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just got my resmed S9 VPAP auto today, looking for setup advice
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space45 Offline

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Post: #1
just got my resmed S9 VPAP auto today, looking for setup advice
this is my first machine, watching the vids and looking at the manuals to see what needs doing for setting this machine up for use. I bought it direct from a online supplier so I have to set it up and program it for my use, no help from any local pros. hope I get it all setup right and not forget anything.

is there any setup check list for guys that have to do everything them selves?
would hate to forget something or mess up setting this thing up for best results.
sure hoping this thing make a big difference as to how I feel.

not sure what settings to start with, any help on starting settings for a vpap?

thanks
Stan
(This post was last modified: 03-28-2014 03:33 PM by space45.)
03-28-2014 03:14 PM
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justMongo Offline

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Post: #2
RE: just got my resmed S9 VPAP auto today
I am using that machine -- but in "S" mode.
It has 3 modes, Auto, S (Spontaneous) and CPAP.
CPAP is fixed pressure, and you can set an EPR.
S mode is a bilevel with two fixed pressures.
Auto allows one to set a max IPAP, min EPAP, and EPR and it will hunt for what it considers best pressure.

Sorry you don't have a sleep study to give you a starting point for pressures. I would not be comfortable suggesting pressures for you.

I suggest you get the clinician manual for the S9 VPAP series.

If you decide to run in S mode, easy breathe must be set to ON to get apnea types scored; and flow limitation and snore data.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-28-2014 03:40 PM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
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Post: #3
RE: just got my resmed S9 VPAP auto today, looking for setup advice
(03-28-2014 03:14 PM)space45 Wrote:  this is my first machine, watching the vids and looking at the manuals to see what needs doing for setting this machine up for use. I bought it direct from a online supplier so I have to set it up and program it for my use, no help from any local pros.
Do you have a copy of the script that allowed you to purchase the machine? If so, what's the script say about pressure settings?

Are you currently using a PAP machine of any sort? If so, what are it's settings?

My first suggestion is to read through the entire Clinical manual paying special attention to the set up section. Post specific questions about anything that confuses you in the Clinical manual.

In particular, the therapy settings are going to be:

Mode: CPAP, VPAP S (fixed bi-level pressures), and VPAP Auto (automatically adjusting bi-level pressures)

Assuming you bought this for VPAP S or VPAP Auto mode, you'll have some or all of the following things to set:

EPAP (or min EPAP)
IPAP (or max IPAP)
PS (perhaps only in Auto mode)

EasyBreathe --- this should be set to ON or Med instead of Off or Fast so that the machine records all the data; it also controls how the pressure transitions between IPAP and EPAP and most people prefer EasyBreathe being on (or med) to off or fast.

There may also be settings for

Ti Min
Ti Max

These control how long the machine is allowed to stay in IPAP pressure. You want Ti Min to not be too long or the pressure won't go down to EPAP reliably when take a very short inhalation before exahaling. You also want Ti Max to not be too short, or the pressure may go down to EPAP before you finish inhaling. My guess is that you should stick to the default values for these unless your script specifically says something about how to set these. Or until you actually run into problems.

You also want to make sure that Sleep Quality is set to ON instead of Usage (the default is Usage). If Sleep Quality is not set to On, the machine won't record any data except for usage data.

There's also a mask setting that needs to be set to the correct type of mask you are using so that the machine knows how to adjust the reported leak rate in the leak data.

And then there are the comfort settings: The humidifier setting is totally up to you, as is the temperature of the heated hose if you are using one. The beginning ramp pressure and the ramp time are also up to you to decided based on comfort.
(This post was last modified: 03-28-2014 05:23 PM by robysue.)
03-28-2014 05:12 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

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Post: #4
RE: just got my resmed S9 VPAP auto today, looking for setup advice
(03-28-2014 05:12 PM)robysue Wrote:  Mode: CPAP, VPAP S (fixed bi-level pressures), and VPAP Auto (automatically adjusting bi-level pressures)

Assuming you bought this for VPAP S or VPAP Auto mode, you'll have some or all of the following things to set:

EPAP (or min EPAP)
IPAP (or max IPAP)
PS (perhaps only in Auto mode)

EasyBreathe --- this should be set to ON or Med instead of Off or Fast so that the machine records all the data; it also controls how the pressure transitions between IPAP and EPAP and most people prefer EasyBreathe being on (or med) to off or fast.

