Comparison Resmed S8 AutoSet II vs Remstar M Series

[Georgio]

Hi RG, good to see you are following this discussion. Personally, I was titrated at 8 and started out with my auto set on 7-12. One of your recent statements regarding auto therapy, prompted me to up my bottom pressure to 8, and the remaining higher pressures be available should I need them. Well it seems to have worked, my AHI numbers and data look pretty much the same, however, I have experienced a marked improvement in the way I feel. Thanks again!

I would like to add that I appreciate being included in a discussion with you knowledgeable professionals.

Georgio

[bigk]

Unfortunately the people who trot out the information about the A10 algorithm appear to do it solely to persuade people to buy their preferred brand of APAP. That is the only reason they do it and I believe that is the point DSM is making.

[Georgio]

Excuse me BigK, but I resent the remark that information about ResMed equipment is "trotted out" to sway patients toward a particular brand. My sole interest is ascertaining the most beneficial therapy and equipment for people requesting advice on this site. What are your motives?

Georgio

[rested gal]

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

bangy, I agree with ozij's suggestion here:
viewtopic.php?p=357611#p357611

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?

In that case, I'd get the Respironics REMstar Auto with A-Flex (it also has C-flex in it) M series machine. If I got that one, I'd want to get a Fisher & Paykel HC 150 heated humidifier to use with it, instead of the integrated M series humidifier. Just my personal preference...I like the machine, but I don't like the M series humidifier.

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.

In that case, I'd get the ResMed S8 Autoset II with the integrated H4i (not the H3i) heated humidifier.

I don't think you'd go wrong with either brand's autopap. Most (not all...most) people are treated well by either one, I believe. And some people do better on cpap than autopap.

I'd make my decision on which features I preferred. If quietness was a major factor, I'd go with the "II" series machines by ResMed. If making exhalation easy was a major factor, I'd go with the A-Flex offered in the Respironics machine, although I'll qualify that by saying I've not tried an Autoset II yet. I was not impressed with EPR the times I've used it in a ResMed S8 machine, so unless the series II's "easy breathe technology" makes the start of an exhalation easier than EPR does.... but you said you don't have a problem exhaling against your prescribed pressure anyway, so that may not matter.

If I were interested in getting data from the machine's LCD window each day, rather than use software, I'd go with the ResMed machine.

If I were interested in using software for my data monitoring, I'd go with Respironics for their Encore software.

Hope you enjoy your new machine, whichever you choose, bangy.

[Georgio]

Bangy, I agree with Ozi and RG: "In that case, I'd get the Respironics Auto with A-Flex M series machine." That's what my mother and I both use and they are great. You have experience with Resperonics so you have some degree of comfort. I don't know where you are located. I believe the humidifier requirements are very much dependent on your climate and location. While both me in Florida and my mother in Missouri are fine with the M-Series humidifier in passover mode, some require an upgraded humidifier as RG stated.

Good luck with your therapy, and keep asking questions, we all seem to learn from them!

Georgio

[dsm]

Just following on reading RestedGal's post on this matter complete with admonitions (thanks RG for not putting any rocks in the handbag but at least I knew when to duck (I well knew what was coming even if SAG played (or is ) plain dumb outside his bizarre persecution of some Illinois cpap user firemen ) )

One matter that is worth explaining is that *no* Auto on the market raises pressure when it believes an 'APNEA' is in progress (apnea as per that manufacturer's definition but in essence a NO-FLOW 'OBSTRUCTION' or 'CENTRAL').

All CPAP Autos (as distinct from ASV machines like the Bipap AutoSV) stop adjusting pressure and freeze if a no-flow APNEA is happening, then after the event has cleared itself, depending on brand & current pressure, they will behave differently.

Resmed over 10 cm consider any 'APNEA' (75% flow reduction) as an untreatable event (this is the heart of the A10 statement). But as RestedGal has so eloquently re-explained, flattening & snores will cause a Resmed machine to keep raising pressure above 10 CMs as pre-empting apneas is exactly what the machine was designed to do. Do no-flow obstructive APNEAs occur without prior flattening and or snores *NOT NORMALLY* this point has been skirted or brushed over in prior posts.

