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Sleep test results. What should I do, now?
RE: Sleep test results. What should I do, now?
Steven Wrote:
Dolla Bill,(time=1315272842) Wrote:I see the Oximeter Adapter. but where is the Oximeter?
You can buy the adapter and the Oximeter as a package.

Watch the video.
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RE: Sleep test results. What should I do, now?
Dolla Bill Wrote:Thanks, Steven, saw the video. I have a Dr ready to write prescription. I talked with my primary care Dr yesterday on the phone and told him of the test results and that I had a "constant pressure" machine. He immediately said, "That won't work properly. You MUST have a variable pressure machine!" He understands and is ready to write a script.

I want to be sure and I am going for Product numbers so there can be no substitution.

I have talked with ResMed USA (San Diego - customer service and tech support +1 (800) 424-0737. Their response was immediate, zero hold time) They gave me the product numbers below.

It seems the Oximeter pack is not carried by ResMed USA, nor is the ResMed Power Station (Lithium battery 24v specific to Australia)

Here is what I have for my list right now:

1. ResMed S9 AutoSet - 36005 If you are ordering the humidifier with the cleanable tub, order the humidifier separately, not the S9 Autoset/Humidifier package.

2. H5i humidifier - cleanable water tub 36901

3. Climateline heated tubing - 36995 Does not need the tubing wrap

4. DC converter - 36970 Plugs into automobile cigarette lighter.

5. Battery cable adapter - 22006 allows the converter to attach to a battery

6. S9 Card reader - 36931 May be only available to clinician. Tech support suggested it may work better than generic. Generic card readers may need drivers that support the SD card as programmed by the S9.

This may be answered elsewhere on this Forum, but Tech Support suggested that it was important to use a Marine Deep Cycle Battery instead of an auto battery. The Auto Battery is made to deliver a surge of power then minimal power to run the engine. It is not designed to be fully discharged and recharged. Doing this will shorten the batteries life.

Thanks again, everyone for your very kind assistance in guiding me and helping me know my rights and who to ask and how to get the equipment I need.

I am fully committed to this therapy and if necessary, am prepared to buy whatever I should have in the remote event my insurance fails to support me in any area.

I also hope that my posts and focus -- guided by the many helpful and much more knowledgeable forum members here -- can help others design their own path to taking control of their therapy and their lives!

Will post again with my progress.

Very kind regards,
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RE: Sleep test results. What should I do, now?
Steven Wrote:Your input is certainly helpful to others & is worth the whole Dolla Bill !

Please do keep us posted with your progress - especially your insurance company's coverage.

Did ResMed suggest where you might acquire the Oximeter package?
Or, did you decide not to purchase that?
I am curious what the insurances reaction would be to someone trying to get that Oximeter package - because I am considering attempting just that.
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RE: Sleep test results. What should I do, now?
Dolla Bill Wrote:ResMed USA says they don't have a product number for the Oximeter package. Possibly it is only available to clinicians. I asked for the ResMed S9 card reader for example and they said it was only available to clinicians.

They also do not show product numbers for ResMed products outside USA, so it could be listed somewhere else.

If you find a way of making this happen, please let me know.

Sending you a PM with a link to another Oximeter. Don't think I should post here. Forum rules?
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RE: Sleep test results. What should I do, now?
Steven Wrote:Sorry, but I am no Oximeter expert since I have never used one privately.

I think you should start a new thread on Oximeters.
You would get more responses that way.

Also, see # 19 on the list of Suppliers at the link below.
I "believe(?)" that most people who buy oximeters get them there.

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RE: Sleep test results. What should I do, now?
Dolla Bill Wrote:Got the S9 Autoset yesterday with Climatline tubing. Viewed the video on setting it up. This is an amazing machine!

Some questions,

1. I can set tubing temperature, for cold or warm ambinet temperature. Manual suggests 80 degrees F. When would I want to change this? I usually sleep about 70 degrees.

2. Ramp is supposed to be set at "the time you need to go to sleep." This sounds easy, but who can tell how long it takes? I am set at 5 minutes and seems ok.

3. Don't see how this matters much, but since I use a ResMed Nasal Swift FX, should the S9 be set for "Nasal" or "Nasal Ultra"?

4. AHI is showing 1.4! This seems VERY good. However with a full face mask during the "Sleep Test" my AHI was 11.8. Could something be off. somewhere?

5. Central Apnea is showing 0.7.

6. Mask is showing good, with Leak: 30.0L/min (??)

7. I am showing "Run hours 7.4" with a "Usage 5.4" What does this mean?

8. Showing "Pressure for night 10.4". Min at 8, max at 12. Does the min and max mean much? Video says set at 4/20.

Thanks in advance,
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RE: Sleep test results. What should I do, now?
Steven Wrote:I will let those who actually have a ResMed S9 AutoSet answer your specific Questions.

But I am an opinionated person, so here are my opinions on a couple of your Questions.

No. 1
I would use the ClimateLine Hose in "automatic" mode.
Let the technology do the actual work.

No. 2
Ramp is a "comfort" feature & some people (me included) do not use it at all.
If you do not have any problem falling asleep with the pressure, I would turn Ramp off completely.
If you do want to use it, then you do have to estimate how long it takes you to fall asleep. 5 Minutes seems short. I would go for 10 to 15 minutes.

