Trying to set ResMed Autoset ??

[Pugsy]

Software is easy. Uncle_Bob has it in his signature line or I can get you a link.
The problem is the special card reader needed to transfer the data from the smart card in your machine to the computer's software.
It is hard to find and pricey. Last I saw was on EBay for somewhere between $75 and $100 and then only from a seller in Israel. Online US suppliers quit offering them and the ResMed Smart card (also hard to find if you don't have one) when the S9 machines came out because they stopped selling the S8 machines.

Personally if it were me and I could afford it. I would put the money towards a S9 Autoset (I would look around and find a used one) so that I could have the SD ease for software along with the added data that the S9 offers. Especially the central thing and especially since I wasn't feeling so good. I would want to eliminate centrals being a possible issue. Your machine doesn't let us know about centrals. We know it won't respond to centrals (might explain the lack of response for some of the apparent events you see and the machine does nothing).

Deals on Autosets can be found. I got a used one here from a forum member for $250 and that included humidifier.
STLMark sometimes has brand new machines for around $475.

Sometimes forum members who now have S9 machines and dead S8 machine might have a used card reader for the S8.
That might be a source for a cheaper card reader.
This is the card reader that is needed for your S8 machine to be able to use the software that is available.
https://www.cpap.com/productpage/resmed ... -cpap.html

[archangle]

Given the difficulty of getting the card reader and the great improvements in new models, consider getting a new S9 AutoSet online.

I would throw in the PRS1 Auto, but right now, sleepyhead doesn't work with the new PRS60 models and the PRS1 is hard to get, unless you get it used through craigslist.

Pugsy says there is software available that works with the PRS60 models, but I don't know what it is.

[grumpygirl]

Good Morning-- Here are my stats from last night with the auto set at 8.4-11.0cm. Again I had trouble falling asleep and am wondering if it is because the lower pressure is too low and not what I am typically used to. Maybe if I set it to 9cm I might fall asleep faster-who knows?? Did wake up 2 times for some reason but don't know why, I fell back to sleep but felt as if I was in a twilight sleep all night, which may account for why my 95% pressure was so low. The night before I slept pretty much all night even though not very long and my 95% pressure was 10.0.

pressure: 9.8
leak: .02
AHI: 1.9
AI: 0.1
HI: 1.8

I was surprised that my 95% pressure was as low as 9.8 and hopefully I won't be as groggy in the early day like I was yesterday since I have my 2 yr old grandson visiting today. Yesterday did improve as the day went on and by evening I felt pretty good. So far this morning I don't feel horrible just a bit groggy and fuzzy headed, also my cognitive abilities seem like I am in slow motion. Thanks- GG

[Pugsy]

Again I had trouble falling asleep and am wondering if it is because the lower pressure is too low and not what I am typically used to. Maybe if I set it to 9cm I might fall asleep faster-who knows??

Very well could explain it. I know that going down just a little (have done it for experiments) does feel a bit stifling but it didn't take me long to get used to it. Some people are more sensitive to change.

BTW should you happen to stumble on a PR S1 machine with full data...don't worry...I got you covered on the software part of it. Even the new 60 series machines.

[-tim]

I would look for another mask.
I've tried several but one worked best... then they stopped making it and its replacement was far worse.

I don't know what your leak data means. Is the .2 good? or could it be bad and good at the same time? I just don't know.

If you have the cash, rent a newer machine or go to a DME that can let you try different masks.

Also how old is your mask? Has it exceeded its useful life of 3 months to a year?

[Pugsy]

I don't know what your leak data means. Is the .2 good? or could it be bad and good at the same time? I just don't know.

S8 machines report leak in L/sec...so to compare it with what we are seeing now L/min...just multiply by 60 seconds..
so that makes the 0.2 leak shown on an S8 machine equal to 12 L/min on a S9 machine and well under the 24 L/min red line large leak territory marker. It is also a 95% number meaning 95% of the time at OR below that number.
Sometimes 95% numbers don't give us a clear picture like we think they would and sometimes people forget the OR BELOW part and go into panic mode.
In this case..points to leaks being well below 24 L/min for the bulk of the night for sure an unlikely to be a problem unless the leaks themselves, even minor, are disrupting sleep. Unlikely that leaks are large enough for any length of time to really impact the therapy part of things but leaks can disrupt sleep without impacting pressure therapy and that is a totally different issue.

