ResMed S9 Elite / Resscan issue, advice needed.

[parabellum]

Hello fellow cpapers!

This is my first post here, I came here from another apnea forum because you were recommended as being more friendly to self tuning.

I'll post my details and such below, I know most of us geek out on the details, but the point of this thread is to help me solve a very basic issue:

I have an S9 Elite, and the 3.10 ResScan software, but I am NOT able to see hour-by-hour data that plots every breath, every apnea event, etc....

When I download data from the card into my ResScan software, if I go to the Detailed Reivew tab, no matter what data types I configure it to display, it is always blank....its as if my machine is only storing basic usage data.

What I can see, is a BAR style plot, where there is one entry for every night, and I see:

Average AI/AHI
Average pressure
Average leak volume


I'm really really interested in seeing detailed data so I can finally drive my AI/AHI down further.

I have the machine unlocked and I can access Clinitian mode, my ENT is very encouraging of me being the primary driver of changes to my machine, as long as I keep him in the loop about what changes I'm making, and as long as I agree to come see him on a regular basis.

So far I have managed to get myself down from an AHI of 65 (untreated) to the 40s with the settings he originally prescribed, and once I took control of my machine, I used the data to carefully get my average AHI down below 10 every night!

But I still have some pretty bad headaches, so I really need to try and get my AHI down further, I'd like it to be less than 2...and I feel that in order to make that happen, I'll need to see better detail in my data.

However, the detailed data that some people talk about....I just can't access that with my current machine settings.


Help me out, I'm a software engineer by education and profession, I'm a scientist and I'm pretty sharp....so the fact that I cannot figure out how to get my machine to record the data I need is pretty frustrating.

Thanks, and good rest to all.

Chris.


EDIT: My details....

Severe OSA. (Untreated AHI=65, O2 Desat to 77%)
Resmed Mirage Full Face Mask
Resmed S9 Elite w Humidity

[jlk]

When you click on download data, you need to click on "all summary data and detailed data". For future downloads click on discard instead of overwrite. Give that a try, seeing your data is great. john

[DreamLady]

Welcome!

Do you have the detailed data enabled? In the Clinicians menu there is a setting that basically turns on the storage of detailed data. Look under Sleep Quality and set it to "on".

Took me a day or two to figure that out!

[parabellum]

Welcome!

Do you have the detailed data enabled? In the Clinicians menu there is a setting that basically turns on the storage of detailed data. Look under Sleep Quality and set it to "on".

Took me a day or two to figure that out!

AH!

Yes that may be it! I tried what John suggested above but it didn't work....I bet that is the setting I was looking for!

Thank you both very much, I'll report back with my results later tonight (tomorrow at the latest).

God, it feels so good to take control of this issue and really figure out how to make myself healthier. I was not cool with the traditional route of seeing the doctor once every few months and having him blindly guess at a new pressure setting.

In my case, turning the EPR reduction pressure from 3 to 1 is what got my AHI down from the 20s to the 10s. If I turn it off completely, I see no difference versus having it at 1, so I keep it at 1 for the amazing comfort it provides.

Right now I'm at:

Pressure: 10
EPR: Full time, Level 1
Ramp: Off
Humidity: I change this depending on how the ambient humidity is, this time of year I run it at 5-6.

Those settings result in an AHI anywhere from 3.8 to 7.8. Usually, my AI is two points lower than my AHI, and the resmed machines are known for aggressively scoring Hypopneas, so I figure I want my AI to be zero and my AHI to be around two or less.

At least, that is my goal!

[jlk]

Great, run any change for at least a week to get a good average. You most likely will reach your goal in a few weeks. Good luck, john

[parabellum]

Great, run any change for at least a week to get a good average. You most likely will reach your goal in a few weeks. Good luck, john

Oh for sure.

For a while I was really just focused on getting my AHI down into the 20s or lower, being in teh 40s was scary bad....so I was making changes almost every day.

Once I sorted out all my issues, and was consistently down into the 20s, then I slowed down.

Now I'm on a 7 day cycle: Make a change, see how it trends over a week, rinse, repeat.

[KatieW]

Those settings result in an AHI anywhere from 3.8 to 7.8. Usually, my AI is two points lower than my AHI, and the resmed machines are known for aggressively scoring Hypopneas, so I figure I want my AI to be zero and my AHI to be around two or less.

