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Question about ResMed S9 data
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vsheline Offline

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Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #11
RE: [split] Question about ResMed S9 data
(05-12-2013 11:11 PM)Nord Wrote:  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)

(05-14-2013 06:50 PM)Nord Wrote:  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.

No way to know if your untreated AHI is worse than 15 except to have the sleep study. One would expect that your AHI when untreated is worse than your AHI when treated, and if a sleep study shows that your untreated AHI is worse than 15 then you would not need to buy a CPAP/APAP machine your own. Right?

I suppose that if the untreated AHI must be 16 before the New Zealand public health system will fund any sort of machine, then there may be a similar threshold for funding an ASV machine, meaning the CAI when under treatment with a CPAP/APAP machine may need to be 16 or higher before the New Zealand public health system would fund an ASV machine.


(05-24-2013 01:20 AM)Nord Wrote:  Unfortunately all the gently used S9 Autoset from #2 have sold out by now.
Supplier #2 may get some in again, in a few days or weeks.


(05-24-2013 01:20 AM)Nord Wrote:  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?

Sounds like your CAI after 4 weeks of treatment is nearly 3, only a little less than during your first 2 weeks of treatment.

I hope you have tried reducing or turning off EPR. If you haven't yet tried this, doing this might largely solve the problem.

Regarding the 30 second central apneas, if they are starting after having hyperventilated then I would expect that your O2 saturation may have been dropping into the mid 80% range or lower, which is at least a little too low. 89% or higher is considered adequate. 94% or higher is considered optimal.

But if 30 second central apneas have been starting during periods of hypopnea (or during periods of less than average ventilation), then (1) I would not expect reducing EPR would improve the situation but increasing EPR might help, and (2) I would expect that your O2 saturation may have been dropping into the mid 70% range or lower.

I suggest you consider getting one of the wrist-mounted Pulse Oximeters which are available from Supplier #19, so you can find out exactly how low your O2 levels are dropping.

(05-24-2013 01:20 AM)Nord Wrote:  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?

The way ASV machines would treat your centrals is by automatically raising the Inhale pressure up to 10 or more cmH20 higher than the Exhale pressure, which causes air to enter and exit the lungs even though your central nervous system is failing to make any effort to breathe. The machine notices when you stop breathing and steps in to breath for you. The exhale pressure may need to be the same as what an APAP or Bi-level machine would need to treat obstructive events (i.e., up to 12 cmH2O in your case). That means that, when CSA events are happening, your Inhale pressure would be above 20, approaching 25. That is a lot of pressure and leaks can be very hard to control. For example, the Exhale pressure I need to eliminate obstructive events is about 14, so my ASV machine is often raising my Inhale pressure 10 or more higher than that, to 24 or 25, and I am constantly working hard to try to control leaks without over-tightening the mask, but I have not quite arrived at how to accomplish that yet. As my face gets sore from one or another of my masks, I alternate between three masks: 2 different ResMed Full Face masks plus one Respironics FitLife Total Face Mask, and I use RemZzzs mask liners or a ResMed Gecko gel nose pad to help protect my nose and to help control leaks.

I think it is likely that an S9 ASV device would largely eliminate your central events. It has lowered my CAI from occasionally being above 5 (when I was using S9 AutoSet and/or S9 VPAP Auto) to now being always zero. That means no apnea lasts longer than 10 seconds, and that means no detectable (sudden) hypopneas occur. However, occasionally my breathing will very gradually become more and more shallow, and the machine does not notice. Eventually I will have an arousal and sudden big increase in breathing. I think if my machine were more adjustable I could fix this (1) by setting the Minimum Respiration Rate to somewhere around 10 or 12 breaths per minute, and (2) by setting my Minimum Pressure Support (Pressure Support is the difference between the high Inhale pressure versus the low Exhale pressure) to something higher than 6 cmH2O, and (3) by setting a minimum target for Tidal Volume (which is the amount of air in one breath) and (4) by setting a minimum for the Target Minute Volume (Minute Volume is the volume of air breathed in one minute, and the Target Minute Volume is a target for how much Minute Volume the machine should try to maintain while it is breathing for you). The relatively unadjustable S9 VPAP Adapt does not allow these things to be done. The Philips Respironics System One BiPAP autoSV Advanced allows the first two to be done. Perhaps a future generation ASV machine will allow all four.

The S9 VPAP Adapt is a simpler "one size fits most" ASV machine, by which I mean it has few adjustable parameters and automatically adapts itself to your needs. Pretty much, one could simply (1) set the EPAP (exhale pressure) range to the same range one has found to be optimal when using a standard CPAP or APAP machine and (2) set a wide open range like zero to 15 for Pressure Support (PS is the difference between the low Exhale pressure versus the high Inhale pressure) and in most cases the result would be that the machine would automatically adjust the pressures to eliminate both obstructive and central events. In general, the Max PS needs to be at least 10 and at least 5 higher than the Min PS. In my opinion the Max Pressure (also called Max IPAP) should be the sum of the Max EPAP plus the Max PS, so that EPAP and PS can both be max at the same time, if needed. By looking at the Detailed Data downloaded from the machine, one could optimize the settings by applying common sense adjustments. In my case I found I need the setting for the Min PS to be fairly high (to reduce how often I have the problem of my breathing gradually becoming too shallow).

