New to VPAP, several questions (been on CPAP)

[Kaylis]

I just started using a VPAP a few days ago, and I'm struggling with a few questions. Any help I can get would be wonderful.

First, I started with the lowest minimum and highest maximum the machine does (3 and 25) using the V setting. With a pressure differential of 3, I had an AHI of over 12, with most of them counting as apnea. On my old machine with a setting of 13 I had fewer than 2 AHI (it didn't differentiate types) unless I was ill. When I raised the minimum to 8 (the 95% pressure was 9. something), my AHI dropped to just over 6 with only one apnea. I don't know how to adjust it now to get better AHI/HI numbers.

Second, I need to get an adapter so I can connect the machine to my computer (USB is best for me) and I don't know how to get one. Then, of course, I have to figure out the software.

I love how quiet the new (used) machine is, but I really hope I can get my numbers down so I'm sleeping better.

[Pugsy]

S8 Machines need the ResMed card reader adapter to use with the smart card.
http://www.ebay.com/itm/Resmed-ResScan- ... 3cc1649d6e

This one above is in Israel. I just saw a used one posted there for $66 that is in Houston,TX

Search EBay for Resmed card reader to see the limited choices.

Unless you can find a friendly DME who will sell you one... EBay is the only source I have found.

[BasementDwellingGeek]

Does it really need to be a Resmed card reader? Years ago, before I was had a computer with a card reader, I picked up a few of these:
http://www.amazon.com/Memory-Reader-256 ... 242&sr=1-1

I'll admit that I wasn't dealing with CPAP data, but this adapter makes any SDCARD look like a flash drive for a lot less money. Has any one tried it?

[robysue]

Does it really need to be a Resmed card reader? Years ago, before I was had a computer with a card reader, I picked up a few of these:
http://www.amazon.com/Memory-Reader-256 ... 242&sr=1-1

I'll admit that I wasn't dealing with CPAP data, but this adapter makes any SDCARD look like a flash drive for a lot less money. Has any one tried it?

BasementDwellingGeek,

The OP has a Resmed S8 listed in their signature. The S8 uses a proprietary card from Resmed, not a standard SD card. And that's why Pugsy says he needs the card reader from Resmed. The Resmed S8 card will not fit into an SD slot.

But the Resmed S9 machines do use standard SD cards and any SD card reader, including the one in the link you posted will work.

[Pugsy]

S8 (and older) model machines use what is called a Smart card to gather the data.
This card.
https://www.cpap.com/productpage/resmed ... -card.html
Respironics had a similar type of card with their machines that were made prior to the PR S1 models.

So very special card readers were needed for either brand. We can still easily find the Respironics card readers but the S8 card readers are nearly impossible to find, along with the smart cards. Online sellers quit stocking them when the S8 machine was discontinued in favor of the S9 models. Or perhaps ResMed quit selling them to online sellers.

ResMed still has them and will ship to a DME. But DMEs don't want us to have access to the software data..Duh....so they tell us they can't get the card reader or "we don't need it".

There is one other card reader that will work but it has to be a very special ACR 38 card reader (there are several model of these) and even that particular card reader is hard to find. A search of this forum for the ACR 38 will explain it. Even if found and someone figures out how to get it to work..it still isn't cheap.

[Kaylis]

Thanks for the info about getting the card reader on ebay. The manual says there is/was also an adapter that connected to the machine and had a USB end to use with the computer. I'll look for both.

I'm still fighting with my settings. Grrr... Last night I tried setting my lowest exhale at 10, and I still had an AHI of over 9. What should I try now?

[robysue]

Kaylis,

What's the distribution of events on the S8? I know the S8 doesn't distinguish between CAs and OAs, but it does distinguish between apneas and hypopneas. And the S8 series is known to be pretty aggressive in scoring Hs.

On a bi-level machine, such as the S8 VPAP, the EPAP is supposed to be set high enough to control the OAs and the IPAP is supposed to be enough higher to control the Hs.

It's also necessary to understand some of the particulars of the auto adjust algorithm since you appear to be using the machine in Auto mode. Because the S8 series does not distinguish between OAs and CAs, I believe the S8's auto algorithm will not increase pressure for apneas when the EPAP presssure is greater than or equal to 10. I think the presumption is that once the pressure is 10+, the risk of pressure-induced CAs goes up and if the pressure is increased for a person who experiences pressure-induced CAs, then there's a chance of the machine and person getting caught in the nasty cycle of: CAs trigger pressure increase, which triggers more CAs, which triggers additional pressure, which leads to more CAs, ... And before you know it, the machine is topped out at the maximum pressure settings and the person continues to experience CAs induced by the pressure. And so the way Resmed to avoid this potential problem was to simply not increase pressure for apneas that occur when the pressure is at 10cm or above.

The relevance of this is that your EPAP is already at 10cm. So the machine is, in effect, not going to respond directly to the As that is scores. So if you have lots of As being scored, it may be that you need to increase your EPAP from 10 to 11 to see if that helps.

If you have lots of Hs scored but very few As, you might want to increase the PS to 4 (or 5) so that you are using a higher IPAP than you currently are.

[Pugsy]

If my memory isn't all messed up I think the the S8 auto will respond to indicators of events above 10 cm IF the other usual precursors for obstructive apneas are present. Lots of discussion about this when I was first starting therapy because people who got the S8 Auto were thinking that the APAP machine simply stopped doing anything at 10 cm totally and wouldn't effectively deal with anything above 10 cm and this isn't true. It won't try to kill a frank sudden apnea with an increase in pressure..but then none of the APAPs do that.
Search the forum for the A10 rule and lots of discussion can be found.

And StillAnotherGuest comments in full here along with ResMed's A10 rule.
viewtopic.php?f=1&t=14225&p=164132&hili ... cm#p164132

Especially this part from the A10 rule.
"Thus, apneas can only cause the CPAP pressure to rise as far as 10 cmH2O, but indicators of partial obstruction can increase the CPAP pressure to 20 cmH2O, which is sufficient to treat the vast majority of subjects. "

and Rested Gal's comments here in a 40 plus page thread...
viewtopic.php?f=1&t=29851&p=257212&hili ... cm#p257212

[Kaylis]

Well, with the exhale minimum set at 9 or above my AHI has still been high, but my AI is below 1. With the settings wide open I had an AI that was higher and my AHI was also higher (about half apneas and half hypopneas I figure). With the comments it seems I'm heading in the correct direction by changing my exhale minimum and leaving my differential low. Thanks for the help.

[Kaylis]

I was able to find a reader for S8 cards on ebay, and it arrived today. I put the card that I got with the machine into the VPAP and got repeated errors. Well, then I figured maybe I could figure out what was wrong if I could get the reader attached to a computer. The computer looked for software for the new device and now lists it as a device, but I can't seem to access it. I'm using an Asus Seashell netbook running Windows 7.

Any idea what I should try now?

Thanks in advance