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[Equipment] Resmed VPAP S9 Pressure
#1
Question 
Resmed VPAP S9 Pressure
Hello all,
I am a new patient (not newly diagnosed....had the UPPP/tonsillectomy surgery 8 years ago) for CPAP/BiPAP/VPAP therapy. About three weeks ago I started using the Resmed S9 VPAP Adapt machine with humidifier. My exhalation pressure is 10 and my pressure supports are at 4 and 15 (for a total inhalation pressure of 14 up to 25).

When I first turn on the machine and put my mask on (full face mask) my exhale pressure is correct at 10, but my inhale pressure will jump around from 14.5, to 16, to 19, to 21, and up to 24. It is all over the place and right at the very beginning of treatment. I know the pressure should automatically increase if I have an event while sleeping, but I am pretty certain the pressure should not be going that high (up to 24), two minutes after I turn the machine on, and while I am watching television, wide awake, with the lights on.

My DME said my data looks fine and doesn't see a problem with it and she said she contacted Resmed technical team and they don't think there is a problem. I am struggling to use the machine because I fight it for 45 minutes of this constant increase in pressure when I believe it should be blowing at a pressure of 14 while I am wide awake, and not at the max pressure.

Does anybody have any ideas as to why this is doing this, or if this is normal, or if the machine has a problem?

My DME acts as though it is normal and not a problem.

Thank you very much in advance,

Andy
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#2
RE: Resmed VPAP S9 Pressure
We breathe much differently when awake than when asleep. xPAP treatment is for when you are asleep, not awake, so you can't really rely on what the machine is saying during that time.

What does the pressure do after you are asleep? Does it continue to jump around? Or does it settle down?

Second, why are you watching television when you are in bed? That's not good sleep hygiene. Put on the mask, turn on the machine, lay down, stop watching the device and the television, and go to sleep.



PaulaO

Take a deep breath and count to zen.




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#3
RE: Resmed VPAP S9 Pressure
Does this machine have a ramp that you can set? If so, you might want to lower the starting pressure and increase the amount of time, thus allowing you to adjust to the pressure and be asleep before the machine is at full strength.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. 
ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.
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#4
RE: Resmed VPAP S9 Pressure
(04-24-2012, 09:40 PM)PaulaO2 Wrote: We breathe much differently when awake than when asleep. xPAP treatment is for when you are asleep, not awake, so you can't really rely on what the machine is saying during that time.

What does the pressure do after you are asleep? Does it continue to jump around? Or does it settle down?

Second, why are you watching television when you are in bed? That's not good sleep hygiene. Put on the mask, turn on the machine, lay down, stop watching the device and the television, and go to sleep.
After I am asleep, I'm not sure. I haven't figured out how to read the data yet! As I stated, this is a new experience for me! I know the treatment is for when I am asleep. This is why I was wondering if anybody else had this issue (or can explain it to me) of the pressure jumping up so high when I am wide awake and do not need an ipap of 24 (or 14 plus my epap of 10...however it is figured Dont-know)

I am not sure what you mean when you say I can't rely on the machine. I know it goes that high every 2-3 minutes because I will be breathing normal, and then for 2-3 breaths, my cheeks are blown against my mask and when I look at the machine, it tells me the current ipap and epap.

Paula, I appreciate the advice on how to fall asleep/proper sleep hygiene, but since this is a new process for me, it takes some adjustment. That is the problem I am having....because the pressure jumps up so high (when I feel that it shouldn't) it is difficult to fall asleep.

Thank you for making a new person to this forum, and to the whole xPAP machine process feel welcome!

(04-24-2012, 09:40 PM)bobg1946 Wrote: Does this machine have a ramp that you can set? If so, you might want to lower the starting pressure and increase the amount of time, thus allowing you to adjust to the pressure and be asleep before the machine is at full strength.

bobg...I don't believe the Resmed VPAP's have the ramp feature.
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#5
RE: Resmed VPAP S9 Pressure
Okay, now I understand your situation better. You had said you'd had the surgery 8 yrs ago so I assumed you were not a total newbie.

What the machine does is it blows air into your throat to keep it open or to convince the brain to keep breathing. Those throat muscles are actually voluntary muscles so when we sleep, they relax along with all the others. This is why a healthy, breathing-on-their-own person doesn't need a PAP all the time. The machine can sense (based on how the pressure is received) if the airway is open or closed or just not working. Closed, small, shallow breathing, or central event and an auto-PAP or variable-PAP will then increase that pressure to re-open the airways or trick your brain into telling you to breathe again. (in a nutshell)

When you are awake, you're breathing differently than when you are asleep and the machine gets confused. It keeps trying to decide if you are blocked or having a central event or nothing at all. So it jumps up and down, trying to find the right pressure. This is why I said not to pay attention to what the machine is doing while you are awake.