If you do decide to get a ResMed ASV device, I would suggest verifying before buying that it would be S9 VPAP Adapt model 36037 (manufactured starting November 2012) rather than S9 VPAP Adapt model 36007 (still widely sold as "the ResMed S9 VPAP Adapt" without without making it clear that this is not the most recent model). ResMed changed the model NUMBER (and capabilities) but not the model NAME.

The slightly less expensive Philips Respironics System One BiPAP autoSV Advanced is more adjustable and customizable, but at the same time that makes it more complex to get adjusted. Nonetheless, knowing what I have learned since purchasing my S9 VPAP Adapt in January, if I could do it all over I would get the PRS1 BiPAP autoSV Advanced, for two reasons. I think I would do better with a minimum Respiration Rate around 10 or 12 breaths per minute and I think I would do better if my Min PS could be adjusted to 7 or 8. On the PRS1 ASV unit I could have done these things, but on the S9 VPAP Adapt I cannot.

But if one were wanting to attempt self titration on an ASV machine, I think the S9 VPAP Adapt would be easier to work with. Also, that one would have the option of using ResScan to monitor one's progress is a very attractive feature of ResMed machines, in my view.

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.
(This post was last modified: 05-25-2013 07:11 AM by vsheline.)
05-24-2013 06:55 AM
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archangle Offline
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Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

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Post: #12
RE: [split] Question about ResMed S9 data
(05-24-2013 01:20 AM)Nord Wrote:  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.

"Do it yourself" treatment with an ASV machine is a lot harder than CPAP. You don't just push the "auto" button and expect it to find the right answer. You don't even do that with APAP, but ASV and CSA is a lot more complicated. It can be hard to get right, even if you have a caring, experienced sleep doc and RT.

ASV is also a lot harder for many people to adapt to.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
05-25-2013 06:01 AM
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Nord Offline

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Machine: Resmed S9 Auto
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: H5i
CPAP Pressure: Auto CPAP 8-13
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: New Zealand

Post: #13
RE: [split] Question about ResMed S9 data
Thank you Vaugn,

What is the difference between the new 36037 model and the older 36007? From what i can find the difference might be just the PaceWave function. I can get the older one for a reasonaly price (1.5k), but would like to hear if that is a good idea in case that the new model with PaceWave has really improved a lot. I suppose the 36007 still has an ASV Auto Mode and similar in terms of noise and breath comfort? Thank you.
05-28-2013 10:28 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #14
RE: [split] Question about ResMed S9 data
(05-28-2013 10:28 PM)Nord Wrote:  What is the difference between the new 36037 model and the older 36007? From what i can find the difference might be just the PaceWave function. I can get the older one for a reasonaly price (1.5k), but would like to hear if that is a good idea in case that the new model with PaceWave has really improved a lot. I suppose the 36007 still has an ASV Auto Mode and similar in terms of noise and breath comfort?

Hi Nord,

No, the older 36007 model does not have the new "ASV Auto" mode. The 36007 has only two modes, basic "CPAP" mode plus the older "ASV" mode. In "ASV" mode the exhale pressure (EPAP) is set manually (as it is in "CPAP" mode), and the Pressure Support (which is the amount the pressure is boosted during inhale: EPAP + PS = IPAP) automatically self-adjusts to treat central events. This ability to auto-adjust PS is what makes it an ASV machine.

The newer 36037 model has the new "ASV Auto" mode, which of course auto-adjusts the value of Pressure Support to treat central events, plus, in addition, a range can be set for EPAP, and within this EPAP range "ASV Auto mode" will auto-adjust the exhale pressure (EPAP) to treat/prevent obstructive events (similar to how a VPAP Auto machine or AutoSet machine will auto-adjust EPAP to treat obstructive events).

Since I have the older 36007 model, I use a fixed 14 cmH2O EPAP to prevent obstructive events. For PS I use the range 6-11. For max pressure (max IPAP) I use 25. This allows PS to be automatically raised (when needed) up to 11 when treating/preventing central events. And the minimum value of 6 for PS makes it easy for me to breath and tends to help keep me well ventilated.

If I had the new 36037, I might set the EPAP range to 11-15, and the range for PS to 6-14. Since the mask vent noise would be lower at a lower pressure, the slightly lower pressure (for example, when operating at an EPAP of 11 instead of 14) would be a little more quiet (except when obstructive events may cause the EPAP pressure to be raised to 14 or 15).

I don't know whether breath comfort may be different/better or not.