There may also be settings for

Ti Min
Ti Max

These control how long the machine is allowed to stay in IPAP pressure. You want Ti Min to not be too long or the pressure won't go down to EPAP reliably when take a very short inhalation before exahaling. You also want Ti Max to not be too short, or the pressure may go down to EPAP before you finish inhaling. My guess is that you should stick to the default values for these unless your script specifically says something about how to set these. Or until you actually run into problems.

You also want to make sure that Sleep Quality is set to ON instead of Usage (the default is Usage). If Sleep Quality is not set to On, the machine won't record any data except for usage data.

My experience with this machine is EasyBreathe is either ON or OFF. But, I have only used S mode. EasyBreathe will gray out the rise time setting (time for pressure rise from EPAP to IPAP.)

Ti min defaults to 300 msec. Ti max defaults to 2 sec.
As per the manual.

I believe sleep quality on/off only affects the display in the LCD window -- not the recording of data on the SD card -- but, I have not run mine with it off. If off, when you push the info button in the morning, it will not display the AHI.

In bilevel, there are the trigger and cycle sensitivities. They control the trigger to IPAP; and the cycle to EPAP.
They default to med (medium.) They have 5 levels of sensitivity.

space45 -- please read the clinician manual to acquaint yourself with the settings and their definitions.
You are pretty much on your own without an Rx to give you a starting point.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 03-28-2014 06:26 PM by justMongo.)
03-28-2014 05:49 PM
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space45 Offline

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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: H5i Heated Humidifier
CPAP Pressure: hope to find out soon
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: B.C. Canada

Post: #5
RE: just got my resmed S9 VPAP auto today, looking for setup advice
I have no RX or script for the machine, I have been evaluated and a Doc did read/ look at my one nights data from a finger o2 and hart rate sensor recorder, and give his findings, but as of now no over night at a real sleep clinic. I live in B.C. Canada and they seem not to worry about the need for scripts and such, I could have bought locally at 2 places with out any script.

I now have my own o2/ hart rate data recorder.

the place that did the in home over night test and then week long tweaking just tried to sell me a machine but did not give me any data as to what pressure they would want to run at. I had a machine here for about a week and they kept tweaking it till they were happy with the readings. they ran it in CPAC mode and used a cell phone unit to talk to it and tweak the settings based on how I answered questions, it did not appear they had any data as to what was going on through out the night. the machine did not seem to capture data and send it to them, not sure why they would not use such a machine, but it appeared they did not.

thanks for the help and feed back
03-28-2014 10:19 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
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Post: #6
RE: just got my resmed S9 VPAP auto today, looking for setup advice
See if they will give you the settings they settled on.
You need some place to start. I'm not familiar with Canada's National Health System.
If I understand your last post, they remotely adjusted the trial machine; but, only based on the question:
"How do you feel?"

Sure seems like they left you in a spot. Sorry, but treatment pressures are something I'm not qualified to suggest.
As they say in Aviation when the tower cannot see you, "Takeoff is at your risk."

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
03-29-2014 08:10 AM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
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Post: #7
RE: just got my resmed S9 VPAP auto today, looking for setup advice
(03-28-2014 10:19 PM)space45 Wrote:  the place that did the in home over night test and then week long tweaking just tried to sell me a machine but did not give me any data as to what pressure they would want to run at. I had a machine here for about a week and they kept tweaking it till they were happy with the readings. they ran it in CPAC mode and used a cell phone unit to talk to it and tweak the settings based on how I answered questions, it did not appear they had any data as to what was going on through out the night. the machine did not seem to capture data and send it to them, not sure why they would not use such a machine, but it appeared they did not.
Sounds to me like they talked to you as well as the machine. My guess is that the machine did record data, but they didn't tell you how to access any of it.

It's a real shame they would not share with you what setting they finally settled on. It sure would save you some time and trouble if you knew what pressure they were going to recommend.


Quote:I have no RX or script for the machine,
Then the best thing to do is probably set the machine up in a wide open VPAP Auto mode for a while and watch the data to see where the machine thinks the pressure should go.

As an initial set of pressure settings, I'd try something like:

Min EPAP = 4
Max IPAP = 20 (or 25)
PS = 3 (or 4)

I'd leave the Ti Min and Ti Max at their default values.

You'll start off with an IPAP = 7 (or 8) and an EPA = 4. The machine will be allowed to increase the pressures al the way to 20/17 (25/21) if necessary. You'll need SH or ResScan to make sense of the data. After about a week of data, you will be able to use the pressure data and the AHI data to get a better sense of what the Min EPAP and Max IPAP should be set at. And depending on your comfort, you may also get a sense of whether you will want to switch to CPAP or VPAP S mode at the end of the autotitration week.

