Tracking RERAs with AirSense 10 AutoSet and online vendors

[reinvigorated]

Hi all,

I need your advice on how to make sure that the Airsense 10 Autoset machine that I'm planning to buy will support tracking of RERAs (to be viewed with the SleepyHead app). It looks like there is some conflicting information on whether all models of Airsense 10 Autoset support this feature or only some of them.

I emailed three online vendors yesterday asking this question. Here are their responses:

1. thecpapshop.com:
Yes, it tracks and records RERAs.

2. directmedical:
No, it looks like it doesn't support this; only the "For Her" version tracks RERAs.

3. cpap.com
Ignored my question about RERA and SleepyJoe. Instead, provided generic info that Autoset supports tracking of usage, events, leak rate, and AHI.

So, my question is to users of Airsense 10 Autoset. How did you ensure that the machine you were planning to buy would support tracking of RERA (if it was important to you) and what vendor did you buy from? Thank you very much!

PS I'm based in the US.

[robysue]

So, my question is to users of Airsense 10 Autoset. How did you ensure that the machine you were planning to buy would support tracking of RERA (if it was important to you) and what vendor did you buy from? Thank you very much!

Get the For Her model since it is KNOWN to track RERAs in the AutoSet for Her mode, which is different than the regular AutoSet mode.

[Pugsy]

I agree with RobySue.
Get the for Her model because we know for sure that all them do the RERA flagging...plus it has that extra auto algorithm available that you might find useful in your situation.
It's going to do everything the regular Autoset will do plus more and more for sure instead of a maybe about the RERAs and that extra algorithm might come in handy.

I didn't know you were looking at online vendors instead of a brick and mortar DME or I would have suggested it the other day.
I thought you were working with someone local to you since you mentioned trialing different masks, etc.

[tedtomato]

The US model of the AS10 autoset is supposed to track RERAs, but it could depend on the software.

The non-US models don't track RERAs, regardless of the software. Nobody knows why, including Resmed.

The "for her" model also has an additional algorithm, and is confirmed to track RERAs, so always a better choice, particularly when sold for the same price anyway.

Resmed have no valid explanations on why those differences apply, as RERAs are not gender specific anyway.

Personally, I wouldn't buy a Resmed AS10 machine anyway (standard or "for her"), as the noise level is "hit and miss" (variations in build quality), they never update the software, and a Philips Dreamstation costs a lot less, and has more data reported.

Just get a Philips Dreamstation from Amazon.com

[reinvigorated]

Thank you all very much for suggestions!

I agree with RobySue.
Get the for Her model because we know for sure that all them do the RERA flagging...plus it has that extra auto algorithm available that you might find useful in your situation.
It's going to do everything the regular Autoset will do plus more and more for sure instead of a maybe about the RERAs and that extra algorithm might come in handy.

I didn't know you were looking at online vendors instead of a brick and mortar DME or I would have suggested it the other day.
I thought you were working with someone local to you since you mentioned trialing different masks, etc.

I'm working with DME to trial a CPAP. But I recently changed my insurance plan and it looks like CPAP won't be covered. So after my two-week trial is over, I'll need to buy one myself. Can you refer to a more detailed description of what that detailed algorithm includes? Thanks so much!

[Pugsy]

Can you refer to a more detailed description of what that detailed algorithm includes?

ResMed had some promotional fluff when that "special" algorithm was released but I didn't keep it.
All I have is what is in the manual.
https://sleep.tnet.com/home/files/resme ... -guide.pdf
There might be something on the ResMed website but I don't have it nor the time to look.

My thoughts in general...it's always better to have something and not need it than need it and not have it.
The For Her model has
cpap mode
regular apap mode
the special apap mode
and for sure the RERA thing you want to target.
There has been some supposition that RERAs and UARS are inter related and if that is the case that "new special" algorithm might be helpful because it's supposed to be "gentler" and it seems like people with UARS tend to be hypersensitive so maybe "gentler" way of doing things is less likely to cause arousals.
All supposition...I haven't seen actual proof but it is logical that it could happen that way.

If it were me and I was in your shoes...I would get the For Her model and would have targeted it from the beginning because of that special algorithm even if the other regular Autosets for sure flagged RERAs. I would want every available option that I could get in my effort to deal with things. I might not ever need or want or even like that special algorithm but I would much rather have it in the arsenal and not need or use it than be wondering forever if I might do better with it.

[reinvigorated]

Thank you very much! I'll take a closer look at the ResMed website and manuals as well. Thanks!

[reinvigorated]

Personally, I wouldn't buy a Resmed AS10 machine anyway (standard or "for her"), as the noise level is "hit and miss" (variations in build quality), they never update the software, and a Philips Dreamstation costs a lot less, and has more data reported.

Just get a Philips Dreamstation from Amazon.com

That's a very interesting suggestion! Aside from the price, what are some other factors that made you prefer this machine?

Could you please refer to a more detailed description of what data it tracks that Autoset doesn't? I would definitely prefer more data to less data! Also, if I get the Dreamstation, would it be better to get a Philips mask as well or would Resmed masks work just as well?

