How to fine-tune setup on ResMed S9 VPap Auto?

For the last five years I've been using a Respironics System One Remstar Auto CPAP. It was set up by the sleep clinic I went to at the time. Now I've been given a free ResMed S9 Auto VPap. I set it up to the same pressure as my old machine, but the pressure seems too strong. I imagine that has to do with some of the other settings. How can I trouble-shoot what else might be going on? Thanks in advance for the help.

Download the free Oscar software. https://www.sleepfiles.com/OSCAR/

People often transfer apap settings to bilevel machines and they don't understand how bilevel works with pressure support.

Tell me what your apap settings were including Flex if you used it and what you chose on the VPAP.
I can explain how to mimic the apap settings but I need to know what they were.

So the S9 VPap Auto is always BiPAP? I actually am not entirely clear on the difference between Auto CPAP and BiPAP, but when I had my sleep study five plus years ago, I couldn't handle the BiPAP. Admittedly, I was a brand new CPAP user at the time. The sleep study was already very uncomfortable in a lot of different ways. I managed to get a little sleep with the ordinary CPAP they put on me. But when they put the Bipap on, the fact that it decided when I should breathe in and out was very unnerving and I couldn't fall asleep at all. The Auto CPAP has seemed like a good compromise and has worked very well for me though.

My settings, on my old machine:

Auto Max 17
Auto Min 13
Opti Start Off
Flex Type A-Flex
A-Flex 2
Heated Tube Humidification On
Humidity Level 2
Tube Temp 4
Ramp Time 30 [but I never use the ramp]
Ramp Start 5 [but I never use the ramp]
Tubing Type Lock Off
Tubing Type 1.5 H
System One Resistance 0
Lock System One Off
Auto On Off
Auto Off Off
Mask Alert Off
Mask fit check On
Humidifer LED Backlight On
Show AHI/Leak/PB On
Split Night Off
Silent Mode On
Language En


Thanks, Pugsy!

jpek wrote: ↑

Tue Apr 14, 2020 9:36 pm

Auto Max 17
Auto Min 13
A-Flex 2

These are the pertinent settings I need.
Flex is a bit weird as it is flow based so not a per cm reduction but close...you were probably getting 1 to 1.5 cm drop during exhale.
The most Flex can ever give is 2 cm even at the setting of 3. It's just the way Respironics exhale relief works.

You were already using your apap as a bilevel machine. You had inhale starting pressure of 13 and during exhale it dropped to 11.5 if you breathe forcefully and got the full 1.5 cm reduction.
Bilevel is nothing more than 2 distinct pressures...one for inhale and one for exhale.

The VAuto has 3 modes of operation
1...fixed cpap mode
2...fixed bilevel mode
3...auto adjusting bilevel mode

PS or pressure support is the exhale relief on this bilevel machine. It won't do a 1.5 PS I don't think but it will do a 2 cm and that is close enough.

So on your old machine you had inhale 13 and exhale 11.5.
To get similar settings on the VAuto you set EPAP (exhale) to around 11....PS is set to 2 and that makes inhale 13...very similar to your apap.

The maximum IPAP setting...doesn't really matter but you can make it 17 if you wish which mimics the apap max.

When you tried the old bilevel a while back...not sure why it was so uncomfortable for you but maybe that had PS really high so there might have been a big change for you to deal with.

The most commonly used PS setting is 4 coming out of a sleep lab.

jpek wrote: ↑

Tue Apr 14, 2020 9:36 pm

So the S9 VPap Auto is always BiPAP?

It's NEVER "BiPAP™" which a registered trademark of Philips Respironics.

It's a BiLEVEL,

jpek wrote: ↑

Tue Apr 14, 2020 9:36 pm

I actually am not entirely clear on the difference between Auto CPAP and BiPAP,

which means you can set the inhale and exhale pressure separately.

Pugsy wrote: ↑

Tue Apr 14, 2020 9:57 pm

Flex is a bit weird as it is flow based so not a per cm reduction but close...you were probably getting 1 to 1.5 cm drop during exhale.
The most Flex can ever give is 2 cm even at the setting of 3. It's just the way Respironics exhale relief works.

I've only ever used one machine, so I don't really kn ow the difference. between flow and per centimeter... or actually even what that means :-/

Pugsy wrote: ↑

Tue Apr 14, 2020 9:57 pm

The VAuto has 3 modes of operation
1...fixed cpap mode
2...fixed bilevel mode
3...auto adjusting bilevel mode

Is the S setting supposed to be the fixed bilevel mode? My machine has CPAP, S and VAuto. Mine is currently set to VAuto.

Pugsy wrote: ↑

Tue Apr 14, 2020 9:57 pm

PS or pressure support is the exhale relief on this bilevel machine. It won't do a 1.5 PS I don't think but it will do a 2 cm and that is close enough.

It can be set to 1.6 or 1.4, not 1.5.

Pugsy wrote: ↑

Tue Apr 14, 2020 9:57 pm

So on your old machine you had inhale 13 and exhale 11.5.
To get similar settings on the VAuto you set EPAP (exhale) to around 11....PS is set to 2 and that makes inhale 13...very similar to your apap.

I tried it with an EPAP of 11 and PS 2 (it was set to 3 before). Considerably better but still a little on the strong side. Makes my heart beat faster, which I don't feel at all with the System One I use. Then I played with it a little, but I don't really know what I'm doing. I set the PS to 1.4 and left the EPAP at 11 and that for some reason felt a little better still, though as I understand it it raises the overall exhale pressure. Then I tried leaving the PS at 1.4 and raising the EPAP to 11.6. That felt worse. So, I'm still a little confused. Also I want to make sure that I'm not going just for comfort but for effective therapy, but I guess that's what the software is for.

You might find you do better at slightly lower overall pressures with the bilevel because of the difference in auto adjusting algorithms between the two brands. I can't know for sure because I have no idea what kind of results you were getting on the apap.
I was just trying to make the overall breathing feel more like what you have been used to. Our bodies do get used to a certain fell for things and when the "feel" changes the body responds with "oh, this is a new feeling and I don't know what it is"...takes a while to adjust.

If you feel 11 ish EPAP is still strong...try 10 EPAP and maybe 2 PS or less (whichever is comfortable) and use it and then use the software to see the results.

You gotta be comfortable to be able to sleep and have to sleep to have worthwhile data to evaluate.

When I went from apap to bilevel I found I could get by with less baseline pressure than I was using with apap.

Pick a setting that is comfortable that you can sleep with....then use it and the software to see how effective it is and whether tweaking is even needed or not. Gotta start somewhere....get close to start with and worry about little tweaks later. I am betting you won't need much tweaking.