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Supposed to get S9 Elite, got S9 VPAP Adapt, Help with settings
#1
I wanted an S9 Autoset so that I could see what pressure I'd actually need rather than the fixed 8 that the sleep study provided. I am in the process of losing 50 lbs, so I think the number will change. Anyways, my Dr. refused to write a script for it saying my study wasn't done with an Auto CPAP so they only had 1 pressure to go on, so I at least got them to write me for an S9 Elite so I could get the data to look at. Today the DME shows up with an S9 VPAP Adapt, saying they were out of the Elite, and that this machine can be run in CPAP mode, so it's the same thing. Assured me it won't cost anymore, though I need to wait until the billing comes through. Assuming that it doesn't, how can I set it up like an Autoset? I've look through other threads, but don't quite understand how the Autoset min & max pressures would relate to the epap and ipap on this machine. For example, I was thinking I'd setup and Autoset at 5 or 6 to 11 (my old sleep study from years ago was 11), and turn EPR on, though this machine doesn't have EPR. What would I sep the EPAP and IPAP min & max to to get sinilar results? And would it be in ASV or AutoASV mode? (guessing AutoASV)

Thanks,
Scott
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#2
Boy, I want to see your DME.
The S9 Autoset will cost ~$800 the VPAP adapt ASV ~$3000.
I am about to make the switch and my insurance requires 20% copayment.
My DME is telling me the copayment will be based on a price of $14,000.
I am doing my titration sleep study tomorrow, so I probably won't know the bottom line until next week.
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#3
The DME is Univita Health, and I have not been impressed with them so far. Customer service said they'd bring out a few different nasal pillows to try, tech only brought ResMed Swift FX. He said they usually only bring the Go Life, which the reviews aren't great, but the FX felt good, so I guess I'm lucky. My doctor's office pushed them as DME, we shall see. My insurance requres $500 deductible, then 10% after on DME, so not like they are providing the stuff at no cost to me.
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#4
Hi scottuf,
WELCOME! to the forum.!
Hang in there for answers to your questions.
Best of luck to you.
trish6hundred
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#5
(10-14-2013, 11:14 AM)bwexler Wrote: Boy, I want to see your DME.
The S9 Autoset will cost ~$800 the VPAP adapt ASV ~$3000.
I am about to make the switch and my insurance requires 20% copayment.
My DME is telling me the copayment will be based on a price of $14,000.
I am doing my titration sleep study tomorrow, so I probably won't know the bottom line until next week.

My bottom line would be not to deal with your DME at all. 20% for 14,000 bucks is almost 3,000. If I had to "copay" that much, Id cut them out and purchase from the internet. Hope your sleep study turns out well!
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#6
I have already done that arithmetic. My plan is to allow the system to process everything down to the point where they ask me for money. If they still think they want the massive copayment I will talk to the DME, the medical group That says I must use them and the insurance company all simultaneously. If I am not satisfied with the outcome I will threaten a complaint to Medicare and the state insurance commission. If that doesn't move things in my direction, I do have an account at Supplier #1

(10-14-2013, 03:50 PM)Bobshouse Wrote: My bottom line would be not to deal with your DME at all. 20% for 14,000 bucks is almost 3,000. If I had to "copay" that much, Id cut them out and purchase from the internet. Hope your sleep study turns out well!

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#7
Man, you lucked out- that is the Cadillac of machines. Since your prescribed pressure is 8 set your minimum EPAP and Maximum EPAP
both to 8. Set pressure support to 0 and max pressure to 8 for a simple cpap setup. If later you want to use the great capabilities of the AUTO SV I could talk you through setting it up. Get the clinical manual first off.
You want the minimum and max to both be eight for cpap.
PM me if this is unclear or if I can help further. It's a great machine. I have the Respironics system one ASV that's a couple of years old and I love it. I do a lot of playing with the settings, but don't get into that until your doc knows you're straight up and compliant. Insurance wants compliance numbers or they won't pay.

If you want a simple auto setup in the meantime set min/max epap to 8, pressure support to 0/4 and max pressure to 12- this will give you a range of 8 to 12, just increase PS and max pressure for a wider range. Have fun and gloat a little. You did great!
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#8
Thanks for the info Skyler. I've got the manual, and it was actually setup with CPAP mode, so no need to use the initial settings you suggested. The fact it has a straight CPAP mode is how the tech said he could justify providing it. I'm going to sleep for a few nights, maybe a week to get some baseline numbers before playing with the auto mode, but that is definitly where I want to go. I'll use your setting to start, and try it out. One question though, if I set epap at 8, that wouldn't give any relief on breathing out like EPR or A-Flex would, so I was thinking of starting lower and let the machine decide. thoughts?

another question - what does the 8-12-20 mean in your pressures? I haven't seen 3 like that before.
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#9
You are correct that your exhale pressure will be the same as your inhale pressure with those settings.

[ Disclaimer: I don't have an S9 VPAP Adapt, so these suggestions are based on my third-hand understanding of its configuration. ]

To simulate an EPR of 3 with an inhale pressure of 8, set min EPAP and max EPAP to 5 (8 - 3) and Pressure Support (PS) to 3. In a Bi-Level machine, Pressure Support is the equivalent of EPR in that it is the difference between EPAP (exhale pressure) and IPAP (inhale pressure).

Note that lowering the exhale pressure has been known to affect the treatment efficacy, and might require raising the overall pressure levels. But your mileage may vary. Creating a baseline with a fixed pressure is a really good idea.

Edit: Apparently, there are different models with the same name (!), so you might have one where the Pressure Support value can vary as well. If so, set the min PS and max PS to the same value.
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#10
Well after a week in CPAP mode, my AHI was averaging 1.3, which I guess is pretty good. I setup the Adapt into AutoASV mode, EPAP 6-11, and PS 0-15 Sunday. Sunday night my AHI was 0.3, and last night it was 0.0! My EPAP on the two nights varied up to 8 and change (don't have the results with me), and IPAP up to 17, but that was only for a few events. Sleeping has actually been easier than in straight CPAP mode, and the high IPAP numbers never woke me up. Happy with the machine, and I'll adjust the values as needed as I get more comfortable with the mask and as time goes on. Just hope the DME doesn't decide to swap it out at some point. They seem to be confused thinking it is a permanent rental with no co-pay by me, while my insurance says it should be a 10 mo rental then I own after $500 deductible and 10% copay, but since DME hasn't filed a claim yet, I won't know for sure until they do.
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