S9 Autoset Settings - On My Own

I have a Resmed S9 Autoset on order, and it's due to arrive on Friday. My sleep study called for a pressure of 13, which I figure to use for the high end pressure. What should the lower setting be? How about EPR? Are there any other settings I need to be aware of?

Thanks.

Is there a reason it's not being set up by the supplier? Does your prescription just call for a pressure of 13?

If you are on your own and choose APAP it may make sense to start lower but have some room to go up if needed - maybe try 10-15 and use sleepyhead to see what pressure to actually need?

What do others think?

Were you using EPR with your Escape?

I know you are anxious to try the new world of APAP and I don't blame you but if it were me I would consider using the same settings as I did on the Escape for at least the first night. See what it shows. Get a starting point and work from there.

If you just have to use apap the first night (and I really, really don't blame you as I would be wanting to myself but what I do myself probably isn't always what I SHOULD do if you know what I mean) I think Englandsf's idea of 10 to 15 would be a good starting point. It won't normally go to where it doesn't think it needs to go so that max may be a moot point.
I would use the same EPR that I did on the Escape or not use it if I didn't use it.

Often when sleep studies advise a pressure they end up with a worst case scenario pressure but sometimes they miss the mark on the other end and come in too low. I know mine did because of my REM stage sleep events need a lot more pressure and I just didn't get the REM sleep that was needed during the titration sleep study I had because I had the titration study/tech from hell to deal with.

Anyone wondering why OP's DME isn't doing this for him it's because his DME supplier wouldn't supply the AutoSet and he had to private purchase the AutoSet. Long story there and I don't blame him if he never wants to let that DME touch his machine.

Pugsy wrote:Were you using EPR with your Escape?

I know you are anxious to try the new world of APAP and I don't blame you but if it were me I would consider using the same settings as I did on the Escape for at least the first night. See what it shows. Get a starting point and work from there.

If you just have to use apap the first night (and I really, really don't blame you as I would be wanting to myself but what I do myself probably isn't always what I SHOULD do if you know what I mean) I think Englandsf's idea of 10 to 15 would be a good starting point. It won't normally go to where it doesn't think it needs to go so that max may be a moot point.
I would use the same EPR that I did on the Escape or not use it if I didn't use it.

Often when sleep studies advise a pressure they end up with a worst case scenario pressure but sometimes they miss the mark on the other end and come in too low. I know mine did because of my REM stage sleep events need a lot more pressure and I just didn't get the REM sleep that was needed during the titration sleep study I had because I had the titration study/tech from hell to deal with.

Anyone wondering why OP's DME isn't doing this for him it's because his DME supplier wouldn't supply the AutoSet and he had to private purchase the AutoSet. Long story there and I don't blame him if he never wants to let that DME touch his machine.

+1 (sort of)

You've been using a non-data-capable machine and now you need to see some data to prove or disprove if what you were prescribed is actually working. Set your new machine up as close as possible to your previous one.

Just because you have a "whiz-bang" APAP, doesn't mean you need to use it in a range of pressures.......just yet.


Den

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Wulfman... wrote:+1 (sort of)

That's why I said what I said. I agree....use exactly what has been used in the past and get a starting point.

BUT I know people...and I am no different...I would be hell bent on trying out the new mode just because I could.
This is where I probably should tell people to do as I say and not as I do. I don't always follow my own advice.

Though come to think about it when I bought my first machine (private purchase also because the first DME was just too much hassle to deal with) I did use apap mode but in a very tight range...8 to 10 and my original RX was for 8. But then I had not ever used any cpap machine prior to getting my APAP.