[grumpygirl]

Thanks for the comments!! At this time buying any new equiment is OUT. I've been laid off again and we just had to replace out heat pump in our house so money is tight to say the least. I just replaced my Opus about 2 weeks ago along with the filter and hose so that is about all I can do now. I do know that sometimes I do wake up with a "leaky" noise but not very often and I usually go back to sleep.

I am going to raise my lower pressure tonight to 9cm. Should I change my "ramp" time or not have ramp at all?? It is now set to 15min.?? I have not applied a EPR fulltime yet so that I can get an accurate picture of what is happening with just the apap at 8.4 ( or 9)-11.0 cm. Thanks-GG

[Pugsy]

Ramp use is a personal choice.
If you can't get to sleep without it...by all means use it but I found that the lower pressures with ramp itself were rather stifling...so it may depend on what your ramp settings are as much as using it for whatever time is needed.
If you feel that 8.4 creates some discomfort when compared to 9.0...what does your ramp create?
But then it sounds like you have used ramp all along so you would likely be used to the lower pressures so that shouldn't be an issue.
Maybe the lower 8.4 pressure isn't the issue I thought it might be as in being slightly uncomfortable and maybe affecting sleep.
Is it possible that your apprehension about all this..the changes and stuff...are contributing to the inability to go straight to sleep? Not everyone can get easily geared up for experiments and if the idea of experiments are making you a bit apprehensive..trying too hard sort of thing...may that is part of the issue. Just a thought.

[grumpygirl]

Not really sure as to why am am lately having trouble getting to sleep. I am not having any misgivings about trying new things with my cpap in fact I am happy to try anything in order to finally feel rested and "human" again. I am always a bit unsure if the changes I make will make my "gas" situation worse or that I will have a day of feeling even worse than usual,but it does not keep me from trying things. I moved my lower pressure up just a little for tonight from 8.4 to 8.6 just to see if that might help a little, I did not turn off the ramp feature since I have kinda become used to having it on every night. Thanks for all the suggestions- GG

[grumpygirl]

Moved lower pressure up to 8.6 last night, did not have trouble falling asleep but woke up around 3 a.m. and could not fall back to sleep. My stats were higher last night including my leak rate. My AHI was 2.1 and my AI was higher too but the HI was high at 1.9. So, I have no idea what the problem was, however believe it or not I feel really pretty good this morning-it may just be that I am so tired that I don't realize just how tired I am yet( it is still early) but I took my mask off around 4:30 since I couldn't sleep and just stayed in bed hoping I might doze off a little-I may have dozed for a few minutes but nothing significant. Well, just something else to confuse the issue- hopefully I'll sleep tonight. Thanks-GG

[Pugsy]

woke up around 3 a.m.

May have been the aliens again. I went to bed at 11 PM and woke up wide awake at 4 AM and I never hardly ever do that.
I might wake up but I can get right back to sleep. Not this time...ended up getting up at 4:30 but unlike you...I feel like total crap and I have so much to do today. If I don't get 7 hours of sleep my butt drags around all day.

[grumpygirl]

Good Morning!!

Well, once again I am stumped as to why I am feeling better this morning with higher AHI and AI than the day before when my numbers were lower and I didn't wake up as much. Here are the last two days stats:
Tuesday night: pressure(with autopap set at 8.6-11.0) 95% pressure was 9.6
leak: .04
AHI: 1.8
AI: 0.1
HI: 1.7
I felt pretty lousy yesterday, sleepy, headache most of the day, and generally no energy. I slept 7 hrs., my usual amount although I did not wake up as much that night as I often do.

