Which Machine? (seeking successful treatment)

[sparkles]

I've read probably half this site, so I know enough to be dangerous, lol.

I could use some help with a few things:

Which machines to consider? Data capable, yes, and the ability to change settings. I also want something really quiet. Your suggestions?

I'm also considering buying something OOP to avoid ins. and DME hassles. Is there much of a 2nd-hand market, and if so, how are prices?

[STL Mark]

Have you had a sleep study yet? If so what type of machine did they recommend? You will need some information about the results to avoid wasting money on the wrong machine...

[sparkles]

Yes, I had 2 studies actually. The prescription, which I got a copy of, doesn't specify a machine.

I think have a bit above-average sensitivity to my environment, so I want something that is "solid" and not on the "reactive" side, otherwise we might get into negative feedback loops, if you know what I mean.

Are the latest models truly better? I suppose I could get a bit older model for less money, which would be good, but of course, optimized treatment is the primary goal.

[SleepWellCPAP]

Please post more detail. Prescribed type of machine and pressure to start. Also, other info would also be handy like, did you sleep well during your studies? Do you travel a lot?

With more info, it will be easier to make a recommendation on a machine. Good luck

[sparkles]

Thanks. I can get either a cpap or apap.
Pressure recommended is 10 (I'm thinking I will do better with a static pressure, or minimal range, to dampen sleep-interrupting stimuli).
I slept like !@#$% during my studies.
I don't travel a lot.

[Pugsy]

What does your RX for cpap say...exactly?

Most likely it will say cpap with heated humidity at so and so pressure and if that is the case then the regular cpap/apap machine would be what to look at. If the pressure stated is rather high then you might want to look at a bilevel pressure machine.

For various models that are full efficacy data machines see this
http://maskarrayed.wordpress.com/
My personal preference would be either the Respironics PR System One or the ResMed S9 machines. Know which model does what though. In the PR S1 line..model #450 or above...and in the S9 model...the Elite, AutoSet or VPAP if in the bilevel pressure line.
Avoid any ResMed product with "Escape" in the model name.
Software for either is easy to obtain and use.

Edit...I see your pressure RX is 10...unless you have issues with aerophagia or substantial problems exhaling against the pressure...you probably would do well with cpap/apap machine and not have a need for a bilevel pressure machine.

[SleepyCPAP]

sparkles,

I'm glad you are reading the site before buying. I did the same three years ago, and it saved me from being issued a no-efficacy-data machine by a local DME.

I'm like you -- I want as few disturbances as possible while I'm sleeping.

I've had good experience buying new machines from our forum hosts (cpap.com). I use both the full-data PRS1 (Philips Respironics System One) "Pro" models that are out there (the "last year's model" #450 which I upgraded to have AutoIQ, and this year's model #460). Those are straight CPAP, but (unlike other manufacturer's CPAPs) they can be run short term in APAP mode if needed to check for changed pressure needs, and can be set long-term in CPAP-Check mode, meaning straight pressure that will update your setting if needed (it will check every 30 hours of sleep). That CPAP-Check is good for folks who don't want to be disturbed by pressure checks all through the night, but want the machine to keep an eye on things. I believe the newer one (460) is quieter at the mask, and the company claims it is quieter "in real use" than the Resmed S9, but I haven't tried the S9 so can't confirm it. The "Pro" models are the least expensive of the full-data machines in the PRS1 line).

Note: if you buy a used 450, see if it is "AutoIQ" or the firmware is v.2.50 or above -- that is what will give you the short-term APAP mode (I'm told the "short-term" limit can be reset on those 450 models, a great trick for those who may later want to run in APAP mode more often, but that the newer 460 model may be limited to "just" 5 resets). A plain 450 model of at least v.2.0 (it will say on the bottom "2.xx" or show it on the screen when plugged in) can be upgraded if you find one at a price you wouldn't want to pass up, I had that done for $65 plus shipping (look up threads on "firmware" if you decide to research that route).

