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Resmed Airsense Auto BiPAP
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swwalden1 Offline

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Machine: Resmed Aircurve 10 Vauto
Mask Type: Full face mask
Mask Make & Model: Resmed Quattro Air
Humidifier: Resmad
CPAP Pressure: IPAP-12, EPAP-8, PS2
CPAP Software: SleepyHead

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Sex: Male
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Post: #1
Resmed Airsense Auto BiPAP
Long time sleep apnea patient. I started off 25-years ago with what by today's standards was a very crude CPAP, switched to a BiPAP in the late 1990s and most recently have been using a Resmed S8 BiPAP. The effectiveness of the therapy has been declining over the last couple of years and I have been waking up feeling less well rested and the classic dull headache. The S8 has limited data capabilities but for the last 6-months I have averaged AHI=25.9 and AI 8.2.

My machine was set at 5 and 11. I did some experimenting and found much to my surprise increasing the IPAP to 13 increased my AHIs to the low 30s and lowering it to 10 reduced my AHIs to about 17. AIs went down to 2.8.

I went to my sleep doctor with this rather crude data and he suggested I try a Resmed Airsense Auto CPAP for 5-nights. Last night, the first night, was terrible. The pressure went up to 20 and stayed there, which woke me up. Since I couldn't go back to sleep at that pressure, I restarted the machine but it immediately ramped back up to 20. So much for that.

Looking at the sleepyhead data, this machine ramped up to 12 before I ever had an event. Is this "normal"? I expected it to coast along a 4 until I had an event and then ramp up the pressure until the events disappeared. I know I can change the range from 4-20 to say 8 to 12, but is there any way to set the maximum pressure before an event occurs?
04-04-2015 08:32 AM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

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Sex: Male
Location: Калифорния

Post: #2
RE: Resmed Airsense Auto BiPAP
It is not just events that raise pressure. Snore and Flow Limitation are measured; and are precursors to obstructive apnea. Look at your data, and you'll likely see one or both occurred before a pressure increase.

Your original experiments with pressure on the S8 bilevel suggests you increased the split between IPAP and EPAP from 6 to 8. A large split can cause a person to expel too much CO2 and cause central apnea. The S8 likely cannot distinguish between a CA and an OA.

The answer to: "...is there any way to set the maximum pressure before an event occurs?" is no.

But, as you know you can narrow the therapy window. 4-20 is wide open. You can move up the 4 and move down the 20. But, this is a weeks experiment in finding a better pressure range for you. You need room at the top end to make it a valid experiment.

I wonder why your doc didn't give you a bilevel auto since you have been on bilevel. Like the AirCurve 10 VAuto. The PS (split between IPAP and EPAP) could be set to 6 and EPAPmin to 6; with IPAPmax at 20. I think it would have been a better test for you.

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04-04-2015 10:23 AM
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trish6hundred Offline

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Posts: 6,449
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: Resmed Airsense Auto BiPAP
Hi swwalden1,
WELCOME! to the forum.!
I'm not sure why your doc didn't put you on a newer bilevel machine.
Hang in there for more responses to your post and much success to you as you continue your CPAP therapy.

trish6hundred
04-04-2015 12:45 PM
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vsheline Offline

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Posts: 1,908
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: #4
RE: Resmed Airsense Auto BiPAP
(04-04-2015 10:23 AM)justMongo Wrote:  I wonder why your doc didn't give you a bilevel auto since you have been on bilevel. Like the AirCurve 10 VAuto. The PS (split between IPAP and EPAP) could be set to 6 and EPAPmin to 6; with IPAPmax at 20. I think it would have been a better test for you.

Another fine auto-adjusting bi-level machine is the Philips Respironics System One BiPAP Auto with Heated Tube. The PRS1 BiPAP Auto has a neat feature which the ResMed AirCurve 10 Auto does NOT have: Pressure Support can be set to a range and the machine will (very slowly) vary PS within the range to use only as much PS as is needed to avoid Flow Limitation. This can help to reduce the number of central apneas. (One type of CA is made more prevalent when PS is higher than necessary.)

But standard auto-adjusting bi-level machines like the BiPAP Auto or the AirCurve Auto cannot treat central apneas or hypopneas.

If the CA Index (number of CA per hr) is not improved so that your CAI is lowered below 5, I suggest you should ask for an ASV titration and an ASV machine.

Adaptive Servo Ventilator (ASV) machines are more expensive CPAP machines which have algorithms to treat both obstructive and central apneas and hypopneas.

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: 04-04-2015 07:02 PM by vsheline.)
04-04-2015 06:43 PM
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swwalden1 Offline

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Posts: 29
Joined: Apr 2015

Machine: Resmed Aircurve 10 Vauto
Mask Type: Full face mask
Mask Make & Model: Resmed Quattro Air
Humidifier: Resmad
CPAP Pressure: IPAP-12, EPAP-8, PS2
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #5
RE: Resmed Airsense Auto BiPAP
(04-04-2015 08:32 AM)swwalden1 Wrote:  Looking at the sleepyhead data, this machine ramped up to 12 before I ever had an event. Is this "normal"? I expected it to coast along a 4 until I had an event and then ramp up the pressure until the events disappeared. I know I can change the range from 4-20 to say 8 to 12, but is there any way to set the maximum pressure before an event occurs?

