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Clinician Setting on Older S9 Machine:
Hi Guys, new member here but long time machine user. I attempted to post this in the "Clinicians Settings" thread but it remains closed to me.

I have Complex SA and my condition has worsened of late. I need to learn the settings on my machine and not doing well. One reason for this is the age and model of my machine. It is old.

The machine I own is a "ResMed S9 Auto" Not AutoSet, and not an EPR machine. Just “S9 Auto.” I also have the H5i Humidifier and both appear to be operating well. I use a ResMed Quatro Air Medium full face mask.
Since my needs have changed, I am looking for increased pressures and of course lower AHI.

I have menu headings for Mode, Options and Config. Mode appears to have several levels and this is where water gets murky! "Vauto" or "S" and different levels appear to give different pressure choices???

I have searched online for data pertaining to my machine but only finding info for the later AutoSet machines and such.

I have studied the settings and can access the menu's but found the several “levels” of control data very confusing and need help badly. Any assistance, any links or help of any form dearly appreciated.
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The ResMed S9 VPAP Auto is not any older than the S9 Autoset.

That's a bilevel machine. Vauto, you set 3 pressures: IPAPmax, EPAPmin, and PS.
"S" mode is "spontaneous" triggered fixed level bilevel. You set a fixed IPAP and a fixed EPAP.

You can request a clinican's manual by following the instructions on this link:

Dig into your menu and find what mode and pressure settings you are presently using.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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You have a good machine. My advice is to stick with it. As Mongo suggests, get the clinicians manual. It is free from this board.

Best Regards,


Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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Thanks for responding. Looks like you have the same machine. Glad to hear it ain't old like I thought. Here are my current settings:
Mode - Vpap Auto
Max Ipap - 19.0
Min Ipap - 4.0
PS - 6
Ti Max - 2.0
Ti Min - 0.3
Trigger - Med
Cycle - High
Max Ramp - 5 mins
Start Epap - 4.0

Not sure what I was looking for when I followed link you provided??
Very foggy on what you mean by 3 different settings. I guess I need a lot of help..
I know this machine can help me but just need to learn it.. Thank you so much!!
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Thanks PaytonA.. I am so happy to hear my machine is a good one. You would not believe the story covering my journey in "Apnea Land!!?"
After I get my settings in order, I hope to find a string somewhere here to tell it in its entirety.. I don't believe it myself but it really happened!
Ok found the manual.. now just to understand it!??!
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(05-10-2016, 05:06 PM)DesertMax Wrote: Thanks for responding. Looks like you have the same machine. Glad to hear it ain't old like I thought. Here are my current settings:
Mode - Vpap Auto
Max Ipap - 19.0 <----- 1st setting
Min Ipap Epap - 4.0 <----- 2nd setting
PS - 6 <----- 3rd setting
Ti Max - 2.0
Ti Min - 0.3
Trigger - Med
Cycle - High
Max Ramp - 5 mins
Start Epap - 4.0

Not sure what I was looking for when I followed link you provided?? follow the link down to where it instructs you how to request a clinician's manual by email.
Very foggy on what you mean by 3 different settings. I guess I need a lot of help..
I know this machine can help me but just need to learn it.. Thank you so much!!

Now, download sleepyhead; and let's see The AHI summary for a night; and the leak, flow, pressure, and events graphs.

Two things sort of pop out, minEPAP = 4 probably is too low as the machine has to bump up several times to hit therapeutic pressure. Can tell more from an actual night's graph. Also, for mixed apnea, if you have a lot of central apnea, then this machine might not be the best choice. The gold standard for treating mixed apnea is the ASV machine. We'll see how is doing for you.

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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Hi DesertMax,
WELCOME! to the forum.!
Hang in there for more responses to your post and ask as many questions as you need to for better understanding of your therapy and your machine.
Much success to you as you continue your CPAP therapy and I look forward to hearing your story whenever you wish to tell it.
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Mongo, I tried my best to understand the settings help you provided but nothing is going right. These are the most difficult days of my life. I am hitting rock bottom.

I do not understand the "bi-level" functionality of my machine. It seems that as a user I can select just one of the following:

or Cpap

is this correct?

I feel that I need very strong pressure. With my Complex SA it just feels like this will help the most but I'm not sure if that is just me muddling through or a medical or scientifically correct conclusion???

I used the S setting last night which appears to give me the strongest in and out pressure but then it wants to blow the mask of my face and I had to tighten the straps.. This feels terrible because of the obvious tension on my facial musculature..

The conversation that keeps returning into my head is why my "healthcare" provider has failed miserably to provide me with the right machine and the proper settings concurrent with my most recent sleep study?
I've completely given up on them. I'm doing this on my own now and I mean alone.

