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Hi all:


I have a remsmed vpap adapt sv, and i think i don´t know how to use it.


i´m not sleeping any better with it, and i thought i was in that phase where you just have to get used to the cpap, but it´s been too long. so now i´m thinking probably there´s a problem with my machine. i think it´s not delivering enough air pressure.


the prescription from the last sleep study i took says they set it and i should sleep at an EPAP of 8, max IPAP 25, min IPAP 12, auto-rate.


But since i´m not sleeping any better and i can´t go back to follow up becasue i live in south america (this sleep study was done in the US), i went into the clinical menu just to check.


I found out that the machine doesn´t support the air pressures it says on the prescription, or on the machine´s manual. the MAX PS on the machine´s screen at an EEP of 8 goes up to 12. the  MIN PS goes up to 6.


is this right or wrong? or am i not understanding this well? Do the minimum and maximun pressure supports change according to the EPAP/EEP?


what is EPAP/EEP?

what is MAX IPAP/MAX PS?

what is MIN IPAP/MIN PS?


i´m embarrased to post here cause everybody knows so much and i should but i´m desperate from severe poor sleep for years. i had to go to the psychiatrist and i´m about to start taking antidepresants. he told me to address my sleep issue first no matter what other health issues i have. i haven´t done good at all with my cpap treatment. i haven´t addressed it properly, although i´ve done a lot. i´ve taken several sleep studies, 2 in the US, one in stanford. i have other health issues like chronic GERD, which i feel render my cpap treatment unsuccesful. i wonder if they have to do with the complex/central apnea.


thanks for any help.


John Serrano.

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"what is EPAP/EEP?

what is MAX IPAP/MAX PS?

what is MIN IPAP/MIN PS?"

EPAP is exhalation positive air pressure- this is the pressure you machine uses when you exhale.  It is probably set in the prescription- yours should be 8.  I don't know what EEP is.

Max IPAP- maximum inspiritory air pressure/ Max PS is max pressure support in your case 20 and 12

Minimum IPAP is the lowest inspriratory air pressure/Min PS is the minimum pressure support- in your case I think it's 13 and 6.  (Though the ResMed may work differently than my machine.

So EPAP would be 8-  IPAP 13- 20.


John  Your machine should be able to do what it's set to do.  Bottom line, I don't think it's broken you just need to give it a good chance- at least a month of 100% use.

Mine is set at Min/Max EPAP  (exhalation air pressure of) 8.  

The minimum and maximum

Pressure support  min 4, max 12

Max IPAP 20

Breaths per minute- AUTO.

So I have an EPAP of 8 always and pressure support from 4-12 which means my IPAP could run from 12 to 20 (EPAP of 8 + PS number).  My pressure support usually runs 5.5.  So that means I have an EPAP of 8 and an IPAP (which can change from 12- 20) of 13.5.


I'm sure your machine can do what it's set up to do.  The ResMed and Respironics machines work differently.  Your machine is essentially set up the same as mine except the PS goes from 6- 12.  The total pressure can never be above 20.  I never feel the changes in pressure.  I have  had much higher pressures prescribed, so 13.5 doesn't feel like much.  As  said in my message to you I expect it to take 3-6 months for the machine and I to get used to one another to start getting the most therapeutic benefits.  This is using it all night, every night.  It doesn't sound like the machine is broken, the prescription and how the machine works is just hard to understand.  But that machine is certainly capable of providing the pressures prescribed 8 EPAP to 13-20 IPAP.


Start using the machine 100% of sleep time.  You could take antidepressants to help get you over the hump.  They may not be necessary after a while.  The same with the sleeping pills-  I used to take them, but do not need them anymore.  I take antidepressants, but my depression is better on the ASV than before.

Good luck, keep us posted, use your machine.



