S9 vpap adapt pressure explaination - simple please!

I am hoping to get my new S9 sometime this next week - fingers crossed!

I have been reading older posts about the pressure settings and I don't "get it".

Here's my RX - Max PS = 15, Min PS = 6, EEP 10

What do these numbers mean?

What kind of pressure ranges will I be experiencing?

And, do the pressure fluctuate as they would with an auto bilevel or do they remain in the same ranges?

Thanks in advance!

Don't know if this will help or not but I'll give it a shot.

http://www.resmed.com/us/clinicians/tre ... clinicians

JeffH

It does not sound as an ASV machine.

Thanks guys! I am still confused. How do my prescribed pressures relate to what pressures and pressure changed I will be experiencing?

Bright Choice wrote:Thanks guys! I am still confused. How do my prescribed pressures relate to what pressures and pressure changed I will be experiencing?

They way I understand it your bottom pressure will be 10. When you inhale it will go up to 16, however, I've noticed on my machine that often I don't go up to the top end of the pressure support minimum. I don't know why.

With the max PS of 15 then the machine can go as high as 25. It won't go any higher than that.

I could be wrong, but this seems to be how my machine works for me.

JeffH

Although interesting and informative, please note that one of the above .pdf’s is for the older resmed ASV machine, the “Adapt SV”. The new S9 VPAP Adapt does not go through a “learning” process for the “airway circuit”, i.e., mask.

NOTE: the following applies to the “Resmed S9 VPAP Adapt”, which is their current ASV machine. (I am new to this, and I have no idea whatsoever about any other brands’ ASV type machines.)

Bright Choice:

Your EEP is the “base pressure” that the tech titrated you at to try to eliminate apneas & hypopneas as much as possible without causing any pressure intolerance. This is the pressure that you will ALWAYS be breathing out against, which will be 10cm.

The Minimum pressure support is the minimum pressure IN ADDITION TO the EEP – this is what you will experience while breathing in. In your case, your inhalation pressure will be no less than 16. (10 EEP + 6 Pressure Support = 16.) So your basic pressure settings are essentially 16 over 10.

The machine will calculate if, when, and how much it needs to increase the “Pressure Support” above your minimum of 6, but your settings will limit the maximum pressure support to 15. This means that you COULD reach a theoretical maximum INHALATION pressure of 25, but your exhalation pressure (EEP) will still be at 10. You will likely rarely, if ever, see that high of a pressure in actual use.

Don’t fret about the higher sounding pressures when compared to CPAP pressure. The ASV machine is a totally different animal than CPAP/APAP or normal BiLevel machines. It will adaptively “learn” your breathing pattern throughout the night, and it will try to make sure that your lungs will always be filling & emptying, much like a ventilator. It feels a bit weird at first, but you will quickly learn to not fight or try to regulate the pattern; you will learn to “trust” the machine, and then you will find yourself breathing quite comfortably with a very natural feel to it. It’s definitely weird at first, but you will quickly adjust. (I’ve had mine for only 5 nights now.)

Hope this helps…

Ah ha! Thanks to all. I knew the answer would be quite simple, I just couldn't wrap my mind around it.

Now all is need is the machine...

ignorant1 wrote: Your EEP is the “base pressure” that the tech titrated you at to try to eliminate apneas & hypopneas as much as possible without causing any pressure intolerance. This is the pressure that you will ALWAYS be breathing out against, which will be 10cm.

The Minimum pressure support is the minimum pressure IN ADDITION TO the EEP – this is what you will experience while breathing in. In your case, your inhalation pressure will be no less than 16. (10 EEP + 6 Pressure Support = 16.) So your basic pressure settings are essentially 16 over 10.

The machine will calculate if, when, and how much it needs to increase the “Pressure Support” above your minimum of 6, but your settings will limit the maximum pressure support to 15. This means that you COULD reach a theoretical maximum INHALATION pressure of 25, but your exhalation pressure (EEP) will still be at 10. You will likely rarely, if ever, see that high of a pressure in actual use.

So, as I understand it then, I will be at a base of 16/10, with the 10 EEP staying constant no matter what the inspiratory pressure is. Am I correct?
Does anyone know if the machine responds differently if it is detecting an obstructive event or a central event? It seems like it must respond in a different manner if it is a central event - otherwise it would not be much different than a straight vpap.

