Comparison Resmed S8 AutoSet II vs Remstar M Series

[dsm]

Now this is about the time RG chimes in and either says what a wonderful guy SWS is on matters of xPAP or smacks me upside of the jaw with her handbag (or her cheerleader baton, or whatever ) never let a decent proveable fact get in the way of a timely rescue

[Today's role of RG will be played by SAG]

Gad, you are such an idiot.

SAG

No !

Just used to the pattern - so now we are into the name calling phase. Good work SAG. So who is the bigger idiot.

DSM

[StillAnotherGuest]

So who is the bigger idiot.

That would be you.

And that's "Mr. SAG" to you.

You idiot.

[bangy104]

Thankyou Everybody it is really interesting to read the whole thread and all of a sudden I am now feeling the need to download the data of my machine and look it my charts once again. Regarding Leaks at 14 pressure I would say that my swift mask gives me a very good fit and there are no leaks infact the sleep tech who conducted my sleep study a few months back also mentioned this fact after the study as she was suprised I had very few leaks even at such a high pressure. I am using Remstar Tank APAP with pressure set between 8 - 20 under the assumption that it would set my pressure according to the needs and when I used to monitor my charts I also found that pressure reduced when my weight went down and again up when my weight went up. I do not feel 14 is a very high pressure for me and I am used to it and can handle the pressure very well.I am very comfortable with APAP although now I do not feel as refreshed as I used to feel when I started APAP. My doctor suggested a day studt (MSLT) which is scheduled on April 25. My old tank is still going strong and only reason I want to get a new machine is because it is free for me and it starts the 5 year period after which I will be eligible for next machine. I would also say I am a laid back user of APAP who after initial enthusiasm would now just like to lay back and enjoy positive effects of CPAP/APAP without monitoring it daily or weekly or monthly if possible. However as Georgio said eventually I need a recommendation but I do have a couple of days to make up my mind so any inputs are really appreciated and also if any info regarding my sleep study or current numbers can be helpful in arriving at a recommendation please let me know and I can post them. Once again thankyou everybody for your help

This discussion probably should have it's own thread....but we need to eventually arrive at a recommendation for Bangy104. I'm now feeling like an instigator, however, at a pressure of 14......if Bangy is buying a machine.....would bi-pap or other be a consideration?

Georgio

[-SWS]

Bangy, at 14 cm H20 I think I would personally prefer one of these two auto adjusting BiLevel machines:
https://www.cpap.com/cpap-machine/Respi ... iFlex.html
https://www.cpap.com/cpap-machine/resme ... chine.html

But as ozij pointed out, either of those machines would require a prescription for auto adjusting BiLevel rather than APAP. Regardless, the above two would be my first choice with a pressure at 14 cm and your weight-related pressure fluctuations.

Here you go, dsm:

An apnea is defined as a greater than 75% decrease in ventilation. The AutoSet algorithm scores an apnea if the 2-second moving average ventilation drops below 25% of the recent time average (time constant 100 seconds) for at least 10 consecutive seconds. Treatment pressure increases based on the duration of the apnea. The pressure will not rise above 10 cm H2O when an apnea is detected, to prevent an inappropriate response to central apneas. Initial pressure increases are rapid, but the rate of increase diminishes as the pressure approaches 10 cm H2O.

So in light of the above current Resmed wording, please allow me to de-spin these statements:

The A10 algorith *does* respond to OSA events over 10 CMs pressure.

I find the above Resmed clinician manual to state the situation accurately. Georgio clearly stated Resmed's information in the red text above. And then for some reason his absolutely correct wording got labeled as "plainly deceptive" while others in this thread were accused of spinning words.

What the algorithm doesn't do (very sensibly) is to respond to an event that has NO PRECURSOR events and is a no-flow event. The algorithm applies the best common sense by deciding if there was no flattening (which means Flow Limitations & hypopneas) prior to the no-flow event then it is more probably a central apnea.

This word spin is very confusing IMHO. It REALLY makes it sound as if today's A10 will raise pressure to a detected apnea above 10 cm if that detected apnea is preceded by just the right precursor signals. That was not the case 10 years ago. And it is clearly not the case with the current S8 AutoSet II model that also happens to employ A10. Your "now-days-some-apneas-will-get-a-pressure-response-above-10cm" counter-claims should have been your burden to prove---not my burden to disprove, good sir.

