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PS is Pressure support or the difference between inhale and exhale.
When you use your ResMed machine with EPR set to 3 that equals 3 cm pressure support because with the setting of 7 inhale you would have 4 cm exhale....7 minus 3 equals 4.
With your ResMed machine to have the benefit of 3 cm difference you have to use the 7 cm starting pressure because the machine can't drop below 4 cm. So if you use the 6 cm starting point the machine can't drop 3 cm and instead will only drop 2 down to 4 cm.

For people having trouble exhaling against the pressure it's this drop in pressure that makes things easier so the bigger the drop the "easier" it is to exhale.
For some reason your own breathing rhythm appears to be slower than the machine's response time and while I think you can make it respond faster I don't think you can slow it down...but you might check the clinical setup menu to see if you can change the EPR speed/response time. I think the default is to "medium" speed and there maybe a "fast" but I don't remember if you can choose "slower" or not.

Normally 3 cm drop is sufficient for most people but some people might do better with a 4 or 5 cm drop in terms of exhale comfort. Unfortunately your machine can't offer more than 3 cm drop.
You need a different type of machine to get more than 3 cm drop...and it's called a bilevel machine where there are 2 separate pressure settings available and the choices available are greatly increased.
Plus with the bilevel machines the response time is also more adjustable and there's a greater chance you could slow it down to more evenly match your own respiration.

If you simply can't get used to your machine by using EPR set to 3...you need to be getting with your doctor and see about maybe trying a bilevel machine that would maybe offer you a greater chance to get more comfortable exhaling.

I've tried the control panel for listing my equipment. It hasn't worked. I don't know what I'm doing wrong. I'll try again.

phopap wrote:I've tried the control panel for listing my equipment. It hasn't worked. I don't know what I'm doing wrong. I'll try again.

It is possible that the current list of machines that display correctly doesn't include your machine even though your machine is on the list. If that is the case, try including the machine make and model in the signature block so it will show up.

phopap wrote:I've tried the control panel for listing my equipment. It hasn't worked. I don't know what I'm doing wrong. I'll try again.

The link to the S9 is broken...so that explains why the machine isn't showing but when I just went to your user profile I saw the comments where you have the machine, mask, etc showing up but it isn't showing on your post.
At the "edit equipment profile" page...scroll down below the equipment menu and look for the line that says
Allow other users to view your CPAP equipment
Make sure it says "yes" then click submit. Be sure you click on "submit"
In the comments section just put your S9 model name like where I have my "S9 Adapt" shown.
The humidifier and mask should work but the S9 machine won't show up because that link is broken.

If that still doesn't work...go to the "edit your signature" tab and put your equipment in your signature line and see if it shows up.

Should I pickup a BiPAP Auto M Series for $45 (its heater doesn’t work) to see if a bi-level machine would eliminate my end-of-exhalation-suffocation response? I know I’ll probably want better data capability in the future, but for so cheap, wouldn’t it tell me if a bi-level would solve the primary, major problem, which is my feeling of suffocation?

OR,

is it such an old model that it doesn’t have the fancy pressure curve options that might be the solution, so failing on this old bi-level model would tell me nothing useful?

As background to this issue, until last night I thought you could set a bi-level to zero exhalation pressure. So I didn't go get the cheap bi-level. But is there any feature in that machine that might solve my problem?

phopap wrote:Should I pickup a BiPAP Auto M Series for $45 (its heater doesn’t work) to see if a bi-level machine would eliminate my end-of-exhalation-suffocation response? I know I’ll probably want better data capability in the future, but for so cheap, wouldn’t it tell me if a bi-level would solve the primary, major problem, which is my feeling of suffocation?

IMO it would be worth a try to see if it does help you. When set up correctly and after you get used to it you can't even tell there is any pressure on exhale. It feels so different. Keep in mind the exhale pressure also serves to reduce events. Meaning set to low on exhale is not a good thing.

phopap wrote: is it such an old model that it doesn’t have the fancy pressure curve options that might be the solution, so failing on this old bi-level model would tell me nothing useful?