My understanding (and I am a newbie when it comes to ASV & BiPap devices) is that the rhythmic aspect of an ASV device IS what treats central apneas. The ASV will continue to “breathe” for you if/when you are experiencing an event, either central (open airway) OR obstructive in nature. In this regard, it acts much like a non-invasive ventilator.

This is in contrast to a traditional BiPap device, which depends upon the patient’s breath to initiate the change from inhalation to exhalation (and vice versa), i.e., to trigger the machine to initiate a pressure change from IPAP to EPAP, (or again, vice versa).

NOTE: The preceding statement applies to “normal” BiPap machines, whereas some BiPap’s have a timed backup, which (to the best of my limited knowledge) will change pressure after a certain amount of time has passed - regardless of patient “triggering”. Of course, the amount of time that elapses may also allow an “arousal” to occur, thereby not necessarily eliminating fragmented sleep as best as current technology allows.

In contrast, an ASV machine outputs a consistent (sinusoidal-like) “breathing” pattern (timing & flow) similar to a person’s own personal breathing pattern. Thus the “adaptive” nature of an ASV device; it “learns” a persons breathing pattern and tries to emulate & reinforce that pattern when a patient’s own breathing starts to go awry. Fairly amazing technology, and very much at the cutting edge of current xPAP therapy.

ignorant1 wrote:My understanding (and I am a newbie when it comes to ASV & BiPap devices) is that the rhythmic aspect of an ASV device IS what treats central apneas. The ASV will continue to “breathe” for you if/when you are experiencing an event, either central (open airway) OR obstructive in nature. In this regard, it acts much like a non-invasive ventilator.

This is in contrast to a traditional BiPap device, which depends upon the patient’s breath to initiate the change from inhalation to exhalation (and vice versa), i.e., to trigger the machine to initiate a pressure change from IPAP to EPAP, (or again, vice versa).

NOTE: The preceding statement applies to “normal” BiPap machines, whereas some BiPap’s have a timed backup, which (to the best of my limited knowledge) will change pressure after a certain amount of time has passed - regardless of patient “triggering”. Of course, the amount of time that elapses may also allow an “arousal” to occur, thereby not necessarily eliminating fragmented sleep as best as current technology allows.

In contrast, an ASV machine outputs a consistent (sinusoidal-like) “breathing” pattern (timing & flow) similar to a person’s own personal breathing pattern. Thus the “adaptive” nature of an ASV device; it “learns” a persons breathing pattern and tries to emulate & reinforce that pattern when a patient’s own breathing starts to go awry. Fairly amazing technology, and very much at the cutting edge of current xPAP therapy.

Great answer, simply told. Thanks so much! I think I finally have a good understanding of the pressures and capatilities of the machine.
azy
No new S9 VPAP ADAPT yet... Is it a criteria for working at a dme that you must love to drive people crazy?

I've been using the Resmed S9 VPAP adapt for some time now. My low setting is 3 and my max seting is 19. The nice thing about this machine is the pressure on exhalation
backs off so much. You don't feel like you're breathing against any pressure at alll. The machine adjusts the inhale pressure on a breath by breath basis. One breath pressure may be
8 and the next could be 18 and the next after that could be 10. This way you get the exact pressure you need to keep your airway open and lungs full of air for each breath, depending on the obstruction or central apnea you're experiencing, But unlike your basic CPAP machines, it doesn't keep you at a high level of pressure for an extended period of
time when it's not necessary. Each breath is controlled on a one by one basis. It's the ultimate machine out there and is VERY intelligent. It's SO comfortalbe, that sometimes I'll wake
up and think that my mask must've come off in the night because I no sense of "feeling" the machine working and then I reach for my mask and it's ON my face. That's how frickin
comfortable this thing gets once you get used to it. It's instantly aware when you NEED the boost and then instantly adjusts back down when it senses you no longer need the boost.

I have a lot of central apnea compared to obstructive apnea. (this is where your brain forgets to tell you to breathe and you stop on your own and it's not due to obstruction.)
My machine memorizes my most recent breathing pattern and instantly senses a break in that pattern and then starts breathing FOR me until I take back over again and then it
returns to a more normal setting. Before this machine, I was having 84 apneas per hour and now I'm down to 3....which is AMAZING.

Congratulations on being an owner of the Resmed S9 VPAP adapt. It's the best machine one can buy!

Jim