Is this right?? (S9 autoset)

phancj · Post by **phancj** » Wed Jul 09, 2014 1:55 am

Hi,

Everything is great (for the most part), AHI between 1 & 4.

Just noticed that altho the ramp function is on, min pressure 9, max 20, EPR 1, start pressure 8 , max ramp 15 min.

Ramp is kinda good for me as a starting pressure of 8 is tolerable but 9 is less so when trying to fall asleep.

However, upon starting machine I noticed the pressure climbs rapidly to 9, sometimes even 9.2...is this normal?

Thanks,

Pugsy · Post by **Pugsy** » Wed Jul 09, 2014 4:56 am

With a minimum pressure of 9 and ramp time of 15 minutes it isn't going to take long to get from 8 to 9.
You can lengthen the ramp time so that it takes longer than 15 minutes...it's a setting change available in the clinical menu.

phancj · Post by **phancj** » Wed Jul 09, 2014 5:49 am

Thanks for the reply..

I am just surprised that the escalation to pressure of 9 is immediate, which suggests the ramping is not effective?

Pugsy · Post by **Pugsy** » Wed Jul 09, 2014 5:53 am

phancj wrote:
I am just surprised that the escalation to pressure of 9 is immediate, which suggests the ramping is not effective?

If the increase to 9 is immediate that would suggest to me that ramp was turned off despite the setting to 15 minutes.
It's been a while since I have been into that menu. Let me finish my first cup of coffee and go play with my S9 to see what is actually available in those settings.
I need to get the cobwebs out of my head.
I will get back with you.

I never used the ramp myself...even when using APAP starting at 10 cm...so never bothered with learning much about it.

Pugsy · Post by **Pugsy** » Wed Jul 09, 2014 6:03 am

Okay...my bad...it's the Respironics machines that have a special on/off selection in the clinical setup menu.
ResMed just has the minutes and pressure setting and to turn it off we just select 0 minutes.

Going from 8 to 9 isn't much of an increase and I don't know how quickly it is supposed to increase. Maybe with such a small difference it does do it pretty much immediately as a normal function no matter how long it is supposed to take in minutes.

Some things I would try if it were me.
Set the ramp for 30/45 minutes...see if the increase is still immediate.
Set the minimum pressure to 6 cm and see how long it takes to get to 9 (using the 15 minute and/or 30 minute) If it goes from 6 to 9 in 5 minutes then something is wrong with the ramp process.

Are you using EPR exhale relief? If not you might look into using it as I think it would make that 8 or 9 starting point a lot more comfortable for you. Might not even care about ramp.

phancj · Post by **phancj** » Wed Jul 09, 2014 6:52 am

Thanks Pugsy will try tonight.

Already using EPR 1.

Cheers!

Mattbnr · Post by **Mattbnr** » Wed Jul 09, 2014 3:14 pm

I use epr of 3. Makes exhaling a lot easier and more natural especially since I use nasal pillows.

HealthyandHopeful · Post by **HealthyandHopeful** » Wed Jul 09, 2014 3:38 pm

What exactly is EPR and how do you know where to set it? Mine is set on 2 (and I probably won't change before my one month appointment) but I have wondered where that number came from and what it meant.

robysue · Post by **robysue** » Wed Jul 09, 2014 3:40 pm

phancj wrote:Hi,

Everything is great (for the most part), AHI between 1 & 4.

Just noticed that altho the ramp function is on, min pressure 9, max 20, EPR 1, start pressure 8 , max ramp 15 min.

Ramp is kinda good for me as a starting pressure of 8 is tolerable but 9 is less so when trying to fall asleep.

However, upon starting machine I noticed the pressure climbs rapidly to 9, sometimes even 9.2...is this normal?

Thanks,

We need to tease apart some things here.

