Need help on RESMED S8 Elite Menu items

[Idget]

I have the S8 Elite. Of course the DME didn't give me the clinical menu book or ability to change pressure, ect on my own. At least that is how she explained it when she gave me the CPAP. However, with guidance from site, I was able to go into the menu and change pressure which greatly helped my results. I paid attention to recomendations and didn't do anything else. I was also able to change the time which was two hours off.

However, I noticed a few things in menu:

1. EPR is off. I thought EPR should be on and helps breathing out?

2. What is the Smartstart. I thought that is when the pressure (ramp) starts when you breath into mask when you enable this function.

3. What is H3I (or 1): There didn't seem to be an ability to change one way or another.

Thanks in advance

Idget

[RipVW]

EPR is exhalation pressure relief, a feature that many of us prefer. It feels more natural when the machine stops blowing so hard as we exhale. I preferred this setting even when I was on a very low pressure (6). If the blowing feels uncomfortable when you exhale, you should turn the feature on (or just try it to see if you like it). Smartstart is an automatic feature that turns the machine on when you put on your mask and breath into it. H3i is the name of the integrated humidifier that works with the machine. Since it is th only integrated humidifier that works with the machine, there's no option to change it.

[Slinky]

The DME's RT probably didn't turn the EPR on because your scripting doctor didn't specify an expiration pressure relief setting.

If you want to use the expiration pressure relief then turn it to On. That will then provide the option to set the EPR to 1 cm, 2 cms or 3 cms of expriation pressure relief. Bear in mind that if you do so about half of the night your pressure will be lower than your scripted set pressure so you will see your reported 95th percentile pressure will be lower than previously w/the EPR turned off.

If you turn SmartStart on you won't need to turn your Elite on and off when you get up during the night. The Elite will sense you've put your mask on and will start itself. It will sense when you've taken your mask off and turn your Elite off. HOWEVER, it is slow turning off allowing for your having lifted the mask from your face just to allow the cushion to refill w/air or for your having dislodged the mask and allowing time for you to reposition it. IF you turn SmartStart on the LeakAlert will not work. Conversely w/LeakAlert on you can't have SmartStart on. I keep them both turned off as I don't like either feature.

The H3i just indicates that you have the Humidaire 3i attached. If you didnt use it ... I forget what appears in that screen but something to indicate that you don't have the Humidaire 3i attached to the Elite.

[jimbassett]

Hi Idget; I have the S8 Advantage, but I'm sure the settings are the same. EPR only works if you are in the CPAP mode. If you are using APAP then it is off by default.


Smartstart is used to turn the machine on by breathing into the mask. However this won't work if you're using a full face mask.

H3i is the heated humidifier. Mine has a knob on top to set the desired heat to humidify the air for breathing. In my dry climate I have it set on high as I need all the humidity I can get.

[Idget]

Thanks to all for such quick responses to my questions. If I had asked the DME or Doctor same questions (of course I would have to try on Monday) it would take forever. Hence this site is sooo valuable to my progress on CPAP. I don't think I will fiddle with either the EPR or smartstart. I have a large pressure 16, but haven't experienced any difficulties breathing out. As far as the smart start don't think it would make such a big difference in just turning off machine myself. I don't use the leak alarm, since my wife would probably$%!@@ me if I woke her up everytime I had a leak. I just stopped snoring, don't want to deal with waking her up again.

[DragonFire]

Idget,

I do have a very high pressure set that come out from titration and the doctor told me that EPR would help me out a lot. The reason why I went was my wife unable to sleep in the gest room with the doors closed and a bathroom between the rooms, so loudly I was snoring. Now she blesses the CPAP machine and the leak alarm which wakes meup and prompts me to reset the mask (otherwise my leak alarm would be my snoring which wakes her but not me). It does not happern very often (only twice in a month).

With EPR on, you might feel much more at ease with wearing the mask the whole night and it may also increase your compliance in future if becomes a problem. It it advisable to discuss with your doctor.

My experience with respiratory care (Naval Hospital Norfolk and the DME) was very positive. After issuing the equipment the DME asked a follow up in 10 days (download and analysis of the data, mask fit and impressions) and the hospital 14 days and one month out. Based on that they adjuested from Straight CPAP (15 with EPR of 3) to APAP 12-16 then to where I am at APAP 10-15. The DME replaced the mask for free (sizing warranty) since I am borderline Medium/Small and the medium was leaking a bit.

Doctor believed that with an AHI below 3 I could take the occasional 10-12 second apnea and feel much better with a lower setting (my 95% is 11.6 now) rather than killing all events and have me breathe against a jet blast .

I still have to my 1 month follow up (week after Thanksgiving).
My impression is doctors will engage more with patients taking charge of their therapy, spend more time to explain and be more reactive if they feel we (patients) are putting effort in following therapeutic indications.