At least, that is my goal!

The S8's were known "for aggressively scoring Hypopneas", but not the S9's. Using the S8 AutoSet II (for 6 months), my HI was 2.0-5.0, on the S9 AutoSet (for 8 months), under 0.5.

The most important statistic is the Leak Rate. Then I look at at AHI, I look at the AI--and the breakdown between CAI and OAI. A few centrals are normal, and I find I get more if I'm over-tired, and I don't worry about them. I look at the obstructive apneas, and whether they are short (10-12 seconds), and spread out through the night, or whether they are clustered together, which usually is position-related for me. If my AI is occasionally higher then my average, I might think about why, but don't make any changes, because it's not so much how you do each night, rather what the trend is.

[parabellum]

Those settings result in an AHI anywhere from 3.8 to 7.8. Usually, my AI is two points lower than my AHI, and the resmed machines are known for aggressively scoring Hypopneas, so I figure I want my AI to be zero and my AHI to be around two or less.

At least, that is my goal!

The S8's were known "for aggressively scoring Hypopneas", but not the S9's. Using the S8 AutoSet II (for 6 months), my HI was 2.0-5.0, on the S9 AutoSet (for 8 months), under 0.5.

The most important statistic is the Leak Rate. Then I look at at AHI, I look at the AI--and the breakdown between CAI and OAI. A few centrals are normal, and I find I get more if I'm over-tired, and I don't worry about them. I look at the obstructive apneas, and whether they are short (10-12 seconds), and spread out through the night, or whether they are clustered together, which usually is position-related for me. If my AI is occasionally higher then my average, I might think about why, but don't make any changes, because it's not so much how you do each night, rather what the trend is.

Interesting, I'll keep all that in mind.

My events are clustered, but usually not longer than 12 seconds. If I have a really really bad night (like when my pressure was too low before I got it dialled in) I see AI events as long as 40 seconds, which scares the heck out of me.

And I did confirm: Setting SLEEP QUALITY to ON is what enabled my machine to gather more than basic usage data.

I'm fighting off a sinus cold, so last night I was at an AHI of 12, but that will drop again when this clears up.

[avi123]

[quote="parabellum"][quote="KatieW"][quote="parabellum"]


Then I look at at AHI, I look at the AI--and the breakdown between CAI and OAI. A few centrals are normal, and I find I get more if I'm over-tired, and I don't worry about them. I look at the obstructive apneas, and whether they are short (10-12 seconds), and spread out through the night, or whether they are clustered together, which usually is position-related for me.
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Question: what your CPAP does when it detects Central Sleep Apneas? Does it convert to a ventilator or a respirator. {This is a servo-ventilator feature that’s found in machines that can treat this condition. When it senses that you’re not breathing, it literally breathes for you, rather than applying constant positive pressure for obstructive events. }

Since an S9 only skip the air flow if it detects a CAI (until it detects an OAI) and does not ventilate during CAI, why do we need to know about it? Is it to tell us to hurry and see our sleep Doc?

[robysue]

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Question: what your CPAP does when it detects Central Sleep Apneas? Does it convert to a ventilator or a respirator. {This is a servo-ventilator feature that’s found in machines that can treat this condition. When it senses that you’re not breathing, it literally breathes for you, rather than applying constant positive pressure for obstructive events. }

The S9 Elite (CPAP) is a fixed continous positive pressure machine---it records, but does not respond to events. So it detects a central apnea, but does not do anything other than continuing to provide the fixed continuous positive pressure at the user's setting.

The S9 AutoSet (APAP) is an auto-adjusting positive pressure machine. It records and is designed to respond (by raising the pressure) to certain types of respiratory events. The S9 raises pressure when it detects obstructive apneas, flow limitations, and snoring. But it is designed to NOT raise the pressure in response to central apneas and hypopneas since central apneas are not "fixed" by increasing pressure to force the UPPER airway to open back up and the auto-algorithm is not currently designed to detect whether hypopneas are obstructive or central in nature, if I recall correctly.

All straight CPAP machines are similar to the S9 Elite: If they are full data machines, they'll record the central apnea, but because they're designed to run at a fixed pressure, they will not "respond" to the event in any way.

