S9 Adapt pressure support cutting in and out

I would not call that tiny amount of air flow an inhalation, your inhalation starts where the green line is, if you look, you'll see that the timing for it is consistent with the breaths before it.

Again I know for a fact that those are inhalations because I've tested it before and immediately checked the OSCAR graph to see that my shallow breathing isn't enough to trigger the machine. The breath before it is a little more in sync and the breath before that is normal (before the abrupt pressure drop). The breath AFTER that one is even worse however, 0.5 seconds out of sync.

You've changed from saying that the PS is zero (which I haven't seen any indication of) to saying that the PS is *late* (also no indication so far of that).

The PS *felt like it hit zero because it was indeed late as my breathing is too shallow.

I think you're misinterpreting the message there.
viewtopic/t115905/Resmed-S9-and-10-VPAP ... nged-.html

What am I misinterpreting here? Another user at the end also agreed that the earlier version of S9 were more responsive.

kmkz58 wrote: ↑

Tue May 21, 2019 6:12 pm

I would not call that tiny amount of air flow an inhalation, your inhalation starts where the green line is, if you look, you'll see that the timing for it is consistent with the breaths before it.

Again I know for a fact that those are inhalations because I've tested it before and immediately checked the OSCAR graph to see that my shallow breathing isn't enough to trigger the machine. The breath before it is a little more in sync and the breath before that is normal (before the abrupt pressure drop). The breath AFTER that one is even worse however, 0.5 seconds out of sync.

You've changed from saying that the PS is zero (which I haven't seen any indication of) to saying that the PS is *late* (also no indication so far of that).

The PS *felt like it hit zero because it was indeed late as my breathing is too shallow.

I think you're misinterpreting the message there.
viewtopic/t115905/Resmed-S9-and-10-VPAP ... nged-.html

What am I misinterpreting here? Another user at the end also agreed that the earlier version of S9 were more responsive.

Well, it seems you've made up your mind, and there's nothing I can do to help here. Best of luck.

palerider wrote: ↑

Tue May 21, 2019 8:10 pm

kmkz58 wrote: ↑

Tue May 21, 2019 6:12 pm

I would not call that tiny amount of air flow an inhalation, your inhalation starts where the green line is, if you look, you'll see that the timing for it is consistent with the breaths before it.

Again I know for a fact that those are inhalations because I've tested it before and immediately checked the OSCAR graph to see that my shallow breathing isn't enough to trigger the machine. The breath before it is a little more in sync and the breath before that is normal (before the abrupt pressure drop). The breath AFTER that one is even worse however, 0.5 seconds out of sync.

You've changed from saying that the PS is zero (which I haven't seen any indication of) to saying that the PS is *late* (also no indication so far of that).

The PS *felt like it hit zero because it was indeed late as my breathing is too shallow.

I think you're misinterpreting the message there.
viewtopic/t115905/Resmed-S9-and-10-VPAP ... nged-.html

What am I misinterpreting here? Another user at the end also agreed that the earlier version of S9 were more responsive.

Well, it seems you've made up your mind, and there's nothing I can do to help here. Best of luck.

You seem to declare things without providing your reasoning behind it. If shallow breathing is not "breathing" then what is it and how should it be treated? And what exactly am I misinterpreting about the other post?

You are looking at the peak flow in the flow chart, at the bottom on the wave. The exhale is still going, till you inhale. The other factor is that the charts may not exactly line up. does that really matter. Pressure is a bit averaged and mask pressure is at that moment. as an example.


Turn off the smart start, that can fix some stuff' and worth a try

your tidal volume and minute vent was fine during those slight events. In fact the tidal rose.

You are saying while awake, you breathe in but the machine doesn't raise pressure. Perhaps the flow sensor and such, that actually triggers the rise is faulty? There is no adjustment. Again smart start can get in the way if faulty. 5 years has some hours up and is coming to the end of reliability. The insurance will buy you a new one

ajack wrote: ↑

Wed May 22, 2019 6:00 am

You are looking at the peak flow in the flow chart, at the bottom on the wave. The exhale is still going, till you inhale. The other factor is that the charts may not exactly line up. does that really matter. Pressure is a bit averaged and mask pressure is at that moment. as an example.


Turn off the smart start, that can fix some stuff' and worth a try

your tidal volume and minute vent was fine during those slight events. In fact the tidal rose.

You are saying while awake, you breathe in but the machine doesn't raise pressure. Perhaps the flow sensor and such, that actually triggers the rise is faulty? There is no adjustment. Again smart start can get in the way if faulty. 5 years has some hours up and is coming to the end of reliability. The insurance will buy you a new one

I've checked, the smart start is off, always been that way. The charts not lining up, do you mean that the mask pressure is slightly behind the flow because of inaccurate data?

