ResMed S9 VPAP Auto pressure setting

I spent 2 hours picking up a bilevel blower at Apria today with an RT who didn't know (or wouldn't share) explanations about about half the settings with me. Useless!

I know from my AutoSet use that I do well with a range of 9-14. The RT stubbornly insisted that my settings remain at the default 4-25 while there. I know how to change them, but some setting names are new, so I'm hoping for some help. My biggest issue is such a dry mouth that I'll have to discontinue therapy if the bilevel doesn't work. I've tried everything else.

I read Robysue's great post on ASV pressure setting. I read the old but relevant post about the dancers, which made sense to me. I can set a MaxIPAP and MinEPAP, and the doc did specify a pressure setting of <= 8. Then the TiMax defaults to 2, TiMin to .3, trigger and cycle both at Medium. I think if it set IPAP to 12, EPAP to 6, and PS to 6, I will go 12-18 and exhale 6-12, always with PS of 6.

I'm reading the clinician manual, which doesn't help too much. Input appreciated!
Thanks, Jean

So, I'm still trying. The good news is that my mouth is less dry, the bad news is that I now have an ongoing sore throat.

My sleep doc prescribed IPAP 4-25 and EPAP 3-25 (which was next to the "default" checkbox), and hand wrote "max delta 8", which prompted the DME to set the PS to 8. After a few nights of pressure too high to sleep, I now have IPAP set to 15, EPAP set to 4, PS 4. I'm hoping that the reduced exhalation pressure will help with the Sahara-dry mouth. The dry mouth isn't just uncomfortable, it has my dentist concerned.

On APAP, I seemed to do best on pressure of 8-14. But the dry mouth didn't respond to any of the many things you all suggested.

There are more settings on the VPAP Auto whose impact I don't understand (TiMax, TiMin, Trigger and Cycle), but the RT Refused to discuss them, and I've left them alone. There is a place for them on the Rx, but they were left blank, and I didn't know to ask the doc about them.

I have the clinical manual, which tends to define more than discuss impact. I don't snore. I understand that the PS setting maintains a constant pressure between IPAP and EPAP. So, I'm trying to keep the EPAP low, but get an IPAP of ~10-ish.

I'm a bit out of my league here, input much appreciated. Many thanks.

It's best to just deal with IPAP,EPAP and PS and leave those other settings at the default setting.

Im in the same boat. I just got an S9 Auto VPAP due to stomach pain from higher pressures on my long used APAPs. I found I could not use the S9 AutoVPAP, its makes me feel "overinflated" when I turn the thing on, just like my APAP when I set my pressures at my old, pre-tonsillectomy minimum pressure of 10.

I too figured out I had four different settings, the ones you mentioned that I had no clue about. I got an older Resmed VPAP clinicians manual and figured out basically what the settings are for, but I really dont have a clue what to set them to. It was given to me by the DME with those four settings set to default type settings (trigger and cycle both set to "medium.")

The goal for me is to be able to sleep on the thing with a higher minimum IPAP, but not get the stomach pain/overinflation feeling I get from sleeping on my S9 APAP with the pressure set higher.

Id be happy if I could make the thing work for me on an IPAP minimum of 8, EPAP minimum of 4. My max IPAP is 14, pressure support is 4. I think the tweaking is the four other settings you mentioned.

I think I will just request a new sleep study and have the thing set in the sleep lab, individualized to me.

Eric

Jeannh wrote:S

There are more settings on the VPAP Auto whose impact I don't understand (TiMax, TiMin, Trigger and Cycle), but the RT Refused to discuss them, and I've left them alone. There is a place for them on the Rx, but they were left blank, and I didn't know to ask the doc about them.

I have the clinical manual, which tends to define more than discuss impact. I don't snore. I understand that the PS setting maintains a constant pressure between IPAP and EPAP. So, I'm trying to keep the EPAP low, but get an IPAP of ~10-ish.

I'm a bit out of my league here, input much appreciated. Many thanks.

Jeannh wrote:... There are more settings on the VPAP Auto whose impact I don't understand (TiMax, TiMin, Trigger and Cycle), but the RT Refused to discuss them, and I've left them alone. There is a place for them on the Rx, but they were left blank, and I didn't know to ask the doc about them. ...

First of all, once the DME / RT is no longer watching your results, you might want to try AUTO for BPM, that will disable the settings that you don't understand. In essence, the ResMed and Respironics ASV units use a very advanced algorithm to follow your breathing. They allow you to breathe on your own, but will step into the picture when you are not breathing.

An ASV (an Adaptive Servo Ventilation) unit is rather like a BiLevel unit. As your breathing changes, it also changes how it responds (that's the Adaptive part of the name). Yes, as much as possible, it follows your breathing effort (that's the SERVO part of the name). Still, if your fail to breathe, it acts as a ventilator (that the VENTILATION part of the name) to help sustain respiration.

