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Question about ResMed S9 data
#1
Hi, I am new here as well. I am just completing a 14 day trial with a RESMED S9 Autoset. With this forums help and a bit of studying the subject I have analysed my data from the SD card with RESMED SW and Sleepyhead and found a fair amount of OSA and CSA events (OSA about 1/3 and CSA about 2/3), with some few Hypopnea events as well. However when I talked to the equipment provider he told me that he can not interpret my results, unless I also complete a full sleep study (waiting time for this is up to six months if funded through the public health system in New Zealand ...). Is this true or can my data be interpreted from the treated results as well???

I am having an average treated AHI 5.45 (AHI ranging from 2.3 - 16.8 per night), Min pressure 5, max pressure 12 at EPR3. (Resmed S9 Autoset with FX Mirage Nasal mask)
I have included some of the data from Sleepyhead below:
Recent AVG 7days AVG 30 days
AHI 5.65 6.32 5.45
Hours per Night 10:05 09:21 09:41
Average Pressure 7.97 7.45 6.54
95% Pressure 10.40 11.76 11.62
Average Leaks 0.94 1.97 1.82
95% Leaks 18.00 20.40 18.00

I am feeling better after most mornings, except after nights with "high events". I am reasonably sure that I benefit from the APAP therapy. Can anyone help and recommend what kind of machine I require APAP, Bilevel, or ASV? Any help is appreciated. Thank you.

(I can post all detailed results as pdf file, but not sure how to upload it to the forum)
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#2
Hi Nord, and welcome to Apnea Board. I'm putting your post in a new thread where it'll get seen by more people.

We can tell one thing for sure from your data, we can see that your leaks are under control. Getting a good mask fit is the first step, without that nothing else matters.

What you were told by that doctor is essentially true because without a sleep study it's impossible to tell if you have simple obstructive sleep apnea (OSA) or some more complicated type of sleep disordered breathing (SDB).

If we assume you have simple OSA then we can try to draw some conclusions from the data. It's likely that your CA index will drop as you acclimate to the threapy. It could be that your machine is setting the pressure too high and that's what's elevating your CA index.

If I were you I'd wait another 14 days and see what happens. Your AHI is low enough now to indicate effective therapy. Getting it below 5 is the target and you may be able to achieve that just by waiting while your body adapts.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
(05-12-2013, 11:11 PM)Nord Wrote: I am just completing a 14 day trial with a RESMED S9 Autoset. With this forums help and a bit of studying the subject I have analysed my data from the SD card with RESMED SW and Sleepyhead and found a fair amount of OSA and CSA events (OSA about 1/3 and CSA about 2/3), with some few Hypopnea events as well.
...
I am having an average treated AHI 5.45 (AHI ranging from 2.3 - 16.8 per night), Min pressure 5, max pressure 12 at EPR3. (Resmed S9 Autoset with FX Mirage Nasal mask)
I have included some of the data from Sleepyhead below:
Recent AVG 7days AVG 30 days
AHI 5.65 6.32 5.45
Hours per Night 10:05 09:21 09:41
Average Pressure 7.97 7.45 6.54
95% Pressure 10.40 11.76 11.62
Average Leaks 0.94 1.97 1.82
95% Leaks 18.00 20.40 18.00

I am feeling better after most mornings, except after nights with "high events". I am reasonably sure that I benefit from the APAP therapy. Can anyone help and recommend what kind of machine I require APAP, Bilevel, or ASV?

Hi Nord, welcome to the forum!

Your data looks pretty good, especially for just 2 weeks on PAP therapy.

Too early yet to tell whether you need more than the S9 AutoSet, which is a great machine.

Turning EPR down (gradually, maybe one notch a week) to 2 or 1 or Off may improve the CA Index (average number of clear airway apneas per hour).

Using EPR can increase (make worse) the CAI number, for the minority of patients who are susceptible to central events. Some long-time CPAP users have found that their CAI numbers improved a lot when they turned off EPR.

At the same time, it is fairly common for the CAI to become smaller anyway during the first few months of CPAP therapy as our system gets used to the pressure while sleeping. So you may be able to turn EPR back up, in a few months time.

Your starting pressure of 5 is way lower than your 95% pressure of close to 12, your max. This may make the machine spend a fair amount of time working up to the pressure you occasionally need to treat obstructive events, allowing obstructive events until it reaches the needed therapeutic pressure. If it were me, I would probably gradually (maybe one cmH2O a week) raise the minimum pressure from 5 to 8 or higher.

I would probably also gradually raise the max pressure to at least a couple higher than my 95% pressure, to around 14 or higher.

Let's consider: Your pressure is most often around 7 or 8. If many or most of your central apneas are occurring around 7 or 8, I would think that shows that CAs are occurring not only or predominately at high pressures like 10 or 11, but pretty much independently of pressure.

On the other hand, if your central apneas occur predominately at pressures of 10 or 11 and only very rarely at 7 or 8 where the pressure spends most of its time, then I would tend to think the higher the pressure gets the more central apneas will occur, and therefore I would reconsider whether I wanted to raise the minimum up to 8 or higher, or raise the maximum pressure to around 14 or higher. I would try to find some happy medium where the AHI number is smallest, or where the average length of time spent in apnea is minimized.

If you can swing it, I suggest getting a Pulse Oximeter, such as are available from Supplier #19 on the Supplier List, a link for which is at the top of most Forum pages.

The wrist-mounted oximeters are more expensive but more comfortable. (There are several threads on the forum which discuss Oximeters.)

Take care,
--- 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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#4
Thanks Vaugn and Sleepster. Appreciated.
I am in a bit of a fix as I do not get any useful answers from my equipment provider following the 14 days trial that has now ended. From what I have heard from friends with Apnea, it is unlikely that the New Zealand public health system will fund a APAP or similar device for patients with consistent AHI levels below 16 (not what my treated trial test results show), so there is no point in waiting for that reason alone.

