Which Machine? (seeking successful treatment)

[JamesW6175]

Check out my equipment, have had it about one year and no complains yet. My EPR is turned off. Use the ResMed software to read my SD card and it provides lots of good info. I may not know everything it is telling me, but my Doctor is happy with my progress. Now using an sleep number bed that adjusts up and down either the head, foot, or both. Got a Chillow pillow insert to sleep on also. Sleeping better, exercising, eating right.

[SleepingUgly]

The Resmed uses lots of small oscillations that last for several seconds,

I never noticed this.

while the System one uses "pressure pulses"

I noticed this.

[robysue]

@SleepingUgly: I noticed both the FOTs and the PPs back when I was a newbie. And its easy to understand some folks will be bothered a lot more by the PPs than FOTs. But a few people will be more bothered by the FOTs than the PPs.

Point is: Different people notice different things. But most people probably won't notice either the FOTs or the PPs.

[archangle]

S9 vs. PRS1 is roughly a toss up. Currently, I slightly prefer the S9.

Get an APAP. You can always use it with a restricted pressure range or full manual if that works better for you.

S9 has numerous advantages over S8.

PRS1 Auto or S9 Autoset are the only Autos to consider. PRS1 Pro or S9 Elite are the only two manual CPAP to consider. (Unless you need bilevel.)

Get a heated humidifier.

Avoid S9 Escape, S9 Escape Auto, PRS1 plus, or PRS1 model 250/260. They don't collect much data.

[OKCSleepDoc]

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.
[/quote]

I would add several things. The other noticeable difference to me is the EasyBreathe technology that the Resmed offers. When this is turned on, I have felt a much smoother delivery of pressure and when turned off, I feel it is similar to the Respironics device. An added advantage of the Respironics device is the new Optistart feature that should raise your Minimum pressure every 30 hours or so(I don't really use this that much when I prescribe CPAP because I think 4-20 is atrocious, narrow the range!).

Either way, I have patients who are on both Resmed/Respironics devices and they both benefit from their machines. Personally, I have a 560, an S9 Autoset, an Icon, and a Devilbiss, and I generally give the S9 a slight advantage primarily on comfort. However, I don't think you would go wrong with a 560 PR1 either.

P.S. - the Respironics has sleepmapper software and while Resmed has similar software they haven't really marketed it heavily for home data monitoring. I would assume however, that the majority of individuals on this forum likely have Encore or ResScan which they use .

[sparkles]

How likely is it that the algorithm could have contributed to arousals and a slight increase in awake time, leading to poorer daytime functioning? (This would be using a fixed pressure because I seemed to sleep better with that than a range. Also, I was fine with EPR turned off.)

Point of information, I believe there was at least some involvement of "alpha intrusions", whatever that means. (No one talked with me about whether something should be done about that or what that something might be.)

When I tried it before, I actually did worse than without it.

One of the key questions asked here is "How do you feel during the day after using the machine when you're sleeping?" I felt worse. I want to treat the apnea, but it has to work for me when I'm awake as well as sleeping. I really want to get this figured out and I don't know what could be going on!

[robysue]

How likely is it that the algorithm could have contributed to arousals and a slight increase in awake time, leading to poorer daytime functioning? (This would be using a fixed pressure because I seemed to sleep better with that than a range. Also, I was fine with EPR turned off.)

The S8 had no FOT algorithm for detecting the difference between CAs and OAs. And if you were using fixed pressure, then the aggressive AUTO algorithm pressure increases should not have been a factor. If you had EPR turned off on the S8, my guess is you'll want it turned off on the S9 as well.

My best guess? You simply had a whole lot of (severe) acclimation issues. I say that as someone who went through hell with sensory overload issues while learning how to sleep with the dang machine. And for sensory overload problems, the only real answer is time and more time. In my case, it took six months or more before my body was able to start ignoring all the sensory stuff that was badly disrupting my sleep. It's not clear that I've really fully acclimated yet since multiple disrupting awakes continue to occur on a regular, nightly basis.

Point of information, I believe there was at least some involvement of "alpha intrusions", whatever that means. (No one talked with me about whether something should be done about that or what that something might be.)

I'll defer to others with more EEG experience. I'd suggest posting this to a different thread with "alpha intrusions" in the title.

[hyperlexis]

How likely is it that the algorithm could have contributed to arousals and a slight increase in awake time, leading to poorer daytime functioning? (This would be using a fixed pressure because I seemed to sleep better with that than a range. Also, I was fine with EPR turned off.)

Point of information, I believe there was at least some involvement of "alpha intrusions", whatever that means. (No one talked with me about whether something should be done about that or what that something might be.)

When I tried it before, I actually did worse than without it.

One of the key questions asked here is "How do you feel during the day after using the machine when you're sleeping?" I felt worse. I want to treat the apnea, but it has to work for me when I'm awake as well as sleeping. I really want to get this figured out and I don't know what could be going on!