People can continue to propagate the untrue statement that 'A10 doesn't respond to apnea over 10 cm' (which is plainly deceptive)

Well, then the above clinician manual must be plainly deceptive as well. But to call people here "plainly deceptive" when they are very correctly stating Resmed's information is mind baffling. Then to make it sound as if some detected apneas above 10 cm will receive a pressure response with just the right snore or FL precursors is either "plainly wrong" or one heck of a confusing "word spin" IMO.

------------------------------------------------------------------------------------------------------


To very clearly RE-re-recap with "swirl-free" words:

To recap:

1) Resmed's A10 algorithm will directly respond to FL above 10 cm (according to Resmed)
2) Resmed's A10 algorithm will directly respond to snores above 10 cm (according to Resmed)
3) Resmed's A10 algorithm will not directly respond to any apneas above 10 cm (according to Resmed)
4) Pressure-response strategies one above (FL) and two (snore) above can and will help prevent many apneas occurring above 10 cm

That was true ten years ago with A10 and according to the clinician's manual, it's still true regarding today's A10 algorithm employed inside the S8 AutoSet II. And since basic obstructive etiology hasn't changed one iota in the last ten years, A10 is still a very smart statistically-based strategy.

[bangy104]

If I can handle the pressure pretty well and have no problems during exhalation why would I need a BI-PAP? Not that I am against getting a BI-PAP but I am not very convinced on what are the additional benefits I would get to be able to go to my doctor and discuss with him a BI-PAP option.

Here are my numbers that i found in one of my previous posts

Here are the numbers from 8/16 - 8/29

Avg 90% Pressure 13.0
Avg Pressure 11.1
Avg Non Responsive AHI 0.0
Average OAI 0.7
Avg HI 1.3
Avg AHI 2.0
Avg FLI 1.1
Avg VSI 15.1
Avg Max Leak 79.1
Avg 90% Leak 40.0
Avg Leak 32.3
Avg Large Leak 0 mins

[-SWS]

If I can handle the pressure pretty well and have no problems during exhalation why would I need a BI-PAP?

If you: 1) can handle the 14 cm pressure well, 2) have no problematic mask leaks at 14 cm, and 3) are treated well by ordinary APAP, then there really is absolutely no point to wasting money on an auto BiLevel IMHO.

People on this message board often have very strong preferences about APAP brands and models. I would personally take either the Resmed S8 AutoSet II or the Remstar M Series Auto without any qualms. The Resmed "physical build quality" is better than Respironics' IMHO.

However, since you know the Remstar algorithm treats you very well, why take a chance on another manufacturer's very different algorithm? If I felt an algorithm treated me particularly well, then I would probably stick with it. If I felt an algorithm had room for improvement, then I'd personally be tempted to try another manufacturer's algorithm.

Better yet, ask if your DME will allow you to trial an S8 AutoSet II for comparison before deciding.

[Fredman]

Now this is about the time RG chimes in and either says what a wonderful guy SWS is on matters of xPAP or smacks me upside of the jaw with her handbag (or her cheerleader baton, or whatever ) never let a decent proveable fact get in the way of a timely rescue

[Today's role of RG will be played by SAG]

Gad, you are such an idiot.

SAG

If anything, I am learning all about "flattening" and "centrals". I discovered I have whole lot more to learn about. I often wondered about the flattening and peaks on the graphs. Not to divert this very interesting thread - can someone point me to info on flattening and centrals etc?

But please do carry on with this debate because I am very interested, learning, and will be buying a second machine in about 15 months or so. I know it sounds so selfish.

All we need is the rest of the crew to jump in - Where's Rooster? Yes and Rested Gal to put the definitive icing on the cake. Seriously though this is very helpful despite the fact that you may feel some frustration on definition of apneas. I do appreciate your points DSM. Is there a way we can get a current statement from Resmed on this issue

[-SWS]

Is there a way we can get a current statement from Resmed on this issue

Yes: see the red text above. Those very clear words are Resmed's exact words in the current S8 AutoSet II clinician manual.

Here they are again:

The pressure will not rise above 10 cm H2O when an apnea is detected, to prevent an inappropriate response to central apneas.

Since Resmed's A10 does not attempt to differentiate central from obstructive apneas, they take a statistical "hands off" approach above 10 cm when they see an apnea. Resmed will instead try very hard to prevent obstructive apneas by responding only to snores and FL above 10 cm. Additionally, Resmed's A10 will respond to apneas, snore, and FL below 10 cm.

That approach works very well for the majority of people.

[ozij]

Fred,
Perhaps you don't realize that the ResMed S8 II series is about a year old - and is their newest.