Last night I woke up several times and even had a horrible coughing event that I think was actually the aftermath of an
apnea event. I got up took off my mask and went to the bathroom and retaped my mouth and went back to sleep. Once again I slept 7 hrs. but today I feel surprisingly better than yesterday. My stats were:
Wednesday night: 95% pressure: 9.6
Leak: .08
AHI: 2.1
AI: 0.2
HI: 1.9
The only thing I can say that I changed last night was that I moved my pressure range to 8.4-11.2cm. I don't know how that little bit of a change could make any difference especially since my stats were higher than the night before. I am totally confused now and am so curious as to what is making the difference in how I feel. I do not have any problems this morning with aerophagia or GERD. I changed my pressure range last night because I was hoping to avoid the "gas" that I had experienced the day before thinking that maybe my lower pressure of 8.6 was a little too high.

I took my data card to my DME yesterday and she printed out my stats for the last few days. Apparently the highest pressure I reached over the previous 3 days was 10.8- with my pressure range of 8.4-11.0 cm. I raised the upper pressure last night to 11.2 trying to see if I would reach a higher pressure than the 9.8, 9.6 95% pressures I had for the days before. I guess it will take more time to see if that happens and I will have to take my data card back to my DME to see if I ever reach that pressure during the night.

I am still stumped as to why on the days I have higher AHI, AI and HI numbers that I actually feel better-more rested and clearer headed than the nights when my stats are lower. I wish I could figure it out and get those results every night!!

Any thoughts out there?? Thanks-GG

[grumpygirl]

Good Morning Again- I am still confused as to why I am not getting better results from my autopap settings. The last two nights have left me feeling drained and mentally foggy. I can't seem to remember the simpliest things!! My setting has remained at 8.4-11.2 and I have slept about the same number of hours since I began this experiment a week ago.

My stats for the last two nights are:
Friday pm: 95% pressure of 9.8, leak-.04, AHI-2.3, AI-0.0,HI-2.3 those numbers are relatively high for me since I normaly get an AHI of around 1.6 when on straight cpap with pressure of 10.2,but I have also felt very tired and drained when using that format.

Saturday pm: 95% pressure of 9.6, leak-.04, AHI-2.4, AI-0.6 (very high for me),HI-1.8. I slept straight through the night maybe waking 1 time, but boy do I feel drained and almost weak. My brain feels so sluggish and not at all alert.

My question I guess is this- why is my machine not climbing high enough to stop the events and keep the AHI from climbing so much higher?? Is is that apap machines really are just "hitting the event almost after it happens" and that allows more events to take place without proper treatment?? Should I narrow my range a bit to maybe take care of the events more quickly-like a range of 9-11.2cm. I am also trying to avoid aerophagia since the higher my pressure the more problems I have. This week has been fairly comfortable in that area since my pressure has not been at a constant
10.2 as with straight cpap.

So now what do I do?? Go back to cpap and still feel tired along with more aerophagia or try something new with this auto till I find a better solution?? I really just don't know what to do!!! Thanks-GG

[Pugsy]

You can't expect to prevent all the events..especially with a S8 machine since it seems to score Hyponeas aggressively.
Since you feel your symptoms are related to the hyponea count...then the only way I can think of to maybe...stress maybe..lower those flagged events would be to raise the minimum pressure to hopefully maintain a little more airway open stability.
It may be a trade off..aerophagia and its discomforts for a lower hyponea count.

[robysue]

grumpygirl,

As someone who had fantastic AHI numbers and leak numbers right from the start of therapy, but who felt genuinely miserable for the first three or four months and "not well" on a daily basis for several more months, I offer you my deepest sympathy and empathy.

As pugsy said, your AHI is not the problem. Your AHI is really excellent. Don't go chasing after a 0.0 AHI every night because it most likely ain't going to happen. In other words, right now the machine is doing its job of managing the OSA, but you are simply getting bad sleep and the excellent AHI cannot overcome the fact that the sleep itself is just bad sleep. You need to start sleeping well with the machine before you'll start feeling better.

So the things you need to address are the things that are clearly making you miserable and making your sleep into bad sleep: The aerophagia and the possibly fragmented sleep are two leading contenders of why your sleep itself remains poor in spite of the low AHI. The two of them may well be feeding each other by the way----you might want to read through this thread to learn more about the connections between aerophagia, arousals, and awakenings during the night.

