ResMed BiPap S9 Auto--how does it really function?

I will be taking delivery of this new machine on 4/1/14. The doctor told me that my new settings will be '15/11.' So this is my question, if I'm breathing correctly while using it, does the machine just lower its pressure and follow along with me OR is it always 'slamming' me with 15cm's Have I asked the question correctly or do you need to know more here

First of all, the name of the Resmed bi-level is the S9 VPAP.

DAG wrote:I will be taking delivery of this new machine on 4/1/14. The doctor told me that my new settings will be '15/11.' So this is my question, if I'm breathing correctly while using it, does the machine just lower its pressure and follow along with me OR is it always 'slamming' me with 15cm's Have I asked the question correctly or do you need to know more here

With settings of 15/11, that most likely means the following:

Doc has prescribed "fixed pressure" settings of IPAP = 15 and EPAP = 11. Meaning the machine is not going to respond to events by increasing the pressure further.

But the machine should follow your breathing patterns in terms of switching between IPAP and EPAP: When it detects the beginning of the inhalation, the machine ups the pressure to 15. When the machine detects the beginning of the inhalation, the machine drops the pressure back down to 11.

It's a bit more complicated than that because of Resmed's "Easy Breath pressure wave" way of doing things, however. (The Easy Breath pressure wave is also used in the S9 CPAPs and APAPs when EPR is turned on.) In reality, the machine will start increasing the pressure up to IPAP at or near the beginning of each inhalation, after the pressure peaks at 15cm during the most intense part of the inhalation, the machine will start (gradually) lowering the pressure during the end of the inhalation, and by the time you are actively exhaling, the pressure will be dropped further until it reaches 11cm. For most people, the Easy Breath pattern does make breathing with the machine feel more natural.

I think you mean the Resmed S9 VPAP Auto. I have one and it's a great machine. 15/11 means your pressure when inhaling is 15 and when exhaling switches down to 11. The machine detects when you are changing from exhale to inhale (and vice-versa) automatically. There are some adjustments for this, but I expect the machine defaults will work fine. It also can be set up in different modes. I expect your doctor will set it up in "S" mode with your two pressures 15 and 11. The other modes are CPAP and Auto.

There are 2 S9 VPAP machine that are what I call "plain" bilevel machines.
The S9 VPAP S...which only offers fixed bilevel pressures and cpap mode
S9 VPAP Auto...which offers the same as the S model plus auto adjusting pressure mode.

The RX you mentioned is a fixed bilevel pressure setting. The DME might give you the S model or they might give you the Auto model and set it to S mode. Most of the time they give the less expensive model when they can..that would be the S model.

There is another VPAP model but it is used to treat centrals and the settings are more complicated than what you mentioned so it doesn't sound like you would be needing that model.

Thanks "robysue" and "citation4444." This then brings me to my next question or maybe just clarifying the one I had. Does the machine allow me to take slower breathes if my body wants one? Or, does it function in a way that it makes me breathe every, say, 4 seconds? Does it work with me in this sense?

Pugsy wrote:There are 2 S9 VPAP machine that are what I call "plain" bilevel machines.
The S9 VPAP S...which only offers fixed bilevel pressures and cpap mode
S9 VPAP Auto...which offers the same as the S model plus auto adjusting pressure mode.

The RX you mentioned is a fixed bilevel pressure setting. The DME might give you the S model or they might give you the Auto model and set it to S mode. Most of the time they give the less expensive model when they can..that would be the S model.

There is another VPAP model but it is used to treat centrals and the settings are more complicated than what you mentioned so it doesn't sound like you would be needing that model.

Mine is the VPAP S9 AUTO.

I believe there is a little setting available to help with the speed or rhythm of the inhale/exhale if it tends to want you to breathe faster or slower than you want.

I suggest you go to here and request the provider manual for your machine if you haven't already done so.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Pugsy wrote:I believe there is a little setting available to help with the speed or rhythm of the inhale/exhale if it tends to want you to breathe faster or slower than you want.

I suggest you go to here and request the provider manual for your machine if you haven't already done so.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Thanks! I did that the other day and have been reading it but understanding some of the settings at this point is out of my range. Too bad there isn't some document made up regarding this machine that would let us patients know how to deal with the settings on our own if we chose. Know of any?

DAG wrote: Too bad there isn't some document made up regarding this machine that would let us patients know how to deal with the settings on our own if we chose. Know of any?