Do you have a manual? The ramp feature is a basic one and should be in the regular manual, not the clinician's manual (the one with all the "secrets"). What ramp does is start out at a lower pressure then slowly increase. If your low pressure is 14, then it will start out lower than that then increase to 14 and then find it's treatment pressure. The starting pressure and the time frame it takes to increase is set by you. Some people love the ramp feature because it allows them to get used to it. Others don't use it because we've gotten so used to the higher pressure, that anything lower makes us feel we aren't getting enough air. It is indeed quite possible that VPAPs do not have it.

As for how to read the data, your machine keeps track of how you are doing during the night. In the back is a memory card. If you have a card reader (doesn't have to be a special one, just one that can read that type of card), then using software you can view the data. Available to you is SleepyHead software and ResScan software. Both are available here.
http://www.apneaboard.com/forums/Forum-P...-and-Links

The data will tell you if you had any events, how many, if the mask leaked, what the average pressure was, etc etc. It's some cool stuff and will allow you to understand how well (or not at all) the treatment is going.

In that same section is the Clinician's Manual which can be good to have around.
PaulaO

Take a deep breath and count to zen.




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#6
RE: Resmed VPAP S9 Pressure
Thank you Paula,
I appreciate the info. I probably didn't do a very good job of explaining my situation and probably shouldn't even have mentioned the UPPP surgery! I did have that done 8 years ago because I didn't want to have to deal with a "machine" for the rest of my life! Two months after the surgery, I moved and never did a follow up. After 7.5 years, I got married and my wife "encouraged" me to do another sleep study (thank you dear for that one!). This study was done in January and they couldn't get a good reading because I struggled with mask all night long. Doctor put me on a auto cpap for 8 weeks to get used to it and after follow up study, they found I had complex sleep apnea, hence the vpap machine!

I am slowly figuring out the sleepyhead software and how to interpret it. From what I have read/investigated, the Resmed Vpap does not have a ramp, only in cpap mode will it offer a ramp. So, unfortunately, it has to start at the ipap of 14 (I think that is how it is said....epap of 10 plus min pressure support of 4???)....as far as I know. My DME has not been much help....have gone through some personnel turnover in the past 3 weeks since I have picked up the new machine. I am just struggling with trying to fall asleep when the pressure is jumping up to 22 and 24 while I am still awake. Makes it difficult to fall asleep. At the lower levels, it is no problem.

Guess I just need to keep working and keep trying to get some info from my DME!

Thanks again. Appreciate the info.
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#7
RE: Resmed VPAP S9 Pressure
my s9 vpap has a ramp feature, but i have turned it off.
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#8
RE: Resmed VPAP S9 Pressure
G'day Andy, welcome to the forum.

I have a VPAP Adapt too and I love it. It has a few foibles and does take a bit of getting used to, but it's a great machine. To get the most out of it you need to have the clinicians manual - you can request a copy here: http://www.apneaboard.com/adjust-cpap-pr...tup-manual Make sure you follow the instructions exactly - there are hundreds of manuals on offer. The Resmed manuals need to be emailed out - you can't just download them.

As to the machine itself, it does have a ramp feature in all modes, and I strongly suggest you use it to get past this hump. The ramp can be set for 5 to 45 minutes. During that period, the EPAP rises gradually to the minimum therapy EPAP pressure and the pressure support is fixed at the lowest setting. The ramp can be turned off by the DME - see P15 of the clinician manual - so make sure it's enabled on your machine. The ramp setting is for your own comfort so make it as long or short as you like - long enough to ensure that you're usually asleep before it reaches therapy pressure. But don't make it longer than you need, because you're not getting any treatment during the ramp period.

The other thing I'd suggest is to temporarily lower your maximum pressures until you're more accustomed to the machine. I'd set max EPAP to 10 or 12, max PS to around 6 and max IPAP to 16. Once you've got used to sleeping at these pressures then you can start easing them back up to the prescription maxima. Again, this is a temporary transition phase to get yourself accustomed to the machine.

By all means wear the mask while watching TV if that helps you get used to it, but don't have the machine running while you're doing that. The VPAP Adapt will react to a breathing pause in a fraction of a second, but when you're awake you will often have pauses of a few seconds without realising it. To you this is just normal, but the machine sees it as an apnea developing and jumps in to head it off.

I turn the machine on as the last thing I do as I put my Kindle down and turn out the light. The machine starts breathing with me, following my own breath-rate. Just breathe slowly and evenly and the machine will match you. This is very restful - within a few minutes you'll be out like a light. Sometimes however, you're not quite asleep when the ramp period finishes and you might get a strong inhalation pressure. If this occurs, just blow back against it quite forcefully - the machine will get the message and back off.

I hope this all helps. The Adapt really is quite different from ordinary CPAPs and you need to be aware of the way it works to get best benefit. But when it all comes together it's like magic!
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