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[CPAP] Need help setting up ResMed S9 VPAP Adapt
I need some help with the initial settings for my ResMed S9 VPAP Adapt.
Current settings on ResMed S9 VPAP S:
Mode: CPAP (was “S”, see additional information)
Set Pressure: 14
Start Pressure: 10
EPR: 3 (would really like this higher, but this is the max)

Therefore, the S9 VPAP Adapt setting should be:
Mode: ASV or ASVAuto?
EPAP (for ASV mode): ?
Min EPAP (for ASVAuto Mode): ?
Max EPAP (for ASVAuto Mode): ?
Min PS: ?
Max PS: ?

The rest I can do on my own.

Some background and additional information:
During my last sleep study in October, 2011, the sleep technician was not able to determine my pressure requirement because even though it was obvious that 12 was too low, whenever she increased it above that amount, I could not sleep. After discussing this with my sleep doctor (I’ll refer to him as Dr. G.), I suggested that something is better than nothing and recommended he allow me to try a CPAP at a lower pressure until I became used to it. He agreed and prescribed a ResMed S9 VPAP S with an initial setting of 8 to 12. Instead of taking it back to the medical supplier each time I needed an adjustment, I did my own adjustments (with the help from the Apnea Board providing the clinical manual). During the first (and only) review of the results with Dr. G., he looked at the data and saw the average AHI at around 5.5 and said I was doing fine. When I pointed out how misleading the average was compared to the sporadic daily results, I suggested more analysis was needed. He refused to look at the daily data and so I decided not to see Dr. G., anymore.

Eventually, my own analysis determined my optimal pressure to be 14. After a while I changed my ResMed to CPAP mode with an EPR of 3 because that gave me more consistent results. However, I still was not getting much sleep most of the time. So, I started keeping meticulous records and with the help of SleepyHead software, I tracked data for 217 days. My average AHI for that period was 3.91, which of course, does not seem bad except that the standard deviation was 2.98 with a high mark of 13.51 and low of 1.3. Plus, I was averaging only about four hours of sleep per night. Looking at the daily results, I noticed a bunch of CA events which were often as many (if not more) than the OA events. Plus, more often than not, it was a CA event that caused me to wake up and then being unable to go back to sleep without the aid of a sleeping pill.

Meanwhile, my PCP (whom I will refer to as Dr. M.) began to “dabble” with sleep analysis and opened up his own sleep lab. I recently showed him my data analysis and suggested I needed a different CPAP machine and suggested the ResMed S9 VPAP Adapt. Dr. M., agreed and wrote a prescription for that specific machine (even though he had never heard of it). For various reasons, I did not use my insurance. I found a great price over the Internet and bought it outright using my HSA.

I’m real familiar with the different options on the S9 VPAP S, but the S9 VPAP Adapt is very confusing with all of those extra settings. I have the clinical manual, but it does not do a good job of explaining things (unless one already understands this unit). So, considering my current S9 VPAP S is set at 14 with an EPR of 3, does anyone have a suggestion regarding the initial settings for my new S9 VPAP Adapt? After that, I can do my own tweaking (as I did with my old machine).

A purist would say I need a new sleep study. The problem with that is I’ve had six sleep studies and have had the same problem during each one: I get very little sleep (one time, only about 1.5 hours). Plus, as virtually everyone who reads these threads knows, I could have a sleep study three nights in a row and completely different results for each one.
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Hi terp1984,
WELCOME! to the forum.!
Hang in there for answers to your questions and best of luck getting your machine set up.
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My opinion is to take advantage of the ASVAuto features. I would reset the machine defaults and select the mode ASVAuto, setting Ramp off, and turning Sleep Quality on. The machine defaults work well for many people. See how you tolerate it and what your AHI rating is in the morning.
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Welcome to the forum~! After so many years with sleep apnea, I just recently joined so I can learn more myself. Congrats on taking the time and effort, as I know many folks that have just tossed their machine as junk a few months after trying.
*I* am not a DOCTOR or any type of Health Care Professional.  My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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STL Mark, if I understand you correctly, you seem to be implying that the default pressure settings in ASVAuto mode will likely provide the airflow I need when I need it. Is that correct?
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I use the Respironics ASV. I didn't know any machines had default settings unless they are 4/20.
My settings are as follows: max pressure 25, epap min 10, epap max 13, pressure support min 7.5, max 12
Try setting the epap min at 9 which mill make exhalation more comfortable. Since we want to keep your ipap at 14
I would put ps at 5 min, max 8 or 9. This will give you possible pressures of 9+5= 14 up to 9+9=18.
So epap min at 9 max epap at 9 (yes, we want to keep the epap at 9 for your comfort)ps 5 min 8 max which would give you the minimum pressure of 14.
I hope this makes sense, pm me if I was totally unclear.
An ASV is the Cadillac of machines and the only machine a totally compliant patient should get. It is a glorified BiPAP AUTO because of the minute adjustments you can make. I'm always changing mine around, checking my AHI and tweaking. It keeps it new and fun. It's funny- my doc recently changed my minimum and didn't trust me to do it- he didn't want me "messing things up". He sent a note to my DME asking them to change the pressure, but I never heard from them. It was a moot point as I had changed the pressure as soon as I got home.

