Switching to a better (but used) machine, no professionals are involved.

[oldmobie]

I've been using a Resmed S8 Escape since 2010. It's been a real champ, except for the start / stop button. It hasn't worked for years. Fortunately, it failed in the "on" position, so I've been unplugging in the morning and plugging in at night. (Until I recently got fed up, chopped the cord in two and installed a light switch. It ain't pretty.)

Yesterday I found a Resmed S9 VPAP S in a thrift store. Marked $19.99, we applied a 20% discount and got it for ~$16. Only thing I've found wrong is the humidifier water tank is missing. I have a new one on the way. (ebay, $15.40)

After a lot of googling, I found a clinician's manual. I set the max pressure (IPAP) to 16, which was my original prescription. I've never had a BIPAP before, so I set my minimum pressure (EPAP) to 13. That was a guess. After one night of use, my AHI is 22.1. I've never had access to that number before, so I don't know how much of a change that represents. Some more googling indicates that I shouldn't panic that my API is above 0, but I should try to get it as low as I can.

Based on my reported Respiration Rate (15) and a chart I found in the guide, I adjusted Ti Min to 1 and Ti Max to 2. Looks like there's a possibility Ti Max should be 1.3? I made these adjustments this morning, so I don't know yet if they've had any effect.

So I'm interested in advice or opinions. Should I switch the S9 to CPAP mode? Should I increase EPAP to decrease AHI? Increase IPAP? (Note: After an in-home sleep study, I was given permission to turn my pressure up on the S8 to any setting that was comfortable between 16 and as high as it would go. I never did it because I can't seem to enter the clinical menu without turning it off.) (Also of note: I lost 100ish pounds since then.) Maybe I need another in home study, unless the S9 can collect the right data to help me.

For what it's worth, I think I like the BIPAP feature. I feel like I got the best night's sleep I've had in a long time.

I've also read that I can import my SD card data for analysis on a Windoze PC. My PC sucks. Does anyone know a way to do the same with android?

[slowriter]

I think it will be hard for people to advise you unless you can post OSCAR charts.

I also don't think you should mess with the Ti settings at this point.

[Pugsy]

What kind of events compose that AHI?
That's what we need to know first thing.

Using S mode with IPAP at 16 and EPAP at 13 means PS (pressure support or the difference between inhale and exhale) would be like using the S8 Escape at 16 with EPR at 3.

Did you use EPR with your S8 at all...if so at what setting?

So we could switch to cpap mode but essentially you are using a fixed mode right now anyway but you have the availability of those additional comfort features (Ti min and max). I actually suggest that people start out at those settings at the factory defaults and then make adjustments if you need additional help. The factory defaults will work well for most people.

There is no android app available to see the detailed data that the machine can give you. Sorry.
What Windows version are you using on your PC? This is important to know because it affects the SD card and the S9 being happy with the SD card.

[oldmobie]

What kind of events compose that AHI?
That's what we need to know first thing.

I don't think I know how to find that information. I'll check the manual. And start learning the PC software.

Using S mode with IPAP at 16 and EPAP at 13 means PS (pressure support or the difference between inhale and exhale) would be like using the S8 Escape at 16 with EPR at 3.

Did you use EPR with your S8 at all...if so at what setting?

I never changed a setting for that. I've been shut out of the clinical menu for so long I really don't remember much, but I think it's only run constant pressure from start to finish. (Since I disabled ramp.)

So we could switch to cpap mode but essentially you are using a fixed mode right now anyway but you have the availability of those additional comfort features (Ti min and max). I actually suggest that people start out at those settings at the factory defaults and then make adjustments if you need additional help. The factory defaults will work well for most people.

It was set to factory default last night. I'll switch it back.

There is no android app available to see the detailed data that the machine can give you. Sorry.
What Windows version are you using on your PC? This is important to know because it affects the SD card and the S9 being happy with the SD card.

Windows 8.1 . The SD card says Resmed on it, it must be original. The S9 says the SD card is in use when I first connect the power. I suspect it's happy with the card and it's formatted correctly. I'll just have to get the PC to play nice. I'll go download software and familiarize myself. I see OSCAR referenced above. I also saw that you have tutorials for one called sleepyhead. Will one of those make it easier to help me than the other?

[Pugsy]

OSCAR is based on SleepyHead so what I said about SleepyHead works for OSCAR.

ResMed S9 machines are a little bit quirky when it comes to the SD card. Windows 8.xxx and higher (and some Macs) add a little text file to the SD card and while the software like SleepyHead or OSCAR or even ResScan don't care about that little text file....the S9 models care and they won't accept the SD card with that little text file on it.
So we tell S9 machine users to lock the SD card (write protect) so the operating system doesn't put that little text file on the SD card.
ResMed S9 machines are the only brand/model of machines that this matters.
The AirSense/AirCurve models don't care and the other brands don't care either.
If that little text file is on the SD card and a person puts that SD card in a S9 machine you get an "invalid card" message and a prompt to erase the card.

