ResMed S9 Results

G'day

I just had my 3rd night on a ResMed S9 Auto with H5i, previously used ResMed S7 Auto for 7 - 8 years & ResMed S8 for 1 month
My fixed pressure is 16 & I have the S9 set for APAP 14 - 20, my AHI's have dropped from 5's to 1-2's but my pressure goes up to 19.9 through the night & has happened for 3 nights on S9, also graph is showing a little bit of snoring as well, BTW there are no leaks, Im waking feeling slightly more refreshed than I did using the other machines
I'm waiting for 7 days of data so I can pass this on to my Doc
My question is:
Is there a problem with the machine or is it time for another sleep study?

Thanks

Different models of machines will respond different and very likely with different pressures. ResMed changed the algorithm with the release of the S9 models. The increase in pressure is just the machine doing its job and nothing to be concerned about. Unless you felt awful or were consistently hitting the maximum of 20 all night long I wouldn't see the need for another sleep study.
3 nights is really too soon with a new model of machine to come to any major conclusions.
It is not unusual at all for there to be some minor differences in the pressures seen between your old machine and this new S9.

Unless you spend a LOT of time at the upper end of your pressures and are having problems using that amount of pressure there is nothing to be concerned about. Now if you spend all night up near 20 cm and you have problems breathing against that much pressure then you might want to talk to your doctor about a different machine that makes it easier to use the higher pressures and has a max of 25 just in case it is needed.

Pugsy wrote: Now if you spend all night up near 20 cm and you have problems breathing against that much pressure then you might want to talk to your doctor about a different machine that makes it easier to use the higher pressures and has a max of 25 just in case it is needed.

Hi Pugsy
What machine would you recommend?

I don't understand why you suspect a problem with the S9 Autoset? Could you post the 7 nights results on a ResScan Stats table, like this:

Stats for 7 days:



If you can, also show a ResScan graph of the pressure, like this:



If you had a fixed pressure on CPAP of 16 cm then I would try to set the S9 in APAP mode on 16 cm max, and 13 cm min, no ramp, EPR = 3, full time.

I think that Pugsy is talking about a BiPAP or a BiLevel machine similar to the one that she is using. On that machine you could set the IPAP on 20 cm or more and the EPAP on lower pressure to make exhaling more comfortable.

Taringa542 wrote:What machine would you recommend

Avi is correct. I was thinking bilevel machine. They offer 2 different pressures ..one for inhale and one for exhale. Makes using the higher pressures easier. Not to be confused with the high dollar bilevel machines that are used to treat centrals. Click on the link in my profile to the machine that I use. That is the ResMed bilevel machine it is called VPAP and the equivalent in the Respironics line is called BiPap. My machine is what I call a "plain" bilevel machine. It won't do the things that the high dollar bilevel machines do to treat central sleep apnea.

You can use the EPR feature on the S9 to get a sort of bilevel experience. Set to EPR of 3 gives you 3 cm reduction in pressure between inhale and exhale. Bilevel machines offer a greater difference between inhale and exhale...up to 8 cm I think. I use just 4 cm difference. It is what is comfortable for me and I sleep great with it. It is almost like not using pressure at all. The difference is what offers the comfort.
Example....inhale pressure of say 15 and exhale pressure of 10....is likely going to be more comfortable than using
13 inhale and 11 exhale.

Taringa542 wrote:...my AHI's have dropped from 5's to 1-2's but my pressure goes up to 19.9 through the night & has happened for 3 nights on S9

Hi,

Can you post a graph? The question that I have is if the machine is going to 20 because it needs to in order to treat you, or if it is going to 20 because of something else (like mask leaks). If it does need to go to 20, then I am wondering how your treatment is going since 20 is the top end of the machine, and it has no where else to go if you need yet more pressure. BiPAP units often go to 25, and ST/ASV units can go to 30.

A fixed pressure of 16 is getting up on the high side. In fact, pressures of 15 and above are often considered to be BiPAP territory rather than CPAP or APAP. The CPAP and APAP can do that, but BiPAP can make it a lot easier to handle high pressures because it can back off considerably during exhale. Your machine can also back off on exhale a bit by setting CFLEX, AFLEX, or Exhale Pressure Relief to 3 (or maybe 2).

I have no clue how your finances work, but with many insurance plans, they won't give a BiPAP to a patient unless they try and fail on CPAP or APAP. That is kind of a poor way to run a system, but I guess it does help control costs. If that is the game they play where you are at, then you might want to consider a "strategic failure" to get a BiPAP.