Honestly, the machines are the best of an ever evolving, far from perfect technology. Some machines aggressively react to apneas and quickly change pressures (ResMed) while others are a bit lazier in response (PRs). Anecdotally, quick pressure changes can cause arousals, etc. But what, honestly can you do? The way this all works, alas, is you buy a machine and you are pretty much stuck with it, unless you can miraculously get the DME to take it back, or you have the cash to try different machines. Until the industry evolves, that's the way most people have to deal with it, unless you are comparing first before starting CPAP. That's what I did. Do I believe I now have a perfect machine with a perfect algorithm, etc., heck no. Numbers often make no sense and I'm still usually tired. But at least I'm not snoring and waking up gasping for air anymore, like before.

Being tired has lots of different causes, other than small nightly arousals from pressure changes. Stress, bad mattresses, medications, bad karma....

You'll make yourself nuts worrying yourself to death over this. Put the mask on, press the on button and go to bed. Other than pressure range settings, that's really the best one can do when the computer inside the auto box is calculating things up and down. Have faith.

If I had it to do over again, I'd seriously consider the F&P -- because it has a big clock and an alarm!

[islandboy5150]

Does anyone know if the F&P Icon has the auto on and auto off feature? Like the S9?

[sparkles]

The S8 had no FOT algorithm for detecting the difference between CAs and OAs. And if you were using fixed pressure, then the aggressive AUTO algorithm pressure increases should not have been a factor. If you had EPR turned off on the S8, my guess is you'll want it turned off on the S9 as well.

Damn! It was such a hopeful little hypothesis, and now...crushed.

I've always had several awakenings during the night when I shift position, and I come pretty fully awake. The awakenings last only very, very briefly before I fall asleep again. I believe I remember most of them in the morning, that's how much I wake up. I noticed that these mini-awakenings were slightly longer when using cpap, and wondered if it could have possibly created enough sleep deprivation to cause the decline I experienced. A bit of a reach perhaps, but I really would like to get this treatment to work.

My best guess? You simply had a whole lot of (severe) acclimation issues. I say that as someone who went through hell with sensory overload issues while learning how to sleep with the dang machine. And for sensory overload problems, the only real answer is time and more time. In my case, it took six months or more before my body was able to start ignoring all the sensory stuff that was badly disrupting my sleep. It's not clear that I've really fully acclimated yet since multiple disrupting awakes continue to occur on a regular, nightly basis.

I'm not sure what you mean by severe acclimation issues. It was weird how reassuring it felt to fall asleep with the cpap machine. I didn't really have the typical complaints that other early users sometimes have. In fact, I felt a peace of mind, but over several weeks my health went steadily downhill. I had to discontinue use. I persevered, trying again and again, but each time, after a few months, the same thing would happen, which was discouraging.

[edited to improve clarity]

[sparkles]

The Resmed uses lots of small oscillations that last for several seconds,

I never noticed this.

while the System one uses "pressure pulses"

I noticed this.

Ah, you've tried both--can you say a bit about how that came about, or point me to a thread where you go over that? How did they compare for you, besides the pressure pulses--Did you notice them to the point of disrupting your sleep?

[SleepingUgly]

How did they compare for you, besides the pressure pulses--Did you notice them to the point of disrupting your sleep?

I don't know if it disrupted my sleep, but it bothered me at times when I was trying to fall asleep. I'm guessing I'd have a central (normal for a transition) and the test pulse would jar me back awake. I think it was more noticeable with certain types of masks than others (it definitely was noticeable with the Oracle oral mask, and I can't remember which other kinds). I was able to sleep with the machine, but all other things equal (which they probably aren't), I'd prefer not to have those test pulses.

[Julie]

Two years ago when I got a new machine I initially chose the PR S1, but on the ? 3rd or 4th night the puffs or pulses began at bedtime and I hated them, didn't know what they were about or if machine was broken, and very luckily was able to exchange it for what I use now and I'm so happy they allowed me to make the change.

[Pugsy]

I have had a chance to use both the S9 and PR S1 machines. I have never noticed the pressure pulses at all on the PR S1 and neither did I ever notice the FOTs on the S9.
I have heard of people being extremely sensitive to both though. Even the S9 FOTs and thus preferring much older models of machines so that there are no pressure pulses or even FOTs.
Neither the FOTs or the pressure pulses should manifest themselves while awake though unless for some reason the machine is sensing a cessation of breathing for some reason. I have tried to see if I could sense them by holding my breath and I can't. Maybe I am just not horribly sensitive to those things.
They are not something that is a common complaint from lots of users. There are lots of PR S1 users out there that don't feel the pressure pulses. On the off chance that you are in the small minority that are super sensitive to things then the S9 would likely be a better choice because the FOTs are much less likely to be noticed while awake.

[archangle]

You should only feel the pulses while you're in the middle of an apnea.

The PRS1 machine seems to be "rough" with its pressure regulation. I'm not 100% sure why, but I tend to feel puffs and pressure changes even when I'm not having apneas. I feel the mask "pumping" up and down on my face as I inhale and exhale. Even if I have flex turned off. It's not a "pressure pulse" for detecting centrals, it's something to do with the way it tries to regulate pressure.

It doesn't bother me, but it is noticeable.

The S9 machine seems much smoother in terms of pressure, both in terms of regular usage and when it uses FOT pulses to detect centrals.

I've almost never felt either type of pressure pulse.