Newbie - which auto CPAP machine?!

[redcoat]

Hi,

New to all this. Was diagnosed with apnea during sleep study 3 years ago - 20.4 API. Tried CPAP and BiPAP and couldn't tolerate then.

Just had another study - 70 API! So really need to get on a machine and try again. Dr says he wants me to try an auto CPAP (I think that's right - CPAP machine that auto regulates it's pressure?).

Am on Medicare with added Anthem Medicare Preferred Select (PPO). Believe they pay 80%.

Don't want DME to fob me off. What's the best Auto CPAP out there?

thanks!

PS in Lexington, KY - any one recommend a DME here?

[Julie]

The best is the Resmed S9 Autoset - look at info under everyone's posts and you'll see a lot of them...

Btw, it's AHI, not API, and stands for apnea hypopnea index..

[jlklinko]

Hi there
1) x2 on Julie's post.
2) The Resmed S9 Autoset is the best in my opinion.
3) Make SURE it says "Autoset" by the on/off switch, not "Escape" or "Escape Auto".
4) The Escape is a model that is outdated and hold no relivant data for you to use.

[robysue]

4) The Escape is a model that is outdated and hold no relivant data for you to use.

It's not that the S9 Escape and S9 Auto Escape are outdated. They are simply cheaper, bare bones machines that do not record full efficacy data. And that makes them machines to avoid.

To the OP: If you have not read JanKnit'z What you need to know before you meet your DME, read it and re-read it a couple of times to prepare you for that all important first meeting with the DME.

[Cindy Lou Who]

Please check out the S9 Autoset. I have no experience with other machines as it's my first one. But so many others have and still recommend the S9 Autoset. Be sure to also get the Humidifier H5i. Some DME's may try to sell you the blower without the attaching H5i Humidifier. AND get the chamber that is Dishwasher safe. It comes apart so you can easily clean and dry it. The Standard chamber will not come apart and is prone to getting mold inside if you are not Very, very vigilant with cleaning.
Also buy the Climateline hose. It has a temperature sensor at the end by the headgear! The S9 controls the temp and humidity you breath based on the readings near your head. People that sleep in a cool room...especially in winter.... can have trouble with a little thing called "rain out" ( moisture that has condensed into drops that run up your nose). If you've ever gotten tap water up your nose you Know that that feels like...Ouch! It's a rude awaking for sure.
That's all I can recommend. Good luck with your DME!!!! Let us know how it goes.
Cindy

[jtmarten]

You can get an S9 autoset with humidifier for $799 brand new, w/2yr warranty, shipped. Your 20% makes it $160 to you. It works great with the SleepyHead software.

[sol]

You cannot go wrong with either S9 Autoset or PRS1 Auto both equally good machines but its the mask that can make or break the therapy.
It is vitally important to find a mask that fits properly and is comfortable to wear.

[Lizistired]

There are several threads on this.
There are some advantages to the PRS1 550:
The hose attaches on the top and swivels, on the S9 it comes out the back and has to do a sharp 90 deg turn where hoses tend to fail. Not a deal breaker but something to consider.
PRS1 has separate on and off settings for auto start & stop. The S9 has one setting that controls both. I like auto on for convenience but if I take the mask off in the middle of the night I don't want the machine to turn off because I won't hear it blowing and put the mask back on. So I can't use "smartstart".
Resmed ResScan software is readily available for free, easy to use. The color LCD screen is bright and clear and gives you more information than the black and white PRS1 screen. Now that Jedimark has made "sleepyhead" available that isn't such a big deal.
Style: S9 is silver and has a fat Bose look and the PRS1 is earthtone but kind of bulky looking, though I don't think the footprint is really any bigger. I only mention this because I know some people care way too much about decor.
I love my S9, but they are both good machines. Others know more about the difference between the S9 EPR and the PRS1 A&C flex, exhale relief.
But really, you will be happy with either one.
I think PR has a 60 model now but we haven't heaqrd much about it yet, so I can't comment on that.

[drog]

I have tried CPAP 3 times over the last 15 years. The S9 Auto is the first machine that has actually worked for me. The first machine back in the 90s was a complete failure (I just wanted surgery and the mask was horrible). The second (Respironics REMStar M series with built in humidifier) almost worked, but it aggravated the the opening between my nose and throat too much so I would take it off in my sleep every time. I also didn't like how the power light was bright enough to make shadow puppets on the ceiling or the kludge of wires in the back (even though the humidifier was built in, it was an afterthought. It was really two separate units that you couldn't detach). Granted, the M series is old and may not represent the latest Remstar offerings.

I'm starting to get along with the ResMed S9 Autoset so that is what I recommend. I have no idea why the Respironics device would aggravate the end of my nasal passage (like a raw, cold burning sensation) when the ResMed does not. Perhaps there's something to the reduced turbulence marketing hype on the S9.

[robysue]

Following up on lizistired's post, here's something I wrote in a different thread several weeks ago.

Both the Resmed S9 AutoSet and the PR System One APAP are fine machines.