Finally, do you know if you are position sensitive (positional apnea)? If so, then sleeping on one side or the other might reduce your pressure needs, making it easier to deal with the air.

Handling higher pressures gets easier over time. For example, I cannot even feel the pressure anymore, and I run at 21 inhale, 14 exhale. I have to look at my machine display or pull my mask off to tell if I am getting air flow. Also, exercise to build strength in your core and upper body can help dealing with the air by making your breathing muscles stronger.

-john-

Hi Guys
Thank you for your replies, Im still trying to post a screenshot Avi & John, not having much luck, Im using windows on a Mac

Someone who uses a Mac posted these instructions for screen shot. Beyond this I don't have a clue but if it is saved to a folder then it can be uploaded to some place like Photobucket.

Cmd + Shift + 3 = full screen shot.
Cmd + Shift + 4 = partial screen, just click and drag the mouse over the area you want to photograph

The screen shot file is automatically saved to your Desktop folder.

Pugsy wrote:Someone who uses a Mac posted these instructions for screen shot. Beyond this I don't have a clue but if it is saved to a folder then it can be uploaded to some place like Photobucket.

Cmd + Shift + 3 = full screen shot.
Cmd + Shift + 4 = partial screen, just click and drag the mouse over the area you want to photograph

The screen shot file is automatically saved to your Desktop folder.

Thanks for that Pugsy, Ive got that working now, as for the rest time will tell

BTW John has been helping me in the backgroung & I was able to email screenshots to him & he was very knowledgeable & I thank him for that

Taringa, I use this software to take a screen shot:

http://wisdom-soft.com/products/screenhunter_free.htm

When I started to use it I had a number of times free but then I had to pay some $37. I see it now free for all time. My above ResScan Stats and graphs were shot with it. When the ScreenHunter takes a shot it is automatically saved as an image on my desktop with a sequential number. Next I go to http://www.photobucket.com and UPLOAD there the image from my desktop. Next, I click there on SHARE and get there a CODE: IMG for bulletin boards & forums Full size, which I post here.

Taringa,

Frankly, I don't know why you use the machine. You wrote that you have increase in OSA. But I see that all your results (except Snore that is not in the Stats) are normal. The other issue is the hi pressures that you are using. Why are you doing it and exhaling into such a hi pressure.

Please no more emails.

Bump the post upwards

avi123 wrote:Frankly, I don't know why you use the machine. You wrote that you have increase in OSA. But I see that all your results (except Snore that is not in the Stats) are normal.

Sigh....this is a report showing very effective therapy where a pressure is used...that is why the AHI is low and it is really not very exciting.
This is not a report where no pressure is used.

Are you saying that if someone has a nice low AHI while using the machine that they don't need to use the machine?
Gosh, I have been using the machine all this time and didn't need to.. My AHI the other night was 0.58. Not much happened...I guess I have been wasting my time and money all this time.

Of course not...all a nice low AHI means is that the machine is doing its job well.
We assume that since a person is using the machine that the doctors have determined that there were enough apnea events happening without using the machine to meet the criteria for a diagnosis and use of the machine.
If the apneas all go away with therapy it just means the machine is doing a great job...it sure doesn't mean that they were never there.

Some people are just lucky...they get a nice low AHI from the beginning of their therapy program.

[quote="avi123"]Taringa, you sent me this screen shot in my email:





Frankly, I don't know why you use the machine. You wrote that you have increase in OSA. But I see that all your results (except Snore that is not in the Stats) are normal. The other issue is the hi pressures that you are using. Why are you doing it and exhaling into such a hi pressure.

Avi

I was diagnosed with servere obstructive sleep apnea & was put onto a fixed pressure of 16 "THAT MY FRIEND IS WHY IM USING THE MACHINE!"

Why am I yelling you may ask?

I sent you screen shots & asked for advice & at no time did I give you permission to publish them on this forum with my name on them

''THAT MY FRIEND IS THE REASON WHY IM YELLING!'

Have a nice day!

Taringa,

To protect your privacy at least a little, i suggest that you ask Avi to delete the post in which he publicizes your screen shot without your permission. Then delete your post with the copy.
You can post the same text in response without repeating the screen shots.

Some people aren't known for their sense or their sensitivity. I thought that PM meant PRIVATE message.