So, instead of a inhalation pressure that normally stays a set amount higher than the EPAP pressure, with an ASV, if the algorithm notes that you are not breathing enough (the volume is too low) or you have stopped breathing (and apnea occurs), then it will increase the pressure upto MAXIMUM PRESSURE to help sustain your respiration. You see, the fact that you stop breathing (as you should) .. for whatever reason .. will cause you to stop breathing again. By sustaining your respiration when you stop making the effort to breathe, it helps break the cycle that causes central sleep apnea. It's not perfect, but it does better than most other techniques - other than perhaps the breathing pacemaker.

Hope that helps explain how it works.

John I don't think they have a ASV but a S9 VPAP Auto. When I was using my VPAP Auto I had my EPAP set at 13.6 and my IPAP set at 20 with a PS of 3 so IPAP and EPAP were always 3 apart from each other. I had it set on 20 but it will only go as high as it needs to go. I reached 19 just one time.

Jean, if you want Ipap at "10ish", you can try settings of Epap=6, Ipap=12, PS=4(the default setting), so when you start the machine the pressure will be 6/10, if you need more pressure, you'd have 7/11, 8/12. If you want you can set Ipap a little higher at 14 in case you need it (9/13, 10/14). I'd leave the other stuff at default settings. Keep us posted.

Thanks, John. Squid13 is right, I have the auto bilevel S9 machine, which they call a VPAP Auto.

I'm trying to lessen the EPAP without compromising the IPAP, hoping this will help with dry mouth/throat. I've already gone the taping, chin strap, raise the head of the bed, increase humidity route without success.

What purpose does the EPAP serve? It doesn't assist in the airway stent, does it? I thought it just got rid of the carbon dioxide.

The EPAP is what holds your airway open. Just remember that PS number is the difference between the them, so if IPAP goes up EPAP will follow at what ever you have your PS at. If say your IPAP is 16 and EPAP is 12 with a PS of 4 if IPAP goes up to 17 then EPAP will go up to 13.

If the EPAP holds your airway open (the way that xPAP makes oxygen available, hence doing its magic) why is the IPAP always higher, using more force? Seems counter-intuitive.

It's job is to keep it open if set right but it may not always do it's job and it may not always be at the right pressure, there's a lot of variables.

Jeannh wrote:Thanks, John. Squid13 is right, I have the auto bilevel S9 machine, which they call a VPAP Auto. ...

Ugh! My bad and apologies for adding my confusion to the mix!

Here's hoping you are getting the answers you need. Best wishes!

Jeannh wrote: My sleep doc prescribed IPAP 4-25 and EPAP 3-25 (which was next to the "default" checkbox), and hand wrote "max delta 8", which prompted the DME to set the PS to 8. After a few nights of pressure too high to sleep, I now have IPAP set to 15, EPAP set to 4, PS 4. I'm hoping that the reduced exhalation pressure will help with the Sahara-dry mouth.

...

I have the clinical manual, which tends to define more than discuss impact. I don't snore. I understand that the PS setting maintains a constant pressure between IPAP and EPAP. So, I'm trying to keep the EPAP low, but get an IPAP of ~10-ish.

It could be that your sleep doc is under the impression that the IPAP and EPAP can vary independently of each other, but he wants the difference between them to never get larger than 8cm. The S9 VPAP Auto won't let the IPAP and EPAP vary independently of each other---the PS setting controls IPAP - EPAP for the whole night. But the PR System One BiPAP Auto will allow the PS to vary---in other words on the System One BiPAP, the IPAP and EPAP can vary independently of each other. And it might be that you would do better on a System One BiPAP Auto than you're doing on the S9 VPAP Auto.

Jeannh wrote:I think if it set IPAP to 12, EPAP to 6, and PS to 6, I will go 12-18 and exhale 6-12, always with PS of 6.

On the S9 VPAP Auto, all night long you will have:

min EPAP <= EPAP <= max IPAP - PS
min EPAP + PS <= IPAP <= max IPAP
IPAP - EPAP = PS

With the settings you describe it sounds like you are talking about:

min EPAP = 6
max IPAP = 12
PS = 6

That will make

6 <= EPAP <= 12 - 6 = 6
6+6 <= IPAP <= 12
IPAP - EPAP = 6

all night long. In other words, those settings turn the S9 VPAP Auto into a fixed pressure bi-level machine.

To get IPAP "12-18 and exhale 6-12, always with PS of 6" you need to set:

min EPAP = 6
max IPAP = 18
PS = 6

Try turning of the climate control and use classic humidity. Climate control uses the ambient air humidity to decide whether to heat water chamber. Settings on your machine have nothing to do with dry mouth