Quote:I now have my own o2/ hart rate data recorder.
You may also want to use these during the week of autotitration to give you further insight into whether or not a given pressure level is high enough to control your apnea.
03-29-2014 09:20 AM
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space45 Offline

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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: H5i Heated Humidifier
CPAP Pressure: hope to find out soon
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: B.C. Canada

Post: #8
RE: just got my resmed S9 VPAP auto today, looking for setup advice
after my first night with a S9 VPAP auto machine
my resmed machine says my AHI is 4.8 my small wrist o2 recorder says my AHI is 1.42, thing is last night my o2 did go down to 56% when sleeping on my back but averaged 89% one point above the 88% min for the night

my wist machine was reporting a AHI from 72 to 87 range over several nights before getting the VPAP machine, so going down to 1.42 is good.

looks like the beginning of the night was some what wild according to the VPAP report but did settle down during the night. I did try sleeping on by back so that may account for the wild start to the night, it was also during that time that the wrist unit recorded the 56% o2 level low, so sleeping on back is not the way to go for now. before VPAP my wist unit would report that towards the end of the night to be the wildest part of the night.

I used most of the default settings of the VPAP, including the high of 25 for max pressure, the data shows the machine pressure going to 21 for a very brief time but hitting close to 19 somewhat often.

one VPAP event had a obstructive rating of 97, not sure what that means

so what should I be looking at and what should I be changing for setting on the VPAP?

thanks again for all the help
(This post was last modified: 03-29-2014 06:36 PM by space45.)
03-29-2014 06:34 PM
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vsheline Offline

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Post: #9
RE: just got my resmed S9 VPAP auto today, looking for setup advice
Hi space45, welcome to the forum!

ResMed selection guide says your machine is their optimal machine for treatment of Obstructive Sleep Apnea.

(03-29-2014 06:34 PM)space45 Wrote:  after my first night with a S9 VPAP auto machine
my resmed machine says my AHI is 4.8 my small wrist o2 recorder says my AHI is 1.42, thing is last night my o2 did go down to 56% when sleeping on my back but averaged 89% one point above the 88% min for the night

An oxygen saturation percentage (SpO2) of 56% is very low, and may indicate it is especially important for you to stay off your back. If it keeps dropping below 88%, be sure to keep your doctor informed.

I have an increased number of obstructive apneas when sleeping in the supine position. I wear a snug teeshirt with a tennis ball in a pocket sewn high on my back, between my shoulder blades. Works really well to keep me off my back.

What was the Pressure Support (PS), the difference between EPAP and IPAP, set to?

Increasing the Pressure Support (PS) will tend to push your average SpO2 higher. But on some people who (like me) tend to get central apneas, too much PS tends to cause excessive central apneas. I think central apneas are not more worrisome than obstructive apneas, especially if short (20 seconds or less), but both central and obstructive apneas or hypopneas will tend to cause arousals leading to poor sleep quality.

I've read that a good target range for SpO2 is about 94 to 96, or a little lower if asleep. If the SpO2 is 97 and above for long periods, this may be too high and may cause health problems.

(03-29-2014 06:34 PM)space45 Wrote:  my wist machine was reporting a AHI from 72 to 87 range over several nights before getting the VPAP machine, so going down to 1.42 is good.

If I may ask, what manufacturer and model of wrist oximeter are you using?

(03-29-2014 06:34 PM)space45 Wrote:  I used most of the default settings of the VPAP, including the high of 25 for max pressure, the data shows the machine pressure going to 21 for a very brief time but hitting close to 19 somewhat often.

If the pressure is going that high, it might have been primarily because you were sleeping on your back, and staying off your back may allow pressure to stay much lower.

Nonetheless, I suggest raising your minimum EPAP from the default value of 4, up to 6 or 8 if not uncomfortable, unless 6 or 8 is very close to your median EPAP pressure.

Actually, a few people find they do best with their Minimum EPAP just a fraction of a cm H2O below their median EPAP pressure, but I think most prefer it at least 1 or 2 cm H2O lower.

If staying off your back allows the EPAP pressure to stay most of the time at the Minimum EPAP setting, then I would suggest the Minimum EPAP setting can be lowered for greater comfort but I suggest not lowering it to less than 2 cm H20 lower than your median EPAP pressure.

Usually not good to set the Minimum EPAP pressure setting a lot lower than your median EPAP pressure. The ResMed AutoSet algorithm treats the Minimum EPAP setting as a target EPAP which it slowly tries to get the EPAP back to (when not having obstructive events). If the Minimum EPAP setting is way too low, the machine will tend drop the pressure too quickly, leading to more obstructive events and lower sleep quality.

