S9Vpap vs S9autoset

In the last year (or so) I have been slowly upping my EPR on my S9 autoset. I now have it maxed-out. I enjoy the "less pressure" upon my exhales as so do my lungs. I'll probably get a new machine this year and have been thinking of getting an S9 Vpap so I can get the "lower" exhalation pressures. My centrals are very low so there are no issues there. Should I "push" the get a Vpap? What do you guys think?

Sheriff

Are you using EPR right now? If so at what setting?
EPR is similar in sensation as to what bilevel feels like except you can use more than 3 cm difference between inhale and exhale.
3 cm difference is nice...4 cm difference is even nicer.

Of course the VPAP allows for pressures up to 25 cm...so if you are using 20 cm often...you may need to have a little more pressure available anyway. If you can get the VPAP...go for it as you won't be sorry. The auto can even be set to function like an unofficial apap machine but with higher available pressures. I call it the 4 th unofficial mode on the S9 VPAP Auto.
The other 3 are...cpap mode, fixed bilevel mode which is called "S", and auto adjusting bilevel mode

Pugs: Thanks for the response... I am using the max EPR level (3). Every time I increased it, I noticed a dramatical change in the comfort level of the exhalation. It helps my lungs and I'm convinced that I feel better during the day.... being the sensitive person that I am . I kick myself for not trying it sooner.

If I was in the autoset mode with the bottom pressure set at 8 cm/h2o... then the machine would reduce the pressure to 5 cm/h2o when I exhale... right? I'm thinking that (in the autoset mode) if the lower pressure was REAL low, I could get that suffocating feeling upon exhale. So I would tend to upp the lower pressure to eliminate that feeling... right?

Do you use EPR or the lower "exhale pressure" on the Vpap? If so... what settings? Also, what do you feel like when you have too much exhale relief?

Sheriff

EPR is not available on the VPAP machines. The reason being that the pressure support (PS..which is the difference between EPAP and IPAP..exhale and inhale) works like EPR does with some very minor timing differences.
I tested my S9 VPAP Auto in cpap mode with EPR of 3 and then tested it in fixed bilevel mode with PS of 3..and they felt almost identical. The timing of the reduction vs inhalation was a little different but still similar.
So with a VPAP you don't need EPR because what it does in terms of the pressure support actually is "better" than EPR.

And yes...if that lower number either EPAP on the VPAP machine or the drop on the AutoSet on exhale gets too low a person can feel rather suffocated. Simply not enough air is moving to feel comfortable. We won't suffocate but it sure can be uncomfortable. I am using the S9 Adapt at the moment...and my EPAP is 5.6...the default was 5.0 and I just was too uncomfortable with it...so I moved it to 6.0..more comfort and got used to it and then moved it down to 5.6.
Remember I was coming from a bilevel machine where my EPAP was 9 or 10...so it was a big change for me.

I found that pressure support of 4 or 5 was quite comfortable...above that and I feel like I am trying to breathe too fast...I know I am not breathing fast but it feels that way..sort of like hyperventilating because of the difference between inhale and exhale is so great. Also I have seen a few reports where a person tried 7 or higher Pressure support and they got a boat load of centrals. I think it can create some instability in the Oxygen/CO2O ratio which causes centrals when PS is too high.

Sheriff Buford wrote:If I was in the autoset mode with the bottom pressure set at 8 cm/h2o... then the machine would reduce the pressure to 5 cm/h2o when I exhale... right? I'm thinking that (in the autoset mode) if the lower pressure was REAL low, I could get that suffocating feeling upon exhale. So I would tend to upp the lower pressure to eliminate that feeling... right?

yes, you are correct in this thinking. Part of it is the exhale pressure is low and the other part is with the AutoSet since the 3 cm is all you can get...when exhale is at 5..that means inhale is at 8. If we could do inhale at 9 on the AutoSet then that 5 cm might not be so uncomfortable.

When I was using the S9 VPAP Auto my pressures were 10 EPAP with PS of 4...so when I started out the night I was using/seeing 10 exhale and 14 inhale. Since I sometimes need upwards of 20 cm in REM sleep I let the IPAP max go to 20 and when it went up then it would drag EPAP up with it...so I might see 18 inhale and 14 exhale on the reports. I never knew it during the night though. I always slept right through any changes like that.

If you can get a VPAP Auto..I pretty much guarantee you will love it.
And yes, I do understand about you are saying that you sleep better using EPR. I had the same thing happen when I made the switch to bilevel machine (first one was PR S1)...I simply slept better and averaged about 45 minutes more sleep with bilevel than I did with APAP. I don't know why but I just did. It might be because the breathing is so much more natural feeling having that drop during exhale on bilevel. More comfort equals sleeping longer. Not that the APAP was uncomfortable but bilevel was just extremely comfortable.