My TD, MV and RR always rise during those pressure cuts because it feels like I'm getting less air than before so I start to breathe more. That is true when I'm awake, but they also rise when I'm asleep as well. Flow sensor could definitely be an issue.

I know that you are concerned. I can see the V shape pressure drop to 9 that you are referring too. I have no explanation. It would be back to the DME. Who may have an idea, but may refer to resmed for an opinion, probably at a cost. Repairing a 5yo machine may not be worth the exercise in cost benefit. if you can put up with it fine, if not get another machine. If insurance or money is an issue, craigslist is an option.

kmkz58 wrote: ↑

Wed May 22, 2019 1:00 am

palerider wrote: ↑

Tue May 21, 2019 8:10 pm

Well, it seems you've made up your mind, and there's nothing I can do to help here. Best of luck.

You seem to declare things without providing your reasoning behind it. If shallow breathing is not "breathing" then what is it and how should it be treated? And what exactly am I misinterpreting about the other post?

I've got better things to do than try to argue with you about how things are.

A very faint possible influx of air followed by a full breath is not "shallow breathing", it's you trying to find some way to find fault with the machine.

Seeing glitches in *sleepyhead* representation of the data is not necessarily a fault with the machine, especially when that glitch in the *pressure* line is not reflected by the *measaured* pressure readings reflected in the mask pressure line. (have you looked at the data in Resscan?)

You've made up your mind that there's something 'wrong' with the machine, and all you want to do is argue with anybody that doesn't agree.

I don't have time for that.

palerider wrote: ↑

Wed May 22, 2019 10:19 am

Seeing glitches in *sleepyhead* representation of the data is not necessarily a fault with the machine, especially when that glitch in the *pressure* line is not reflected by the *measaured* pressure readings reflected in the mask pressure line. (have you looked at the data in Resscan?)

Attached is a snip from Resscan My min EPAP is 6 min PS is 3 (Running ASV mode) and there are times when the Pressure plot drops to a value that looks like the Inspiratory pressure matches the expiratory pressure which means a PS of 0. It does not affect my numbers and therapy so I ignore it. Why I don't know I see the effect on both my S9 36007 and my newer S9 36037 (Not so often on the 36037 but it still occurs) have no idea if it occurs on an Aircurve 10 ASV as I have never used one.


And there is absolutely nothing I as a user can do about it

Jas_williams wrote: ↑

Wed May 22, 2019 2:44 pm

palerider wrote: ↑

Wed May 22, 2019 10:19 am

Seeing glitches in *sleepyhead* representation of the data is not necessarily a fault with the machine, especially when that glitch in the *pressure* line is not reflected by the *measaured* pressure readings reflected in the mask pressure line. (have you looked at the data in Resscan?)

Attached is a snip from Resscan My min EPAP is 6 min PS is 3 (Running ASV mode) and there are times when the Pressure plot drops to a value that looks like the Inspiratory pressure matches the expiratory pressure which means a PS of 0. It does not affect my numbers and therapy so I ignore it. Why I don't know I see the effect on both my S9 36007 and my newer S9 36037 (Not so often on the 36037 but it still occurs) have no idea if it occurs on an Aircurve 10 ASV as I have never used one.


And there is absolutely nothing I as a user can do about it

Plus, no matter what the "pressure" trace says, (that's a target pressure), what matters is the "mask pressure", which is measured pressure, and nowhere has the ps gone to zero.

palerider wrote: ↑

Wed May 22, 2019 10:19 am

kmkz58 wrote: ↑

Wed May 22, 2019 1:00 am

palerider wrote: ↑

Tue May 21, 2019 8:10 pm

Well, it seems you've made up your mind, and there's nothing I can do to help here. Best of luck.

You seem to declare things without providing your reasoning behind it. If shallow breathing is not "breathing" then what is it and how should it be treated? And what exactly am I misinterpreting about the other post?

I've got better things to do than try to argue with you about how things are.

A very faint possible influx of air followed by a full breath is not "shallow breathing", it's you trying to find some way to find fault with the machine.

Seeing glitches in *sleepyhead* representation of the data is not necessarily a fault with the machine, especially when that glitch in the *pressure* line is not reflected by the *measaured* pressure readings reflected in the mask pressure line. (have you looked at the data in Resscan?)

You've made up your mind that there's something 'wrong' with the machine, and all you want to do is argue with anybody that doesn't agree.

I don't have time for that.