By the way, one cm H2O is a very small amount of pressure. It takes about 72 cm H2O to make one pound per square inch (psi) of pressure.

(03-29-2014 06:34 PM)space45 Wrote:  one VPAP event had a obstructive rating of 97, not sure what that means

On ResScan plots, apnea events are labeled with their length in seconds. An apnea event lasting 97 seconds would be very long, indeed. Hopefully keeping off your back while asleep will prevent long events.

(03-29-2014 06:34 PM)space45 Wrote:  so what should I be looking at and what should I be changing for setting on the VPAP?

As mentioned above, you may be able to adjust PS to optimize your SpO2.

Also, it is important to note the Central Apnea Index (CAI), the average number per hour of central apneas or clear airway apneas, compared to the Apnea Hypopnea Index (AHI).

If someone's CAI is higher than 5, and if the CAI is more half of the AHI, I think that person would benefit from an Adaptive Servo Ventilator (ASV) class of CPAP machine. But I think that does not apply in your case, so I think you have the best machine to treat your Obstructive Sleep Apnea.

I use ResScan to zoom in and look closely around the times of my apnea events, looking at the High Rate Pressure plot and (especially) the Flow plot, to verify an actual apnea did happen, and to see its duration. (Interruptions in breathing which do not last at least 10 seconds are not reported and do not count as official apneas.)

It is not unusual for us to require months of treatment before we are able to adapt to therapy well and for excessive daytime sleepiness to no longer be a problem.

Take care,
--- Vaughn


ADDED: I see that in my post above I have mixed long term suggestions with short term ones. My only short term suggestion would be to raise the Minimum EPAP if it is obviously way lower than the median EPAP pressure your machine automatically adjusts itself to, and only if raising the Minimum EPAP would not be uncomfortable.

At this point it is most important that the machine settings are comfortable enough that you will be able to use the machine whenever sleeping or napping, and to gather information to form a baseline for future adjustments. Adjusting the Pressure Support would be a long term task, not for the present.

Below, robysue has provided excellent advice, as always.

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: 03-30-2014 04:05 PM by vsheline.)
03-30-2014 06:52 AM
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robysue Offline
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Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #10
RE: just got my resmed S9 VPAP auto today, looking for setup advice
(03-29-2014 06:34 PM)space45 Wrote:  after my first night with a S9 VPAP auto machine
my resmed machine says my AHI is 4.8 my small wrist o2 recorder says my AHI is 1.42, thing is last night my o2 did go down to 56% when sleeping on my back but averaged 89% one point above the 88% min for the night
Several comments:

1) Not everybody desats with every apnea/hypopnea. That may explain the discrepancy between the two numbers.

2) If you were awake for significant periods of time, the S9 might have misscored some perfectly normal WAKE breathing patterns as examples of sleep disordered breathing.

3) While the 56% O2 reading is definitely a concern, it's also possible that it's just an artifact---the sensor could have slipped significantly for a bit. How often was your O2 really low? And for how long?

4) Are you able to correlate the O2 drops with the respiratory data from the machine?

Quote:my wist machine was reporting a AHI from 72 to 87 range over several nights before getting the VPAP machine, so going down to 1.42 is good.
While this is good, keep in mind that one night does not a trend make. Let's hope the numbers stay good. And there's good reason to believe that they will stay good.

Quote:I used most of the default settings of the VPAP, including the high of 25 for max pressure, the data shows the machine pressure going to 21 for a very brief time but hitting close to 19 somewhat often.
I know there are people who are already telling you to increase the pressure. And that may indeed need to be done. But I would recommend getting a full week's worth of data with the machine set wide open (the default settings) before changing the pressure settings. Again, one night does not a trend make.

Quote:so what should I be looking at and what should I be changing for setting on the VPAP?
For now you're just gathering data.

After a week, the data you will want to look at carefully in order to determine what setting(s) to change and what to change them to include:
  • The 95% pressure level.
  • The AHI
  • Whether there seems to be clustering of events, when the clustering happens and what the pressure has to get up to before the event clusters start to resolve. This requires looking at event tags superimposed on the wave flow data at the same time you are looking at the pressure curve.
  • The median and 95% leak rates, along with the leak curves. You're mainly looking for how much time you spend with a leak rate AT or ABOVE 24 L/min.
And then there's some data that you can't get from the machine that's also important:
  • How do you feel when you wake up in the morning?
  • How well do you feel during the daytime?
  • Are you having any trouble getting to sleep with the machine or staying asleep with the machine?

Once you have a week's worth of data, then it's time to figure out where to go based on that data.
03-30-2014 10:10 AM
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