Resmed vs. Respironics, which is better for?

[DYNE540]

Hi xpapers,

I'm gonna get a new machine soon, one that tracks detailed data (ahi, leaks, events, etc...).
Usually, every night i go thru a cycle of an Apnea, then a Hypopnea or two occurs.
Throughout the night this cycle occurs, lesser now since i have an Xpap.
I usually don't have central Apneas or Hypopneas with flow limitations.
my pressures are from 8.5 to 10. I use a full face mask by FP.

Q: Which machine handles the Apnea/Hypopnea cycle throughout the night best for you? Resmed or Respironics?

thanks for your opinions!
VVE

[ozij]

Any special reason for you not to consider the Sandman Auto?

And, what pressures are your apneas at?
How is your present machine set up?
What are you event idexes?
O.

[DYNE540]

Any special reason for you not to consider the Sandman Auto?

And, what pressures are your apneas at?
How is your present machine set up?
What are you event idexes?
O.

My pressures are 8 to 10. I used to have a PB 420e. I'm became dissatisfied with my PB. My doctor prescribed a respironics machine which only tells me how many hours i've used it.

Since i don't have any event data i want to know from the community as to which machine they find best for their symptoms.

[ozij]

What made you dissatisfied with the 420E ?

What can the present Respironics machine do for you that the data capable 420E could not?

If your macine is indeed an auto, set at minimum 8 maximum 10, then there's a way to get it to show you your data, and you don't have to buy a new one.


If your respironics machine can only report hours, then it's not capable of automaticall adjusting pressuer between 8-10. Maybe you have a ramp at 8. And fixed pressure of 10.

If you still have your 420E (and its software), you can set both minimum and maximur to equal 10, (in Auto mode) and you'll get some of the best data reporting in the business.

If you want a new machine to work in auto mode, then you should know that different people respond very differently to different machines. If you could be more specific about bothered you in the 420E, we may be able to give you better advice.

O.

O.

[RipVW]

Isn't ResMed discontinuing permitting the sale of software to patients? That would be primary Respironics advantage unless one already had the software or knew someone to get it from.

[Slinky]

Aw, come on, RipVW. You know darn well there is always a way around some dumb regulation like that!!!

[RipVW]

Aw, come on, RipVW. You know darn well there is always a way around some dumb regulation like that!!!

Yep, where there's a will there's a way, at least for those who are resourceful.

[Muse-Inc]

Q: Which machine handles the Apnea/Hypopnea cycle throughout the night best for you? Resmed or Respironics?

The top 3 I've been told are ResMed, Respironics, and F&P -- they all deliver pressurized air to splint open the airway to reduce apneas and hypops with their resultant oxygen desaturations. Each uses a slightly different algorithm to identify each event. I don't believe there is much difference between these in their ability to generate a flow of pressurized air to treat apnea.

I share my sleep doc's bias toward ResMed, afterall that's where my bias originated . My machin is quiet, has easy to use controls and humidifier (12 settings), and a ramp timer from 5-45 mins in 5-min increments -- what else could I want? Oh yeah, a CURE for apnea

[Ruby Vee]

My doctor prescribed Respironics, and the DME just gave me a ResMed instead. That was fine with me. My ex brother-in-law (not so affectionately called "Dildo" by my folks and I) worked for Respironics for years . . . that was a big mark AGAINST them in my book!

[jdm2857]

All of the manufacturers use different proprietary algorithms for their APAPs, each trying to be the best for the most people.

While any individual may do better with a specific brand there is no way to find out which is best for you short of actually trying each of the machines for at least a few weeks.

[DYNE540]

Thank you all,

For your opinions. to answer a few comments...I a student who does software and hardware engineering. it occurred to me that some machines use different algorithms. I noticed that the 420e, [using 8/10 pressure settings & fl1 off, fl on] that i was still getting AHI's in the 5 range. This started to irk me b/c some days i would have a 1 or 2 AHI. The days of a 1/2 AHI was amazing. I checked leaks and tweaked the 420e with input from many others and i couldn't get a consistent result.

Now, when I check the boards i see people mentioning resmed or another particular manufacturer does better with Central Apneas and such. So my engineering side of me says, ask the forums their experience and recommendation.
Unfortunately, the last comment is true: I would have to try each manufacturer for a month or so before i find out if it works for me. But before i do that i will continue to find out what biases are true and personal before i get a new machine. The my current respironics one isn't that great so far, but that's more personal bias just b/c of the DME i'm dealing with. I'll fix that tomorrow when i visit them.

thanks to all for you thoughts & input, especially ozji.

