Initial Start Pressure of ResMed S9 & EPR

[Physician]

As I've posted before, one of my two primary complaints about the S9 Auto is that in AutoSet mode it takes TEN SECONDS to get to my set minimum pressure of 8. This feels stifling and mildly suffocating.

Even though the S9 LCD screen shows the unit starting at 0.0 pressure, I heard that it might actually start at 4.0. If that's true, it takes ten long seconds to go from 4.0 to 8.0. To me, it feels like the initial pressure is 0.0 as the screen indicates.

Does anyone here like that "gentle" slow climb to their minimum pressure ? Or would you prefer the pressure to go immediately to the lower limit like it does on the S8 ?

Do you wish this feature was user selectable on the S9 ?

ALSO, for those using the S9 in either CPAP or AUTO mode with the EPR on (set at 1, 2, or 3) does it feel like the EPR is working at all ? Can you sense the EPR ? If someone told you the EPR is NOT working on the S9, would you believe it ?

Has anyone here used a manometer on their S9 to demonstrate whether or not the EPR change is objectively present and operating properly ?


Thank you.

[DreamOn]

Does anyone here like that "gentle" slow climb to their minimum pressure ? Or would you prefer the pressure to go immediately to the lower limit like it does on the S8 ?

I would prefer that it would go straight to my minimum pressure, like the S8 machines. But my minimum pressure is low (7, right now), so it doesn't take that long to get to pressure. It doesn't really bother me. But I may actually tend to hold my breath during that period. I'll have to pay attention to that. Perhaps if my pressure was high I would actually appreciate the slow climb? It can't be pleasant to be slapped in the face suddenly with strong pressure.

ALSO, for those using the S9 in either CPAP or AUTO mode with the EPR on (set at 1, 2, or 3) does it feel like the EPR is working at all ? Can you sense the EPR ?

I've never used EPR on the S9 machine. I did use it on my S8 Elite II for a while, and it was quite noticeable on that machine. Have you double-checked your machine settings? What is your EPR setting: Off, Ramp Only, or Full Time? And which EPR level: Off, 1, 2 or 3?

I have noticed that breathing is easier for me on the S9 machine. I think they must have improved their EasyBreathe technology. It's very smooth and natural for me. Perhaps I'll try EPR at 3 tonight just to see if I notice an inhale/exhale pressure difference.

P.S. I haven't tried Ramp on the S9. I'm just wondering, if you set Ramp to start at 7 if it would start there (without the slow climb). That may be worth trying.

[Physician]

Does anyone here like that "gentle" slow climb to their minimum pressure ? Or would you prefer the pressure to go immediately to the lower limit like it does on the S8 ?

I would prefer that it would go straight to my minimum pressure, like the S8 machines. But my minimum pressure is low (7, right now), so it doesn't take that long to get to pressure. It doesn't really bother me. But I may actually tend to hold my breath during that period. I'll have to pay attention to that. Perhaps if my pressure was high I would actually appreciate the slow climb? It can't be pleasant to be slapped in the face suddenly with strong pressure.

ALSO, for those using the S9 in either CPAP or AUTO mode with the EPR on (set at 1, 2, or 3) does it feel like the EPR is working at all ? Can you sense the EPR ?

I've never used EPR on the S9 machine. I did use it on my S8 Elite II for a while, and it was quite noticeable on that machine. Have you double-checked your machine settings? What is your EPR setting: Off, Ramp Only, or Full Time? And which EPR level: Off, 1, 2 or 3?

I have noticed that breathing is easier for me on the S9 machine. I think they must have improved their EasyBreathe technology. It's very smooth and natural for me. Perhaps I'll try EPR at 3 tonight just to see if I notice an inhale/exhale pressure difference.

P.S. I haven't tried Ramp on the S9. I'm just wondering, if you set Ramp to start at 7 if it would start there (without the slow climb). That may be worth trying.

Your minimum pressure is 7, and mine is 8. No significant difference. Don't you find that 10 seconds annoying ? I do the same thing ! I hold my breath for ten seconds until it gets to 8.

Please pay more attention to this and repost in this thread.

My EPR is at 3 and Full-time. I cannot detect that it is working. Please try your EPR and report back in this thread or PM me.

My Ramp is off.

Looking very much forward to your (and others) reply and investigation.