Bottom line, engage with your supporting physician and DME, this place is great to validate impressions and get support, the doctor is responsible for your therapy. If you are new to CPAP like me, talking to him will provide you the best solution for your confort and therapeutic benefit.

[Guest]

Thanks Dragonfire for excellent advice. I do have an excellent doctor up here in Williamsburg. He spent over an hour with me my first visit and on the phone he takes as much time as possible to explain; however, I started at end of September with CPAP and don't see him for a visit until December. In the meantime we upped my pressure from 15 to 16 since I was getting AHI from 10-20. I still had AHIs from 7-10 at 16 and upped myself via menu to 16.6. Along with sleeping back on my side I am down the past two night under three with only five apnea events around 10-12 seconds duration. As far as pressure up at 16 I really don't have a problem with it. I can sleep through the night with the liberty without discomfort. Actually much better than waking up in middle of night out of breath in panic with apneas that apparently went up to 2 minutes long. I can try the EPR but don't really understand yet the settings for it (you have set at 3, but not sure what that means).

Thanks again, you appear to be navy pilot, myself spent 11 years with Navy, now DoD civilian.

take care

Idget

[rested gal]

I can try the EPR but don't really understand yet the settings for it (you have set at 3, but not sure what that means).

It means that if you set EPR at "1", the machine will drop the pressure 1 cm when you breathe out.

If you set EPR at "2", there will be a 2 cm drop in pressure each time you breathe out.

EPR "3" = a 3 cm drop when you breathe out.

The machine will always go back up to your regular set pressure each time you start to inhale.

If your pressure setting is 16 and you set EPR at "3", you'll breathe in at a pressure of 16 and breathe out against a pressure of 13.

Slinky pointed out something very important to know, if you decide to use the EPR feature:

Bear in mind that if you do so about half of the night your pressure will be lower than your scripted set pressure so you will see your reported 95th percentile pressure will be lower than previously w/the EPR turned off.

That also means that your therapeutic pressure (say, 16) will not be in place when you try to inhale. That might or might not make a difference in a person's treatment. Where it could make a difference is if the person really needs a pressure of 16 to keep the throat from collapsing into an apnea. With EPR at "3" (giving a reduction of 3 cms of pressure until you start to inhale again) IF the pressure of 13 allows the throat to close, you're not going to be able to inhale and get the pressure of 16 started again to open the throat.

EPR does have a safety feature in it, that if you don't start to inhale (or can't) for X number of seconds, EPR will turn itself off and the regular pressure will resume.

Personally, I prefer the exhalation relief feature called "C-Flex" (or "A-Flex" in some of the newer M series autopaps) used in Respironics machines. C-Flex affects only the beginning of each exhale, dropping the pressure some (not an exact number of cm's) to make STARTING to breathe out easier.

As the force of the person's exhalation starts to dwindle, C-Flex (and A-Flex) allow the regular pressure to come back in before the exhalation is completely finished. That means the therapeutic pressure is already in place, doing its job to keep the throat open, before you start to inhale again.


Dragonfire, when I read this, I thought..."Wow, what a smart doctor Dragon has!" A doctor with common sense and a good grasp of how to help his cpap users be as comfortable as possible while still getting effective treatment.

Doctor believed that with an AHI below 3 I could take the occasional 10-12 second apnea and feel much better with a lower setting (my 95% is 11.6 now) rather than killing all events and have me breathe against a jet blast Razz .

You made an excellent point:

My impression is doctors will engage more with patients taking charge of their therapy, spend more time to explain and be more reactive if they feel we (patients) are putting effort in following therapeutic indications.

Yep, that's true with "good" doctors. Of course there are also the "god" mentality doctors who get offended, exasperated, or just plain angry if a person shows any signs of having researched their condition or treatment, and is not simply "doin' what the doc sez" unquestioningly.

[Treesap]

RestedGal,

What's the difference between EPR, C-Flex, A-Flex, and a Bipap then? I thought a bipap lessens the pressure for inhaling.

[rested gal]

RestedGal,

What's the difference between EPR, C-Flex, A-Flex, and a Bipap then? I thought a bipap lessens the pressure for inhaling.

A bipap lessens the pressure for exhaling (which may be what you meant to type.)

I may be wrong, but the way I understand those things:

EPR - lessens the pressure to an exact number of cm(s) for the entire exhalation, then sits at that lessened pressure, waiting for you to inhale. If you don't inhale after so many seconds, EPR is suspended and the regular (higher) pressure resumes.

C-Flex - lessens the pressure some (not an exact number of cms) for the beginning of the exhalation. How much it drops and how long it stays dropped depends on the forcefulness and steadiness of a person's exhalation. The regular pressure comes back in before the exhalation is finished. How soon "before" depends on at what point in breathing out a particular person's exhalation first shows a sign of dwindling...first shows a sign of "less force."