[ozij]

I noticed that the 420e, [using 8/10 pressure settings & fl1 off, fl on] that i was still getting AHI's in the 5 range

You terminology is confused -- both about your present machins settings and about the 420E -- the 420E has two switches: IFL1 and IFL2.
IFL1 is a make or break switch for many people when the machine is used on auto.

If you haven't read this post from me, about setting up the 420E now it is the time for you to do it. It is set up differently from other machines.

viewtopic.php?p=259412#p259412

A few days ago, deep into a meandering discussion called "Resmed vs. Respironics - Help" we started discussing auto algorithms in various machines, and I described things having to do with the 420E. The following is a summary of things I posted on that thread.

I've been a user of the PB 420E auto for 3 years, and had been doing some reading about it. I'm not a sleep professional in any way. My recent reading has convinced me the PB algorithm was planned for a special kind of setup.

When setting up the PB 420E (Puritan Bennett with the Evolution Algorithm) there are 4 different pressures you should look at:

Initial - where the machine goes when you turn it on and when the ramp is finished

Ramp - can start as low as you want, and you can make it lower than the minimum

Minimum - the lowest pressure the machine will go down to when in therapy mode

Maximum - the highest pressure the machine will go up to when in therapy mode

4 different pressures to set.

When PB submitted the machine to the FDA, the automatic mode's function was described as follows:
(my emphasis added:)
http://www.fda.gov/cdrh/pdf3/k031470.pdf

The GoodKnight 420 Evolution can operate in either Constant or Automatic mode. In Constant mode, the device delivers a constant positive airway pressure to the patient at a fixed level prescribed by the practitioner between 4 and 20 cmHrO. In Automatic mode (APAP mode), the practitioner sets a maximum and minimum pressure range above and below the prescribed reference pressure and between 4 and 20 cmHz0. The pressure is adjusted within this range according to the patient’s respiratory pattern and the type of respiratory events detected. Data concerning the type of events detected, their frequency and duration, etc. is stored in the device data memory and can be accessed by the practitioner through the use of the optional Silverlining'" software. Pressure delivery for
the GoodKnight 420 Evolution is regulated by a pressure sensor which monitors both ambient and output pressure and provides feedback to the control system.

The following sentence, in a paper on cardiogenic oscillations by D.M. Rapoport, ( http://www.chestjournal.org/cgi/content/full/116/3/660 ) sent me on a patent search.

"Dr. Rapoport and Mr. Norman have a financial interest in the development of automatic CPAP in the form of patent rights (assigned to New York University and licensed to Mallinckrodt Nellcor Puritan Bennett)"

If you read US Patent no. 5803066, (also no. 5,546,933) given to Rapoport et. al. and licensed to PB, you will see that the licensed auto algorithm assumes the existence of a prescribed pressure, a "preferred" pressure which is neither the min. nor the max. of the range. I'm adding emphasis to the quote, from pat. 5803066:

This is from patent no.

38. A breathing device for optimizing the positive airway pressure to a patient, comprising:

a source of breathing gas at controlled positive pressure to the airway of a patient;

a flow sensor configured to generate first data values representative of an inspiratory flow of breathing gas to the patient;

computer memory configured to store the first data values generated by said flow sensor;

a microprocessor including means for calculating the area of the inspiratory waveform from said first data values and calculating the area of a pure sine wave to generate a ratio of said areas and configured to generate a first signal when said ratio indicates a flow limitation in the patient; and

a pressure controller responsive to the first signal from said microprocessor and coupled to said source of breathing gas for increasing the positive pressure to the airway of the patient.

39. The breathing device of claim 38 wherein said micropressor is further configured to cause said pressure controller to increase the positive airway pressure to the patient at a greater rate when said positive airway pressure is less than a preselected prescribed pressure that (sic) when said positive airway pressure is greater than said preselected pressure.
40. The breathing device of claim 38, wherein said microprocessor is further configured to cause said pressure controller to decrease the positive pressure to the airway of the patient when said ratio does not indicate a flow limitation in the patient.