I answered your question in your other thread. See here
viewtopic.php?f=1&t=114540&st=0&sk=t&sd=a
I wasn't aware the humidifier wasn't working but in terms of settings to see if you would have better luck with a bilevel machine...this M series machine would at least let you find out if it is worth looking for newer.
In terms of what it will do..it only lacks one thing that the newer models offer and it isn't something that is a deal breaker if you don't have it. At least for what you are wanting to find out.

Now the lack of humidified air might be a problem but that's a separate problem and not related to how the machine goes about it's job.

A few things you should consider...
I forgot to mention, while the M series is a decent xpap it
1. DOES NOT work with Sleepyhead
2. DOES need a special Smartcard
3. DOES need Encore software to read the data

but will still give you the bi-pap feel and can make an excellent backup or used for travel or use on 12V battery.

But if this is you first time using a bipap you may be better of to just put that $45 towards a System 1 that uses an SD card that will plug into your PC and can be read by Sleepyhead.

phopap wrote:Should I pickup a BiPAP Auto M Series for $45 (its heater doesn’t work) to see if a bi-level machine would eliminate my end-of-exhalation-suffocation response?

No. That's a wild goose chase.

phopap wrote:.... At the end of my exhales I observe that I'm not finished breathing out and the pressure from the machine is preventing the completion of my exhalation, and my physical response is that I'm suffocating. ...

Can you walk up three flights of stairs without gasping and stopping to rest? I bet you can. In that case, you are experiencing something that is common with CPAP newbies.

The key to the problem is this word - observe. You don't have a physical problem. It's a "mind" problem.

When you are awake, you are thinking, even concentrating, on your breathing. You are trying to carefully control each inhale and each exhale. Quit observing your breathing. If you can distract your mind away from breathing, you might be able to fall asleep, and the problem goes away.

I had a little bit of this problem when I first started with CPAP. The solution for me was to think of lying on a sunny beach with a light wind and the sound of the surf. This distracted my mind from breathing and the CPAP. I would soon fall asleep. After a couple of weeks, I didn't even notice the pressure when I turned on the machine.

If you can walk up three flights of stairs, your body can easily and fully exhale against 4 cm (or much more) pressure. If you fell asleep, you would breathe normally and gently all night long. Your autonomous nervous system would take over to control your breathing easily.

Good luck.

ChicagoGranny,

I speak from experience: Six years ago I had problems very similar to phopap's: While using an S9 AutoSet in Auto with pressure range 4-8cm and EPR = 3 (as well as 2). I had real trouble exhaling fully even at those low pressures and I felt as though the machine was forcing me to inhale before I was done exhaling. There was an annoying tickle in the back of my throat towards the end of every exhalation that was triggered by the S9's EPR algorithm's choice of where to start increasing the pressure. Switching to a PR S1 BiPAP Auto (initial settings fixed BiPAP with EPAP = 6, IPAP = 8, BiFlex = Off, RiseTime = 3) fixed the problems of not being able to exhale fully, feeling like the machine was forcing me to inhale before I was ready to, and the annoying tickle in my throat.

In a discussion with -SWS and others concerning the differences between EPR, the Remed VPAP algorithm, and the PR BiPAP's timing of the pressure increase when Flex is turned off, -SWS was able to demonstrate that with EPR, the S9 AutoSet does indeed start raising the pressure just before the beginning of the inhalation. There's a very subtle difference between EPR and the bilevel machines. Not enough of a difference for most people to feel, but just enough if you are very sensitive to such things. The wonderful graphics that -SWS included are now gone, but the rest of the thread still exists; the relevant part starts with this post anc continues for a about a page and a half: viewtopic.php?f=1&t=58773&st=0&sk=t&sd= ... 15#p555317.

Given that phopap can get a used M-Series for $45, that's a good way to experiment with seeing whether a bilevel machine might be less irritating and more comfortable while phopap is awake so that phopap can get to sleep with the machine.

robysue wrote: PR BiPAP

It's highly likely that you just went through an adjustment period. SWS's words and a different machine may have given you the confidence to use CPAP. It was likely just a mind game that made you successful.

When you get newbies in here, it is very common for them to have adjustment problems that have nothing to do with the machine type. It is much more common to have simple adjustment problems than to have to switch to a more advanced machine.