My priority is treating RERA/arousals. The diagnostic sleep study didn't show any apneas or hypopneas, but I had a lot of arousals that lead to zero deep sleep. I was told that this situation used to be classified as UARS but is now classified as mild apnea. So, it's the main culprit right now behind my daytime drowsiness, fatigue, and brain fog. I would get whichever machine is most likely to address this issue the best – I'm guessing gathering enough data for the effective feedback loop would be critical here.

Thanks so much!

[Pugsy]

if I get the Dreamstation, would it be better to get a Philips mask as well or would Resmed masks work just as well?

ResMed mask works just as well as any Respironics mask on the DreamStation.

Could you please refer to a more detailed description of what data it tracks that Autoset doesn't?

It doesn't really gather anything other than all the DreamStation machines will flag RERAs. Pretty much both brands will gather the same data but they report it visually a little differently.

Both brands will do Flow limitations and snores....ResMed gives FLs and snores as a graph and Respironics flags each individually on the Events graph.

I have owned both brands...not in the DreamStation model for the Respironics but the prior models (probably 5 or 6)...and I have owned both the S9 and now the AirCurve 10 ResMed models.. I think that ResMed is slightly less noisy.

This thread has some examples of some reports
viewtopic/t103468/Need-help-with-screen-shots.html
and the SleepyHead tutorial at the top of the Announcements section has even more examples.

Again...if I was even remotely thinking I was battling UARS...I would opt for the ResMed for Her model if I was going with an apap capable machine.
I base my recommendation on my past experience with both brands and their regular apap algorithms and even though I have never used the For her algorithm...if I had a chance to get it I would just because it might be something that worked well for me if I had UARS or even regular OSA.

Now Respironics apap mode algorithm is a bit slower to respond...it's that an advantage or disadvantage...that's where personal preference or needs might come in.
The algorithms are not the same. Each brand goes about it's job just a little differently but they each get to the end goal (holding the airway open) quite successfully.

[tedtomato]

That's a very interesting suggestion! Aside from the price, what are some other factors that made you prefer this machine?

The Philips machine just reports more data than Resmed, and is also less prone to manufacturing differences. With the Resmed Airsense 10 machine, you could get a quiet machine or a noisy one, it's just random. It has happened to me.

With Resmed AS10 machine, you also get some random features available or not available, depending on the batch. They don't do software updates.

The Philips Dreamstation machine is also quieter by default, and it's smaller than the Resmed AS10 when the humidifier is disconnected (for travelling for instance).

On the basis that it costs less than half of the Resmed machine, it's an easy choice.

[LSAT]

That's a very interesting suggestion! Aside from the price, what are some other factors that made you prefer this machine?

The Philips machine just reports more data than Resmed, and is also less prone to manufacturing differences. With the Resmed Airsense 10 machine, you could get a quiet machine or a noisy one, it's just random. It has happened to me.

With Resmed AS10 machine, you also get some random features available or not available, depending on the batch. They don't do software updates.

The Philips Dreamstation machine is also quieter by default, and it's smaller than the Resmed AS10 when the humidifier is disconnected (for travelling for instance).

On the basis that it costs less than half of the Resmed machine, it's an easy choice.

If the Philips is so much better than ResMed, why don't you have one?

[palerider]

That's a very interesting suggestion! Aside from the price, what are some other factors that made you prefer this machine?

The Philips machine just reports more data than Resmed, and is also less prone to manufacturing differences. With the Resmed Airsense 10 machine, you could get a quiet machine or a noisy one, it's just random. It has happened to me.

With Resmed AS10 machine, you also get some random features available or not available, depending on the batch. They don't do software updates.

The Philips Dreamstation machine is also quieter by default, and it's smaller than the Resmed AS10 when the humidifier is disconnected (for travelling for instance).

*every* single statement here, is wrong.

the philips machine is noiser, larger, philips machines are more prone to failure, and reports less data.

[robysue]

Chiming in with my two cents:

The differences between the AirSense 10 AutoSet for Her and the PR DreamStation AutoCPAP are negligible and for most people it really doesn't make a dime's worth of difference which one you get. So if cost is a significant factor and you intend to buy a new machine, then the PR DreamStation is likely to be (much) less expensive.

But there are some differences and some people (including tedtomato and palerider among others) strongly favor one brand over the other. But in truth, it's rather like the Coke vs. Pepsi debate: For most people, most of the time, it doesn't really matter.

In terms of data, the only thing that the AirSense records that the DreamStation doesn't is "pressure at mask". Perhaps that's important to palerider, but it's not important to me, and when folks post SleepyHead data and include that graph, I tend to tell them to please omit that graph because it doesn't add anything that I don't see in the pressure graph itself.

