I did receive the S9 vpap adapt asv with auto Epap

So far, it has been the most comfortable machine i've ever used - with the settings from the doctor (based on my sleep study), my ahi was around 8 but with extending the range of the auto epap up to 10, raising the max IPAP to 25 from 20 and wearing my dental appliance, i've had two nights in a row with ahi numbers of 1.2 and 1.0. The Sd card works just fine with my mac sleepyhead which is a plus. I was wondering why it doesn't track centrals given that the S9 VPAP S does. Given that ASVs are specifically built to treat centrals i would think that this would be a critical value. The reason i'm concerned is that while on the two nights i had my ahi down around 1, my nocturia was worse than ever, and that usually tracks with my ahi score perfectly. My nocturia has - so far - been bad with this machine every night that i have used it and i was wondering if it is possible that my ahi score is actually very high with centrals that it isn't scoring? I put a call into the doctor about changing the values and i hope that they don't have a problem with it - so far, they've been very agreeable as long as i documented everything. It always something with sleep apnea, i don't think I'd wish it on my worst enemy.

It is my understanding that the adapt reports apneas, and does not distinguish between central and obstructive. Regarding what features you have on your adapt the model number 36007 was produced prior to October 2012 and does no have all of the features of the model number 36037 machines produced after that. Both machines say VPAP Adapt near the power button.

I got the same machine last week and have used it 4 nights now. So far I feel great and my AHI numbers seem about as good as you can get.

As for comfort, I found the Bipap with the fixed pressures seemed more comfortable and easy to sleep with. It was steady, consistent and easy for me to adapt to. More often than not the ASV machine seems to be running at a lower pressure than the BIPAP was, which is nice, but then that makes it all the more noticeable when it decides to ramp up a bit higher which tends to happen right as I'm nodding off. The sleep lab said those apneas didn't count for scoring my apnea, but they should as they are the ones that cause me the most issues as far as getting to sleep. Once I do get to sleep I don't notice what the machine is doing unless it gets really extreme.

Good luck with getting everything dialed in. You appear to be going in the right direction

The model is 36057, auto epap with heated humidifier and hose

It is great that you received the newer machine. I knew those were product codes used for ordering. I didn't know that it actually appeared on the back of the machine after the REF prefix. Is it really 5 and not a 3 in the REF code?

John I am so happy that you are enjoying the machine. I wish you good health and if there is anything else I can do for you just PM me.

Hi John, I got the same machine nine weeks ago. Those nice low AHI numbers actually include your untreated Centrals (CA) combined with (untreated) Obstructives (OA). About-to-occur, successfully machine-treated apnea never BECOME true apneas (which by definition require at least 10 seconds duration); i.e., they have been quickly and successfully treated by the amazing ASV within 10 seconds of onset. Thus they neither appear in the graphs nor are they counted in the AHI computations. Hopefully ResMed will one day provide updated firmware or improved ResScan software that separately breaks out those untreated CA and OA as they do in other S9 machines. Congrats on the low AHI. Don't be concerned if you occasionally see it spike higher. I get low numbers too, but in my case the (HI) Hypopnea sometimes adds too much to the (AI) Apneas and runs up the AHI number.

I'm thinking you're off to a great start. You've only just begun with the newer ResMed ASV model of the same name. In my experience and others', it gets even better in the days and weeks just ahead, not just low apnea numbers, but behavioral things like number of trips to the bathroom at night.

Are you using the Auto mode? My doc advised me NOT to right now. He indicated that if I did, I'd be experiencing many larger, more dramatic pressure swings than if I use the straight ASV mode. Since I'm paying him, I go along with him unless problems occur and I get lots of "uh-oh's" from the forum. So you might want to consider the straight ASV mode for a few nights if you're on Auto ASV now, and staying with your doc's pressure settings. (Document it if you do, per your doc.)

If you ABSOLUTELY feel that you must adjust settings, if it were me I would lower the upper limit of 25 down to 20. My thinking is that the high pressure swings could be what's awakening you (that and a too-full bladder that you can control by not drinking so much in the hours before bed time). High pressure swings can also cause mask problems, leaks and loud sounds that can be quite jolting. (Document any changes for your doc who sounds like a reasonable guy to work with you in this way.) Comments about the above from more experienced members are invited.

