Sierra

We have a trailer and sometimes camp without AC power supply. To do this with both my wife and myself using a ResMed CPAP, I had purchased a DC to DC converter for my wife's S9 machine and my AirSense 10 machine. I decided on a DC to DC converter instead of just using a DC to 115 volt inverter (which we have used) as the DC to DC converters are more energy efficient. When you camp off grid the amount of energy you use becomes an issue. We have two 6 volt golf cart batteries in our trailer which is quite a bit, but not so much when you start running two CPAPs each night. To help I have a 70 watt solar panel to help recharge the batteries each day, but it still is a bit marginal. I wish I had bought a 100 watt panel!! This has not gone perfectly as my wife found out with some distress that the ResMed DC to DC converter for the S9 has a design deficiency. With returns to the vendor I have tried three different ResMed converters for her machine with none of them working properly. If you shut off the heated hose and humidifier the converter works fine. But as soon as you turn these features on, the power supply trips out on overload. Surprisingly the converter I have for the A10 works fine even with the heated hose and humidifier turned on. The two power supplies look identical except for the connections to the machine. ResMed could not resist changing the power connection to make the S9 converter not work with the A10 machine. In any case we have made do with the defectively designed converter by turning off the extra features. This does help with power conservation also.

More recently my wife got a new AirSense 10 For Her and the S9 converter is not suitable for it due to the connection fitting. So I looked for a new converter and discovered that Amazon sells a knock off converter from China. It is much smaller, and cheaper. In Canadian dollars on Amazon.ca the ResMed converter is $125 while the knock off KFD unit is $65. The reviews were very favourable so I thought I would give it a try. Delivery was 2 days and it arrived today. My wife tried it out with an afternoon snooze in our trailer. It worked well with both the humidifier and heated hose turned on. See the SleepyHead chart below. Based on this test, I would suggest this is a good alternative to the ResMed converter. If we discover any issues I will try to remember to post again. My routine has been to leave this DC to DC converter in the trailer and I use it even when connected to the grid. My AC to DC converter stays at home so I don't have to bother to bring it.

The big difference between this knock off and the original ResMed converter is the size and weight. The knock off KFD unit is much smaller and lighter. I wondered if that would mean it is less efficient. Not a quantitative measure, but as it was used with fairly high power draw I found it got warm but not hot. I think it is probably just as efficient as the ResMed version.

Hope this may be of help to those looking for an off the grid solution to using a ResMed CPAP. I believe this company also makes converters for the S9, so it may be a good alternative to the defective design one sold by ResMed.

My wife just got a new ResMed AirSense 10 AutoSet For Her to replace her 24,000 hour+ ResMed S9 Auto. I set it up the same as my older AutoSet 10, with the Climate Control set to Auto with a tube temperature of 80 F (27C). With an 8 hour sleep we both pretty much use the whole fill of water in the reservoir. Neither of us has had any issues with rainout. We could not ask for better performance.

Have you considered that the Phillips machine may not be responding as well to your apnea events and that is the reason why you are getting a higher AHI with the DreamStation? I have seen many OSCAR/SleepyHead graphs from the DreamStation and it is very persistent at trying to reduce pressure all night long, and when you get an event the pressure pops up again briefly and then heads down. Pressure is up and down like a yo-yo all night long. I guess this minimizes average pressure, but it also probably results in more apnea events.

It is quite easy to tell if your machine is ignoring apnea events if you use OSCAR. Just look at the flow graph in detail and you will see every recorded event or near event. You can manually determine if an event was missed or not.

A BiPap machine is generally used by those that need more pressure than the standard CPAP can provide - 20 cm. So they tend to run at higher pressures. It does take some time to get used to those higher pressures. It may also be a result of the type of mask you are using. You may want to look at the type of masks called "minimal contact" which are made by ResMed and F&P.

The other possibility is that the air pressure being used is not optimized. You can download OSCAR to view your sleep results and see if there is any room for optimization. The more pressure you have, the tighter the mask has to be to keep it from leaking.

To perhaps give you a bit of encouragement on how things may seem bad now, there is hope with some perseverance to get things sorted out. Here are a couple of my Daily reports. The first is from my first week on the ResMed AirSense 10 AutoSet from 4 years ago. It was in Auto mode with a minimum pressure of 10.5 and maximum of 16 cm or so. The second one is from last night, with the same machine, but with the setting that have evolved over the past 4 years. It is now in fixed pressure CPAP mode, with a set pressure of 11 cm. This is not likely the solution for everyone, but it has worked for me. It does show that while the Auto mode may work for some, it is not a cure all. My wife still has hers set in Auto mode, and that works well for her. In general in Auto mode most end up with a fairly narrow band between minimum pressure and maximum pressure. Set this way, it behave more like a fixed pressure CPAP mode

The only issue I have had with the A10 water reservoir making noise is if you do not push it firmly into the machine. If it is not firmly in, then it will kind of click on each breath. Probably the silicone seals flapping back and forth.