I still suggest use the same settings as was used with the Escape BUT if the lure of the APAP mode can't be fought off ...start with small range with same EPR as when using the Escape and pick something very close to original cpap RX...maybe 11 to max 13 or 14 or in that general area. If you start much lower than 13 you may find that you feel rather suffocated because you have been used to 13 for so long. I know that when I dropped from a 13 minimum back to a 10 minimum (I went up slowly and back down quickly in an experiment) I was uncomfortable at 10 for 2 or 3 nights until I readjusted.
Keep your changes small because your body is used to one thing right now and if you go making big changes it ain't going to like it.
You don't have to find the optimal pressure settings the first night...it's okay to take a little while.
If you are okay with 10 cm minimum starting point..it's a good one but just be aware that you might not be okay starting out 3 cm less than what you have been using. I should have mentioned that part. I experienced it myself. It wasn't horrible but it was a bit uncomfortable until I readjusted.

englandsf wrote:Is there a reason it's not being set up by the supplier? Does your prescription just call for a pressure of 13?

If you are on your own and choose APAP it may make sense to start lower but have some room to go up if needed - maybe try 10-15 and use sleepyhead to see what pressure to actually need?

What do others think?

I ordered the machine from Secondwind. I had a prescription and would have sent it to them if they asked, but they never did. As far as the prescription goes it has no pressure settings on it at all. It was written by my PCP, at my request, and only says what I asked him to write, "autoset with full data capability".

The Secondwind people did send me an email saying that they would be willing to set up the machine with whatever settings I needed, but I didn't know what settings to tell them to use and I didn't want to delay the shipment. They also offered to check with my doctor, but since I don't have one at the moment I didn't see any point to that.

I went to four different sleep doctors, trying to avoid this situation, but here I am. For the foreseeable future I'm on my own.

@ Pugsy & Den: So the consensus is to try it first in CPAP mode? That's a good thought if I have you right. Then adjust it as the data indicates. I have no reason to prefer APAP really, it's just that the third sleep doc I saw (the one who wanted to put me on amphetamines) said that he only prescribed APAP, because the problems people have with aerophagia are mostly due, not to pressure settings being too high, but to pressure settings being too high during phases of sleep where the top pressure isn't needed. That made sense to me.

JQLewis wrote:

englandsf wrote:Is there a reason it's not being set up by the supplier? Does your prescription just call for a pressure of 13?

If you are on your own and choose APAP it may make sense to start lower but have some room to go up if needed - maybe try 10-15 and use sleepyhead to see what pressure to actually need?

What do others think?

I ordered the machine from Secondwind. I had a prescription and would have sent it to them if they asked, but they never did. As far as the prescription goes it has no pressure settings on it at all. It was written by my PCP, at my request, and only says what I asked him to write, "autoset with full data capability".

The Secondwind people did send me an email saying that they would be willing to set up the machine with whatever settings I needed, but I didn't know what settings to tell them to use and I didn't want to delay the shipment. They also offered to check with my doctor, but since I don't have one at the moment I didn't see any point to that.

I went to four different sleep doctors, trying to avoid this situation, but here I am. For the foreseeable future I'm on my own.

@ Pugsy & Den: So the consensus is to try it first in CPAP mode? That's a good thought if I have you right. Then adjust it as the data indicates. I have no reason to prefer APAP really, it's just that the third sleep doc I saw (the one who wanted to put me on amphetamines) said that he only prescribed APAP, because the problems people have with aerophagia are mostly due, not to pressure settings being too high, but to pressure settings being too high during phases of sleep where the top pressure isn't needed. That made sense to me.

Yes. Set up the new machine as closely to match the previous (non-data-capable) one to at least get some data to evaluate the therapy you HAVE been getting. Might even leave it that way for a few nights to a week.

And, if you have aerophagia, (at the point you're willing to try a range of pressures), you may want to closely monitor your therapy......where your pressures are going and the extent they may be having on the aerophagia. For some, the range of pressures can exacerbate it. Just sayin'........

