Quick help please --S9 VPAP Adapt or Respironics auto Bi SV?

[DeepBreathing]

In my experience the S9 VPAP Adapt is noisier than the Respironics, though there's not much in it. In both cases SWMBO can't hear it so that's the main thing.

[jcarerra]

Well this afternoon I picked up an S9 elite and I will run it later to see if I think it is any noisier than my PRS1 but honestly I don't think it is based on my quick test.

And yes, FL is in the USA but trust me we're just too far or I'd invite you over

I think you will find it to be the reverse; the Elite will be quieter than the PRS1.

[Galactus]

Well this afternoon I picked up an S9 elite and I will run it later to see if I think it is any noisier than my PRS1 but honestly I don't think it is based on my quick test.

And yes, FL is in the USA but trust me we're just too far or I'd invite you over

I think you will find it to be the reverse; the Elite will be quieter than the PRS1.

Yah, that was what I meant. I'll download a sound meter app for my phone, and try and get back to you as soon as I can with what noise they each make.

You know I also noted that the PRS1 has a larger hose diameter than the the S9 and the air ports are bigger.

[jcarerra]

...You know I also noted that the PRS1 has a larger hose diameter than the the S9 and the air ports are bigger.

I had missed that. I thought hose dia was standard and there were two standard sizes.

[jcarerra]

News...
I was able to pick up the S9 VPAP Adapt SV yesterday afternoon and used it last night.
So much to say, but straight to the real important stuff...

Settings
min/max EPAP 9/15
min/max PS 4/15
^^only real settings this machine has.

Results--
I did still have one of my 'thick' clusters of events, about a 45 min one; would have been longer, but I woke up.

The SV did not 'solve' it. It went to max 25 cm pressure throughout much of that period, but the apneas looked same as always--even a bit longer than typical (several 45-48 sec).

I am flustered, to say the least; can't increase the pressure.

Also, in statistics, it did not differentiate obstructive vs. centrals like the Elite did. Wow.

Also, I got a Quattro original mask (with the forehead piece) since I strongly suspected the Quattro FX I have been using would not hold the pressures I knew would be coming. EXTREMELY UNCOMFORTABLE across the bridge of the nose--felt like the hard plastic was digging in; dent this morning, and deeper ruts along the vertical sides as well.

[vsheline]

But they did say that I could change to RS1 in a month if this one does not work well for me.
^^ important

So I guess I will start with this S9 even though I really want the other settings to tweak the 'comfort' things, which it does not have.

Hi jcarerra,

Sounds like a great opportunity to try both, if the VPAP Adapt doesn't do the trick.

Oh, I forgot to mention about the S9SV...it has NOTHING whatsoever in the menus about backup ventilation rate. Nothing.

In my view, the S9 VPAP Adapt is a "one size fits most" type of machine. Most things are automatic (such as the Backup Rate, Rise Time, Trigger and Cycle).

The PRS1 autoSV has more settings which, if misadjusted, definitely can cause misery. If adjusted optimally, would they cause bliss? Not necessarily, I think, and no doubt some would still prefer one versus the other.

News...
I was able to pick up the S9 VPAP Adapt SV yesterday afternoon and used it last night.
So much to say, but straight to the real important stuff...

Settings
min/max EPAP 9/15
min/max PS 4/15
^^only real settings this machine has.

Results--
I did still have one of my 'thick' clusters of events, about a 45 min one; would have been longer, but I woke up.

The SV did not 'solve' it. It went to max 25 cm pressure throughout much of that period, but the apneas looked same as always--even a bit longer than typical (several 45-48 sec).

I am flustered, to say the least; can't increase the pressure.

Also, in statistics, it did not differentiate obstructive vs. centrals like the Elite did. Wow.

Also, I got a Quattro original mask (with the forehead piece) since I strongly suspected the Quattro FX I have been using would not hold the pressures I knew would be coming. EXTREMELY UNCOMFORTABLE across the bridge of the nose--felt like the hard plastic was digging in; dent this morning, and deeper ruts along the vertical sides as well.

Are your "clusters" Cheyne-Stokes Respiration (CSR)?

If you are sleeping flat on your back, can you sleep on your side?