APAPs can be fine too, if you set it right. You might follow the advice of many folks on this board and seek out an Auto machine, and just use it in straight CPAP mode until you feel you are used to treatment and want to see if Auto mode is something which doesn't disturb you after all. The new PRS1 560 models now have a test mode (Opti-start) that can help you find a good starting pressure in APAP mode, or can be switched to CPAP-Check mode just like the 450AutoIQ or 460 models.

--SleepyCPAP

[Super Iridium]

I have the PR system One Remstar Auto with A-flex and the Devilbiss Intellipap Auto. Both are really great machines, and even though they use different algorithms, I don't notice the difference at all. The Devilbiss seems to have a slightly quieter airflow, but it also seems to have a slightly higher pitch when working, so maybe I'm just conflating the two things. As for used machines, if there were a ton of quality machines out there in the market and some way to compare them, I'd be interested in trying a used machine, but there isn't a market like this anywhere. Instead, you see one every once in a while, but often with nothing to compare it to, no warranty and no returns, it seems like it's just better to buy a new machine, especially given how important it is to have one that works properly. Stick with something new.

[sparkles]

Regarding the different algorithms...
Have many people tried different ones to speak to how those differences are experienced? Do they come into play only when run in apap mode, or in cpap mode also?

Regarding data...
I do want some data? How much am I likely to need for it to be helpful? Is some of the data more for "bells and whistles". I don't need lots of numbers and pretty graphs for their own sake, but for meeting the objective of good treatment without studying for a doctorate in science.

Regarding making a selection...
I think I'd like something that is a full APAP. The "short-term apap" and limited resets sounds confusing and I'd like to steer clear of that, having quite a lot of detail to contend with already.
Besides price and data-capability, what else should I look at? Seems like the pool is already down to machines of comparable quietness.

Thanks for sharing (which can include links to useful discussions I may have missed).

[oak]

get a resmed s9 autoset or a pr system one 560 if your doctor hasn't specified a bipap or asv machine and if you have plain vanilla obstructive apnea. they can be set at a constant pressure or variable pressure and both are quiet data capable machines.

are you buying on your own or through insurance and a durable medical equipment provider?

[STL Mark]

I have a Respironics Auto CPAP model DS560 that is new with zero hours for $400. It comes with the power supply, matching heated humidifier, chamber, SD card, and travel case. An optional kit can be added for an additional $75 that converts it to a heated hose unit. I ship free to US addresses. PM me if interested. The machine runs in CPAP mode or APAP mode.

That will give you some idea of what to compare with your insurance copay.

[sparkles]

Just back from a trip and hoping to move forward on this! I have to find out what my coverage is...I'm expecting a grand run-around between the ins. co. and local dme cos.

resmed s9 autoset
vs.
pr system one 560

Do these provide the same amount of data? Do they differ in the type/amount of data reported?
Are there instructions available for me to program either one?
Have many people had a chance to try both--what differences have you noticed?

[robysue]

Just back from a trip and hoping to move forward on this! I have to find out what my coverage is...I'm expecting a grand run-around between the ins. co. and local dme cos.

Forewarned is forearmed. Good for you.

resmed s9 autoset
vs.
pr system one 560

Do these provide the same amount of data? Do they differ in the type/amount of data reported?

They both record the same kind of data. The Resmed S9 has more data available on the machine's LCD and if you have no intention of ever downloading the data yourself into an appropriate software package, that may be a real point in the Resmed's favor. But the 60-series PR System Ones have more data available on the LCD than the older 50 Series machines like I use do.

That said: The S9 is typically more expensive than a System One and both will deliver excellent quality therapy and data for making sure your therapy is working (which is important regardless of whether you look at the data yourself or defer to the doctor and expect him/her to look at the data.)

Are there instructions available for me to program either one?

The DME will not give you the clinical instructions, which tell you how to program the therapy settings, which include the pressure setting. But if you want the clinical instructions, clinical instructions can be obtained for both machines if you ask for them.

Have many people had a chance to try both--what differences have you noticed?

Not many people have had a chance to use both machines. Back when I was a newbie, I did have an S9 AutoSet. I was switched to my current System One BiPAP because of aerophagia issues.

