AirFit P10. If you have issues with opening your mouth, again my preference is to address that with mouth taping instead of going to a full face type.

A pressure of 8 cm is not that high, and I'm sure you will get used to it. Normally an AutoSet has a minimum and maximum pressure between which the machine is allowed to adjust the pressure to your needs. However, they can also be set to fixed CPAP mode. You can tell pretty much how it is set up from the screen display you see when you turn the machine on. In the example below the minimum pressure is 12 cm and the max is 20 cm, so it is in AutoSet mode. The current pressure is 4 cm, so it probably was just turned on with a ramp start pressure of 4 cm. In the bottom left the icon indicates the AutoRamp is turned on so it will only use that ramp pressure until you go to sleep. In this case after going to sleep it will ramp up to 12 cm and turn the control over to automatic. In the bottom right the icon indicates the humidity is in manual at is set at 4.

For maximum comfort, if you do not have it already, I would suggest using a ClimateLine heated hose. It will then default to automatic humidity control and you can set the temperature which is normally 27 C or 81 F.

For maximum comfort I like to start my ramp pressure higher than the default 4 cm. If you set therapy pressure is 8 cm, I would suggest using the AutoRamp with a start pressure of 7 cm. I would also turn on the EPR set to 3 , and put the EPR type to Ramp only. That way it will give you 7 cm on inhale and 4 cm on exhale which should feel quite comfortable. It will stay like that until you fall asleep. Then it will go to 8 cm and the EPR reduction on exhale will stop.

As Bonjour suggested you can get a much more detailed report of how you are doing if you download SleepyHead and copy the data from your SD card to view it in SleepyHead.

There are a couple of sleep dentists that check in here, and they may be able to address your concerns. About all I can says is that the general objective in apnea treatment is to get AHI under 5 and ideally lower is better if can be done with comfort.

You might be interested in a new technology that allows for a titration test of a MAD by using a motorized test which adjusts the device while you are sleeping to determine the optimum setup. Here is news article about it.

CTV News Article

It has been developed by this company:

Zephyr Sleep Technologies