Should I find a different machine and how do I get the settings right?
Bottom line.. when I got the machine I have now... years ago.. the "sleep tech" told me I would achieve results he termed "glorious!"
Before the sleep disease I had an abundance of natural energy and I have not felt anything like that for many many years with one small exception.

The last machine that BMC gave me here in Bend area of Oregon as printed on the invoice from Norco a "Vpap ST" but in doing a search it looked like the AirSense 10 AutoSet. (forum will not let me post image I have of this machine...?)

Here is what happened: I was visiting my sister with family out of town and brought this machine with me. The settings felt terribly wrong and the thing was constantly out of sync with my breathing, wrong respiratory cadence and felt as though it was trying to blow me up with air like a big balloon.
However, I did use it that night and awakened for some reason at about 3 AM and for just about a minute or so I really felt the "glorious!" It was startlingly apparent that I could have a life again but with that feeling I realized I had two choices. I could stay up and sit quietly for the rest of the night (alone in my glorious) until the others got up or go back to sleep which of course was the choice I made... Later when I woke up in the morning it was back to the ugly monster I have come to know that I have been turned into by this terrifying and awful disease.. Why so difficult finding myself in this life once again? Why?
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Well, we all ask "why me?" and I've certainly done it (and do it) myself. But one day I heard the answer to that question and it's "why not me?".

Indeed, why not me? What's so special about me that I shouldn't be visited by the travails of life? I mean it doesn't cause me an existential crisis to hear about bad things happening to other people, so why does it cause one for me when it hits me?

Well, I still say "why me?" lots, but it doesn't quite have the force it used to have.
Ed Seedhouse

Your brain is not the boss.

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Hi DesertMax,

You have an excellent machine, a premium bilevel auto-adjusting machine. No need to think about getting a different one until you are able to adjust the machine properly to see how well it can be made to work for you.

I suggest using Vauto therapy mode. This is the mode wherein the machine will automatically adjust the pressures to reduce/avoid obstructive events.

When put in Vauto mode, the pressure settings will be the three justMongo has pointed out.

Pressure Support (PS)

EPAP is the low pressure used while breathing out. In Vauto therapy mode, EPAP will adjust itself higher when needed to reduce/avoid obstructive events like obstructive apneas and obstructive hypopneas and Flow Limitation and snoring.

PS is the amount the pressure is further boosted during inhalation. The pressure during inhalation is IPAP, which is the EPAP pressure plus the PS pressure boost. IPAP = EPAP + PS

If EPAP Min is 4 and PS is 6, this would mean that when in Vauto mode the pressure will start out at 4 during exhalation and 10 during inhalation. If the machine automatically raises EPAP to reduce obstructive events, it will not change PS, so IPAP will remain always 6 higher than EPAP. So it raises both EPAP and IPAP by an equal amount.

If the machine raises EPAP as high as 13, IPAP would be 19. If IPAP Max is 19, the machine cannot raise EPAP any higher, because EPAP always stays PS lower than IPAP.

I think you will need to download SleepyHead and post for us a screenshot of the daily data (waveforms of Flow and Mask Pressure and Leak and statistics for one day). Then we will be able to make suggestions.

In general, it sounds to me like you will probably need to increase the Min EPAP to be about two or 3 lower than your 95% EPAP, and may need to decrease PS as much as you can while still being comfortable.

Your 95% EPAP is the EPAP pressure the machine was at or lower than for at least 95% of the night. It is also the EPAP pressure the machine was at or higher than for at least 5% of the night.

For those of us who get central apneas, in most cases, the higher PS is set, the more CA events will occur. Lowering PS may be less comfortable and may increase the likelihood of obstructive conditions occurring like Flow Limitation but may be necessary to lower the number of CA events we are getting.

However, on the other hand, I think CA events, if fairly short like 20 seconds or less, tend to be less stressful on the body than obstructive apneas. With central apneas, as soon as we try to resume breathing, we do. With obstructive apneas, we are struggling to breathe but cannot until we arouse ourselves enough to gasp for breathe for a while, until we again relax into deeper sleep and the airway collapses again. The jolts of adrenalin to arouse ourselves from obstructive apneas are more stressful, I think, than central apneas. So I think it is usually more important to reduce/avoid obstructive apneas than central apneas.

If feasible for you, I also suggest getting a wrist watch type recording pulse oximeter. This is the type with separate finger sensor and is much more comfortable to wear all night, and has less of a tendency to fall off during the night. Supplier 19 on the Supplier List is a reputable source for these. A link to the Supplier List is at top of all forum pages. There is no financial benefit to Apnea Board from using the Supplier List. Nor does Apnea Board necessarily "recommend" any suppliers on the list as having lowest prices or best service. But I've used Supplier 19 and was happy with the product and service.

Take care and hang in there,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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