Newbie requests help choosing APAP: PR1 or S9?

[Languid]

(Note: If anything in my post is unclear -- e.g., I've used the wrong terminology, or haven't identified something completely, or provided enough information -- please let me know. I will attempt to clarify ASAP.)

I've been reading through this forum's very helpful discussions comparing different APAP machines. Thanks, everyone who contributed.

I've narrowed my decision to two different APAPs: The Respironics PR1 and the ResMed S9. My reason: these are the machines that offer highly detailed data collection (via external software on a computer, sold separately).

Here are my impressions based on what I've read in this forum:

* The PR1 and the S9 are pretty similar overall.
* I'm guessing they're fairly similar in terms of the data they gather. (I'm not too interested in viewing the data on the machine's screen. I'd rather just upload it to my computer.)
* Both have a 2-year warranty.
* The S9 is designed a little more with comfort in mind; the PR1 a little more with preventing apnea events. The PR1 puffs a little harder to keep the airway open after exhalation. This might wake some people. The S9 might miss a small number apnea events, but might be easier to sleep thru. It probably depends a lot on the individual. For some people, it might not make much difference.
* The PR1 might be a bit more durable.
* The PR1 is a bit cheaper for the machine itself. (I don't know how costs compare when one adds in software, humidifier, etc.)
* The S9 does not have a leak alarm.

At this point, I'm very strongly leaning toward the PR1 for a single reason the leak alarm. I have a beard and sleep on my side. I used an APAP unit from my health care provider (Kaiser Permanente) for a week, and I think my mask came off at least once.



However, the idea of the ever-so-slightly gentler S9 does sound appealing. The APAP unit I used was, I think, a Respironics, but probably an older model. Sorry I don't know more than that. I could contact Kaiser Permanente and find out. pressure from the machine did seem pretty strong. I found I'd been swallowing a lot of airwhich wasn't pleasant. I've read some of the discussions about aerophagia. Some say it tends to go away with time. (I suppose it would be extremely helpful for me to know whether the model I was using was the model I'm considering buying, wouldn't it. Duh! I'd better call them and find out.)

In the meantime, I'd be grateful for any guidance along the following lines:

* Are the data collection capabilities of the PR1 and the S9 indeed similar? (Leaving aside the machines' own onscreen display capabilities, that is.)

* Do you folks think that, given my beard, etc., the leak alarm is critical? Or is preventing leaks and preventing the mask from falling off more a matter of finding the right mask?

* Does anyone have any idea whether the S9 would be more likely to prevent aerophagia?

* Any other thoughts you may have are more than welcome.


Thanks for any help you can provide.

[Otter]

* The S9 is designed a little more with comfort in mind; the PR1 a little more with preventing apnea events. The PR1 puffs a little harder to keep the airway open after exhalation. This might wake some people. The S9 might miss a small number apnea events, but might be easier to sleep thru. It probably depends a lot on the individual. For some people, it might not make much difference.

You've got the gist of it , but there are actually two different things here. The puffs are diagnostic pulses used to check if your airway is open. PR1 uses a single 2cm pulse that bothers some people, though in Rev 1 this was softened and bothered fewer people. Now I think they're on Rev 3, so do your homework. S9 uses a smaller, oscillating series of pulses that very few can detect even when awake.

When using exhalation relief, the S9 waits for you to inhale before bring the pressure back up to full, thus risking an OA if the pressure hasn't been raised to compensate. The PR1, OTOH, will bring the pressure back before you're done exhaling, thus risking driving you up a tree because you feel like the machine is trying to make you breathe faster.

* The PR1 is a bit cheaper for the machine itself. (I don't know how costs compare when one adds in software, humidifier, etc.)

Software for the S9 is free. Software for the PR1 is expensive, but arrgh, there ought to be a better way, and if you ask, someone will tell you about it. Also, the open source alternative, Sleepyhead, written by one of our own, is coming along nicely and will support both machines.

* Are the data collection capabilities of the PR1 and the S9 indeed similar? (Leaving aside the machines' own onscreen display capabilities, that is.)