Congrats on landing the machine!

Papit wrote:Are you using the Auto mode? My doc advised me NOT to right now. He indicated that if I did, I'd be experiencing many larger, more dramatic pressure swings than if I use the straight ASV mode. Since I'm paying him, I go along with him unless problems occur and I get lots of "uh-oh's" from the forum. So you might want to consider the straight ASV mode for a few nights if you're on Auto ASV now, and staying with your doc's pressure settings. (Document it if you do, per your doc.)

... Comments about the above from more experienced members are invited.

I have the PR ASV with auto-EPAP, and I actually like it. Then again, my untreated condition was only hypopnea, so the pressure swings aren't usually very large. My 90% EPAP number is reliably 6.0 (from a minimum of 5.0).

Given my issues with aerophagia, I'm glad that EPAP stays as low as possible as much as possible. But if you're having leaks or other issues adjusting, fixed vs. auto EPAP is certainly a reasonable thing to consider.

Thanks for all the feedback. Last night my ahi was down to 0.5, I slept 8 hours and the nocturia was gone. The nocturia seems unaffected by my drinking liquids at night - i'm sure there is some effect but it is relatively minor. For example, 2 nights ago, i just happened to not drink anything after about 5 or 6 in the evening and I produced about a gallon of urine, and it's not concentrated, it's like water, odorless and colorless. Last night, i had tea at around 10 and i went through the entire night without getting up and in the morning, the urine is highly concentrated. It's very weird, can the difference between 1 and 0.5 be required? My sleephead report indicates that the pressure does go up to 25 a couple of times a night but as far as i know, it doesn't wake me up. Although i do wake up a couple of times at night so it is possible that it has and i'm not aware of it. I need to record the times i'm awakened and compare it with the graphs. Long term i'd like to be able to dump the dental appliance as my teeth hurt for about 15 min after i take it off and it has been determined that -over time - they damage dental work and i have a Ferrari's worth of caps and implants in my mouth covering a lifetime of dental work.

Sigh! Folks, please remember that I keep harping on the fact that it takes a little bit of time for you and your body to adjust to the ASV therapy. There is not magic involved in this. It all requires gradual (albeit possibly rapid) acclimation to the therapy.

First, I suspect part of the reason that you had more problems with nocturia was that the ASV therapy was awakening you in the middle of the night. When the pressure ramps up (to combat a central apnea), then it tends to cause leaks which lead to awakenings. If you are not now using them, you should consider using a mask liner to help reduce those awakenings. It helps reduce the sound of the leak - if not the leaks themselves.

Second, your unit definitely DOES differentiate between central and obstructive apneas. It must do so to properly respond to each. The fact that SleepyHead may not properly decode the data may be an issue. As I understand from Pugsy's posts, it might require Encore Pro (V2.12 ?) to properly read the output of the newer model ASV units.

Hope that helps.

JohnBFisher wrote:Sigh! Folks, please remember that I keep harping on the fact that it takes a little bit of time for you and your body to adjust to the ASV therapy. There is not magic involved in this. It all requires gradual (albeit possibly rapid) acclimation to the therapy.


Hope that helps.

Thanks, I've mentioned it before, but i'm not new to asv machines - i've been on asv for almost a year - the only difference is the move from the Resmed Vpap adapt enhanced to the Resmed S9 Vpap Asv with auto epap.

JohnBFisher wrote:Second, your unit definitely DOES differentiate between central and obstructive apneas. It must do so to properly respond to each. The fact that SleepyHead may not properly decode the data may be an issue. As I understand from Pugsy's posts, it might require Encore Pro (V2.12 ?) to properly read the output of the newer model ASV units.

I think he got the latest and greatest ResMed S9 ASV type of machine and not the Model 960 from Respironics which does require Pro 2.12.

johnthomasmacdonald wrote:The model is 36057, auto epap with heated humidifier and hose

This is the S9 model...I forget the exact ASV name and I am battling BPPV at the moment so I don't want to go searching for it but it's the one with the new added auto epap to compete with the Respironics Auto EPAP.