The biggest noticeable difference between the two machines is how the exhalation relief system works. The Resmed S9 EPR system lowers the pressure by a fixed amount (1-3 cms depending on the setting) at the beginning of each exhale and raises the pressure back up to the full therapeutic setting right before the inhalation starts. The Flex system used by PR System One machines lowers the pressure by a variable amount which depends on the strength of the exhalation. The more forceful the exhalation, the greater the drop in pressure. The Flex system also starts raising the pressure back up to the full therapeutic setting during the middle part of the exhalation. I'm convinced that most people probably can't notice enough difference between EPR and Flex for it to make a difference. But some people can. And which machine they prefer depends on what it is they are sensing. In other words, some people prefer EPR and say it feels more like natural breathing. Others prefer Flex and say it feels more like natural breathing. And some people don't like exhalation relief at all.

A more subtle difference is that the Auto algorithms are different. The Resmed S9 reacts to events by quickly increasing the pressure and it can be slow to lower the pressure back down. The PR System One has a "hunt-and-peck" part of the auto algorithm where the machine periodically tests whether a small increase in pressure improves the airflow or not. If no improvement is seen, the pressure is lowered back down. If improvement is seen, the "set pressure" is adjusted upwards to the test pressure. Hence the PR System One can be proactive and raise the pressure before events start occurring in some circumstances. The PR System One also uses a hunt-and-peck algorithm in reverse to test whether it is safe to lower the pressure after it has increased the pressure in response to events. In a nutshell:

• The S9 is faster to react to events once they start occurring and slower to lower the pressure back down once the events are resolved.
• The System One is slower to react to events, but it does periodic tests to see if an increase in pressure smooths out the wave flow before events start to occur. The System One is also slower to lower the pressure back down after events are resolved because it will test whether the it is "safe" to lower the pressure rather than just lowering it until more events occur.

If you want a lot more detailed information concerning the Auto algorithms, you can read my old post Re: What is the best Auto CPAP This post compares the older Series 50 System Ones to the S9's, but the Auto algorithm remains much the same on the Series 60 as it was on the Series 50 System Ones.

Another subtle difference is how the two Auto algorithms test for OAs vs. CAs. The Resmed uses lots of small oscillations that last for several seconds, while the System one uses "pressure pulses" where the machine raises the pressure by 1 or 2 cm for less than a second. Some people find the S9 oscillations irritating and some people find the System One pressure pulses irritating. A very few people find the CA detection algorithm on each machine irritating enough to wake them up. But most people don't notice either system.

Some people say the S9 is a bit quieter, but both machines are very quiet. Conducted noise can be a problem with either machine.

Some people dislike the default humidifier tank on the S9, but tanks that open and are dishwasher safe can be obtained if you insist that the DME get them for you.

[sparkles]

That's really excellent info, thank you! Do you know if the model before the S9 (S8?) does the same "tests"? I think I used that machine for a bit and it was not working well for me. I'm wondering if it was causing enough periodic wakefulness to keep me from deep sleep and cause other issues...

[robysue]

That's really excellent info, thank you! Do you know if the model before the S9 (S8?) does the same "tests"? I think I used that machine for a bit and it was not working well for me. I'm wondering if it was causing enough periodic wakefulness to keep me from deep sleep and cause other issues...

The "FOT" CA vs OA detection algorithm was new with the S9 AutoSet and S9 Elite machines.

But---the basic algorithm for how the machine responds to obstructive events---the rapid increase in pressure followed by the slower decrease---that creates the characteristic "wave shape" in the S9 AutoSet's pressure curves---is essentially unchanged between the two machines.

If you were using an S8 AutoSet in Auto mode, then the aggressiveness of the Auto algorithm might have been what was disturbing your sleep, and you might do better with a less aggressive pressure response OR you might do better on fixed pressure instead of an APAP running in Auto mode.

If you were using an S8 with EPR turned on (particularly turned on to 3), then it may be that it was the EPR algorithm that you didn't particularly like. In that case you might do better with a different exhalation relief system OR you might do better with the exhalation relief system turned OFF.