At a certain point further sleep studies are useless. It's a picture of one night. My tech could not titrate me properly on one than more occasion.
terp1984 you did good. I predict you will do great. Many of us are leaving the doctor out of the loop and watching our own numbers and making adjustments. Your experience is common- wide variations in ahi from day to day- but you do have to look at the big picture. If you start micromanaging the settings you will never acclimate to the settings or get a good picture of how the settings are working. With the numbers I suggested (only suggestion, I am not a dr. or tech) You have a range of 14 to a possible 18 which leaves you plenty of "room to grow". The epap stays at 9 for comfort.
Keep us posted, please. We do like to read track records of progress and if no progress brainstorming a solution.
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(10-06-2013, 08:34 PM)terp1984 Wrote: STL Mark, if I understand you correctly, you seem to be implying that the default pressure settings in ASVAuto mode will likely provide the airflow I need when I need it. Is that correct?
Yes that is correct. It is amazing with that machine. If you have the version with ASVAuto those default numbers should be remarkably similar to what I have in my profile. Compare and ask more questions. Try it out while you watch TV and are awake. It is a much different experience than traditional CPAP and BiPAP. It decides on a breath by breath basis what assistance you need.

Once you have spent a night or some time asleep with it look at your data and decide on further changes if any are needed.
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My new machine arrived yesterday, so last night was my first time to use it. The results were quite disappointing. I do realize this is only one night and I have to be patient (it took almost a year for me to get completely comfortable with my old machine).

Based on what I read combined with my own engineering intuition, here are the initial settings I chose (for reference, the defaults are shown in parentheses):

Mode: ASVAuto (ASV)
Min EPAP: 8 (4)
Max EPAP: 11 (15)
Min PS: 4 (3)
Max PS: 10 (15) – only because the manual explicitly recommends this value to be 10 or higher
Ramp: Off (45 minutes)

I understand STL Mark’s logic in using the defaults, but I have a real problem with the high pressures and I wanted to put a tighter restriction on that (as it turns out, more restriction is needed). skyler's recommendation to set Min EPAP and Max EPAP the same was rather interesting, but if I were to do that, I may as well use ASV mode instead of ASVAuto. I may end of doing that eventually, but since the latter is supposed to be the best of all worlds, I will try to get that working first.

The AHI for last night was 9.38, but that number in and of itself is misleading. During the first hour, each time I was about to fall asleep, I was jolted awake by a rush of air (kind of reminded me of my sleep studies – ugh). At this point, I took 12 mg of Ambien CR (this was one of my aids to help me get used to my old machine). 3.5 hours after this I woke up to realize the hose was removed. The SleepyHead software results indicate this removal occurred two hours after taking the Ambien and so I continued to sleep for another 1.5 hours after that.

To be fair, I should point out that I made an additional change. I typically sleep propped up (I have an adjustable bed) at an angle of approximately 30 degrees.

[By the way, as an aside, I have been sleeping this way for about 10 years. This was my alternative treatment for Sleep Apnea when my first attempt at using a CPAP failed miserably. This made a huge difference for me. I don’t recall the AHI numbers, but my SPO2 was 80% sleeping flat and 87% propped up (each without any other treatment device). So, sleeping propped up is also what allowed me to use the CPAP at a lower-than-otherwise-would-be-needed pressure.]

For three nights, using my old machine, I lowered that to about 20 degrees with pressures of 14, 14.6 and 15. The AHI for each was 15.99, 12 and 5.52 respectively. Clearly, I was getting closer to my ideal pressure for that angle (as indicated in my opening thread, my average AHI propped up at 30 degrees with a pressure of 14 was 3.91). Plus, my back was feeling so much better. Therefore, last night I set the bed angle to 20 degrees.

There are several puzzling things about last night’s experience. The results indicate many Hypopnea (unusual for me) and Apnea (virtually never for me) events and zero CA and OA events.

[By the way, I sure would like to know the difference between an Obstructive Apnea event and an Apnea event. That is, I know what OA is, but how is Apnea different? I think I understand the other two.]

Also, the pressure was maxed out at 21 about half the night. Even after I woke up the last time and I was lying awake for two hours attempting to go back to sleep, the pressure was often as high as 18. To me, this makes no sense whatsoever and makes me suspect there is at least one bug in the algorithm.

If anyone has some insightful comments, I will be most grateful.

My plan for tonight is to change the bed angle back to 30 degrees and make the following changes to my VPAP Adapt:

Min EPAP: 7 (from 8)
Max EPAP: 9.4 (from 11)
Min PS: 1 (from 4)
Max PS: 6 (from 10)

My goal here is to never allow the pressure to go above 15.4. I have successfully slept at 15, but have never been successful at 16 (without using a sleeping pill). I may have to increase the two minimum values – I’ll let you know tomorrow.
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I had a huge success last night! The short story is an AHI of 1.06!

This was another unusual experience. I woke up around 2:00 AM and sensed I would not be able to go back to sleep, so I took 10 mg of Ambien. It took me over two hours to go back to sleep. This has happened before with other sleep medication, but never with Ambien. Then after reviewing the results with SleepyHead, I realized there were no events that triggered me to wake up the first time and I had been sleeping for six hours (my optimal amount when I can get it). I had forgotten that I went to bed so early due to extreme exhaustion from the previous night. Also interesting was that during that first six hours, there were two Hypopnea events, one Apnea event and zero OAs and CAs (again, I sure would like to know the difference between an “Obstructive Apnea” event and an “Apnea” event as reported by SleepyHead). That was it.

I’m really tempted to switch to ASV mode (from ASVAuto) and shorten the pressure range. I’m thinking this would cut down on the extreme air flow oscillations (which I find very annoying), but considering last night’s good results, my intuition tells me to leave it be for a while.

I’m heading out of town for five days or so, so I won’t be able to update this thread until then. Meanwhile, I will be most grateful for any and all comments, especially from you VPAP Adapt users.
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That is one limitation of the S9 VPAP Adapt is no distinction between types of apnea events. Since each user has different requirements your usage of the machine has been different than mine. I am very grateful to have my Adapt. I am sure you will land on the optimum settings, you seem to be comfortable with it already.
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