Again I didn´t understand all that presures thing. it´s like you have to be an expert or something. did your cpap provider or respiratory technician train you on all this? why do sleep apnea patients on these american forums know so much about cpap therapy if you´re not supposed to touch your machine´s settings after you´re prescribed? i changed mine and i don´t know how to go back to what the prescription says. are you a respiratory technician?


sorry to ask but, if you can tell me, why are you on antidepresants if you´re sleeping better now? by the way i´m glad you are. thanks,



hi john

stay with your treatment, important, you are probably better than you think, its a perception thing, it is better to ask others how you look to reassure you, work with your doc to tapper off tablets, do not go cold turkey

You should contact your DME to find out what your original settings are. The ASV units are not your typical CPAP unit. The algorithm is very advanced. The settings on these machines should never be changed without medical advice.

John Serrano said:



Again I didn´t understand all that presures thing. it´s like you have to be an expert or something. did your cpap provider or respiratory technician train you on all this? why do sleep apnea patients on these american forums know so much about cpap therapy if you´re not supposed to touch your machine´s settings after you´re prescribed? i changed mine and i don´t know how to go back to what the prescription says. are you a respiratory technician?


sorry to ask but, if you can tell me, why are you on antidepresants if you´re sleeping better now? by the way i´m glad you are. thanks,



John, I know what I know about CPAP and ASV because I've read everything I could find about therapy.  I read and studied my users and clinicians manuals.  I would never change the setings on my ASV because as Rock said, they are very sophisticated machines.  I let my sleep doctor set my prescription and help me if I'm having problems. Nothing is going to help you untill you start using the machine 100% of sleep time.  I have never heard you say you are using the machine.

If you don't want to take antidepressants that's fine, but a therapist that you see every week could give you some support and encouragement to use your machine.

You need to get it back to your oiriginal prescription.  Why would you change the settings when you don't understand the machine and don't know the settings that were prescribed?  That's what your sleep doctor is for, in particular with and ASV.  You are far too sick to keep fooling around.  Get your machine set back to the original prescription and use it every night, all night.  Don't expect improvement for a least a month, maybe longer, but keep using the machine.  Your treatment has not been successful because you are not using it all the time, haven't given it enough time- it takes some people six months.  You said you are very sick- it is going to take time to feel better.

Good luck.

John, Mary and Rock are right, I see you are in columbia, how can you get your machine back to your DME? You really need to make this a priority. The sooner you get back to the original settings the better and you will need to give it time. I know it's frustrating but that's the way it goes. You have been sleep and oxygen deprived for so long, it is going to take quite a while to feel better after you have got the settings right but the benefits are worth it in the long run.

In order to try to better understand what's going on, you should realize that there are 4 different ASV machines (and consequently algorithms) right now:


Respironics BiPAP AutoSV

Respironics BiPAP AutoSV Advanced

ResMed AdaptSV

ResMed AdaptSV Enhanced


It appears that your titration was done on Respironics BiPAP AutoSV.  Is your AdaptSV first generation or Enhanced?


If your original prescription was EPAP 8, max IPAP 25, min IPAP 12, auto-rate on first generation AutoSV, the corresponding settings on AdaptSV should be EEP 8, MinPS 4 (EEP 8 + MinPS 4 = min IPAP 12) and MaxPS 16 (EEP 8 + MaxPS 16 = MaxIPAP 24)(close as you can get as MaxPS 16 is the upper limit of the machine).


That said, because the algorithms are slightly different in a number of ways (including how the rate is determined in auto modes), a conversion may not necessarily be completely accurate.


However, what you suggest is that in addition to a Sleep-Disordered Breathing problem is a Sleep problem, and if you're not sleeping, you can SV all night long and it won't do you any good.  This needs to be addressed by a sleep specialist, preferably with a sub-specialty in behavioral sleep medicine.


Mollete makes a good point here about sleeping- if you're not able to sleep no therapy can help you.