In terms of auto algorithms: The AutoSet For Her does have two algorithms, and the "For Her" algorithm is the one that is known to flag Resmed-defined RERAs. It also is more aggressive in increasing pressure in the presence of flow limitations, but that may or may not be a "plus" for a particular individual since not everything that gets reported as a "flow limitation" responds well to additional pressure. (More on that in a bit.) The Resmed AutoSet algorithms in general are more aggressive than PR Auto algorithms. Again, that may or may not be an advantage---in my case the pressure swings on my old S9 AutoSet were enough to trigger arousals and I find it much easier to sleep through the regular PR test pressure increases that palerider likes to criticize so vehemently. But that's just me, and I will admit that others find the sharp pressure swings on the Resmed machines less bothersome than PR's regular test pressure increases. Quite frankly, I think that the majority of PAPers will sleep through both without any problems once they've learned how to sleep with their machines.

As for accurately flagging RERAs: We really don't know whether the PR or Resmed algorithms for flagging a RERA are more accurate. In both cases, the machine only has the flow rate data available for flagging an event that requires an EEG arousal in a sleep lab. Both companies have come up with algorithms that they believe allow their machines to identify a series of flow limited breaths that end in a characteristic fashion (recovery breaths) that is correlated to real EEG arousals on full PSG sleep tests. But in examining lots of people's flow rate data, it's clear that on both machines there will be times when you scratch your head and say, "Why was that flagged as a RERA?" and there will also be times when you scratch your head and say, "Why WASN'T that flagged as a RERA or some other event?" Still, machine-scored RERAs as approximate data are better than no data at all if you've got problems with UARS.

Finally a note about Flow Limitations. Some of this is based on my own experience with my own machines. And some of it is based on posts that Morbius/Dave/Sludge/Muffy/NotMuffy used to post back when he was still active here. (He went by many names.)

Not all flow limitations are "real" in the sense that they indicate an airway in imminent danger of collapsing. And if a flow limitation is caused by something other than an imminent danger of airway collapse, then there's not much point in increasing the pressure because it won't fix the underlying problem. In some PAPers, flow limitations that are caused by something other than imminent danger of an airway collapse can lead to unnecessary pressure increases. And for some PAPers, those unneeded pressure increases don't make the data look any better and, more importantly, don't make the PAPer feel any better. In some cases (like myself) the unnecessary pressure increases actually leads to other problems, in particular more aerophagia, more arousals, and (very occasionally) more problems with pressure-induced central apneas. Too much pressure can irritate a sensitive airway in ways that lead to overall bad sleep in some people.

In my own case, my Flow Limitation Index have ranged from 1.0 to 4.0, but pretty consistently stay in the 2.0-3.0 range ever since I started using PR BiPAPs in Auto mode. (FL are only recorded when a PR machine is in Auto mode) I have experimented with allowing my max IPAP pressure to go much higher than I normally allow it to go, and the FL doesn't decrease (at all) and neither does my AHI. But my 90% IPAP does go up, usually right up to where ever I set the max IPAP to, and once the IPAP goes up to beyond 10cm, I'm miserable in terms of aerophagia. In other words, I happen to be in that group of PAPers whose flow limitations are not always caused by an airway in danger of collapsing.

[palerider]

In terms of data, the only thing that the AirSense records that the DreamStation doesn't is "pressure at mask". Perhaps that's important to palerider, but it's not important to me, and when folks post SleepyHead data and include that graph, I tend to tell them to please omit that graph because it doesn't add anything that I don't see in the pressure graph itself.

Point of order.

Resmed records, and presumably uses, a much more active pressure graph, varying nearly continuously between min and max pressures as needed, whereas the respironics step in half cm increments... so you can see, if zooming in, more responsiveness to activity.

As to the mask pressure graph, yes, when zoomed out, it's useless, when examining breaths, it can tell you more about what's actually going on, while the 'pressure' graph is the target pressure, the mask pressure graph shows measured pressure.

[robysue]

In terms of data, the only thing that the AirSense records that the DreamStation doesn't is "pressure at mask". Perhaps that's important to palerider, but it's not important to me, and when folks post SleepyHead data and include that graph, I tend to tell them to please omit that graph because it doesn't add anything that I don't see in the pressure graph itself.

Point of order.

Resmed records, and presumably uses, a much more active pressure graph, varying nearly continuously between min and max pressures as needed, whereas the respironics step in half cm increments... so you can see, if zooming in, more responsiveness to activity.

And all that activity in a Resmed machine *can* be disruptive to the quality of sleep if you're sensitive to it.

As I said: I found the constant changing of pressures on the S9 AutoSet far more disruptive to my sleep than the PR search algorithm's test pressure increases.

As to the mask pressure graph, yes, when zoomed out, it's useless, when examining breaths, it can tell you more about what's actually going on, while the 'pressure' graph is the target pressure, the mask pressure graph shows measured pressure.

Again, when someone is trouble shooting, this graph doesn't really tell us anything that's not picked up in the other graphs.

In other words, in my opinion, that graph is bells and whistles. It's nice to see the "EasyBreathe" (that was NOT easy for me to breath with) in action so that you can explain to someone how EPR vs. Flex works. But it's not a critical graph for tweaking the therapy settings.