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.
(This post was last modified: 05-29-2013 03:20 AM by vsheline.)
05-29-2013 03:01 AM
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OMyMyOHellYes Offline

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Machine: Respironics 560 Auto
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage FX
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CPAP Pressure: 08.0-15.0 cm/H2O
CPAP Software: EncoreBasic

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Location: Texas

Post: #15
RE: [split] Question about ResMed S9 data
(05-24-2013 01:20 AM)Nord Wrote:  Thank you all for your answers so far. Unfortunately all the gently used S9 Autoset from #2 have sold out by now.

Keep watching - and call them. Their inventory in any given machine moves up and down all the time as they are actively buying as a well as selling. The website may not reflect that. What they didn't have on Monday, they may have on Thursday or Friday. Maybe you could ask "when you get one of this model, can you call me?" Maybe they will or maybe they won't, but you can always call back and check availability at any time.

I bought from them and had a great experience. Got an S9 AutoSet for less than $500 (no H5i humidifier) and it had 32.2 hours on it (yes, only three nights!). I think they aim for less than one year usage when they buy machines, so some may have many more hours. Don't know what their absolute cutoff is to qualify as "gently used". I felt very lucky in my purchase.

OMyMyOHellYes
05-29-2013 06:12 AM
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Nord Offline

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Machine: Resmed S9 Auto
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Mask Make & Model: Mirage FX
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CPAP Software: ResScan SleepyHead

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Sex: Male
Location: New Zealand

Post: #16
RE: Question about ResMed S9 data
Hi,

I have tried to switch off EPR on my rented S9 Autoset, the result is a consistent increased AHI of above 5, consisting of CSA events and a large number of Hypopnea events (no OSA's). Many of the longer lasting CSA events (20-30 seconds) occur within minues after Hypopnea events. So I guess using EPR is the better option. But thank you Vaughn for the suggestion as it clarifies that a higher EPR value (e.g. lowered EEP for bilevel, ASV) would indeed be beneficial if I understand you correctly. Thank you all.
06-01-2013 03:03 AM
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zonk Offline

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Machine: A10 AutoSet
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Post: #17
RE: Question about ResMed S9 data
Why don,t you set the machine at CPAP mode and see how you get on with fixed pressure all night long
You can always go back to auto if the trial proved unsuccessful, its worth a shot
Its going to be a bit trial and error to find one optimum pressure to deal with obstructive apnea and not induce central apnea .. sort of compromise
CPAP mode allows you set EPR inhale @ fast or medium which is not available on AutoSet mode

I don,t use EPR but use Ramp, I find more comfortable to start at lower pressure before auto kicks in
06-01-2013 03:35 AM
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goodonya Offline

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Machine: S9 Vpap Adapt
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Other Comments: No longer know the new sleep study instead of a break out of percentage OSA and CSA simply says OSA

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Post: #18
RE: Question about ResMed S9 data
I am working on sending in for a manual. It says put exactly the right name that matches the list.

I have a Resmed Vpap Adapt Model number 36037

The list shows a ResMed S9 Vpap Adapt and way down the list it shows a ResMed S9 Vpap Adapt SV

Which do I have?
06-18-2014 03:52 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #19
RE: Question about ResMed S9 data
(06-18-2014 03:52 PM)goodonya Wrote:  I am working on sending in for a manual. It says put exactly the right name that matches the list.

I have a Resmed Vpap Adapt Model number 36037

The list shows a ResMed S9 Vpap Adapt and way down the list it shows a ResMed S9 Vpap Adapt SV

Which do I have?

Hi goodonya,

Actually, the one way down on the list does not have S9 in the name, so I think it may be for an S8 model.

In the body of your email request, say you have the newest model, so you need whichever manual was most recently published for the S9 VPAP Adapt.

I am not sure whether Apnea Board has the latest manual for your model, which I believe was first made in November 2012. The 2011 edition does not cover the new "ASV Auto" mode which your machine includes, in addition to the older "ASV" mode and standard plain "CPAP" mode.

Good luck,
--- 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.
(This post was last modified: 06-19-2014 04:49 AM by vsheline.)
06-19-2014 04:46 AM
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diamaunt Offline

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Machine: S9 VPAP Auto 36006
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Post: #20
RE: [split] Question about ResMed S9 data
(05-25-2013 06:01 AM)archangle Wrote:  [quote='Nord' pid='37062' dateline='1369376410']

"Do it yourself" treatment with an ASV machine is a lot harder than CPAP. You don't just push the "auto" button and expect it to find the right answer. You don't even do that with APAP, but ASV and CSA is a lot more complicated. It can be hard to get right, even if you have a caring, experienced sleep doc and RT.

ASV is also a lot harder for many people to adapt to.

that's actually pretty much what you do with a resmed S9 vpap adapt 36037... there's only four settings on it at any rate. you can raise the starting epap though.
06-19-2014 10:51 AM
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