EPR level question

Hi everyone,

This is my first post. I checked other posts about my question and understood the function of EPR. I recently purchased Resmed S9 APAP. My sleep test resulted with AHI of 17 and my doc said this model will help me easily. After my first 5 days, I got my results report. My average AHI dropped to 0.6 but CA appeared with 0.4.

The levels are pretty low but I had sleep disturbances a couple of times when CAs were higher than average though were still low, below 5.

When I checked the setup, I saw EPR setting at 2. My average pressure is 6. Minimum pressure is 5. With a basic calculation, I assumed that (6-2) =4 < 5 min level can cause my mac to stop giving pressure (not sure?). I then thought that I may change EPR to 1 to have a continuous pressure.

However I am quite new with all these things. That is why I wanted to ask your comments about my situation.

Note: I will talk with my doc as well.

With ResMed machines, an EPR of 2 means your pressure when you exhale is 2 cm less than when you breath in. However, your pressure will never go below 4 cm. If your IPAP (inhalation pressure) is 5, your EPAP (exhalation pressure) will still be 4, a difference of 1. It is common for people to have occasional central apneas when they sleep. Your machine is expecting nice, even breathing when sleeping. When you are awake, ore in the transition period between wake and sleep, your breathing is uneven and this can cause the machine to think you are having some sort of event. If you hold your breath for 10 seconds with the mask on, the machine will call it a central apnea.

kvck wrote: ↑

Wed Jan 20, 2021 1:44 pm

I recently purchased Resmed S9 APAP. My sleep test resulted with AHI of 17 and my doc said this model will help me easily.

As a side note...can I ask why you purchased a Resmed S9 APAP?

- Was that your decision and you purchased it on your own - thus saving a LOT of money.

- or Did a DME provide you with that machine and billed your insurance?

If the latter, I'm thinking the DME screwed you by providing you an older machine and thus billed your insurance for a much higher amount and they got rid of old stock - insurance companies pay one rate for a CPAP machine based upon an insurance code - and you should have received a newer flavor (AirSense 10 models) of the machine. I don't believe ResMed has produced the S9 in more than 5 years.

Latest Models of ResMed Machines: https://www.resmed.com/ap/en/healthcare ... ml#Bilevel

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JLROhio wrote: ↑

Fri Jan 22, 2021 2:08 pm

kvck wrote: ↑

Wed Jan 20, 2021 1:44 pm

I recently purchased Resmed S9 APAP. My sleep test resulted with AHI of 17 and my doc said this model will help me easily.

As a side note...can I ask why you purchased a Resmed S9 APAP?

- Was that your decision and you purchased it on your own - thus saving a LOT of money.

- or Did a DME provide you with that machine and billed your insurance?

If the latter, I'm thinking the DME screwed you by providing you an older machine and thus billed your insurance for a much higher amount and they got rid of old stock - insurance companies pay one rate for a CPAP machine based upon an insurance code - and you should have received a newer flavor (AirSense 10 models) of the machine. I don't believe ResMed has produced the S9 in more than 5 years.

Latest Models of ResMed Machines: https://www.resmed.com/ap/en/healthcare ... ml#Bilevel

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Personally, I think the S9 was as good if not better than the Airsense 10. It has the same features and a better footprint. My Airsense 10 is currently out for a minor repair and I am back to using my S9....I think it's quieter than my Airsense (If that's possible). If he is without good insurance and he found a low hour S9 APAP, he will be happy with it.

LSAT wrote: ↑

Fri Jan 22, 2021 2:57 pm

Personally, I think the S9 was as good if not better than the Airsense 10. It has the same features and a better footprint. My Airsense 10 is currently out for a minor repair and I am back to using my S9....I think it's quieter than my Airsense (If that's possible). If he is without good insurance and he found a low hour S9 APAP, he will be happy with it.

I never had an S9 - I started out with the AirSense 10.