41. The breathing device of claim 40, wherein said microprocessor is further configured to cause said pressure controller to decrease positive airway pressure to the patient at a greater rate when said positive airway pressure is greater than a preselected prescribed pressure than when said positive airway pressure is less than said preselected pressure.

The above mentioned preselected prescribed pressure is the 420E's initial pressure.

When you don't set an initial pressure, initial and min. default to same. Meaning that you are set up for a slow rise (inhibiting the machine's preemptive capabilities) and speedy decrease back to your minimum - with not much chance of stabilizing around a preferred pressure, since the machine assumes preferred=min.

If you do set up an initial pressure, and make sure it is higher than the minimum, an closer to your preferred or prescribed pressure therapy will start at that pressure, and the pressure will drop if there are indications of airway stability. Once below the initial pressure, the machine will be more responsive to flow limitations, snores etc. On reaching the initial pressure, the rate of change upwards will slow down, and further pressure will be added more carefully, Once higher than your preferred pressure, it will drop back to that quickly and then drop further more carefully.

The bottom line is that you have more chances of staying at or below an optimal pressure if you tell the machine what that optimal pressure is - and you do that by setting it as the initial pressure.

The difference in rate of change is true for all breathing events. Not setting up the initial pressure therefore hobbles the PB's ability to respond quickly to apnea precursors. And also hobbles its ability to respond differently when below the optimum and when above it

Now, the machine does start therapy mode out at initial pressure. Which is why ramp is crucial (not optional) in this automatic machine. If your initial pressure is too high for comfort, you use the ramp to fall asleep. The machine checks your breathing at optimal pressure, and will gladly drop you down if everything is OK.


In summary:

Initial - where the machine goes when you turn it on and when the ramp is finished - (I now set it up with the pressure recommended in my PSG)

Ramp - can be handled like any ramp - based on comfort.

Minimum - the lowest pressure the machine will go down to when in therapy mode - you may want this for many comfort reasons.

Maximum - the highest pressure the machine will go up to when in therapy mode - you may want this for those times your initial is not enough.

Edit: added "for three years" to "user" and "recent" to "my reading"
O.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): 420E, respironics, Puritan Bennett, CPAP, Ramp, auto

Now, when I check the boards i see people mentioning resmed or another particular manufacturer does better with Central Apneas and such. So my engineering side of me says, ask the forums their experience and recommendation

Not sure where you got that info -- and I'm not sure how correct it is.

I get pressure induced central apneas when pressure is too high for me. The only machine that's lets me tell it at which pressure that happens it the PB (420E, and Sandman). Resmed sets the response limit for apneas at 10 -- for everyone -- because that's a good number for most (not all) people. Respironics avoids pressure induced apneas by backtracking once it has raised the pressure unsuccessfully -- it then assumest that the non-responsive apneas encoutered were not obstructive, pressure should not have been raised in response to them, and therefore, the Respironics auto drops the pressure.

The PB machines identify central apneas by listening for you heartbeat oscillation in on the air column. It the oscillation are heard during an apnea, that means there's no obstruction. This works great for some people -- those whose open airway apneas oscillate to the sound of their heartbeat. It may not work at all for others.

In addition, PB lets you set the machine's response to apnea manually. For me, anything above 8 or 8.5 spells trouble.

What is your present machine set at? Did you have a titration?

[DYNE540]

I'll PM you ozji. Maybe i shoulda stuck with my first resmed. oh well. thanks for all the help.

[mindy]

I was getting pressure-induced centrals with my Respironics in Auto Mode and had to go to a single fixed pressure to prevent them and I never could get AHI below 3-5. With my Sandman Auto, I have minimum=prescribed, maximum=20 and (I think it's IFL) off. That avoids the constant "chasing" of apneas when they are actually centrals. My typical night my average pressure is 0 to 0.2 above minimum and my AHI=1 or less. I've been using this machine for the past 6 months.

Mindy

[ozij]

I'll PM you ozji. Maybe i shoulda stuck with my first resmed. oh well. thanks for all the help.

No need to PM -- public discussion is better.
.
Once upon a time you said your machine was a PB 418P and you asked about a 420E.
Then you said you had 420E -- no specific result reported.
You then a accepted a switch of a data capable automatic mahcine for a fixed pressure Respironics Plus which is not data capable.
Now you say you had a Resmed.

I can't help you more than I did.

O.