Now I am using the S9 Adapt...I don't need it in terms of central management as centrals were never much of an issue for me but again I find it even more comfortable than the VPAP Auto. The rapid pressure changes don't bother me at all.
I see increases from 9 IPAP to 20 IPAP in about 20 seconds...and I sleep right through them. I have also seen IPAP go to 22 cm...again sleep right through the changes. With the Adapt and its rapid pressure changing availability I can use a lower EPAP/IPAP combination than I could with the VPAP Auto because of response time. Makes for super comfy breathing night.

With the S9 VPAP Auto you still have to think about setting the minimum pressure (EPAP) optimally like you do with AutoSet in APAP mode. It can't respond as quickly as the Adapt does but you would probably be able to use a little less EPAP because IPAP helps keep the airway open a little better.

Pugs: thanks for your response!! This is much nicer than when you are tryin' slap me silly!!

Sheriff

Pugsy wrote:...
With the S9 VPAP Auto you still have to think about setting the minimum pressure (EPAP) optimally like you do with AutoSet in APAP mode. It can't respond as quickly as the Adapt does but you would probably be able to use a little less EPAP because IPAP helps keep the airway open a little better.

Hi Pugsy,

myself and a family member are having difficulty adapting (no pun intended!) to our respective auto cpap machines and I am wondering if it might be worth getting this machine or similar to see it it would 'help' with being a sensitive sleeper and/or general comfort as I've mentioned before. Have you only tried resmed ASV?

In europe here and resmed doesn't sell these machines directly, are any of these machines similar? http://www.eu-pap.co.uk/products/bipap.html

I was also wondering as our sleep centre uses best guesses for pressure if the machine could just be set on auto everything rather than be manually programmed with specific inspiration/expiration rates as we don't know the levels.

EDIT: I just called resmed UK and they don't sell the adapt here! Is that their best ASV? I wonder if any shop would export to here...

Overflow wrote:Have you only tried resmed ASV?

In the ResMed brand I have also used the S9 VPAP Auto.
In the Respironics brand I have used both the regular APAP (comparable to your AutoSet) and the bilevel mode PR System One BiPap Auto and the BiPap Pro.

This recent change (Jan this year) to the S9 Adapt which is their ASV mode was done on a whim just to try it out. If someone is super sensitive to pressure changes then I don't know how well they would do with the Adapt as it changes a lot and very quickly when it does (if it thinks it needs to). I have always been able to sleep through pressure changes so that wasn't a problem for me. For some people those rapid pressure changes to hurricane force winds causes them to wake up with the changes...not a good thing.

In the link you provided above...the middle machine would be comparable to the model 750 PR System One BiPap Auto which I have used.

Overflow wrote:myself and a family member are having difficulty adapting (no pun intended!) to our respective auto cpap machines and I am wondering if it might be worth getting this machine or similar to see it it would 'help' with being a sensitive sleeper and/or general comfort as I've mentioned before

I don't know if it would help or not. It all depends on what the trouble is that a person is having.
What are the current pressure settings being used? Using EPR? If so, at what setting?
What is the problem? Comfort with pressure? Comfort with mask? Trouble falling asleep? Trouble staying asleep? Just not feeling so great despite good reports?

Pugsy wrote:]

I don't know if it would help or not. It all depends on what the trouble is that a person is having.
What are the current pressure settings being used? Using EPR? If so, at what setting?
What is the problem? Comfort with pressure? Comfort with mask? Trouble falling asleep? Trouble staying asleep? Just not feeling so great despite good reports?

I have used EPR yes and it does seem more comfortable. I can have problems with being woken by the machine, and with mask leaks. Also very rarely feel better despite what the AHI might say. Had a small period of relief that only lasted weeks then it stopped working.

Overflow wrote: I have used EPR yes and it does seem more comfortable. I can have problems with being woken by the machine, and with mask leaks. Also very rarely feel better despite what the AHI might say. Had a small period of relief that only lasted weeks then it stopped working.

Can you isolate what about the machine is waking you up? Like looking at the software reports to see if it was maybe the pressure changing? Or wake up from leak? What are your pressure settings? If using auto mode..what is the typical range that you are seeing?
Leaks are always a battle no matter which machine we use. If there's a wide range in pressure sometimes we have to fit the mask to the upper range despite starting out the night at the lower range.

