New ResMed S9 VPAP AutoSet Questions

[kimbo]

Hi All,

I was recently diagnosed with moderate sleep apnea -- 22 AHI during my initial sleep study. I finally purchased a ResMed s9 VPAP Autoset from secondwindcpap, it arrives in 2 days and I had the following questions:

1. My doctor prescribed set pressures (12cm IPAP & 9cm EPAP), is it a good idea to use the machine in auto mode to start out with or should i start with the actual pressures?

2. Does the S9 AutoSet automatically determine pressures when set to automatic mode or does the user still need to provide a range of min/max pressures? How does one determine what their min/max numbers are if these are required for auto mode?

3. How long after getting a new machine should I wait to schedule a review of my data card results with my sleep center?

Thanks!

[Pugsy]

1. My doctor prescribed set pressures (12cm IPAP & 9cm EPAP), is it a good idea to use the machine in auto mode to start out with or should i start with the actual pressures?

Probably would be advisable but that is a tiny PS support range..3 cm...not much different than using the Elite with EPR of 3.

2. Does the S9 AutoSet automatically determine pressures when set to automatic mode or does the user still need to provide a range of min/max pressures? How does one determine what their min/max numbers are if these are required for auto mode?

No, you still need to give it a minimum and maximum range with the minimum being the most critical with the AutoSet.
Same thing when using the VPAP in auto mode. Minimum EPAP needs to be a good base number to help keep the airway open and then the auto adjusting feature has a better head start for preventing the stubborn events. Default is EPAP at 4 and probably would take a little too long to get to your 9 EPAP. Probably 7 or so would be a better auto adjusting EPAP minimum...maybe 8cm.
Generally with bilevel pressure machines....EPAP for obstructive apneas and IPAP for hyponeas.

How do we determine minimums and maximums? A conservative starting point would be 2 cm above and below a RX cpap pressure and then watch the software reports to see how things materialize.
One could probably apply same rationale to VPAP auto adjusting pressures.

3. How long after getting a new machine should I wait to schedule a review of my data card results with my sleep center?

Hard question. Depends on how you feel and how well you feel you are adjusting to things. If having a horrible time...sooner than later. If doing well a month or so maybe...Probably would be a good idea to find out if your insurance wants compliance numbers or has requirements for face to face meeting within a certain length of time...Medicare requires it.

If you want a copy of the provider/clinical pdf manual for the S9 VPAP...send me a private message with your private email and I will send it to you as an attachment. I can't do it with forum email. Resmed combines the S9 VPAP Auto with the VPAP S but it is easy to understand. I have a S9 VPAP Auto...great machine. I don't know why the tiny Pressure support of 3 cm because the whole beauty of the VPAP is the greater flexibility in Pressure support and this difference is what makes the VPAP so nice.
It's easier to exhale with a 4 or 5 pressure support than a 2 or 3. VPAP Pressure support (difference between EPAP & IPAP) is fixed though. If using Auto adjusting mode...if IPAP needs to go up it drags EPAP up with it and if EPAP wants to go up it pushes IPAP up with it. So the Pressure support remains constant between the 2 settings.

[kimbo]

Thanks for the detailed response Pugsy! I've been reading up as much as possible from this board -- can't imagine tackling this solo I've been on the machine for 2 nights -- my first night has an AHI of 12.71 (around the same #'s that I had during my sleep study machine). Second night I switched from medium to large nasal pillows - slept longer, but worse results AHI of 15.65.

Any ideas or advice based on my SleepyHead data? I'm hoping the Clear Airway events are just from waking up, but I felt like I only woke up once during the night.

[Pugsy]

Your leaks are massive and see those green apneas??? Those are unknowns meaning your leaks are so bad that the machine can't determine what to call the events.
Any chance you are doing a lot of mouth breathing? That would be my first suspect.
With this amount of leaking therapy has been impaired and also the machine's ability to sense and identify and record properly.

Gotta fix the leaks first. Then evaluate your therapy.

Your line in the sand to avoid is 24 L/min...you are above that a lot of the time and for long periods of time as well.

[kimbo]

Thanks Pugsy -- I figured the leaks didn't help.. Mask feels pretty well sealed, I'm definitely a mouth breather -- it's how i've always slept . Any tips on making a swift fx nasal pillow mask work for a mouth breather?

[Pugsy]

Your choices are limited if you want to stay with the nasal pillows...
chin strap
tape
polygrip
Something to get you to try to keep your mouth shut and learn to keep it shut.
With that amount of apparent mouth breathing...going to be a lot of work and probably a lot of time and experimenting.
I did it with tape..took about 2 months and I quit doing the serious mouth breathing. So quit taping.
Even now I probably back slide every now and then but never for very long and not nearly as massive as yours.

If you can get a good segment with leaks within acceptable limits then you can at least evaluate that good segment but you need a 3 or 4 hour segment to even start.

[kimbo]

Thanks again for the tips -- i've been mouth taping for the past 2 days and my leaks are down slightly and my AHI is finally single digits -- it was 6.0 last night! Encouraged by the progress, but the leaks are still super high. I toss and turn quite a bit in my sleep so would not be surprised if the pillows are coming off when I shift to my side.

Ordered a Chin Strap, SnuggleHose and a HoseBuddy -- hoping these help with general comfort and the leak issues (fingers crossed). I'll post some updated graphs once I get the leaks under control.

[kenmac1005]

I also move around a lot at night. For the last couple of weeks I have used the new Fisher and Paykel Pilairo mask. I was using the Resmed pillows.. It is counter intuitive because you dont need to have it tight to the face. It seems to float on the nose. It improved leaks for me tremendously.

There are a number of other comments about as usual good and bad but it works well for me

[deerhound]

If you are a football fan, this is a good time to practice using your mask and machine while you are awake. I am normally a mouth breather by day. In my recliner with my machine, I watched a lot of football when I wanted to try nose pillows instead of my full face masks. If you hold your tongue up to the roof of your mouth just behind your front teeth, it will keep air from leaking into your mouth and out. With much practice I was able to train myself into breathing only through my nose when I have my mask on. I don't use a chin strap or tape.