A faint influx of air is exactly what shallow breathing is. I'm not the only one who is having this problem, so far I've found at least 2 people on this forum who consider the later version of the machine to be less responsive than the earlier ones.

I've looked at Resscan, but it doesn't show flow rate. I've downloaded "all available data", but the detailed graphs still show everything except flow rate for some reason.

Ignoring sleepyhead glitches and ignoring all data completely, I've tested the machine with various attempts at inhalation, it's simply less responsive to shallower breaths (resulting in a small delay while the breath is winding up or until the machine decides to breathe on it's own). Another thing I've realized is when MV and TD are high above target, the response is much longer, even to deep breaths, once MV and TD are lowered back to target, it becomes more responsive again, so that part is obviously a "normal" part of the algorithm.

I'm arguing using the facts that I've found, you are the one who seem to argue just for sake of arguing. Assuming there is nothing physically wrong with the machine like a faulty flow sensor, 'right' or 'wrong' algorithm is a matter of preference with a majority of people having no problems with it. I was merely asking if anyone else experienced it or knew any coping strategies, something like "blow back" that resets the machine for 3 minutes if it's breathing too much, or I don't know - a way to train your breathing to be more in sync with the machine. I tried the reverse blow back / sharp inhale and it doesn't do anything.

haven't had to use this one for awhile-

kmkz58 wrote: ↑

Thu May 23, 2019 3:09 pm

A faint influx of air is exactly what shallow breathing is.

Not if it's followed by a full breath.

The fact that you're *playing* with the machine, trying to find some fault does not mean that there's a fault.

All bilevel machines have a trigger threshold, a certain rate of inhalation before they are triggered to move to IPAP, your playing around with it trying to see how shallowly you can inhale before it triggers isn't a valid *sleep* issue.

kmkz58 wrote: ↑

Thu May 23, 2019 3:09 pm

I'm arguing using the facts that I've found, you are the one who seem to argue just for sake of arguing.

Well, not any longer

A shallow breath and the machine not triggering into the ipap ? There has to be enough flow to trigger the machine for a spontaneous breath. The machine follows minute vent and initiates a breath if needed. The trigger on the resmed asv isn't adjustable. I don't think the trigger on the philips asv is either. You would need to check. If you have a serious issue. The more advanced type may, but they are expensive and the insurance would want definite need. A slow trigger here and there wouldn't cover it, I would think. There is more of a chance of it being determined that a ST would be suitable.

palerider wrote: ↑

Thu May 23, 2019 7:27 pm

kmkz58 wrote: ↑

Thu May 23, 2019 3:09 pm

A faint influx of air is exactly what shallow breathing is.

Not if it's followed by a full breath.

The fact that you're *playing* with the machine, trying to find some fault does not mean that there's a fault.

All bilevel machines have a trigger threshold, a certain rate of inhalation before they are triggered to move to IPAP, your playing around with it trying to see how shallowly you can inhale before it triggers isn't a valid *sleep* issue.

kmkz58 wrote: ↑

Thu May 23, 2019 3:09 pm

I'm arguing using the facts that I've found, you are the one who seem to argue just for sake of arguing.

Well, not any longer

I never said there was a "fault" with the machine, just a less sensitive algorithm/trigger. You are literally rephrasing everything I said in a way to make me look wrong. Is pontificating on medical forums a hobby of yours?

I do have hypopnea/shallow breathing and it's not always followed by a full breath, sometimes IT IS a part of the full breath while it's slowly winding up, that's where the trigger sensitivity comes in.

ajack wrote: ↑

Fri May 24, 2019 1:52 am

A shallow breath and the machine not triggering into the ipap ? There has to be enough flow to trigger the machine for a spontaneous breath. The machine follows minute vent and initiates a breath if needed. The trigger on the resmed asv isn't adjustable. I don't think the trigger on the philips asv is either. You would need to check. If you have a serious issue. The more advanced type may, but they are expensive and the insurance would want definite need. A slow trigger here and there wouldn't cover it, I would think. There is more of a chance of it being determined that a ST would be suitable.

I've tried ST machine and it's very difficult to sleep with compared to an ASV. The issue isn't big enough for insurance to take note. Although I've read that the new Dreamstation made a big improvement over the previous generation, if someone can confirm that.

If ASV isn't doing it for you you may want to check out Alternative approaches to treatment of Central Sleep Apnea

The author's preferred treatment protocol is to do a sleep study to titrate EERS volume and straight CPAP pressure along with a low dose of acetazolamide.

In one of his other papers he looks into the factors that indicate when ASV doesn't result in improved outcomes. Estimation of adaptive ventilation success and failure using polysomnogram and outpatient therapy biomarkers