O.

[Fredman]

Is there a way we can get a current statement from Resmed on this issue

Yes: see the red text above. Those very clear words are Resmed's exact words in the current S8 AutoSet II clinician manual.

Here they are again:

The pressure will not rise above 10 cm H2O when an apnea is detected, to prevent an inappropriate response to central apneas.

Since Resmed's A10 does not attempt to differentiate central from obstructive apneas, they take a statistical "hands off" approach above 10 cm when they see an apnea. Resmed will instead try very hard to prevent obstructive apneas by responding only to snores and FL above 10 cm. Additionally, Resmed's A10 will respond to apneas, snore, and FL below 10 cm.

That approach works very well for the majority of people.

Excuse the questions please if it seems obvious - I am learning. So above to 10cm when an apnea occurs the Resmed in the absence of snores and FL's will ignore the event. In ignoring the event I would imagine that the airflow would remain at 10cm? And if it were an apnea event as DSM is trying to describe - then what would be the worst case outcome if statistically Resmed was wrong? I assume that the pressure at 10cm would allow the event and worst case you record a hypopnea?

[-SWS]

The clinician-manual text that I have highlighted in red above was copyrighted by Resmed in the year 2008. Resmed's own printed words don't get much more current than that.

So above to 10cm when an apnea occurs the Resmed in the absence of snores and FL's will ignore the event.

That's exactly right. Statistically, that's the smart thing to do.

In ignoring the event I would imagine that the airflow would remain at 10cm?

Then A10 would sit at whatever pressure it happens to be at above 10 cm when the apnea was detected.

then what would be the worst case outcome if statistically Resmed was wrong

At a low-rate or zero-rate of occurrence, this situation would pose no problem. However, at a moderate-to-high rate of occurrence, then the patient is better off with another algorithm or in some cases another xPAP treatment platform. All the APAP algorithms have some minority of patients for whom the pressure-response strategy is not suitable. That situation is not at all unique to A10.

I assume that the pressure at 10cm would allow the event and worst case you record a hypopnea?

The worst-case is that a frank apnea occurs---in which case it would be recorded as an apnea. That worst-case will happen for statistically-anomalous patients who are not a good match for A10. Again, all APAP manufacturers have statistically-anomalous patients who are not a good match for their algorithm. It's just a reality of APAP treatment regardless of brand.

[bangy104]

How likely is that I will have an apnea event which is not preceded by FL or Snore above 10cm? Is this a very common occurence or a rarity? Is there anything I can see on my charts in Remstar to determine that. For eg the chart is will show my pressure going up and my events throughout. Is there a way to coorelate them to accurately answer this question or another way Can I put my APAP to CPAP mode with fixed pressure of 10 for a night and see what is recorded if that can help answer this question?

[
Excuse the questions please if it seems obvious - I am learning. So above to 10cm when an apnea occurs the Resmed in the absence of snores and FL's will ignore the event. In ignoring the event I would imagine that the airflow would remain at 10cm? And if it were an apnea event as DSM is trying to describe - then what would be the worst case outcome if statistically Resmed was wrong? I assume that the pressure at 10cm would allow the event and worst case you record a hypopnea?

[-SWS]

Is this a very common occurence or a rarity?

It's a statistical rarity. If it was a common occurrence, then Resmed would have abandoned epidemiologically-based A10 long ago.

The odds of being poorly treated by another manufacturer's algorithm are similar IMO.

[Georgio]

"Is there anything I can see on my charts in Remstar to determine that?" A very reasonable question. I would imagine you would look for on your charts numerous apneas recorded, where the pressure is indicated above 10 to resolve them? I'm stating this as a question for more knowledgeable members to comment.

Georgio

[ozij]

Bangy,
"Apneas" "Hyopopneas" and flow limitations are defined differently by the various manufacturers. So any data you have on the Respironics may be helpful, but may just as well turn out to be misleading. Velbor has compiled some of the differences here:
viewtopic.php?f=1&t=40350&p=356255#p356255

What it boils down to, in practical terms is:
Is it worth your while to switch from an algorithm that works well for you, with software that lets you track the data, to another algorithm, that may necessitate an investment in new software too?

The probability that the unknown algorithm may be good for you is very big - but it's not a certainty. Are you curious, Adventurous, capable of saying: well, that was great try, but the machine didn't fit me? If you are, go for it. Try the ResMed. I don't think there's any way for you to know for sure without trying.

O.