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S9 VPAP ST in bilevel pap mode and epr?

I started cpap therapy last month after being diagnosed with very severe OSA (144 ahi).

Since then I have been struggling quite a bit with trying to get leaks under control and with aerophagia (sp?).

This past weekend my RT sent me a new mask - the AirFit F10. I was using mirage quattro which had a lot of leaks and would wake me up and I could only get a good seal by having the straps too tight. I think I am liking the F10 more but its more sensitive to movements and sleeping on my side, but I don't have to have the straps too tight to get a good seal. I am also using mask liners because if it does start leaking the sound wakes me up and once I wake up I cant go back to sleep easily because of my high pressures (bipap 20-24 cm h2o).

So now that I think I have the leaks under control with the new mask I am still suffering from swallowing air and burping and farting it out all night. I was looking through my manual and some other posts suggest trying the EPR setting on the machine to reduce the amount of swallowed air, however this can only be enabled from the clinicians interface (which I know how to access) but I am concerned I might void some sort of warranty or something and not have my insurance cover the machine if I alter the settings.

Should I just go ahead and try enabling EPR or should I not modify the settings?

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Welcome to the forum, BenHur
EPR is a comfort feature, does not void the warranty or insurance coverage, insurance only want to know if you,re using the machine in the compliance period

As you,re using S9 VPAP ST on such high pressure range, maybe talk to your sleep doctor about aerophagia issues and EPR adjustment
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Hi BenHur,
WELCOME! to the forum.!
You might talk to your doc about the problems you are having with aerophagia.
Using EPR won't void your warrranty, it's a comfort feature but hang in there and someone who knows the ins & outs of your machine will be along to help you, soon.
Best of luck to you with your CPAP therapy.
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Does S9 VPAP ST have an EPR? I would think that since it is bilevel it would not.

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(08-06-2014, 12:51 AM)PaytonA Wrote: Does S9 VPAP ST have an EPR? I would think that since it is bilevel it would not.

ResMed VPAP (bi-level) machines do not offer EPR because ResMed EPR would be redundant on a ResMed bi-level machine. ResMed EPR is a limited form of bi-level.

I suggest working with your doctor to see if your prescription can be lowered a bit at a time.

Usually obstructive sleep apnea varies strongly with sleep position. Usually, sleeping on our back requires much more pressure than when sleeping on our side. (By the way, usually it is also much worse during REM sleep stage, so the worst case is usually when we are in REM stage sleep while in the supine position.)

To lower my pressure needs I wear a snug teeshirt with a tennis ball in a pocket sewn right between my shoulder blades or a little higher. When I roll onto my back while asleep I wake up enough to keep rolling until I reach my other side.

You should ask for copies of the full reports (including data and event plots) for each of your overnight sleep lab visits. You have a right to have these for your own records.

Based on the lab titration report, which may show that your pressure needs are far lower when you are not sleeping on your back, if you take action to ensure that you will never roll into the supine position (flat on your back) while asleep, then your doctor may be able to greatly reduce both EPAP and IPAP, right away.

If you spent most or all the overnight lab titration sleeping in the supine position, such that the titration report does not have enough data to clearly show whether your pressure needs are much lower when sleeping only on your side, this would only mean you and your doctor would need to try lowering the prescribed settings a little at a time (perhaps lowering both EPAP and IPAP by only 1 cm H2O each week) and look at your SleepyHead reports or ResScan reports, to see if the AHI is staying low and perhaps the settings can be lowered even farther, as long as you have made sure that you will never be sleeping on your back.

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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(08-05-2014, 07:19 PM)BenHur Wrote: Should I just go ahead and try enabling EPR or should I not modify the settings?
I thought the Resmed S9 VPAP ST did not have an EPR setting in bilevel (VPAP) mode: The Resmed EPR algorithm acts very like the algorithm used to reduce the pressure from IPAP to EPAP on a Resmed S9 VPAP machine, but EPR is limited to a max of 3cm, whereas your VPAP is already reducing the pressure by 4cm on each exhalation.

Quote:... this can only be enabled from the clinicians interface (which I know how to access) but I am concerned I might void some sort of warranty or something and not have my insurance cover the machine if I alter the settings.
Changing the settings in the clinical menu won't invalidate the machine's warranty, but it may earn you a wet noodle whipping from the sleep doc or the DME.

A more serious concern, however is this: Before you change anything in the clinical menu, you need to know exactly what you are doing. And you need to know why you are doing it and what you hope to accomplish by making the change.

In your case: It's important that you don't change the mode the machine is set up to run in. In other words, if the only way to enable EPR is to change the machine from "VPAP S" or "VPAP ST" mode to "CPAP" mode, then you really should not make the change: You'll have less exhalation relief in CPAP mode with EPR = 3 than you do with your current settings.

Since aerophagia is an on-going issue, you should call the sleep doc's office. If your machine is running in VPAP S mode, it may be that decreasing the EPAP by 1-2 cm might help with the aerophagia, while not leading to an unacceptable increase in your AHI. If your machine is running in VPAP ST mode, it's worth asking whether the back up rate in the "T" part of ST mode is set correctly: If the machine's target BPM rate is too high, you may be swallowing air when the machine is (incorrectly) attempting to trigger inhalations.

Questions about SleepyHead?  
See my Guide to SleepyHead
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Thank you all for the great information!

I have contacted my RT already about the aerophagia and I sent them the SD card in the machine last week - they called me two days ago saying that they lowered the pressure and once I get the SD card back in the mail and put it in the machine the new settings will take effect.
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Great news .. did they tell you the settings so you could change them before you had to wait on the US Mail ??

When my doctor changed mine the DME insisted I mail or bring it in .. I told him I could do it myself and I wasn't going to bother driving 30 miles or send it in. I was told I couldn't .. it was at that moment I explained to him I was the customer and was very capable of doing so myself and all I would use him for was new equipment purchase. That any changes would be between myself and my doctor not him or I would go to a different DME. His tone and attitude change immediately. They didn't want to lose the business.

I am lucky in that there a number of DME's in and around where I live so changing would have be very easy to do .. and my insurance doesn't care who I go to.

He tried to tell me I wasn't capable and I explained to him I had the clinicians manual and was as versed as he was on the machine I had.
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