[DreamOn]

I hadn't noticed that it takes that long to get up to pressure, but I will time it and pay attention to it more. In fact, I'll raise my lower pressure to 8 tonight and time how long it takes to get there. The gradual pressure increase hasn't really bothered me, other than it seemed strange initially, after using the S8 for 8 months.

I'll try EPR at 3 too, and I'll post my results here. In the meantime, I hope you'll get responses from others. I don't recall anyone else mentioning those things on the forum, but I could have missed it.

I just thought of something else to add.... The Activa LT nasal mask that you're using was the first mask I used. I like it a lot, and I still use it off-and-on. That mask, in particular, seems to react to pressure changes noticeably because of the way it "inflates". I'm just wondering if that may be part of the reason that you're sensitive to the gradual pressure increase. I remember when I was a newbie that it actually sucked my breath away a few times when I turned the machine off, which startled me!

[Physician]

I hadn't noticed that it takes that long to get up to pressure, but I will time it and pay attention to it more. In fact, I'll raise my lower pressure to 8 tonight and time how long it takes to get there. The gradual pressure increase hasn't really bothered me, other than it seemed strange initially, after using the S8 for 8 months.

I'll try EPR at 3 too, and I'll post my results here. In the meantime, I hope you'll get responses from others. I don't recall anyone else mentioning those things on the forum, but I could have missed it.

I just thought of something else to add.... The Activa LT nasal mask that you're using was the first mask I used. I like it a lot, and I still use it off-and-on. That mask, in particular, seems to react to pressure changes noticeably because of the way it "inflates". I'm just wondering if that may be part of the reason that you're sensitive to the gradual pressure increase. I remember when I was a newbie that it actually sucked my breath away a few times when I turned the machine off, which startled me!

Oh please do test the start to full pressure time in AutoSet mode. I guarantee it's 9-10 seconds. There is no longer an "instant on" for the low limit pressure like there was in the S8. on your S9, you'll see the LCD screen start at 0.0 in the lower left corner and go ten seconds to your lower limit as the horizontal bar progresses to the right.

Please confirm or deny this.

Then try the EPR full time at a level of three. Let us know if you feel a difference when you breath out (Didn't want to say "when you expire" !). I'll bet you do NOT feel a difference on expiration with EPR full time at a level of three.

I'm off to some hardware stores to see if I can get a pressure meter 0-20 cm. H20 and the appropriate fittings. Do I have some Obsessive-Compulsive traits ? Hell yes.

[unadog]

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[cpapernewbie]

agree with unadog.

With a pressure of 7-8 cm H2O it does not make sense that you need EPR, let alone EPR of 3

[sproatd]

I'm fairly new to Cpap. I do use the S9. I haven't noticed that it takes time to get to full pressure, although I changed my ramp time from 20 minutes to 5 minutes. My setting is at 9. I was having a lot of trouble at first until I figured out that I could turn on the EPR setting. I had a hard time exhaling prior to changing it. I set the EPR to 3 and definitely notice it on my machine. I can also hear a difference when I inhale and exhale. The EPR on my S-9 is what made my Cpap do-able for me. I was struggling with each breath until I found EPR. I have to wonder if your S-9 is working correctly since I notice such a difference with mine with the EPR on, although I don't have any experience with the S-8 to compare it to. I wish the best of luck to you and hope you get it working the way you like it soon.

Denise S.
Alaska

[Physician]

agree with unadog.

With a pressure of 7-8 cm H2O it does not make sense that you need EPR, let alone EPR of 3

It does make sense. My minimum pressure is set at 8 and maximum is 18, and the auto-trirating usually hovers at 14. EPR is a comfort feature, so it's a matter of PREFERENCE, not need. Thus I simply prefer EPR on full time at 2 or 3 level. It's not a matter of "need". It's a matter of what feels best.

Tonight I made an inline T adapter with a bushing, and now I'm seeking a 0-20 cm. H20 meter. In the meantime I attached a condom and observed the condom's inflation with and without EPR. Fascinating. I'll report on this after I substitute an actual metering device.

[Physician]

As I've posted before, one of my two primary complaints about the S9 Auto is that in AutoSet mode it takes TEN SECONDS to get to my set minimum pressure of 8. This feels stifling and mildly suffocating.

I really don't understand tge issue with this.

Turn the machine on as you start to put your mask on. By tge time that you buckle the mask, it will be up to pressure.

It is only one time per night, and a few seconds.