A-Flex - Does the same thing as C-Flex at the beginning of an exhalation. Then behaves like "Bi-Flex" to smooth the transition between exhale and inhale. Rounds out the inhale wave form instead of letting it be a choppy jump up to inhale from exhale.

Bi-flex - Does the same thing as C-flex for the beginning of an exhalation. Bi-flex is in the Respironics bipap machines. It also smooths the transistion between exhale and inhale. Bi-flex does that in a bipap machine, like A-Flex does it in an autopap machine. Both A-Flex and Bi-Flex use C-Flex for the beginning of the exhale.

C-Flex and EPR affect only the exhalation pressure. A-Flex and Bi-flex affect the pressure for both exhaling and inhaling.

Those are all "features"...not types of machines.

BiPAP is a type of machine, not a feature. BiPAP is Respironics trademark name for their bi-level machine. VPAP is resmed's trademark name for their bi-level machine. Bi-levels are set at one pressure for exhaling (EPAP pressure) and a different pressure (the higher IPAP pressure) for inhaling.

When you finish breathing out while using a regular bi-level machine (we'll skip the more specialized S/T or ASV machines), the higher inhale pressure does not happen UNTIL you start to breathe in again...no matter how long you wait. You can hold your breath at the end of an exhale until the cows come home and a bi-level machine will keep it down at the lower exhale pressure, waiting, and waiting, and waiting for you to start to breathe in again. It won't let the higher inhale pressure happen until you initiate another breath.

This is why it's so important, in most cases, that the EPAP pressure (exhale pressure) in a bi-level machine be set for enough pressure to prevent a full apnea in the first place. You don't want to be using so little EPAP pressure that the throat can close and you can't even START to take another breath.

EPR in a cpap machine also waits (bi-level style) until you breathe in. But EPR won't wait "forever" for you to start to breathe in again, the way a true bi-level machine would wait. If you don't breathe in after so many seconds, EPR quits holding the pressure down and the regular pressure comes back in again.

C-Flex and A-Flex don't wait at all. They do their drop just at the beginning of the exhale when you most need "help" to breathe out against pressure. The C-Flex and A-Flex reduction in pressure lasts for however long the exhalation is staying "strong." Once the exhalation begins to weaken, they let the regular pressure start coming back in. That way, when you are ready to breathe in again, your treatment pressure is already there.

Bi-Flex (similar to A-Flex) in a bipap machine drops the beginning of the already lower EPAP (exhale) pressure, then lets the regular EPAP pressure back in before the exhalation is finished. Also smooths the transition up to IPAP pressure when you start to inhale. I think of Bi-Flex as "icing on the cake comfort" in a bipap machine.

C-Flex, A-Flex, and Bi-Flex are Respironics trademark names for their exhalation comfort features. EPR is resmed's trademark name for its exhalation comfort feature.

[billbolton]

That also means that your therapeutic pressure (say, 16) will not be in place when you try to inhale.

"Treatment with EPR is equivalent in efficacy to treatment without EPR"

"EPR is synchronised to patients’ inspiratory and expiratory cycles, with highly predictable pressure relief."

But EPR won't wait "forever" for you to start to breathe in again, the way a true bi-level machine would wait. If you don't breathe in after so many seconds, EPR quits holding the pressure down and the regular pressure comes back in again..

"After determining the baseline breathing average for each patient, the device suspends EPR if the patient’s breathing drops 75% below the baseline for 10 seconds or more. EPR re-starts when the event is over and breathing is again within range."

All "text" from http://www.resmed.com/en-au/assets/docu ... nz-eng.pdf

Cheers,

Bill

[DragonFire]

Dragonfire, when I read this, I thought..."Wow, what a smart doctor Dragon has!" A doctor with common sense and a good grasp of how to help his cpap users be as comfortable as possible while still getting effective treatment.

Doctor believed that with an AHI below 3 I could take the occasional 10-12 second apnea and feel much better with a lower setting (my 95% is 11.6 now) rather than killing all events and have me breathe against a jet blast Razz .

You made an excellent point:

My impression is doctors will engage more with patients taking charge of their therapy, spend more time to explain and be more reactive if they feel we (patients) are putting effort in following therapeutic indications.

Yep, that's true with "good" doctors. Of course there are also the "god" mentality doctors who get offended, exasperated, or just plain angry if a person shows any signs of having researched their condition or treatment, and is not simply "doin' what the doc sez" unquestioningly.

Rested gal, what I mostly value from any professional is their ability to accept a new view point filter it based on their professional knowledge and come up with a qualified answer. This requires first of all a capability to listen and accept you are not the depositary of the whole truth. In addition the capability of listening is, in my view, one of if not the main professional skill for a doctor ({joke on}distinguishing him from a veterinarian), therefore I will avoid any doctor unwilling to discuss therapy options and/or answer any questions I might have about my condition or therapy.

Cheers

Fabio