If phophap can relax and get his mind off breathing, he will most likely become a successful AutoSet user. (I am a little concerned about his low settings, but that can be addressed after he can sleep a night or two and look at his AHI and leak on the machine display.)

Seek the simple, basic solutions FIRST.

BTW,

robysue wrote:I speak from experience

that's called one anecdote. Real experience would be guiding hundreds of patients through successful adjustments to CPAP. (Anyone here? Maybe Pugsy?)

ChicagoGranny wrote: Maybe Pugsy?

I am not sure what you are wanting me to say but here are my thoughts about OP's situation here.

The perceived discomfort associated with exhale and current machine is very real to the OP. It really doesn't matter that we (collective we) find it hard to imagine that someone would have such difficulty at such a low (to us) setting. It's what the OP perceives that is important. I get the sense that the OP is having a very real "I can't do this cpap thing" moment and is coming close to giving up. This scares me because of the severity of his OSA and the low 80s desats. It's not like he has mild OSA with no real significant desats. For this reason I think that anything the OP wants to try to enable him to treat his OSA is fair game to try. $45 for a bipap to try sure falls into the "fair game" territory IMHO.

I have already mentioned that I think the OP needs to convey his issues to his doctor. If there are other health issues going on that could be a factor then I would have to trust the doctor to be aware of those potential issues and/or be able to evaluate things in that regard. That aspect is beyond our (collective our) control and the best we can do is the CYA statement "tell your doctor about your issues".
Then we move on to possible experiments to try to help resolve the issues.

The timing of the exhale/inhale thing when using bilevel might (stress the might) be enough to make the OP very comfortable with the therapy. As someone who has used both cpap/apap with and without exhale relief and bilevel pressures...there is a slight difference and it's hard to put into words what that difference is but it's there.
EPR mimics a bilevel in terms of 2 pressures but it still isn't exactly the same as bilevel even if we are using EPR at 3 and a bilevel with PS of 3. It's real close but not exactly the same and for some people that slight difference could be a make it or break it moment in terms of being able to use xpap therapy.

If someone simply can't get into the rhythm of 6/4 or 7/4 (using EPR of 2 or 3) comfortably then bilevel is a logical next step. It might work. It also might not work but it's sure worth trying. Ideally the DME would be the one to maybe help out and loan out a bilevel machine but we all know how some DMEs are as well as some doctors. They might just say "you did great at so and so during the titration sleep study so you probably just need to give it time" and they won't go the extra mile to dig deeper and OP might fall through the cracks.

To be honest my first gut reaction is/was babies can use 6/4 or 7/4 settings and there must be something physically wrong with someone who can't handle such low settings but it really doesn't matter what I think. The doctor for sure needs to be aware of the problem just in case there is something physical going on but beyond that line of thinking about all we can do is offer the idea that bilevel might work. Anything is fair game when it comes to doing something to enable someone to successfully use xpap. If a person can't get comfortable with the machine then they can't go to sleep and we all know you gotta get to sleep first.

If it were me I would first check with the DME to see if they had a loaner bilevel machine that could be tried...even if it was just in the office to get an idea if bilevel offered a solution to the issue. DME would need the doctor's okay but the doctor should already be aware of the problem anyway.
Free is always better than pay for but if there isn't one or they won't do it then $45 for a bilevel to try isn't horribly expensive and IMHO is worth trying.

I am NOT saying to deal the doctor out...just in case there's something physical going on.
But once the doctor has been notified....anything else is fair game to try.

Pugsy's latest post +1.

That was a great explanation of what I was referring to about the turn around difference between ResMed and Respironics.
$45 for a test sounds like a reasonable thing to do.

The Philips bilevel either old or new does not seem to me a valid comparison. The Resmed bilevel machines have far more adjustability for inhale timing than the Philips machines. If you want to see what you can do with inhale adjustability, get a Resmed bilevel-preferably one that operates in S mode. That would be either the VPAP S or the VPAP Auto.

Go ahead and the Respironics machine and try it out. I know what you are talking about - slower respiration. You may simply find that the different algorithm of the Respironics machine works better for you than the Resmed machine.