How are you doing, John?



hi all:

i´m sorry for not writing before. i have a hard time doing anything. but i´m hanging in there. oh gosh i didn´t realize people would respond, which such helpful info and being so nice.


first of all, i managed to changed the sv settings to my last sleep study´s prescription (stanford 2010) and i´m already using my cpap every night, after seeing my psychologist. i´ve been using the sv for 2 nights.


yes, mollete is right. the machine they titrated me with was a respironics. it´s respironics´ lingo. i have a resmed sv. i didn´t know this. that´s why i couldn´t change it back. i called my cpap provider (don´t know what DME is?) and he explained it all to me. or tried to. in the end he made the conversion an told me what MIN and MAX PS to set my machin in to change it back. i don´t even know if they even set it to what they prescribed at Stanford, cause they used a Respironics to titrate me. not my own machine. I took it there to have it checked, cause i was already feeling like it wasn´t delivering enough air at that time. they told me i was being undertreated (not enought air pressure?) and gave me that prescription (EPAP 8, max IPAP 25, min IPAP 12, autorate). my sleep doc there told me the graphics said i slept better with the machine they titrated me with. that they corrected my apneas. i told her what i always think: then how come i feel so tired right now? she said that i should try and sleep with my SV.


My provider told me to set the SV and i did on the phone with him at: EEP 8, min PS 4, max PS 17 (actually 12, my SV is old and doesn´t go pass 12).


Aslo it doesn´t have the card or software or cable to keep track of the apneas nor can i buy these accesories to do this, it´s just too old. my provider told me this).


so, the first night i felt so much air coming in and i did´t take my sleeping pill cause i was feeling sleepy (which i don´t normally feel, but that day i exercised under the sun and kept active, which sometimes helps) so i had a light sleep all night, which i feel i do when i don´t take my sleeping pill.


the second night, last night, i took my sleeping pill (zopiclone). not so light sleep, i don´t remember anything during the night and didn´t wake up, but i´m not feeling rested either today.


it is only until now that i´m realizing that i have to use the cpap even if i don´t sleep any better or probably sleep worse for a long time. kind of like the same with antidepresants, which i don´t want to start taking for the same reason. i don´t think i can take any more, at least until i see any bit of improvement with my sleep and feel a little better. i have this altered nervous system, don´t know if it´s anxiety or depresion or both from severe lack or restorative sleep and chronic reflux since i was a child (i´m 37 not overweight, but a small chin and very crowded and restricted mouth and airway), but i haven´t been able to take antidepresants for more than a week.


the good thing about all this recently is that my psychologist made me realize that i do need my sleep, which i have neglected for many years, trying to go around it and live my life exhausted. that i should fight for my sleep. which i hate. i hate to sleep, i hate the night, i´ve been having delayed sleep phase syndrome for many years now.


i understand the using the cpap thing for a while even if i don´t sleep any better, but the antidepresants i´m so hesitant about. i don´t wanna feel worse. i don´t feel afraid or anxious all the time, but have anxous thoughts and habits according to my psychologist like going late to bed, keeping active on my laptop till late, sometimes eating at night, being exhausted the next day and not going out to exercise or work because of this... according to him and my psychiatrist the antidepresants will help. i wonder how? will they make me sleep better when what i have is sleep apnea? and he even explained this. what will make me sleep better is my cpap. so, why should i take antidepresants. they make you feel worse (they warned me and i´ve felt it before) and be anxious and sleepless in the beginning before you "feel better". so, what is "feeling better"?, if what´s gonna make me feel better is to sleep well with my cpap?


they say it´s an aid. that my brain is reheated from poor sleep and all the other health issues (digestive, reflux, bloating, pressure to breathe) that i have. that my brain doesn´t have the necesary chemicals to think and feel good and even to sleep that everybody has. and i feel i don´t have them, but is it true that these pills will give me all this?


ok now i´ll try and explain why i ´ve had such a hard time with my cpap therapy or haven´t adjusted to treatment or haven´t known how to handle it.


i had a hard time with sleep apnea and doctors here in Colombia since the begining. i had poor sleep and already insomnia for years before i was diagnosed, so it´s even hard for me to fall asleep. taking sleep studies is hard because of this. they always have to give me sleeping pills, even if they don´t want to.


when i was finally diagnosed complex sleep apnea in 2008 in a sleep clinic in Columbus, Ohio, i was given this SV machine. those were the original settings. they even told me i had mild narcolepsy. my sleep was so disturbed i had hallucinations before i fell alseep and had some sort of electric shock and jumps/jerks when i was falling asleep. i was already feeling my reflux symptoms and couldn´t stand (still that way) to fall asleep on my back. i feel sofocated, have nightmares, can´t fall asleep that way. they had a hard time with me, but did the best they could. one night without cpap the other night they tried different machines on till they said the SV corrected my apneas. but i felt exhausted the next morning. same as at Stanford. Same as always.