Whether a given company's APAP machine will or will not raise the pressure when it detects a central apnea depends on that company's propriatary algorithms. Some companies do not yet claim that their machines can reliably distinguish between central and obstructive apneas; others do.

But in any case, plain old CPAPs and APAPs NEVER act like ventilators in the sense of actually assisting in breathing for you: Their function is much simpler---it is to simply keep the UPPER airway from collapsing and to help force the UPPER airway to open back up in the event that it does collapse.

[KatieW]

Since an S9 only skip the air flow if it detects a CAI (until it detects an OAI) and does not ventilate during CAI, why do we need to know about it? Is it to tell us to hurry and see our sleep Doc?

With the S9, I find it useful to know whether it's a central or obstructive apnea. For example, if my AI is .7 (a total of 7 apneas that night), and I know that 5 of them were centrals, and I can see that several of them happened just while I was falling asleep, and then it's normal, and I don't worry anymore about them. Search previous threads to read more about Centrals.

Then, I know that I had 2 obstructive apneas, but they were several hours apart, and only 10 seconds long. It could be that I rolled over on my back, or positioned my head so that my airway was blocked, or the apap couldn't respond quickly enough to the decreased air flow. No big deal.

If was experiencing daytime sleepiness or waking up with a headache, or was really worried about the apneas, I would wear my oximeter and see if my oxygen levels were dropping too low. If I find I am desaturating, I would considered adjusting my pressures, but for now, I'm satisfied with my data.

With the S8, I would have no way of knowing whether those 7 apneas were obstructive or centrals. And might be tempted to raise my pressures, which could backfire on me, since higher pressures can cause more centrals.

[avi123]

If you're using a Resmed machine and want to discuss your treatment then please try to post these kinds of ResScan data:


One night Stats report:



If you have, 30 days Stats report:




If you have, 6 months Stats report:



Pressure and Events graphs:

(Data for APAP= AutoCPAP mode is shown)



This set-up took me some time to arrive at by following the pressure graph in Rescan. I strated with the first set- up by using the optimal CPAP pressure from my latest sleep study. But later, I fine tuned the setup, by changing the limit pressures gradually as to have the pressure graph only "kiss" the two limit lines of max and min pressures. See the graph above. The idea was to set the limits so that the machine should not 1) Waste time responding to events, and 2) Run the pressure up, suddenly, and cause new Emergent Central Apneas and also cause the ingested air to rise.

Leak and Snore graphs:



Flow and Flow Limitation graphs:

(the Flow graph will be needed to show detailed graphs in the double panels)




Example of location of Flags and checking the shape of my respiration waves:





Example of Skewed data on the S9:

[Breathe Jimbo]

The goal is AHI below 5.0.

Don't worry about your leak rate unless you have a lot of leaks and they cross the line. The machine is designed to compensate for leaks. At a pressure of only 10, you are unlikely to have a significant leak issue.

[KatieW]

Thanks Katie. Could you by any chance answer this data that was posted on another forum:
(From S9 Alite)
apnea index was 5.1
AHI was 5.5
obstructive 0.7
central 4.8
unknown 0
hypopnea index 0.4

All pretty good numbers.....but the poster was wondering how accurately the machine is able to distinguish between central and obstructive events.

Sorry I don't have the technical knowledge or experience to answer that question. But having used the S9 AutoSet for 10 months now, I do trust that my S9 works well enough for me.

Another question: you wrote, Then, I know that I had 2 obstructive apneas, but they were several hours apart, and only 10 seconds long. It could be that I rolled over on my back, or positioned my head so that my airway was blocked, or the apap couldn't respond quickly enough to the decreased air flow. No big deal

When is it a big deal?

For me, it would be a big deal if the apneas were more frequent or longer duration, and for several days in a row. And if my oximeter reports I was desaturating. And I don't feel as well rested as I usually do....that is, over a period of time, the results were on a downward trend. We all occasionally have a rough night for any number of reasons: added stress, physical activity, changes in weather, diet or meds, illness, pain, etc.

I keep a journal, and look for trends. eg. if I'm over-tired, I have more Centrals. If I wake up and am sleeping on my back, maybe an obstructive apnea woke me up. If I have more leaks, I may wake up more frequently.

Hope that helps.

[Diplomacy]

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