You can get the provider manual via email from here for your new machine if you don't have it.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

There is some limited data available on the machine's LCD screen and the provider manual explains how to turn that feature on and how to get to that data.

Once I know the event category breakdown of your AHI....I will have a better idea how to advise you on your settings.
So even if you can't get the software up and running just yet...you can get the category breakdown off the machine's LCD screen from the Sleep Report feature.

[Pugsy]

Did you remember to erase past user data from the machine and from the SD card?

[oldmobie]

Did you remember to erase past user data from the machine and from the SD card?

Yes. I did that last night, before use. Hopefully that will prevent averaging between my results and someone else's.

[oldmobie]

Once I know the event category breakdown of your AHI....I will have a better idea how to advise you on your settings.
So even if you can't get the software up and running just yet...you can get the category breakdown off the machine's LCD screen from the Sleep Report feature.

Some of this may not be relevant, but I'm sure some of it will be.

Period: 1 Week
Days Used: 2/2
Days >4hrs: 1/2
Avg. Usage: 4.1 hrs
Used Hrs: 8.2 hrs
Insp. Pressure: 16.0
Exp. Pressure: 13.0
Leak: 3L/min
Vt: 500ml
RR: 15
MV: 8.1L/min
% Spont T: 100.0%
% Spont C: 97.0%
AHI: 13.1
Total AI: 11.4
Central AI: 0.0

[oldmobie]

The Ti settings are now restored to default.

[Pugsy]

If you feel the need to change the Ti settings....you can do it but just go by how it feels with your own breathing.
Go with whatever feels more natural/comfortable to you.

AHI: 13.1
Total AI: 11.4
Central AI: 0.0

AI....that's the obstructive index so you had 11.4 OA index and 1.7 hyponea index
Index is just the hourly average.
AHI is the total of all categories so 13.1 and all obstructive in nature.

This tells me a lot. I was worried that you were having some central apneas (show up as clear airway on OSCAR) and how to deal with centrals is different than how to deal with obstructive apneas or hyponeas.
We increase the pressure for the obstructive stuff. For centrals we don't because more pressure wouldn't help because the airway is already open.

When you set EPAP for 13 that lowers the pressure during exhale and it's allowing the airway to collapse.
So if you want to use a lower EPAP than IPAP setting then you will need to compensate for that drop during exhale by increasing the IPAP.

So if you like that 3 cm drop and want to keep it, for comfort, then you need to have a higher IPAP....so maybe 18 cm IPAP and 15 cm EPAP.
See what happens tonight with more EPAP to help hold the airway open.
Or you can set it for EPAP 16 and IPAP 16 and it will function like your old Escape functioned but you have the Ti comfort settings to maybe help with comfort. It is not a nice as using PS though....that 3 cm PS is pretty nice to have when using pressures in the mid to upper teens. Heck, I use it with my IPAP of 7....just makes the breathing so much more natural like.

[oldmobie]

So if you like that 3 cm drop and want to keep it, for comfort, then you need to have a higher IPAP....so maybe 18 cm IPAP and 15 cm EPAP.

I've just downloaded OSCAR to my phone. I'll tranfer to the PC and check it out. If I don't learn something new that changes my mind, I'll try the above settings first. I'll try to report back tomorrow how it went. Thank you very much.

[palerider]

I've never had a BIPAP before,

And you don't have one now.... you've got a VPAP.

I've also read that I can import my SD card data for analysis on a Windoze PC. My PC sucks. Does anyone know a way to do the same with android?

Well, yes, yes you can.

[oldmobie]

I've never had a BIPAP before,

And you don't have one now.... you've got a VPAP.

Oops! The only categories I was aware of were CPAP BiPAP and AutoPAP. One more thing I'm learning today.

[Pugsy]

BiPap is actually a Respironics marketing term generalization for their bilevel pressure machines.
ResMed has never using the term bipap anywhere in their marketing materials. They either say the correct term which is bilevel or that call it their marketing term which for the S9 was VPAP and for the newest model they just use the term AirCurve 10 for their line of the different models that do bilevel.

So you don't technically have a BiPap because you don't have a Respironics machine.
But you do have a bilevel machine.

It seems like the term "bipap" has sort of become used as a generic term to encompass all bilevel machines but I prefer to use the correct terminology when at all possible just to avoid potential confusion later. This stuff is confusing enough without adding in calling a ResMed machine by a Respironics marketing term.

More confusing stuff....
There's not really a single apap model or classification of machine....an apap capable machine is a cpap machine that has a mode that with do auto adjusting pressures.
cpap/apap....single pressure
Bilevel.....dual pressures

[raisedfist]

% Spont C: 97.0% means that you should probably leave the Ti min and Ti max at the default values because they are working for you. You are switching from IPAP to EPAP naturally as you are in control. At most we sometimes recommend bumping up Ti max a bit if you feel like you want to inhale for longer/the breathe is getting cut off (on sleepyhead/oscar you can look at the inspiration chart and see what's happening). Ti min is only really adjusted if you have an illness that effects your breathing and you can't sustain a normal inhalation.