Yes. Jedimark, who is busy working on Sleepyhead, says the S9 has a few more condiments, but both have the meat and potatoes.

* Do you folks think that, given my beard, etc., the leak alarm is critical? Or is preventing leaks and preventing the mask from falling off more a matter of finding the right mask?

Finding the right mask. I'm a bearded sidesleeper myself, and did have trouble with my Quattro FX at first, but it was more a matter of the leaks annoying me. If they were really bad, they woke me up. Even the ones that weren't so bad in terms of liters/minute woke me up sometimes. Now, maybe you're the type to sleep through a major leak and wake up exhausted when your alarm goes off. But even then, it's more about the mask than the machine. I only remember one person who complained about the lack of an alarm. She really needs it, but I don't think most people do.

BTW, my beard turned out to be a non-issue, but YMMV.

* Does anyone have any idea whether the S9 would be more likely to prevent aerophagia?

Given the the mini-bilevel style exhalation relief, I think it would. But if you really have trouble with aerophagia, you may need a true bilevel machine, and then you'll be glad you got the cheaper one on the first go. If you're paying out of pocket, definitely check out secondwindcpap.com. I got my S9 there, and they have amazing CS. Be careful to the original version if you buy used PR1. They're said to be much louder and somewhat more intrusive than the first revision.
viewtopic.php?f=1&t=61099&st=0&sk=t&sd=a

*

Any other thoughts you may have are more than welcome.

Sounds like you've done your homework. Unfortunately, it's very hard to tell which is best for you without trying them both. In your position, I went with the S9 because almost no one reported having to abandon it, while there were a few who couldn't tolerate the PR1.

The PR1 attempts to detect RERAs (respiratory effort related arousals), but I'd take that data with a pound of salt since the machine doesn't have an EEG input.

What people kept telling me is that they are both good, and I should worry more about the mask. I believed that then and still do.

[cowlypso]

I keep seeing people talk about the pressure pulse on the PR machine, but honestly I've never felt it. I've even held my breath while awake to see if I could feel it, and nothing. Maybe I'm just oblivious?

[Janknitz]

You've got the general idea of it. One thing is that I've never used the leak alarm on the PRS1, but I'm given to understand it's not very loud and people who do use it sleep right through it. So if that's your deciding factor . . .

I love my PR S1, but if I'd had any choice in the matter (I didn't, see below) I would have gotten the S9 because of a few things: 1) the mask fit feature; 2) the on screen info available in color and backlit so you can actually SEE it (I think it's a PITA to have to download my card to see what's happening); the temperature control over the humidifier. But the PRS1 is a fine machine and I'm getting really good therapy from it, so I can't complain.

You should be aware that if you expect Kaiser to pay for it you may have no choice. Here in my region, Kaiser does ONLY PR's, and it's Kaiser, not you, who decides if you are going to get an APAP or not. They do like data capable PR's, at least, because if you are having difficulty they will check your card and make adjustments accordingly. But if Kaiser is paying (except for the co-pay) you get what they give you. They also have a limited formulary of masks, and to my knowledge the newer masks like the Quattro FX are not on the formulary yet.

[kempo]

I own both the PR System one auto and the S9 auto. Both are very good machines. If I had to pick just one it would be the S9. It is a little more comfortable for me to use and the climateline hose is also a plus.

Oh yea, you can download free software from this forum for the S9.

[cowlypso]

I love my PR S1, but if I'd had any choice in the matter (I didn't, see below) I would have gotten the S9 because of a few things: 1) the mask fit feature;

The PR S1 does have a mask fit feature. It's only available in auto mode (only needed there, too, I guess...). You have to go into the clinician menu to turn it on or off. I've never used it, but it's listed there.

[Languid]

You've got the gist of it , but there are actually two different things here. The puffs are diagnostic pulses used to check if your airway is open. PR1 uses a single 2cm pulse that bothers some people, though in Rev 1 this was softened and bothered fewer people. Now I think they're on Rev 3, so do your homework. S9 uses a smaller, oscillating series of pulses that very few can detect even when awake.

