My S9 AutoSet arrived today

Very nice machine, Katie!

KatieW wrote:

DreamOn wrote:KatieW,

What do you think about your new S9 so far? Any major difference in results numbers? I hope that you're sleeping well.

I was in Phoenix all day, and picked up a SD Card Reader on the way home. Have spent the last few hours playing with ResScan 3.10. Amazing data!

I wouldn't say there's a major difference in results numbers. Thursday on the S8 Autoset II was a pretty average night for me: Leak 0, AI .2, HI, 1.6, AHI 1.8.

Here's my results from last night on the S 9 Autoset. I'm not too concerned with numbers right now, there was a slight increase in AI--likely due to 1st night excitement, and getting used to the new set-up. And a drop in hypopnea, maybe due to a different algorithm. (?) As others have said it is very quiet (and as you know, the S8 is quiet) and the EPR is even more gentle and comfortable. I used EPR 2.

My hope was that the Climate Control would be a major improvement, and I am very pleased with it so far. I used the Auto setting for the Humidifier, and the default of 80 degrees. It was perfect--not a drop of mask condensation, or that feeling of having a "hot head" when I wake up.

I don't understand Flow Limitation or Minute Ventilation, so any input would be appreciated.

Flow Limitation- A slight upper airway restriction that can limit breathing and cause sleep arousals. Those anatomically-based flow limitations will actually distort the tops of a patient's (inhalation) flow curve.

See the three blue "squiggly" lines that serve as your graph's legend for flow limitation? That top line is a nice, rounded flow curve. If the graph line stays up there, then you aren't experiencing flow limitations. Those next two blue "squiggly" lines get progressively more severe. So your flow-limitation graph line reflects either light or moderate severity in the middle zones and more flow-limitation severity at the bottom. There are a variety of ways in physiology to experience flow-limited breathing, including a stuffy nose in some cases.


Minute Ventilation- "A measure of the respiratory rate times the tidal volume" (according to Resmed's VPAP Adapt SV manual)

Respiratory Rate- Breaths per minute

Tidal Volume- "The amount of air, in liters, breathed in or out during one breath" (according to Resmed's VPAP Adapt SV manual)


Put the above definitions together and you also get "Minute Ventilation" as the amount of air we breathe in or out during one minute---since we breathe in the same volume we breathe out.

-SWS, thank you for the very clear explanation. Can I bounce this off you?

When I look at the lower pane of the detailed graph, the 2 obstructive apneas and 1 hypopnea are preceded by flow limitation, which would be expected.

But when I had a central apnea, (the purple 12 second one), there is no flow limitation, because it's a central, which would also be expected.

Is my reasoning correct, and are these 2 graphs useful for any other purposes?

When I googled Minute Ventilation, "normal" is 5-8 liter/minute. I'm mostly in the normal range, and at the high end when awake. But there is a rise in minute ventilation, following a flow limitation, as I try to compensate.

Katie

KatieW wrote: When I look at the lower pane of the detailed graph, the 2 obstructive apneas and 1 hypopnea are preceded by flow limitation, which would be expected.

I agree that's a pretty typical escalating pattern of obstruction.

KatieW wrote:But when I had a central apnea, (the purple 12 second one), there is no flow limitation, because it's a central, which would also be expected.

And I agree that would be highly typical of centrals as well. As a side note, it's possible to have a flow limitation (stimulus) followed by a central SDB event (response). But I don't know how prevalent that particular pattern might be.

KatieW wrote: are these 2 graphs useful for any other purposes?

Since Flow Limitations can deteriorate sleep, that graph line is worth watching irrespective of the other SDB events. Some patients feel tired despite wonderful AHI scores. In some cases flow limitations are literally pestering their sleep. So IMHO it's not a bad idea for flow-limitation inclined patients to attempt to correlate poor daytime symptoms with an increase in machine-reported flow limitations. Still, there are plenty of reasons for tiredness that have nothing to do with A/H/FL/S.