If you are waking often for any reason then you won't be feeling so great no matter how good the reports might look.
Figuring out the exact cause of the wake ups...can be difficult sometimes.

Using a bilevel pressure machine affects mainly comfort with breathing...it won't necessarily fix leak issues or wake up issues unless they are related solely to comfort.

You can do sort of an experiment comparing bilevel to your AutoSet by using EPR at 3 and see if that helps with comfort or sleeping or feel better. It is comparable to a bilevel machine with pressure support at 3. Some people have to increase their pressure just a little to compensate for the drop of 3 cm on exhale when using EPR to max. It is still more comfortable though than not using EPR or using EPR at 1....so worth a try.

Have you posted any of your reports so that we can see what might be going on? I don't remember.
Numbers might be good but flow limitations might be crappy...and that potentially could impact how we feel during the day.

Pugsy wrote:

Overflow wrote: I have used EPR yes and it does seem more comfortable. I can have problems with being woken by the machine, and with mask leaks. Also very rarely feel better despite what the AHI might say. Had a small period of relief that only lasted weeks then it stopped working.

Can you isolate what about the machine is waking you up? Like looking at the software reports to see if it was maybe the pressure changing? Or wake up from leak? What are your pressure settings? If using auto mode..what is the typical range that you are seeing?
Leaks are always a battle no matter which machine we use. If there's a wide range in pressure sometimes we have to fit the mask to the upper range despite starting out the night at the lower range.

If you are waking often for any reason then you won't be feeling so great no matter how good the reports might look.
Figuring out the exact cause of the wake ups...can be difficult sometimes.

Using a bilevel pressure machine affects mainly comfort with breathing...it won't necessarily fix leak issues or wake up issues unless they are related solely to comfort.

You can do sort of an experiment comparing bilevel to your AutoSet by using EPR at 3 and see if that helps with comfort or sleeping or feel better. It is comparable to a bilevel machine with pressure support at 3. Some people have to increase their pressure just a little to compensate for the drop of 3 cm on exhale when using EPR to max. It is still more comfortable though than not using EPR or using EPR at 1....so worth a try.

Have you posted any of your reports so that we can see what might be going on? I don't remember.
Numbers might be good but flow limitations might be crappy...and that potentially could impact how we feel during the day.

I have posted some of my stats here before: viewtopic.php?f=1&t=97195&p=900441#p900850

Trying a hybrid mask now which is still waking me up with leaks sometimes, seem to have a very mask unfriendly face. I can breath through my nose but will even open mouth with chinstrap so pillows and nasel never worked.

Overflow wrote: I have posted some of my stats here before: viewtopic.php?f=1&t=97195&p=900441#p900850

I responded in this thread above. Take the discussion to a thread of your own as it will be easier to follow and not hijack this thread any further.

Your pressure needs appear to be quite low...I don't think bilevel would be that big of a help at this point.
Mask leaks that wake a person up...even if they don't go to large leak territory need to be fixed.
Anything that causes sleep disruption is unwanted.

What symptoms during the day are you having now that were initially resolved but have returned?
Do you take any meds? Even OTC?

Going to pose same questions in your thread. So please respond there.

Pugs: how did the fitlife total mask work out for ya'?

Sheriff

Sheriff Buford wrote:Pugs: how did the fitlife total mask work out for ya'?

Funny you should mention the Fitlife. I did get it sort of fitted for my face to maybe try it last night but I felt so bad that I didn't want to add a new mask into things..so didn't try it.
BUT.. last night I dreamed I wore it.
In my dream it seemed fine.

It's really hard for me to get too excited about trying something that is so far away from my personal preferences. I want to for the sake of experimenting but that headgear scares the devil out of me.

I may have to settle for a trial with a nap instead of all night. Problem being there is no time for a nap lately. Lots to do.
Yesterday built a small retaining wall for my mom for accent to her flower bed. Squished my pinky finger and now it is black and it hurt like the devil last night. So I just didn't try it last night but I had it all ready to try.
Today won't have time for a nap either. Going to take a friend's Mom tile shopping so that I can build a counter top for her new kitchen island. So won't be home till way past any potential nap time.

I will let you know when I do try the Fitlife for real and not just in my dreams.

I thought about the comment you made on the bottom straps and the effect that it may have on your neck. I keep that (those) straps real loose. I can run my finger between the strap(s) and my neck. Its only suppose to keep the bottom of the mask in place and not flop at night.

You seem to be a "good ole' country girl"... a keeper!!

In my job, it's a treat to encounter a "good ole' country girl", but one thing's for sure... YOU DON'T MESS WITH EM' !

Sheriff