If the starting ramp pressure is 8cm and the min pressure is 9cm with a 15 minute ramp time, the pressure ought to be increasing at a rate of 0.67 cm/minute. I'd expect that you'd see a jump from 8.0 to 8.1 at the end of either the first or second minute. It's also possible that the ramp pressure increases in 0.1 units and hence it's at 9.0 by the end of 10 minutes.

But you are saying that you see an increase to 9.2 sometimes. The question then becomes: How long are you breathing with the machine while watching the pressure rise? If that 9.2 happens just after the ramp is over then the machine is detecting something that's triggering a pressure increase. Most likely a flow limitation.

If you look at the data in SleepyHead, you will be able to see the pressure increase during the ramp up period along with what ever increases immediately follow the ramp up period. And that might help us help you understand why the machine is doing what it is doing.

As for getting more comfortable: Pugsy's ideas of increasing the ramp time and seeing what happens is reasonable. Also increasing the EPR from 1 to 2 is reasonable. You might even want to experiment with EPR = 3. And if you're deeply uncomfortable with a starting ramp of 8cm because of too MUCH air, you could even reduce the starting ramp to 7 to see if that helps.

LSAT · Post by **LSAT** » Wed Jul 09, 2014 4:11 pm

HealthyandHopeful wrote:What exactly is EPR and how do you know where to set it? Mine is set on 2 (and I probably won't change before my one month appointment) but I have wondered where that number came from and what it meant.

You set the EPR on whatever setting is the most comfortable for you. There is no right or wrong settings.

palerider · Post by **palerider** » Wed Jul 09, 2014 5:05 pm

HealthyandHopeful wrote:What exactly is EPR and how do you know where to set it? Mine is set on 2 (and I probably won't change before my one month appointment) but I have wondered where that number came from and what it meant.

EPR stands for Eexpiratory Pressure Relief, and what it means is, it lowers the pressure by whatever you have it set to, when you're not inhaling.

so if your machine is set to 10, and epr is at 2, then your pressure is at 8 until you start to inhale, then it bumps it to 10 till you start to exhale, and it drops it back down 2.

it's primarily a comfort thing, if you like it, great, if not, change it, play with it, you may find you like it better at another number, or even at zero.

Sheriff Buford · Post by **Sheriff Buford** » Wed Jul 09, 2014 5:22 pm

I was on cpap for several years, and I noticed my chest (lungs) were sore. I started using the EPR and it helped me a lot. I kicked myself for not using it sooner. It allowed the pressure to drop upon exhaling. My lungs were sore because the pressure was to high to breath out.

Sheriff

zoocrewphoto · Post by **zoocrewphoto** » Wed Jul 09, 2014 6:43 pm

I'm pretty sure my S9 autoset had a separate line in the menu for ramp on/off in addition to starting pressure and length of time. It sounds like it is set to off.

Pugsy · Post by **Pugsy** » Wed Jul 09, 2014 6:56 pm

zoocrewphoto wrote:I'm pretty sure my S9 autoset had a separate line in the menu for ramp on/off in addition to starting pressure and length of time. It sounds like it is set to off.

Would you mind looking to confirm? My S9 VPAP Auto and the current Adapt doesn't have a separate on/off in the menu for Ramp. I have never seen or used the AutoSet and it might very well have it. If you would look and let me know for my own education I would appreciate it.

palerider · Post by **palerider** » Wed Jul 09, 2014 8:34 pm

Pugsy wrote:
zoocrewphoto wrote:I'm pretty sure my S9 autoset had a separate line in the menu for ramp on/off in addition to starting pressure and length of time. It sounds like it is set to off.
Would you mind looking to confirm? My S9 VPAP Auto and the current Adapt doesn't have a separate on/off in the menu for Ramp. I have never seen or used the AutoSet and it might very well have it. If you would look and let me know for my own education I would appreciate it.

I don't believe it does, but different firmware may vary.

the clinican menu should offer 'max ramp' and 'start pressure'.

then the default menu let's you change from off up to that max value.

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