KatieW wrote:When I googled Minute Ventilation, "normal" is 5-8 liter/minute. I'm mostly in the normal range, and at the high end when awake. But there is a rise in minute ventilation, following a flow limitation, as I try to compensate.

My understanding is that brief Minute Ventilation fluctuations like you have above are not at all a problem. Your Minute Ventilation baseline is going to be that trend or narrow range you present night after night when your health is fit and your SDB is well-treated as it is above. Large-trend drastic changes in Minute Ventilation are what you want to keep an eye out for as something you can mention to your doctor. Chances are you won't encounter that scenario, and your Minute Ventilation line will continue presenting you with visual "peace of mind" as it does above.

Congrats Katie both on the machine and getting the software up and running, they're great stats!

Thanks for sharing your information, Katie! Good to hear that the climate control is working well, since I know that was important to you. Your numbers look great!

Thanks also to -SWS for explaining the graphs so well!

The info the S9 gives you is nice, Katie, enough to be jealous of. But your data itself looks wonderful. How do your stats on the S9 compare to your stats on the S8?

R

KatieW, SWS -
Thanks for this excellent discussion. My flow limitations are pretty flat. I'd been wondering what the line was for. Now I can watch it with more understanding.
Cheers.

Katie, pretty cool stuff!
Thank you! and all the S9 users for sharing.
How do you feel??

Couple of things:
It is neat that you(all S9 users) can see this stuff now.
How is knowing/seeing this going to change your therapy?

The climate control feature is what is drawing me to this machine, also.
What is the range that the temperature can be set to?
If there is one thing, for me, that can make my therapy uncomfortable,
it is when the air is too cold or too hot.
Anymore details/observations about that would be appreciated.

SWS-as always, thanks for the explanations.

Rebecca R wrote:The info the S9 gives you is nice, Katie, enough to be jealous of. But your data itself looks wonderful. How do your stats on the S9 compare to your stats on the S8? R

Rebecca, my Stats on the S8 were:

Jan: AHI 3.1, AI .2, HI 2.9

Feb: AHI 3.9, AI .2, HI 3.8

On the S9--

My 1st night was: AHI .8, AI-Obstructive .4, AI-Central .1, HI .3.
Last night was: AHI 1.0, AI-O .2, AI-C .4, HI .4

I'm interested (of course) in the numbers, but will wait a week to see the trend. And maybe try APAP then, and compare results.

carbonman wrote:Katie, pretty cool stuff!
Thank you! and all the S9 users for sharing.
How do you feel??

Couple of things:
It is neat that you(all S9 users) can see this stuff now.
How is knowing/seeing this going to change your therapy?

I've been wrestling with machine zooming in response to my supposed flow limitations for years.
Recently, with the help of the S8's EPR I can try higher pressure than I could on the PB420E.
If I had the S9's reporting capacity, I would be able to see if higher pressures made any difference in my flow limitations - it would make my decisions about my therapy easier -- far less trial and error to them.

The climate control feature is what is drawing me to this machine, also.

Oh yes, me too --.

carbonman wrote:Katie, pretty cool stuff!
Thank you! and all the S9 users for sharing.
How do you feel??

Couple of things:
It is neat that you(all S9 users) can see this stuff now.
How is knowing/seeing this going to change your therapy?

The climate control feature is what is drawing me to this machine, also.
What is the range that the temperature can be set to?
If there is one thing, for me, that can make my therapy uncomfortable,
it is when the air is too cold or too hot.
Anymore details/observations about that would be appreciated.

SWS-as always, thanks for the explanations.

CarbonMan, I feel about the same, but I felt good with the S8. Though I have slept an hour less, the last 2 nights, due to staying up and learning about the S9.

I don't think this will change my therapy--at least, not in the 1st week. I'm thinking about doing a self-titration with APAP after a week, just to see....