When using exhalation relief, the S9 waits for you to inhale before bring the pressure back up to full, thus risking an OA if the pressure hasn't been raised to compensate. The PR1, OTOH, will bring the pressure back before you're done exhaling, thus risking driving you up a tree because you feel like the machine is trying to make you breathe faster.

Thanks for helping me to understand this, Otter. As you can probably tell, I've relied heavily on some of your postings. I've found them very valuable.

Your observation about the PR1 feeling like it's trying to force you to breathe faster is definitely something for me to consider.

Software for the S9 is free.

Ah! That does make a difference. And my understanding is that software is always going to be an out-of-pocket cost. However...

Software for the PR1 is expensive, but arrgh, there ought to be a better way, and if you ask, someone will tell you about it.

I got that impression from the postings. That's a factor to consider, too.

Also, the open source alternative, Sleepyhead, written by one of our own, is coming along nicely and will support both machines.

Interesting! (My son, the computer science major, is a big open source enthusiast.)

Are the data collection capabilities of the PR1 and the S9 indeed similar?

Yes. Jedimark, who is busy working on Sleepyhead, says the S9 has a few more condiments, but both have the meat and potatoes.

Good to know. Thanks.

Do you folks think that, given my beard, etc., the leak alarm is critical? Or is preventing leaks and preventing the mask from falling off more a matter of finding the right mask?

Finding the right mask. I'm a bearded sidesleeper myself, and did have trouble with my Quattro FX at first, but it was more a matter of the leaks annoying me. If they were really bad, they woke me up. Even the ones that weren't so bad in terms of liters/minute woke me up sometimes. Now, maybe you're the type to sleep through a major leak and wake up exhausted when your alarm goes off. But even then, it's more about the mask than the machine. I only remember one person who complained about the lack of an alarm. She really needs it, but I don't think most people do.

This info is an enormous help. Thanks, Otter.

Does anyone have any idea whether the S9 would be more likely to prevent aerophagia?

Given the the mini-bilevel style exhalation relief, I think it would. But if you really have trouble with aerophagia, you may need a true bilevel machine, and then you'll be glad you got the cheaper one on the first go.

Wow. I might have to rethink this whole decision. But, again, I'm grateful for the information. You need a special prescription for a bi-level, right? I don't think mine covers it, but perhaps I could get that changed.

If you're paying out of pocket, definitely check out secondwindcpap.com. I got my S9 there, and they have amazing CS.

For used only? Or for new, too?

Be careful to the original version if you buy used PR1. They're said to be much louder and somewhat more intrusive than the first revision.
viewtopic.php?f=1&t=61099&st=0&sk=t&sd=a

Yes, I read this thread. The detailed information was extremely helpful. If I do go with the PR1, I will rely on the identifying features mentioned in the thread.

Sounds like you've done your homework. Unfortunately, it's very hard to tell which is best for you without trying them both. In your position, I went with the S9 because almost no one reported having to abandon it, while there were a few who couldn't tolerate the PR1.

Good point! That's excellent info, too.

Thanks again, Otter.

[Pugsy]

The PR S1 does have a mask fit feature. It's only available in auto mode (only needed there, too, I guess...). You have to go into the clinician menu to turn it on or off. I've never used it, but it's listed there.

Are you talking about Mask Resistance setting?
If so, this is not the same thing as ResMed's mask fit thing.
I have clinician manual for PR S1 Auto and I have seen nothing about mask fit.

[Languid]

I keep seeing people talk about the pressure pulse on the PR machine, but honestly I've never felt it. I've even held my breath while awake to see if I could feel it, and nothing. Maybe I'm just oblivious?

Oblivious? Nah. I wouldn't put it in those terms. I figure that some individuals are sensitive to certain things, and some aren't. It's the luck of the draw. Consider yourself fortunate. Hearing from someone who isn't bothered by this effect is just as important as hearing from someone who is. Thanks for your input.

[Languid]

You've got the general idea of it. One thing is that I've never used the leak alarm on the PRS1, but I'm given to understand it's not very loud and people who do use it sleep right through it. So if that's your deciding factor . . .

Good to know. Thanks!