Autos DO NOT CLEAR IN-FLIGHT APNEAS and never did. They anticipate them and raise pressure in the expectation they will prevent a subsequent APNEA, if an APNEA (obstruction or central) occurs they STOP changing pressure. What they do after it is the variance.

Resmed look at the insp curve breath by breath for signs of flattening & as per the Wulfman post (which really was a godsend to this crazy thread) will within seconds raise pressure 0.2 cms per second.

The Respironics algorithm also monitors flow looking for FL, Hypopneas and 'APNEAs' but when it reaches 11 CMs and it detects a no-flow 'APNEA' it as mentioned stops adjusting pressure, then after the event has passed naturally, adjusts pressure up by (IIRC) 1 cm then waits 30 secs & if events are still occurring raises pressure by 1 cm & again waits the does 1 more try before deciding it needs to go the other way. If you look at the charts from Respironics machines you can see lots of what we call 'chairs' IIRC these are the seeking pattern the Respironics go into above 11 CMs when trying to treat events. In effect Resmed over 10 cms say a no-flow is to be ignored whereas flattening & snores arean't. Respironics say, lets go into this 'chair pattern' probe where we see if raising pressure works but if it doesn't after 3 cms we go back home.

Again I will come back to my overriding point in this whole thread, anyone who restates the mantra of 'A10 offers no response to APNEAs over 10 cms' to a newbie audience is just being mischievous or naive. It is a totally irrelevant matter to newcomers to cpap therapy because all it does is elicit mistaken comments such as Georgio innocently made.

DSM

[dsm]

Excuse me BigK, but I resent the remark that information about ResMed equipment is "trotted out" to sway patients toward a particular brand. My sole interest is ascertaining the most beneficial therapy and equipment for people requesting advice on this site. What are your motives?

Georgio

I agree Georgio, it can be trotted out in the genuine belief it means something to people making choices, even if that belief is naive.

I know you were merely repeating what you had been fed repetedly by others who either knew better or should have.

Cheers DSM (sorry if you feel picked on as I am sure you did not in any way intend to mislead or misconstrue any isse to do with how Autos work).

[StillAnotherGuest]

(I well knew what was coming even if SAG played (or is ) plain dumb outside his bizarre persecution of some Illinois cpap user firemen ) )

So does that mean I am not "dumb" (feigning or otherwise) in regards to the assessment and management of AMI including PAMI and the role of an EMS system?

You idiot.

SAG

[dsm]

(I well knew what was coming even if SAG played (or is ) plain dumb outside his bizarre persecution of some Illinois cpap user firemen ) )

So does that mean I am not "dumb" (feigning or otherwise) in regards to the assessment and management of AMI including PAMI and the role of an EMS system?

You idiot.

SAG

SAG,

Get a grip - those of us who understand you know you lose the plot with humanity from time to time & are willing to tolerate it but to stick your nose in here with insults really reinforces why you need to be kept in a cage (cpap center). Just ask that fireman why he quit cpaptalk - he just didn't understand why you chased him down to where he worked in pursuit of your classic obsessions and persecution. He came here to discuss his cpap therapy, he got jumped on. I can handle that type of idiocy, he didn't understand it. Now again I ask who is the bigger idiot.

DSM

(Just go back to what you do best).

[StillAnotherGuest]

Ahh, this thread flows so much more smoothly with the Idiot Blocker turned on:

[ozij]

Bangy, I agree with Ozi and RG: "In that case, I'd get the Respironics Auto with A-Flex M series machine." That's what my mother and I both use and they are great. You have experience with Resperonics so you have some degree of comfort. I don't know where you are located. I believe the humidifier requirements are very much dependent on your climate and location. While both me in Florida and my mother in Missouri are fine with the M-Series humidifier in passover mode, some require an upgraded humidifier as RG stated.