I'm really liking the Climate Control. With the Arizona climate, and using S8 and Aussie Hose, it has been a nightly tweak for me--checking the humidity/temperature in the room, and making adjustments. For me, optimum room temperature is 68-70 and humidity is 40%. So this required opening and closing the window, and running a Vicks Warm Mist Humidifier, on low, high, or off. I have the Aussie heated hose, but found it ran a little too warm, so experimented with different weight hose covers, then using none. I was ready to go to Radio Shack and see if there was a gizmo that would adjust/reduce the heat. If I set the H4i at 3, I got big mask rainout, at 2 I got a sore throat, so 2.5 was a compromise which gave me minor mask rainout, using the Resmed Activa LT. Less so with the SoftGel, but the mask felt warm. In the morning, the area inside the mask was hot and sweaty, and after wearing the papcap all night, my hair would be damp and flattened down.

With the Climate Control--not a drop in the mask, and no "hot head". On Auto mode, the humidity is preset at 80%. I set it on Auto, and used the default temp of 80 degrees. It doesn't feel too hot or cold to me, just comfortable. On Auto, you can set the temp for 61-86 degrees.

The room temperature was 73 degrees, humidity 35% with the Vick's Humidifier turned off all night.

On Manual, the air temperature and humidity can be set independently, but without the rainout protection guaranteed. Temp can be set 61-86, and the humidity settings are 0-6. If rainout occurs, either increase air temp or decrease humidity settings.

-SWS, many thanks for your explanation. As with many of your posts, I will print and put in my 3-ring binder.

Congratulations Katie, I was traveling so I miss the great day.

How can you compare the numbers of the two machines? Did you have centrals in your sleep study? How is it that the S9 shows a central?

Please let us know how do you like your machine after the days pass.

I'm really puzzled, each time I travel my numbers go up. I raised my pressure from 7 to 9 while traveling and still the numbers went up. I don't know what to do; I was thinking to buy an auto cpap but I read a post about cpap vs apap and now I don't know.

What do you think? Have you ever experienced with the two modes?

Thanks Katie

Rosacer

rosacer wrote:
I'm rally puzzled, each time I travel my numbers go up. I raised my pressure from 7 to 9 while traveling and still the numbers when up. I don't know what to do; I was thinking to buy an auto cpap but I read a post about cpap vs apap and now I don't know.

What do you think? Have you ever experienced with the two modes? Rosacer

Rosacer, there are so many variables when we travel--bed, temperature, humidity, new noises, change in diet, exercise, etc. I don't think it's surprising that your numbers go up. When you've been home for a few days, do they go back down again? Or, maybe you're adjusting to raising it to 9 when you travel?

I have experimented with the 2 modes, and for me, decided that I would rather stay on cpap at 10.6 and live with the slightly higher AI, then raise my maximum pressure above 11, even if only occasionally, using apap. I found I slept more comfortably with cpap, and had less aerophagia. That was with the S8 though, and the S9 may be different, and I will try that in a week or so.

Others have had the opposite results, so your results could go either way.

KatieW wrote:

Rebecca R wrote:The info the S9 gives you is nice, Katie, enough to be jealous of. But your data itself looks wonderful. How do your stats on the S9 compare to your stats on the S8? R

Rebecca, my Stats on the S8 were:

Jan: AHI 3.1, AI .2, HI 2.9

Feb: AHI 3.9, AI .2, HI 3.8

On the S9--

My 1st night was: AHI .8, AI-Obstructive .4, AI-Central .1, HI .3.
Last night was: AHI 1.0, AI-O .2, AI-C .4, HI .4

I'm interested (of course) in the numbers, but will wait a week to see the trend. And maybe try APAP then, and compare results.

Katie, now two nights are only two nights, but something definitely different is being measured. So AI is up and HI is down. Forget the numbers -- How do you feel? Does it feel any different? You might want to keep track of how you feel in the morning - also, were your last two days "normal" days in terms of your lifestyle, what you ate, the last time you ate before you sent to sleep, how much you exercised, etc.

Also consider with the climate control, it may mean you may need to adjust the humidity (must be nice to have a new toy to play with.)