Since a public funded sleep test is probably still 6 month away (unless I fund a HST myself) I will have to make a decision on whether to outright buy a machine like the S9 Autoset, or keep renting the same machine from the equipment provider which is expensive on the long run. As long as I rent I will loose money compared to buying my own equipment on the long run. On the other hand I might buy a simple S9 Autoset APAP machine, while I would actually need a bilevel or AVS. What are the odds?

Given my data (I can provide more deatiled data if it helps), would you suggest that my current S9 Autoset machine is an appropriate solution and treatment reasonably effective as I am feeling better compared to before? Or am I likely wasting money buying an Autoset machine and actually do need a Bilevel or ASV due to a possibility of mixed Apena or complex Apnea (high percentage of CSA events)? Any suggestions are appreciated.
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#5
(05-14-2013, 06:50 PM)Nord Wrote: Given my data (I can provide more deatiled data if it helps), would you suggest that my current S9 Autoset machine is an appropriate solution and treatment reasonably effective as I am feeling better compared to before? Or am I likely wasting money buying an Autoset machine and actually do need a Bilevel or ASV due to a possibility of mixed Apena or complex Apnea (high percentage of CSA events)? Any suggestions are appreciated.
No point wasting money on ASV machine if you don,t really need one. The only way to find if you really need one is sleep study at sleep lab.
S9 AutoSet does good job in treating obstructive apnea, yet it detect central sleep apnea but does not treat it

I buy my gear from Supplier #2 and # 10, both ship outside US
Suppliers List: http://www.apneaboard.com/forums/Thread-...plier-List
Machines are multi-voltage ... you only need a power plug adapter

Phillips Respironcis System One Auto (550 or 560) cheaper than S9 AutoSet
Supplier #2 prices slightly cheaper and have some used machines low hours and comes with warranty which you might consider


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#6
Hi Nord,
WELCOME! to the forum.!
Hang in there for more responses to your post and best of luck.
trish6hundred
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#7
(05-14-2013, 06:50 PM)Nord Wrote: Since a public funded sleep test is probably still 6 month away (unless I fund a HST myself) I will have to make a decision on whether to outright buy a machine like the S9 Autoset, or keep renting the same machine from the equipment provider which is expensive on the long run.

I think it's safe to assume you don't need a bilevel machine. At the end of your two-week trial what are your rental options? Can you rent it for another two weeks or a month? If you can get your CA index to drop in that amount of time it's probably safe to assume you don't need an ASV machine.

It's not all that high right now, so you might be safe buying the S9 Autoset outright right now, or maybe a less expensive data-capable CPAP machine such as the ResMed S9 Elite or Philips Respironics System One REMstar Pro.

There's also a less expensive Philips Respironics System One REMstar APAP. The older 50 Series machines are just fine.

Check out Supplier #2 for some good deals on reliable used machines. For example, they've got a Gently Used DS450 REMstar Pro (without Heated Humidifier) for $275 but you can add the humidifier for $70.

Or if you refer the APAP, Gently Used DS550 REMstar Auto AFLEX Machine without Heated Humidifier for $369. At that price I may just buy one for myself to have as a back up!
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
(05-14-2013, 06:50 PM)Nord Wrote: As long as I rent I will loose money compared to buying my own equipment on the long run. On the other hand I might buy a simple S9 Autoset APAP machine, while I would actually need a bilevel or AVS. What are the odds?

Hi Nord,

Any machine you buy must be a model which can distinguish between clear airway (central) apneas versus obstructive apneas:

http://www.apneaboard.com/wiki/index.php...ne_Choices

If you were to buy a gently used S9 AutoSet for $569.00 from Supplier #2 (low hours with 1 year warrantee, a good deal), you may be able to get all your money back selling it on craigslist (or wherever) if you decide in 6 months that you need an ASV machine.

In 6 months the used machine would still be under warrantee for another 6 months, so it might retain its resale value fairly well.

Take care,
--- 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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#9
Thank you all for your answers so far. Unfortunately all the gently used S9 Autoset from #2 have sold out by now.
I found that even now I am still having quite a lot CSA events. Most nights about 25 events with a number of them quite long lasting (above 30 seconds). Is this still in the range of normal? I understand that my current rented S9 Autoset is only able to deal with the OSA, but is not able to treat CSA.
Could I do anything wrong in buying a Resmed ASV device and use it in ASV Auto mode? Maybe this would solve the CSA events? Your input is much appreciated.
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#10
Supplier #10 have Pre-Owned S9 AutoSet $699 include humidifier and SlimLine - 1 year warranty.
ClimateLIne extra $51 and plug adapter au/nz $9.99

New S9 Autoset include humidifier and ClimateLine (not sure about SlimLine) plus 2 years warranty $999

Supplier #2 New S9 AutoSet include humidifier and both ClimteLine and SlimLine $879 2 years warranty
warranty means machine have to be sent back for any warranty issues
If not mistaken ... Unlike Australia ... CPAP machines are not GST exempt in New Zealand

A diagnosis of central sleep apnea (CSA) requires all of the following:
An apnea index > 5
Central apneas/hypopneas > 50% of total apneas/hypopneas
Central apneas or hypopneas occurring at least 5 times per hour
Symptoms of either excessive sleepiness or disrupted sleep
http://www.resmed.com/us/clinicians/abou...clinicians

S9 AutoSet can not be used for diagnosis of central sleep apnea
It can detect central events but not 100% reliable because the machine cannot tell if you were asleep or awake when events are scored

ASV machines are complex machines and different ball game than setting APAP
From what read, It can be difficult to set and getting used to the machine

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