When I rechecked the Airsense settings, the minimum CPAP pressure was set at 10--not 4. The ramp begins at 4, so the machine should have ramped up to 10 not 12. All this happened in the first 5-minutes and I didn't see anything in the sleepyhead data to explain why it overshot the minimum pressure. I have reset the minimum to 6 and the max to 12 and I'll see what happens tonight
04-04-2015 07:30 PM
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vsheline Offline

Advisory Members

Posts: 1,908
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: #6
RE: Resmed Airsense Auto BiPAP
(04-04-2015 07:30 PM)swwalden1 Wrote:  When I rechecked the Airsense settings, the minimum CPAP pressure was set at 10--not 4. The ramp begins at 4, so the machine should have ramped up to 10 not 12. All this happened in the first 5-minutes and I didn't see anything in the sleepyhead data to explain why it overshot the minimum pressure. I have reset the minimum to 6 and the max to 12 and I'll see what happens tonight

Because you are accustomed to using bi-level therapy, I recommend setting EPR to its max (3) and enabling EPR "Full Time".

In order for EPR to operate at 3 fully, the Minimum Pressure must be at least 7, which is 3 higher than 4. (A pressure of 4 is the minimum pressure the machine will put out even when using EPR).

Except during the Ramp, the IPAP will start at whatever pressure you set for Min Pressure (I suggest a Min Pressure around 8 or 9), and your EPAP would be 3 lower than that (5 or 6).

You will not need the Ramp, so I suggest turning it off, but if you want to use the Ramp then the ramp Start Pressure must be at least 7 in order for the EPR of 3 to work fully.

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: 04-04-2015 09:52 PM by vsheline.)
04-04-2015 09:48 PM
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swwalden1 Offline

Preferred Members

Posts: 29
Joined: Apr 2015

Machine: Resmed Aircurve 10 Vauto
Mask Type: Full face mask
Mask Make & Model: Resmed Quattro Air
Humidifier: Resmad
CPAP Pressure: IPAP-12, EPAP-8, PS2
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #7
RE: Resmed Airsense Auto BiPAP
I reset the pressure to min-6, max-12, turned the humidifier up to 6, changed to a full-face mask and turned on the EPR at level 3. Slept for about 6-hours and felt OK except for slight dull headache. Sleepyhead reported AHI 6.47. I have never used a full-face mask for any significant periods of time in the 25+-years I have been on CPAP/BiPAP therapy. When I have used one for a night or two, my machines have reported very-high RRs. Last night was no exception with RR between 12 and 50. The Oximetry readings were--pulse rate between 30 and 70, no SpO2 levels below 90%.. I’m worried about the effects of the high RR on the study data, so tonight I’m going back to a nasal mask but adding a chinstrap. I’m also going to increase the max pressure to 13.
(This post was last modified: 04-05-2015 10:29 AM by swwalden1.)
04-05-2015 10:24 AM
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Crimson Nape Offline

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Joined: Oct 2014

Machine: ResMed S9 Autoset
Mask Type: Other
Mask Make & Model: P-10 / F&P Simplus / DreamWear
Humidifier: H5i w/Climateline
CPAP Pressure: 8 - EPR 3
CPAP Software: SleepyHead

Other Comments: CMS-50F & 50IW

Sex: Male
Location: Georgia

Post: #8
RE: Resmed Airsense Auto BiPAP
(04-05-2015 10:24 AM)swwalden1 Wrote:  I . . turned the humidifier up to 6 . . .

Unless you're using a heated hose be careful setting the humidity level to 6 as you apt to get rainout.

Statistics prove that people who have more birthdays live longer.
04-05-2015 01:04 PM
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vsheline Offline

Advisory Members

Posts: 1,908
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: #9
RE: Resmed Airsense Auto BiPAP
(04-05-2015 10:24 AM)swwalden1 Wrote:  I reset the pressure to min-6, max-12, turned the humidifier up to 6, changed to a full-face mask and turned on the EPR at level 3. Slept for about 6-hours and felt OK except for slight dull headache. Sleepyhead reported AHI 6.47. I have never used a full-face mask for any significant periods of time in the 25+-years I have been on CPAP/BiPAP therapy. When I have used one for a night or two, my machines have reported very-high RRs. Last night was no exception with RR between 12 and 50. The Oximetry readings were--pulse rate between 30 and 70, no SpO2 levels below 90%.. I’m worried about the effects of the high RR on the study data, so tonight I’m going back to a nasal mask but adding a chinstrap. I’m also going to increase the max pressure to 13.

What did the SpO2 do during times when the Respiration Rate was high? (If SpO2 was 94 to 96, perhaps there is no harm in the high RR?)

I recommend increasing Min Pressure to at least 7 or 8. You do understand why it is that when operating at a Min Pressure of 6 the machine will be producing a difference between IPAP and EPAP of only 2, even if the EPR setting is 3, right?

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: 04-05-2015 01:46 PM by vsheline.)
04-05-2015 01:36 PM
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swwalden1 Offline

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Posts: 29
Joined: Apr 2015

Machine: Resmed Aircurve 10 Vauto
Mask Type: Full face mask
Mask Make & Model: Resmed Quattro Air
Humidifier: Resmad
CPAP Pressure: IPAP-12, EPAP-8, PS2
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location:

Post: #10
RE: Resmed Airsense Auto BiPAP
(04-05-2015 01:36 PM)vsheline Wrote:  What did the SpO2 do during times when the Respiration Rate was high? (If SpO2 was 94 to 96, perhaps there is no harm in the high RR?)

I could very well be wrong, but it seems to me the depletion of CO2 would be a bigger concern than a drop in O2.

(04-05-2015 01:36 PM)vsheline Wrote:  I recommend increasing Min Pressure to at least 7 or 8. You do understand why it is that when operating at a Min Pressure of 6 the machine will be producing a difference between IPAP and EPAP of only 2, even if the EPR setting is 3, right?

Actually, I didn't understand. But I get it now, Thanks
04-05-2015 04:55 PM
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