How do I tweak my Resmed s9 Adapt SV Settings?

[LittleRedTruck]

My Asv ramps up pressure to about 23 CMH20 at times . This makes mask leaks difficult to manage. Looking at settings, it seems about the only settings are Epap = 8, Max pressure support = 15 and minimum pressure support = 3. Although its a VPAP, I don't see a setting for Ipap. Actually that looks like it might be a function of Epap + Ps. Is that correct? What makes me think this, is last nite my median Ipap was 11.6, my 95 percentile Ipap was 16.9 and my Maximum Ipap was 19.3. Which computes to Epap of 8 plus some amount of pressure support. Anyway, looking at all this, it seems if I reduced Epap setting, I would reduce total pressure, or instead reduced Maximum pressure support, I would reduce total pressure. It seems like a pretty basic process to experiment a little! What do you think ? Dan

[adipasqu]

My Asv ramps up pressure to about 23 CMH20 at times . This makes mask leaks difficult to manage. Looking at settings, it seems about the only settings are Epap = 8, Max pressure support = 15 and minimum pressure support = 3. Although its a VPAP, I don't see a setting for Ipap. Actually that looks like it might be a function of Epap + Ps. Is that correct? What makes me think this, is last nite my median Ipap was 11.6, my 95 percentile Ipap was 16.9 and my Maximum Ipap was 19.3. Which computes to Epap of 8 plus some amount of pressure support. Anyway, looking at all this, it seems if I reduced Epap setting, I would reduce total pressure, or instead reduced Maximum pressure support, I would reduce total pressure. It seems like a pretty basic process to experiment a little! What do you think ? Dan

On the PRS1 ASV, IPAP = EPAP + PS, so there is no IPAP setting. The Resmed S9 VPAP Adapt may be the same way. Reducing your EPAPmin is not necessarily a bad thing, because the machine will increase EPAP as necessary to prevent obstructive events. Just make sure EPAPmax or PSmax is not limiting the auto-algorithm (i.e. pressures not bumping up against your max). Oh, and get yourself some mask liners if you haven't done so already. They will help big time with the leaks.

-A

[LittleRedTruck]

Thanks, Kinda what I thought ! I will use mask liners when I decide on the mask . I went into the ASV using pillows. Then using pillows and taping my mouth! Discovered I was blowing open at mouth corners. So digging in my bag of old masks, found a Hybrid and got that going. The leak rates are pretty good with that! Im going to call the hospital Monday and tell them Im having a problem with the pressure and see what recommendations they may have for masks! Dan

[LittleRedTruck]

Just me ! Looking for more ideas on reducing the Adapt wind tunnel !

[dsm]

My Asv ramps up pressure to about 23 CMH20 at times . This makes mask leaks difficult to manage. Looking at settings, it seems about the only settings are Epap = 8, Max pressure support = 15 and minimum pressure support = 3. Although its a VPAP, I don't see a setting for Ipap. Actually that looks like it might be a function of Epap + Ps. Is that correct? What makes me think this, is last nite my median Ipap was 11.6, my 95 percentile Ipap was 16.9 and my Maximum Ipap was 19.3. Which computes to Epap of 8 plus some amount of pressure support. Anyway, looking at all this, it seems if I reduced Epap setting, I would reduce total pressure, or instead reduced Maximum pressure support, I would reduce total pressure. It seems like a pretty basic process to experiment a little! What do you think ? Dan

On the PRS1 ASV, IPAP = EPAP + PS, so there is no IPAP setting. The Resmed S9 VPAP Adapt may be the same way. Reducing your EPAPmin is not necessarily a bad thing, because the machine will increase EPAP as necessary to prevent obstructive events. Just make sure EPAPmax or PSmax is not limiting the auto-algorithm (i.e. pressures not bumping up against your max). Oh, and get yourself some mask liners if you haven't done so already. They will help big time with the leaks.

-A

Just a word of caution.

I don't believe the Vpap ASV does adjust epap to address OSA events other than at time of titration/setup. The 1st two versions of Resmed ASV didn't offer OSA (auto) algorithms & out of curiosity I checked all Resmed's literature re the new S9 model & there is still no mention of it adjusting epap for OSA.

The Respironics models since the Bipap AutoSV Advanced, do offer epapMin & epapMax settings which are driven by an OSA auto algorithm. The Wienmann SomnoVent CS also adjusts EEP for OSA events. But, to the best of my knowledge they are the only 2 ASV machines that do.

The Resmed ASV also doesn't allow limiting the ipap+ps upper end. You can set epap (called EEP on the Resmed) & PS min (Pressure Support) but that is it. PS has a min value of 3 & IIRC can be set between 3-15 on the 2 most recent models (0-10 on the 1st model).

On a Resmed ASV, I would not be lowering epap (EEP) without doctor's advice. The last thing you need is for a lowered epap to allow OSA to return & the machine to try to use ASV pressures to clear it. Also I am pretty sure that FOT (pressure signal) is not used in the Resmed ASV yet (but I could be quite wrong on this) as FOT would at least allow the machine to try to determine if an apnea is an open or closed airway apnea & if was a closed airway, then don't apply ASV algorithm.

DSM