Nothing puzzling here. When taking the first breath with Smart Start, it's ten seconds for the pressure to get to the set minimum. What's not to understand ? With Smart Start, if the mask is off the face, the unit will turn off.

a) ten seconds is too long
b) instant on should be a user selectable setting and choice.

[Physician]

As I've posted before, one of my two primary complaints about the S9 Auto is that in AutoSet mode it takes TEN SECONDS to get to my set minimum pressure of 8. This feels stifling and mildly suffocating.

I really don't understand tge issue with this.

Turn the machine on as you start to put your mask on. By tge time that you buckle the mask, it will be up to pressure.

It is only one time per night, and a few seconds.

I turned OFF "SmartStart" and let the pressure go to 8 (with takes 9-10 seconds) then put on the mask. Okay. EPR of 3 seems undetectable. Will try to find a 0-20 cm H20 meter today, but the initial condom inflation inline test shows no difference between EPR on and EPR off.

How does one post pictures here ?

[jdm2857]

You must upload pics to a photo sharing site. Photobucket.com is one.
The paste the link to the photo between img tags. The Img button will insert them for you and put the cursor between the tags. Then just paste the link. Or, on photobucket you can copy the img link (with tags) instead of the regular link.

[unadog]

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[DreamOn]

Okay, I experimented for you last night. I had machine pressure set to Autoset 8-11 with EPR at 3 full-time. There is definitely a very pronounced difference in inhale/exhale pressure. I can hear it with each breath as well.

I had tried EPR on my S8 Elite II for a while and eventually decided that I preferred it off, so I used the S8 with EPR off for many months. I had never even tried it on my S9 Autoset. So I would imagine that I would be more sensitive to the sensations than someone who was already acclimated to EPR at 3. Last night it felt like it was pushing air into me, especially at the end of inhales, which is the same sensation I had with the S8. It feels like it's expanding my lungs. In contrast, when I have EPR set to off, I don't feel the air movement at all. With EPR off, the S9 is easier to exhale against than the S8, in my opinion, and breathing feels smooth and natural.

My results numbers weren't good with EPR at 3 last night either! AHI was more than double what it is typically, and Total AI was double or triple what it usually is. I had had only two obstructive apneas total in the 37 days I've used the S9. I had two obstructives last night alone, and many more central apneas than I normally do. My chest is a bit sore this morning, and I woke up with a very slight headache too. Ugh!

As for the time it took to get to minimum pressure, I can confirm that it took 9-10 seconds to get to pressure of 8 from the time I started the machine. I would prefer that it took about half that time, but I think I've learned to time my initial breaths in response to that. It's definitely different than the S8, but only a minor annoyance for me. As I mentioned before, it may feel more exaggerated with the Activa LT nasal mask, since it "inflates." I use nasal pillows masks most of the time these days.

I hope this information helps you. I can understand why you would prefer to use EPR since your overall pressure is higher. It would be good to confirm that it is actually working on your machine. If you purchased your machine from a local DME, I suggest that you return it for replacement with a new machine. From my experience last night, you should be able to detect that EPR (especially at 3) is working, both by feel and sound.

If you do get your machine replaced, I would be interested to know what you think of EPR on the S9 versus the S8.

[Physician]

Thank you so much for testing and posting.

This is NOT making sense.

You said: "With EPR off, the S9 is easier to exhale against than the S8, in my opinion, and breathing feels smooth and natural."

With EPR on in the S9, exhalation should be easier than when it is off. This suggests strongly the S9 EPR is either not functioning or is inadequate. Your finding is exactly what I have found.


YOU SAID: "Okay, I experimented for you last night. I had machine pressure set to Autoset 8-11 with EPR at 3 full-time. There is definitely a very pronounced difference in inhale/exhale pressure. I can hear it with each breath as well."

Was this with the S8 or the S9 ?

YOU SAID: "Last night it felt like it was pushing air into me, especially at the end of inhales, which is the same sensation I had with the S8. It feels like it's expanding my lungs. In contrast, when I have EPR set to off, I don't feel the air movement at all"

EPR is not supposed to modify inspirations. If only changes the expirations. Puzzling.

My machine makes no sound changes with inspiration or expiration, with or without EPR on and at any 1-3 level.

TODAY: I'll replace the condom with a column of water in a tube, or a proper meter. Given what I observed with the condom inflation and deflation, I'll bet my EPR section is defective.

Stay tuned !!