No. 4
Means your therapy is working.
Anything below 5 is great. Yours is excellent!

No. 6
That seems high to me.
The machine "excludes" the "vent" leak, so that leak is all an actual leak.
If your leak rate is too high, the stats may not be accurate.

No. 7
Run Hours is the number of hours the machine actually ran.
Usage hours is just that - the number of hours it was used.
In just 1 day, the machine ran 2 Hours MORE than you used it.
Could be some DEMO time in there. Did the DME set up the machine for you?

No. 8
There are two schools of thought on the pressure range.
Some use a wide pressure range. Others use a small pressure range.
Your pressure range is small but seems to be working, so don't @%$ with perfection.
My intent would be to set my pressure range 3 below to 3 above my current straight CPAP range.
I would NEVER set "MY" pressure range from 4 to 20 (the outer limits of your S9)
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RE: Sleep test results. What should I do, now?
Dolla Bill Wrote:Steven, thanks for your response.

1. The Climateline tubing is in automatic mode, but there is a setting there where the temperature can be varied. Wonder if I should get it close to room temperature?

2. "Ramp" setting of 5 minutes was short for me. Reset it to 15 minutes.

4. The second night was a bit higher, AHI at 3.0. Average for both nights at 2.1. Still Excellent.

6. The "Leak" is still at 30..0L/min. The S9 has a "mask test" mode where you check to see if the fit is acceptable as far as leaks. This test showed "Good", a green Smiley. "bad" is a red Smiley. So the "leak" does not seem to be affecting performance. I do have the S9 set for "SmartStart (starts when you put on the mask and stops when you take it off, like for a bathroom break in the middle of the night). Curious, but not worrying about this.

7. You are correct. A DME did set this up, so that may be why the "run hours" is different from the "Usage Hours."

8. The DME asked me what pressure range the Doctor had wanted. Pressure range is an important consideration because this requires an autoset. A constant pressure machine can't do a range. (As I understand it.) If you want an autoset it is very important the you make sure a pressure range is indicated on your prescription!

I had asked for 8/12. After watching the S9 Video, they suggested 4/20 settings. Last night it felt a little strong, but not sure the pressure range matters that much because the S9 apparently sets the pressure for you according to some feedback it gets about your AHI and what pressure is best for your AHI event. Mine is showing it was an average of 10.4. Best I can tell, the S9 set itself for this pressure.

Folks, please understand that I am new at this and double check, by doing a search, on information I am presenting.

For the last few months, when I was not using a cpap, I was developing a dread of going to bed. Now I feel good about it. Perhaps subconsciously I knew that sleep, instead of being refreshing and renewing, was dangerous without the CPAP to help me breath properly. Now I am excited about going to bed!
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RE: Sleep test results. What should I do, now?
Misguided Wrote:You sent me scrambling for my machine....I don't recall seeing the "Nasal Ultra" option before.

The leak is still high, IMO, despite the smiley face. I typically run 4.8 or lower. Perhaps your mask is too snug?

I also have mine set at 8/12. My typical pressure is less than 9, so that's fine. Your average is higher, so you might be better off with a slightly higher max, like 13 or 14. Best thing to do would be to look at your data after a few more days and see if you are actually hitting the cap or not.
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RE: Sleep test results. What should I do, now?
Bill, just to add a bit more... there are two philosophies on operating Auto-CPAPs... first is the "wide-open" method (pressure set for the machine's limits with a range of 4-20 cm/H20)... second is the belief that "tightening up" the pressure range settings will provide an overall lower AHI over time.

I used to be a believer in the first suggestion, but I'm moving more toward the camp that uses a smaller pressure range. Certainly there is room for a compromise position as well.

The idea for the smaller range of pressures is that the CPAP algorithm can operate more effectively within a tighter range of pressures than it can in "wide open" mode. I don't pretend to understand why that is the case, but I have seen personal evidence that it seems to work that way - at least for me.

My titrated pressure during my sleep study was 14 cm/H20. I currently have my S9 AutoSet at a "compromise" setting, between 11.6 and 18 cm/H20. This seems to provide an overall lower AHI for me. When I was running it "wide open" my AHI was around 3.5 to 4.5 or so... after I messed around with my settings, I eventually found the best range for me, which has lowered my overall AHI to a 2.0 to 3.0 average... can't seem to get much below that for some reason, no matter how I adjust the ranges.

I will say that you need to look at your AHI primarily when making pressure range adjustments - if you're closing in on an AHI lower than 2.0, then that's pretty good. It's a scientific process of controlled experimentation. You might get some ideas from this page - it deals with setting pressures on a constant-pressure CPAP, but many of the concepts apply to Auto-CPAPs as well. Also applicable is this page, which talks about the benefits of Auto-CPAP machines.

It will help reduce your AHI if you solve the mask leak issue. The leaks will definitely negatively influence your treatment effectiveness. Once you get those leaks down below 20 or 25 at a minimum (preferably below 10), then you'll have a bit more confidence that the machine is providing the best possible pressures to reduce your AHI.

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