What type of mask are you using? The most common ResMed AirFit P10 mask is very quiet. Opening your mouth with a nasal mask is a problem however and the air rushing out will be noisy. Air will go in your nose and back out your mouth. That will cause large leaks that tend to have flat tops on the OSCAR leak rate graph. It reduces the effectiveness of the machine and you can also wake up with a very dry mouth. I am also a mouth breather, and tried various things to solve the issue. A chin strap kind of works, but it also makes the whole setup more uncomfortable. My final solution has been to tape my mouth closed with 3M micropore tape. You can get it at Walmart. This works for me, but it is not for everyone. The only other solution is a mask that covers your nose and mouth. I tried a ResMed AirFit F20 and simply could not stop it from leaking and waking me up. So I now use the P10 with mouth taping.

Setting the ramp time at 0 and increasing minimum pressure can work for some, but I prefer to use the Auto ramp feature. That way you can control the start pressure independently. Where do you set your EPR? When you use the Ramp you can set the EPR to be full time or for Ramp Only. Some find that using the EPR to improve comfort during the going to sleep phase, but having it turn off after that gives the best results. For others EPR full time works best. You can only try each way and see what works for you.

I would suggest kind of breaking your attempts to improve your setup into two parts. First try to get better comfort while going to sleep, and then find out if there are any ways to reduce the pressure the machine is using to treat you after that. One way is to simply limit maximum pressure. Another way is to switch the machine to fixed pressure CPAP mode. My wife's machine is setup to limit maximum pressure, while I have switched mine to fixed pressure mode. I have issues with CA events and using a fixed pressure seems best in controlling OA's while limiting pressure enough to not cause CA events.

It would be best to post your typical Daily screenshot from OSCAR and I could provide better comments.

If you want comments on your OSCAR daily screen, just post it here. On a PC, F12 saves it. Take note in the lower right part of the screen, where it is. Then with file explorer find it and drag it into an open post. Use the orange Write a Reply screen so you get a full width post size.

What you should be looking for for the events which are causing your air pressure to go up. Also important is the type of events you are having, such as obstructive (OA) or central (CA). In general obstructive events can be reduced with more pressure. But, central events can be made worse with more pressure.

One of the things you can do to get more detail on what is going on is to download OSCAR which allows you to see in minute by minute detail what is happening with events and pressure. It requires a PC or Mac and a SD card reader. The first thing you need to figure out is if you really need all that high of a pressure. You said you had 8 events over an 8 hour period. That is an AHI of 1, and is considered very normal - essentially no apnea. Over 5 per hour is considered mild apnea, while over 15 is moderate, and over 30 is severe.

This is an example of a screenshot. Notice how the pressure (red line) stays at a constant 9 cm and then when the machine decides you are asleep it ramps the pressure up. You can see during the night how the pressure responds to flow limitations and events.

This is a common problem. From what I can see, you could benefit from some comfort setup changes. Depending on how your machine has been set up, you may be able to do this from the user menu, or if not you will have to go into the Clinical Menu. To do that you hold the rectangular home button and the round set button down at the same time for 5 seconds. I would move your minimum pressure up to 7 cm. And instead of choosing a ramp time, choose Auto. In auto mode it actually holds a fixed pressure until you fall asleep. You also need to set the Start Ramp pressure to 7 cm. These changes will give you a fixed 7 cm of pressure instead of 4 (default) until you fall asleep. After that it will switch to control the pressure based on the number of events you are having.

If a start pressure of 7 cm and minimum of 7 cm is not enough to feel like you can breath easily, then you could try 8 cm. Hope that helps some. Any questions, just ask.

That appears to be the inlet filter on the S9 and A10 machine. I don't bother to clean mine and just replace them every 3 months now. Some of the after market filters are much finer than the standard ResMed filters and need to be replaced more often.

My recollection is that the home test I did, Phillips Alice NightOne, must have a positional sensor in the device that straps on your chest. It reports what your apnea is in each position. On your back does tend to be the worst, but I recall they add the events from positions up to get your AHI.