In my own case, I was on straight pressure for a little over a year before I got my first APAP. Tried it in a range of 10 - 15 for a week, since I had been on my own prescribed setting of 10 cm. for over a year and because my sleep doctor had originally prescribed a pressure of 18 cm. (couldn't handle that much pressure). And, for the previous couple of months, I had been experimenting with pressures of 11 and 12. In any case, in that week, I only hit 15 for 1.5 minutes on one night. So, that told me the sleep study was a little flawed (they only went to 16 cm.) and the sleep doctor in particular, got the pressure wrong. However, I DID find out in that week that the changing pressures were horrible on my sleep architecture as I was waking up very frequently. After a few nights, I couldn't wait to finish the week to go back to straight pressure. AND, my AHI was worse than with straight CPAP.


Den

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Are you having aerophagia issues with the Escape at 13 cm?
Are you using EPR? If so at what setting?

Yes...APAP can come in handy for people who have varying pressure needs during the night. Like REM sleep or supine sleeping.
Mine happens to be REM stage sleep pressure needs....sometimes I would need twice as much and sometimes not much of a difference at all. And yes, APAP could help lessen aerophagia issues.

I wasn't aware (or I forgot) that you were having aerophagia issues? If you are and they are significant, I might re-evaluate the thought to use exactly what you were using on the Escape.

JQLewis wrote:I have a Resmed S9 Autoset on order, and it's due to arrive on Friday. My sleep study called for a pressure of 13, which I figure to use for the high end pressure. What should the lower setting be? How about EPR? Are there any other settings I need to be aware of?

Thanks.

Wow.....

Im at the same Rx number as you. I was using a ResMed S8 for 7 years on CPAP mode only and recently (1 week) upgraded to the ResMed S9 AutoSet. Pugsy has helped me with great (for me) results.

As a for instance my current settings are 6.0 Start....9.4 Minimum....16.0 Maximum and EPR setting of 1.

I tinkered with both Minimum/Maximum and EPR numbers looking at the results daily using SleepyHead software (Mac computer user).

Examples of my settings......Im not by any means suggesting you do what I did. I haven't had a STUDT/TITRATION in 7 years (insurance wasn't covering , but now is ).

Start MIN MAX EPR
4.0 7.4 20.0 3
6.0 8.0 20.0 3
6.0 8.2 15.0 3
6.0 9.6 15.0 2
6.0 9.4 15.0 2
6.0 9.4 15.0 1
6.0 9.4 16.0 1

I plan to leave the setting the same for a week (6.0---9.4---16.0 EPR 1).

My minimum average is 10.12 and my maximum is 13.0 all according to SleepyHead software.

As I understand it (someone please correct me if Im wrong). EPR setting will effect the MINIMUM pressure when breathing out.
Example: In APAP if your Minimum pressure setting is 9.4 and the EPR setting is 1 the the Minimum will actually be 8.4 when breathing OUT.
Math is: Minimum Pressure minus EPR equals the Minimum pressure when breathing out.

fdw wrote:

JQLewis wrote:I have a Resmed S9 Autoset on order, and it's due to arrive on Friday. My sleep study called for a pressure of 13, which I figure to use for the high end pressure. What should the lower setting be? How about EPR? Are there any other settings I need to be aware of?

Thanks.

Wow.....

Im at the same Rx number as you. I was using a ResMed S8 for 7 years on CPAP mode only and recently (1 week) upgraded to the ResMed S9 AutoSet. Pugsy has helped me with great (for me) results.

As a for instance my current settings are 6.0 Start....9.4 Minimum....16.0 Maximum and EPR setting of 1.

I tinkered with both Minimum/Maximum and EPR numbers looking at the results daily using SleepyHead software (Mac computer user).

Examples of my settings......Im not by any means suggesting you do what I did. I haven't had a STUDT/TITRATION in 7 years (insurance wasn't covering , but now is ).

Start MIN MAX EPR
4.0 7.4 20.0 3
6.0 8.0 20.0 3
6.0 8.2 15.0 3
6.0 9.6 15.0 2
6.0 9.4 15.0 2
6.0 9.4 15.0 1
6.0 9.4 16.0 1

I plan to leave the setting the same for a week (6.0---9.4---16.0 EPR 1).

My minimum average is 10.12 and my maximum is 13.0 all according to SleepyHead software.