No, the user manual is all we are supposed to know about and remember...patients are told we can't change the settings.
It's too ultra secret and way above our pay grade...gag We aren't supposed to be smart enough to understand.
We aren't supposed to know about the provider/clinical manual either. It comes with the machine from ResMed but there's a big sign on it "Remove this before giving to patient".

No machine manufacturer offers any documentation for helping the patient figure out what they might change and/or why.

DAG wrote:

Pugsy wrote:I believe there is a little setting available to help with the speed or rhythm of the inhale/exhale if it tends to want you to breathe faster or slower than you want.

I suggest you go to here and request the provider manual for your machine if you haven't already done so.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Thanks! I did that the other day and have been reading it but understanding some of the settings at this point is out of my range. Too bad there isn't some document made up regarding this machine that would let us patients know how to deal with the settings on our own if we chose. Know of any?

Once you get your machine you will be able to better understand those additional settings which help fine-tune the sensitivity of the machine to your own breathing patterns. While awake, try out some tweaks on those settings which mostly have to do with how quickly the machine switches from the IPAP pressure to the EPAP pressure and vice versa. I did that and could feel those subtle differencs -- on some settings it felt like the machine was too slow with the switch so that I was still getting inhale pressure (IPAP) at the beginning of my exhale, and on other settings the switch from IPAP to EPAP happened too soon, so I'd still be inhaling and that 'too early' drop in pressure made it feel like the air flow had suddenly stopped. I ended up leaving everything on "medium" which works best for me, but you may find that some fine tuning makes the machine more sensitive to how you normally breathe.

Thanks for the information you've provided. I see that you have the same machine I will be getting. Tell me, how do you like it?

DAG wrote:Thanks for the information you've provided. I see that you have the same machine I will be getting. Tell me, how do you like it?

As much as anyone can "like" PAP , I love this machine. I started out with an S9 Autoset and about 7-8 months into therapy I switched to the VPAP Auto. It is easier for me to use than the Autoset was -- though the Autoset was also a good machine the VPAP helped me overcome my aerophagia and it seems much more sensitive to my own breathing patterns.

DAG wrote:Thanks "robysue" and "citation4444." This then brings me to my next question or maybe just clarifying the one I had. Does the machine allow me to take slower breathes if my body wants one? Or, does it function in a way that it makes me breathe every, say, 4 seconds? Does it work with me in this sense?

In "S" mode or in Auto mode, the machine is supposed to follow your breathing and you should not feel that the machine is rushing you to inhale or exhale on a regular basis.

If you feel rushed in your breathing, the first thing that you might need to check are two settings called Ti-max and Ti-min. They will control the minimum and maximum time the machine will spend at IPAP before lowering the pressure back to EPAP. If they are not set correctly, the drop to EPAP may take place too soon or too late relative to the beginning of your exhalation. But if Ti-max and Ti-min are set correctly, then drop in pressure should be occurring at the right place in the exhalation cycle.

DAG wrote:Thanks "robysue" and "citation4444." This then brings me to my next question or maybe just clarifying the one I had. Does the machine allow me to take slower breathes if my body wants one? Or, does it function in a way that it makes me breathe every, say, 4 seconds? Does it work with me in this sense?

Since I don't think anyone addressed this question directly, NO, the machine does not function in a way that makes you breathe after a period of time (unless your machine is a ST or ST-A with additional prescription information). Those machines monitor your breathing very precisely and in great detail.... how much air you breathe, how long you breathe in, how long you breathe out, etc. The standard bi-level machines use that information to switch between to the exhale pressure when YOU stop inhaling and to the inhale pressure when YOU stop exhaling, though there are comfort settings that adjust precisely how that transition happens (faster, slower, extra pressure relief at the start of the exhale, etc). Regardless, you drive and the machine follows, not the other way around.

That said, in my experience, the amount of difference between inhale and exhale pressure changes the way it FEELS. Too little pressure difference and I feel like the machine doesn't want to let me to exhale. Too much and I feel like the machine wants to inflate me like a balloon when I inhale. In between is a range where my breathing and the pressure switches are in sync and breathing with the machine feels natural and effortless.

DAG wrote:Thanks for the information you've provided. I see that you have the same machine I will be getting. Tell me, how do you like it?

I have the Respironics equivalent, but from everything I have seen the Resmed S9 Autoset S is widely considered to be the best machine in the category.