Short after that my GERD/digestive issues flared up and i started to have severe shortness of breath attacks. never had them before, i´m not asthmatic. that raised my anxiety i went to the ER everyday. they sent me to the shrink. that was when i took antidepresants and couldn´t stand them for more than a week. had reflux surgery and PPI´s but didn´t work. i don´t have the shortness of breath any more, just occasionally, thank GOD (i prayed a lot) but i keep having the bloating to the left side which pushes against my left lung and makes me feel like it´s difficult to breath or take a deep breath. imagin this when i lie down at night with reflux in my throat and the post nasal drip it causes me all the time. it´s no wonder why i don´t sleep or breathe well at night. all of this i realize only until now that i have tests and i´ve gone through all this journey.


i´ve tried different masks, cpaps, pressures, bed elevated, medication for reflux, sleeping pills, etc. plus i don´t have follow up here in my country cause the good or last sleep studies i took were in the US. last one in Stanford, where they changed the settings of my original sleep study in Columbus. needless to say i don´t hold a job for years and can´t keep active or do almost anything but work on my computer. i´m a graphic designer, photographer and artist. but all of this as a hobby or free lance cause i don´t have the energy to persue this well.


i use a full face (Quatro) which makes it hard to fall asleep, it´s so uncomfortable, but the nasals didn´t do it for me cause i leak air through my lips even with the mouth closed. is it true that GERD sufferers shouldn´t use full face masks?


i´m sorry for this long message, for ranting. this is what i hate to do, but i guess it was time on this forum. i´m sorry for neglecting my sleep, but it´s been one thing after another and you all know how debilitating can be to not sleep well at all, for years.


that´s why i changed my cpap settings even knowing i shouldn´t. i didn´t realize it was such a sophisticated technology that i couldn´t changed it back. i´ve read how some people help self titrate themselves making little changes to their pressures when then don´t have good follow up like i do.  i also didn´t realize how wrong it was to neglet my sleep for so long. it´s just hard to fight being so tired all the time. i feel i can´t think right. or do anything right.


should i take another sleep study in the us (off course after giveing CPAP a try after while)?


Gosh! I feel I sound so negative and depresed! but anyway. i´m gonna post this message. i hope it helps. please don´t preach. i´m already beating myself up and have my shrinks beating me up, ha ha. i know i am the one who has to get off my butt and heal my life (like louis hay says). i am using my CPAP now. i´ve just had a lot of complications with the therapy.


thanks to all tha have written and who will want to write something helpful. this website is great.









John, I'm here to support you not to preach, it's great to hear that you got your setting back to how they should be. Forget about the settings etc now, it will just confuse you. You are now aware that you have to use CPAP everynight so leave it at that. We are similar, we have been so sleep and oxygen deprived for so long, it will take time to heal again. I use the Mirage Quattro and it takes a bit of getting used to but now I have got most of the issues resolved I love it, what problems are you still having with it? There are a number of small things you can do to make it better. Are you using mask liners and do you have the hose coming from above your head, do those two things first. On the antidepressants, I was like you and didn't want to take them, they have there place for some people but I think they probably made me worse because I had SA not depression. I think you said your psych said you don't have to start taking them yet, so give CPAP a go and you may not need them. Keep us updated and keep asking questions, a bit over a year ago I was where you are now, today I feel great and you can too, it will just take time. I hated hearing it myself but you will have to be patient.

John Serrano said:

hi all:

Aslo it doesn´t have the card or software or cable to keep track of the apneas nor can i buy these accesories to do this, it´s just too old. my provider told me this).

Actually, the early AdaptSV units downloaded data directly from the serial port on the back of the machine.



thanks for the support.


i don´t know what a mask liner is. how can i make my cpap higher than me and why?


my psychiatrist said i HAVE to take antidepresants. i don´t know how they´ll help if what i need is to sleep well with the CPAP. why are you not recomending them?


Mollete: what´s a serial port? like an usb port?



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