Good luck with your therapy, and keep asking questions, we all seem to learn from them!

Georgio

Slight correction, Georgio.
Both Rested Gal and I were pointing out to Bangy, an experienced user, that he had 2 options:
Either: Try something new (that's a ResMed Autoset in his case) or cotinue with the algorithm he knows because it has treated him well, and, furthermore, he already has the software. Neither of us said one option was better that the other in absolute terms.

If anyone wants to see how well the ResMed algorithm works, look at tattooyou's thread: He was titrated at 16, his machine Autoset is set at 12-16 IIRC, and gives him everything he needs at about 13.x (again IIRC). That's a person for whom the ResMed algorithm works just great. On the other hand, Portageegal isn't doing so well on it, no matter how she sets it.

We can find examples like that for each auto algorithm.
Many people did very well with the Intellipap algorithm - Georgio did not.

Etc.

As for accusations of ulterior motives: readers will no doubt make up their minds about that based on their reading - not on pronouncements. I certainly have my own opinion of the motivations of those who trot out those accusations.

For those interested in an academic comparison of algorithms responding to real patients:
Titration Efficacy of Two Auto-Adjustable Continuous Positive Airway Pressure Devices Using Different Flow Limitation-Based Algorithms
This was published in Respiration, vol. 75 no.1 2008 and is fully downloadable.
O.

[dsm]

Ahh, this thread flows so much more smoothly with the Idiot Blocker turned on:

Wonderful



Good for you - may you find eternal peace

D

[pastorj]

I am still a newbie to this forum and have noticed that some think we newbies should not give advice. I admit that I know very little about Sleep Apnea but first got on this forum because I believed that I could learn much about my treatment and I am doing so thanks to many of you. I think that there are a lot of others like me out there. We get on this forum everyday with notebooks in hand to record information that will be helpful to us. However, when we see people criticizing others over subjects such as this (machine preference) it causes confusion. I was diagnosed with severe sleep apnea and was titrated at a pressure of 16. I tried a respironics m series auto with c-flex with a minimum of 14 and a maximum pressure of 18 and I did not do well with it. I was put on a resmed auto with the same settings (except EPR instead of c-flex) and responded very well. My numbers were much better and I slpept more confortably. On the other hand, I have a friend who has tried both and does better on the respironics auto. To say that a resmed is not a good machine for someone who needs pressure over 10 is misleading to us who are new to all this.
I wish that we could admit that each of us is different and will respond differently to different machines. I believe that most if not all of the machines on the market can be effective if set up right. And this is what I look to this forum for---information on how to best set up my machine for the best therapy. That is what most of us need, not people's opinions about what machine is best.

[track]

I don't want to get in the middle of this cat and dog fight but I offer this observation. My AHI on resmed averaged 5.3 over the last two years. My first AHI on the remstar m series auto was 1.9...that's more than 2 times lower than my very LOWEST AHI on the resmed over a 2.5 year period.The two machines definitely report AHI differently. I am not saying one is better than the other...but you will get different numbers.

[-SWS]

I know you were merely repeating what you had been fed repetedly by others who either knew better or should have.

Apparently A10's response above 10 cm is sufficiently counterintuitive to lead newcomers and old timers to the wrong conclusion about A10's effectiveness.

But the answer to clarifying that A10 confusion is not all the name calling and character-condemning accusations that I have been on the receiving end in this thread, Doug. Your protective Resmed policy of: 1) suggesting that there are now brand new pressure responses above 10 cm, and of 2) referring to old-timers such as myself who perfectly understand A10 as if they were exploitative liars is really at the heart of why this thread has repeatedly diverged from rationality starting on page one.

I'll restate what I think the inherent problem really is: A10's statistically-based pressure response above 10 cm is sufficiently counterintuitive to lead newcomers and some old timers to the wrong conclusion about A10's overall effectiveness.

Doug, let's nail it down with rational discussion, but let's not castigate people around here with false character insults about deceptiveness and exploitation.