The ResMed Forced Oscillation Technique for distinguishing OA versus CA takes about 4 seconds, and the machine will respond in the same way whether the apneas are CA or OA, so taking the time to distinguish CA versus OA would only delay response to the apnea without changing the type of response. I think this is probably why the ResMed ASV machine does not take the time to distinguish CA from OA.

When I was using the Mirage Quattro for several years, I found I needed a gel nose pad to protect my nose bridge from developing an open sore. TheResMed Gecko is thicker and is I think the best of the nasal gel pads which various manufacturers offer. For me it does a good job at stopping leaking around the eyes and allowing the forehead adjuster to be adjusted more loosely, so the nose bridge is not subjected to as much pressure.

Take care,
--- Vaughn

[bwexler]

I have been using the PRS1 960 ASV since Oct.
I would like to fine tune the settings but still don't have a clue what to mess with. I did reduce the max IPAP to about 19 I think. That helped a lot with leaks and comfort and got my ahi below 3, often below 1. Before this adjustment the IPAP stayed between 20 & 25 most of the night.
I do find the PRS1 MUCH NOISIER than my old S9 Autoset.

[vsheline]

I have been using the PRS1 960 ASV since Oct.
I would like to fine tune the settings but still don't have a clue what to mess with. I did reduce the max IPAP to about 19 I think. That helped a lot with leaks and comfort and got my ahi below 3, often below 1. Before this adjustment the IPAP stayed between 20 & 25 most of the night.
I do find the PRS1 MUCH NOISIER than my old S9 Autoset.

Hi bwexler,

Maybe you can start your own thread, with title something like What do settings on PRS1 960 ASV machine mean, do? (If that is what you would like to understand better; and list everything the very brief Clinician set-up manual says about each setting, and what each is set to on your machine, and post some SleepyHead or Encore plots?)

Take care,
--- Vaughn

[jcarerra]

Answers:
Cheyne-Stokes Respiration (CSR)? Don't think so. Does not have the envelope waveform of that. CSR is characterized by a shallow then up to not-shallow resumption of breathing, then decline to apnea, then repeat. Mine is an instantaneous resumption of strong breaths at the end of the apnea.

Back? Could be. I start on sides always and feel more comfortable there, but definitely could be getting onto back. I know about sewing in a tennis ball in the PJs but have not done that yet.

Atch is a 5 minute clip from within the cluster on first night. The highly disturbing thing is that shortly after I enter the non-breathing period, the SV is increasing the pressure to its max--yet no flow is showing at that point. Even 25 cmH2O is not forcing air in. Pretty big bummer right there. Those apnea patterns look just like before with the CPAP nonSV machine at 13cm.

I just looked at last night's data, 2nd night, and there one cluster similar to my "standard", but there is also one period where it looks like my flow was getting ragged, pressure went up, and no apnea started. I do not know if the machine actually prevented it, or if that was just what my body wanted to do at that point.

[attachment=1036]

[vsheline]

Answers:
Cheyne-Stokes Respiration (CSR)? Don't think so. Does not have the envelope waveform of that. CSR is characterized by a shallow then up to not-shallow resumption of breathing, then repeat. Mine is an instantaneous resumption of strong breaths at the end of the apnea.

Looking at the data you posted, yes, those apneas are definitely extremely severe obstructive events.

Probably associated with sleep position.

Back? Could be. I start on sides always and feel more comfortable there, but definitely could be getting onto back. I know about sewing in a tennis ball in the PJs but have not done that yet.

In my view, it is clear that you are going to have to avoid whatever sleep position is causing those extremely severe obstructions.

Time to take extreme preventative measures, starting right away, I think. Something to record (time lapse photography?) or prevent (backpack, tennis balls?) supine sleeping.

Don't waste the 30-day S9 Adapt trial by failing to prevent the sleep position which causes these events.

Atch is a 5 minute clip from within the cluster on first night. The highly disturbing thing is that shortly after I enter the non-breathing period, the SV is increasing the pressure to its max--yet no flow is showing at that point. Even 25 cmH2O is not forcing air in. Pretty big bummer right there. Those apnea patterns look just like before with the CPAP nonSV machine at 13cm.

The PRS1 ASV model won't be able to do any better if a pressure of 25 is not sufficient to cause Flow to occur.