As I understand it (someone please correct me if Im wrong). EPR setting will effect the MINIMUM pressure when breathing out.
Example: In APAP if your Minimum pressure setting is 9.4 and the EPR setting is 1 the the Minimum will actually be 8.4 when breathing OUT.
Math is: Minimum Pressure minus EPR equals the Minimum pressure when breathing out.

That is correct. EPR drops pressure on exhale in centimeters what the EPR setting is. 1=1 cm., 2=2 cm., 3=3 cm.


Den

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I agree. Do at least one night at the previous pressure setting. That way, you have an idea whether any new problems that crop up are due to the different machine or the different settings. If you feel the same, then start tinkering I would start with small changes from the previous settings, evaluating as you go.

Wulfman... wrote:

fdw wrote: As I understand it (someone please correct me if Im wrong). EPR setting will effect the MINIMUM pressure when breathing out.
Example: In APAP if your Minimum pressure setting is 9.4 and the EPR setting is 1 the the Minimum will actually be 8.4 when breathing OUT.
Math is: Minimum Pressure minus EPR equals the Minimum pressure when breathing out.

That is correct. EPR drops pressure on exhale in centimeters what the EPR setting is. 1=1 cm., 2=2 cm., 3=3 cm.

that's not exactly correct... if you look at the mask pressure waveform, what EPR does is reduce the pressure by 1, 2, or 3 cm, *except when breathing in*. it is exactly like a bi-level machine with the epap reduced, and the ipap being your set pressure.

so if you set your pressure to 9.4, with 1 epr, what you have is a simple bi-level 9.4/8.4 setting. the only time you get 9.4 is when you start to inhale.

the downside of that is by dropping your epap, you may get more apneas/hypops. than if it really maintained set pressure except at inspiraiton (the way the misleading name implies it does.)

Pugsy wrote:Are you having aerophagia issues with the Escape at 13 cm?
Are you using EPR? If so at what setting?

Yes...APAP can come in handy for people who have varying pressure needs during the night. Like REM sleep or supine sleeping.
Mine happens to be REM stage sleep pressure needs....sometimes I would need twice as much and sometimes not much of a difference at all. And yes, APAP could help lessen aerophagia issues.

I wasn't aware (or I forgot) that you were having aerophagia issues? If you are and they are significant, I might re-evaluate the thought to use exactly what you were using on the Escape.

I was having problems at 13, which is why I dropped the pressure to 12.4 a month ago (posted here). That's the only adjustment I've ever made. The result, subjectively, was a great reduction in the aerophagia and an improvement in the number of arousals per night. Otherwise I have no idea what that change did to AHI or O2 levels.

My EPR settings are:

EPR: full time
EPR level: 3
EPR inhale: med

Then I would use 12.4 as the starting cpap pressure on your new Autoset with EPR just like you have been using it.

I also wouldn't use a wide range if/when you decide to go to apap mode...because of the aerophagia. Sometimes the machine will want to go fixing snores and flow limitations and it might go higher past the threshold where you would maybe have aerophagia issues and the aerophagia might be a bigger problem than letting a few snores or FLs go under treated.
Cross that bridge if/when it needs to be crossed...so when you decide to try apap mode...I would start with limiting the max to no more than 13...see if it even goes there or if it even needs to before giving it free reign.

Pugsy wrote:Then I would use 12.4 as the starting cpap pressure on your new Autoset with EPR just like you have been using it.

I also wouldn't use a wide range if/when you decide to go to apap mode...because of the aerophagia. Sometimes the machine will want to go fixing snores and flow limitations and it might go higher past the threshold where you would maybe have aerophagia issues and the aerophagia might be a bigger problem than letting a few snores or FLs go under treated.
Cross that bridge if/when it needs to be crossed...so when you decide to try apap mode...I would start with limiting the max to no more than 13...see if it even goes there or if it even needs to before giving it free reign.

Sounds like a sensible plan. Thanks. All I'm really looking forward to is finally seeing some data.