You should be aware that if you expect Kaiser to pay for it you may have no choice. Here in my region, Kaiser does ONLY PR's, and it's Kaiser, not you, who decides if you are going to get an APAP or not.

That's true. It turns out that my Kaiser plan does NOT pay for a machine. Some people's Kaiser plans do; mine doesn't. That's why I'm on this forum. If my Kaiser plan did cover it, I'd still be using the machine the let me use for a week, and assuming that this machine was the best I could do.

Thanks, Janknitz. Much appreciated.

[Pugsy]

BTW I never notice the pressure pulses either but then again I sleep through pressure variations from 10 to 18

Should you opt for PR S1 you have several software options. Send me a PM if you want more information on Encore Pro. There is no need to spend money if you don't want to.
viewtopic.php?f=1&t=64906&st=0&sk=t&sd=a

Regarding AFlex or CFlex... it is like a rhythm. For me setting of AFlex 3 seems a bit fast but setting of 1 mimics my normal breathing perfectly. Hard to describe though.

[Languid]

I own both the PR System one auto and the S9 auto. Both are very good machines. If I had to pick just one it would be the S9. It is a little more comfortable for me to use and the climateline hose is also a plus.

That's great information. Thanks, Kempo!

[rested gal]

Welcome to the forum, Languid!

Otter did a great job answering your questions.

A couple of things you mentioned in your first post, Languid, that I'd like to touch on again...

* The S9 is designed a little more with comfort in mind;

Different people find one or the other brand to give more comfortable therapy for them. That could be a toss up.

the PR1 a little more with preventing apnea events.

I don't think either one is better at preventing apneas than the other. That's the main design goal in both brands. I think either machine does an equally good job at trying to prevent apneas. With either one, where a person sets the minimum pressure will be the important factor in preventing apneas. Much more important than which of those two brands a person uses.

Results: 1st night with Auto A-Flex (topic started by TSSleepy)
Two nights graphs posted using pressure range 4 - 20 and 10 - 20
viewtopic.php?p=348963#p348963

Wulfman, DreamStalker, and ozij explain why autopaps make changes slowly.
December 2008 Why adjust APAP. Isn't it auto? (topic started by oxygenium65)
viewtopic.php?p=323218#p323218

The S9 might miss a small number apnea events

There's no reason to expect the S9 to miss even "a small number" of apnea events. Again, if the minimum pressure is set to effectively keep the airway open during exhalation, both brands should be equally good at preventing apneas.

* The PR1 might be a bit more durable.

If either can be said to be a bit more durable than the other, my nod would go to ResMed.

Either brand should do a very good job for you.

When it comes right down to it, which brand of machine you decide on isn't going to be anywhere near as important as finding a mask that suits you well. The mask will be the main key to being able to actually sleep while using any CPAP/Autopap/WhateverPap. Of course, one does have to have a machine, and it looks like you're doing your research very well!

[Bluecat]

I have a PRS1 REV3 (now that I know how to check the REV )
There is a mask fit feature (long press on the ramp button, it cycles through a range of pressures, tells you if the mask fit is ok or not, and then starts therapy).

I have never noticed the puffs of air to check if the airway is open or not, although I know they happen since I see the red ticks on the waveform.

All in all, I am really pleased with the PRS1, even if the on screen information is not extensive and not with lots of colours

[Otter]

The S9 might miss a small number apnea events

There's no reason to expect the S9 to miss even "a small number" of apnea events. Again, if the minimum pressure is set to effectively keep the airway open during exhalation, both brands should be equally good at preventing apneas.

RG is right, and I may have given you the wrong impression. The difference I was talking about is more a matter the philosophy I see behind the design. Resmed seems to be giving undisturbed sleep a higher priority. While the the S9's EPR may allow more apneas at the same pressure as the PR1, there's no reason why you have to run the two machines at the same pressure. Another way to look at it is that you may have to bump up the pressure with EPR, and so C-flex/A-flex may be superior if you are already at 20 cm or having trouble keeping the mask from blowing off. My AHI is about one, so my s9 isn't allowing much apnea.

Also keep in mind that functionally the machines are more similar than not. We have to focus on the differences in order to choose, but for most people, either one will work well.