I just recently read (on someone's blog here) how DME's will try to give someone a lower cost machine but yet they get paid one price regardless of the machine provided.
I just thought it was odd, that someone starting therapy today would start with an S9...which made me wonder why they started with the S9 to begin with.

For all I know, they'll come back and tell us that they don't have insurance, or are in another country, or some other reason...and they scored a new S9 for $100 - if so, great! If the DME stiffed em' though...I'm curious about that and want to make sure they know that they probably have a reason to go back and get a newer machine - then again, your experience with the S9 is also valuable info for them to know...as I don't have that S9 experience to pass along.

JLROhio wrote: ↑

Fri Jan 22, 2021 3:04 pm

I never had an S9 - I started out with the AirSense 10.

One of the "joys" you have missed by not having the S9 experience is having to lock your SD card every time you put your SD card in your computer and you missed not having to download at least weekly without losing data and even if you did after a period of time your detailed graphs would disappear in OSCAR/SleepyHead. I never figured out why the old detailed graphs would disappear but they did.
I got loads of S9 reports to prove it. I used to have detailed data in those old reports but I don't now.

Otherwise the S9 is a good machine.

The S9 is a good model if someone is short on funds or lacks insurance or even if they have insurance but maybe have a really high deductible.
It has been discontinued for some years now though so that should affect the cost and make it more of a bargain.

You are correct though...if a DME is now supplying a S9 machine and filing insurance...they are scum bags. The S9 models were discontinued 4 or 5 years ago...I forget exact time frame but it has been several years.

JLROhio wrote: ↑

Fri Jan 22, 2021 2:08 pm

kvck wrote: ↑

Wed Jan 20, 2021 1:44 pm

I recently purchased Resmed S9 APAP. My sleep test resulted with AHI of 17 and my doc said this model will help me easily.

As a side note...can I ask why you purchased a Resmed S9 APAP?

- Was that your decision and you purchased it on your own - thus saving a LOT of money.

- or Did a DME provide you with that machine and billed your insurance?

If the latter, I'm thinking the DME screwed you by providing you an older machine and thus billed your insurance for a much higher amount and they got rid of old stock - insurance companies pay one rate for a CPAP machine based upon an insurance code - and you should have received a newer flavor (AirSense 10 models) of the machine. I don't believe ResMed has produced the S9 in more than 5 years.

Latest Models of ResMed Machines: https://www.resmed.com/ap/en/healthcare ... ml#Bilevel

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I did not use any insurance for S9, paid with my money. I also saw the model 10 but not convince that any significant difference between 9 and 10. There may be some but I did not find it any better for me.

Okie bipap wrote: ↑

Fri Jan 22, 2021 12:41 pm

With ResMed machines, an EPR of 2 means your pressure when you exhale is 2 cm less than when you breath in. However, your pressure will never go below 4 cm. If your IPAP (inhalation pressure) is 5, your EPAP (exhalation pressure) will still be 4, a difference of 1. It is common for people to have occasional central apneas when they sleep. Your machine is expecting nice, even breathing when sleeping. When you are awake, ore in the transition period between wake and sleep, your breathing is uneven and this can cause the machine to think you are having some sort of event. If you hold your breath for 10 seconds with the mask on, the machine will call it a central apnea.

Is it possible that the mac pressures at 4cm during exhale (6 IPAP & 2 EPR) even I have a low limit pressure of 5?

EPR is subtracted from your pressure, whatever it is. If it's at the minimum, then it's subtracted from the minimum.

kvck wrote: ↑

Sat Jan 23, 2021 1:57 am

I did not use any insurance for S9, paid with my money. I also saw the model 10 but not convince that any significant difference between 9 and 10. There may be some but I did not find it any better for me.

Thanks for getting back to me on my question...and it's good to know you were not screwed over by a DME.

It also sounds like you did your research...and made a very wise choice (i.e. investment) at a lower cost! Congrats!