Since your current numbers look good as far as the AHI goes, there is no need to set that max pressure any higher than the straight CPAP pressure you've been using. Or only the tiniest smidge above is enough. As for what to do with the pressure setting? Since the tummy can bear a night of straight CPAP at 10.2, but you get uncomfortable on a night of straight CPAP at 10.4, I personally would set the max pressure to 10.5 instead of 11. And as long as the AHI was reasonably low, I wouldn't really worry that much if I was maxing out at times. So I'd try running in Auto mode with a very narrow range of 8.5-10.5 for a week or so.

You also write:

Good Morning All- Set my ResMed to Auto last night and here are my morning results:
Pressure setting 8.4-11.0
Avg. Pressure- 10.0
Leak- .10
AHI- 1.5
AI-0.2
HI-1.3

I had a hard time falling asleep last night-took me maybe 45 min. to finally get to sleep, but after I did I seemed to sleep through the night until about 5:40 a.m.

Does the aerophagia ever start before you fall asleep? I know that even with 21 months of PAPing behind me, I still cannot tolerate lying in bed for 45 minutes waiting/fighting to get to sleep. The aerophagia kicks in about 20 minutes after I lay down if I don't fall asleep. If i fall asleep, I'm fine as far as aerophagia is concerned unless my EPAP winds up being elevated for the night.

This morning I feel very "spacey" and not able to focus. I am tired and feel like I could go back to sleep and sleep ALL day!! Don't want to do that because I feel like it would waste the day.
I almost feel flu-like, or that I need a big jolt of caffeine!!! Would it be to my advantage to raise the minimum pressure up to maybe 9. I have the EPR set a 1 for ramp only for about 15 min.

I know those stats are very good-so why do I still feel like crap???!!!! Could it be that the slight pressure changes of the apap stir me out of sleep just enough that I am still not getting rested??

And it could be that you are just super sensitive to pressure changes and respond better to CPAP than APAP. APAP's constant adjusting of the pressures can cause arousals in some people. And arousals can lead to "bad sleep".

Why did my machine not raise the pressure enough to take care of the few apneas I experienced?? I always seem to suffer more from hypopneas(SP??) than apneas.
Why would that be? Is it because my pressure is not high enough? Even when I have my machine set on straight cpap I always have higher HI numbers.

Your AHI is very low----even your HI Is very low considering the aggressive scoring of H's by the S8 machine. The most likely reason the machine did not increase the pressure when you had it on APAP is that the events were spaced far enough apart that no pressure increase was warranted. What most people seem to not understand about the Auto algorithms is that they do NOT try to blast through an on-going apnea to "end" it and they do NOT increase the pressure after every single OA or H. The machines are set up to behave somewhat like the standard titration algorithm used by the techs who run the sleep tests. The pressure is increased for events only when you have two or more events occurring very close to each other---as in the second one occurs within 2-3 minutes of the first one. And the pressure is increased after the second event is over. And the older machines also had no way to determine the patency of the upper airway. And so some of them are designed to NOT increase pressure for apneas if the pressure is already above 10cm. And I believe that the S8's may not increase pressure in response to H's at all.

Finally you write:

Should I set my EPR of 1 to a fulltime setting??

Let's consider EPR for a minute: EPR reduces the pressure by a set amount at the beginning of each and every exhale. An EPR = 3 reduces the pressure by 3 full cm. So if the machine is runnning at 10cm of pressure, the pressure drops to 7cm on every exhalation. Now some folks find this a big relief. And it can even help with aerophagia since it reduces the overall pressure needs. But some folks do find that their AHI goes up when they turn EPR on. And other people simply don't like it. And one of the things that some people don't like about EPR is the constantly changing pressure every time they switch between inhaling and exhaling. Obviously since you are already wondering if the changes in APAP pressure might be causing you problems, it's reasonable to posit that you might also have trouble dealing with EPR = 3; at that setting the change in pressure may simply be too much for you to be comfortable. Same thing for EPR =2. You could try changing the EPR to fulltime, but if fulltime EPR increases your total discomfort OR if you have problems with the AHI going up, the reasonable thing to do is turn it off completely.