But it's important to realize that the Auto algorithms of the S9 and System One do differ. They are both fine machines with auto algorithms that have been thoroughly tested. And both machines can provide top-notch therapy to a patient. But, while the algorithms are not the same, it's impossible to say one is somehow better than the other. It's rather like debating whether Coke or Pepsi tastes better: It all depends on who you ask. And rather like Coke vs. Pepsi, some folks have very, very strong preferences, but for the most part, most people can't really tell enough of a difference to for it to matter.

Still there are some real differences in the algorithms and for a small minority of patients, the subjective way the two machines feel will make a difference in their comfort while using the machines.

Both machines will respond to snoring, flow limitations, and clusters of OAs and Hs by increasing the pressure. Both machines will attempt to determine whether a given apnea is a clear airway apnea or an obstructive apnea. Both machines will lower the pressure back down after the algorithm is satisfied that your breathing is now stable.

The S9 algorithm tends to respond to events by rapidly increasing pressure and then, once it is happy with the shape of the wave flow, it immediately starts to slowly decrease the pressure back down. And it will keep decreasing the pressure until the machine detects snoring, flow limitations, OAs, or Hs. If more events occur, the machine once again will rapidly increase the pressure. This gives the S9's pressure curve a characteristic "wave" appearance where the fronts of the waves are steep and the back sides of the waves are much more gently sloped.

The System One algorithm is slower to respond to events and is slower to start decreasing the pressure back down once it is happy with your breathing. The System One also uses a "hunt-and-peck" algorithm for determining the optimal pressure: About every ten minutes or so, the System One will increase the pressure by 2cm over something like a two minute period while checking for improvements in the wave flow pattern. If improvements are found, the baseline pressure is reset to the pressure that gave the optimal wave flow. If no improvements are found, the pressure is then dropped back to the baseline setting over the course of a minute or so. And the machine waits for about 5-6 more minutes before starting the new hunt-and-peck cycle. To decrease the pressure, the System One does a reverse "hunt-and-peck": It temporarily decreases the pressure slightly looking for any deterioration in the shape of the wave flow. If it sees any deterioration, no matter how minor, it bumps the pressure back up to the current setting. But if no deterioration is seen, then the baseline pressure setting is reset at the lower level. And the machine then waits for about 5-6 minutes before testing whether the pressure can be decreased again. The "hunt-and-peck" algorithm used on the Respironics machines gives the pressure curve a characteristic saw tooth appearance.

The net result of both algorithms is that the machine can gracefully respond to a need for a modest increase in pressure and hence improve patient comfort by reducing the overall pressure needed to splint the airway open. Both machines have some problems providing high quality therapy if the minimum pressure setting is way, way below what the person needs. (Hence running the machine wide open with a pressure range of 4--20cm usually does not improve patient comfort.)

But each has its own strengths and weaknesses in terms of therapy:

The S9 can respond very quickly to a nasty cluster of events (in an effort to "bust the cluster up" as it's often put around here). And that quick response to events is a real strength of the S9 algorithm. But it can be very slow to lower the pressure back down. And if the min pressure is set far too low, it can lower the pressure back down to a pressure level that is clearly not high enough, which can then trigger another cluster of events. The fact that the S9 increases pressure only in response to snoring, flow limitations, OAs, and Hs also means that it always waits until something happens to increase the pressure and it always tries to lower the pressure all the way back down the minimum pressure setting.

The System One is much slower to respond to clusters of events. Judging from the pressure curves I've seen it appears that the System One will raise the pressure in 1-2 cm increments once a minute in response to snoring, flow limitations, OAs, and Hs. And then it waits to see if things clear up before it increases the pressure again by a 1--2 cm increase. So that can make it less effective at "busting up" clusters of events. But the System One is less likely to lower the pressure too much after the events are over. And theoretically that "hunt-and-peck" algorithm proactively raises the pressure before the flow wave deteriorates to the point of where snoring, flow limitations, OAs, and Hs can take place. In other words, the "hunt-and-peck" algorithm is supposed to help the machine figure out the appropriate pressure level even in the absence of event clusters.


As for comfort? Again there are strengths and weaknesses of both algorithms:

The S9's rapid pressure increases disturb some folks and wakes them up. Those rapid pressure increases can also trigger leaks. But except for when the machine is actively increasing the pressure in response to clear events (including snores and flow limitations as well as OAs and Hs), the machine is running at a stable or slowly decreasing pressure. And if the min pressure is pretty much set to what you need for at least 50%-60% of the night, you'll have nice long periods where the pressure is not changing at all.

The System One's pressure increases are not dramatically fast. And that means they are less likely to wake you up. And they're less likely to trigger a leak. But that hunt-and-peck algorithm is constantly kicking in. And so every 10 minutes or so there is a pressure increase. And that's enough to bother some people. But that hunt-and-peck algorithm is also going to help keep the machine from decreasing the pressure below a therapeutic level when the min pressure setting is set too low: Once the pressure is suboptimal, the subtle differences in the wave flow combined with the hunt-and-peck algorithm will prevent the machine from further decreasing the pressure much of the time.

Overall, there is some evidence that the System One's algorithm provides less overall variation in pressure and a quicker return to the baseline pressure after a series of "events" and attempts to locate a meaningful baseline pressure through the hunt-and-peck algorithm. The S9's algorithm provides a quicker response to clusters of events, a gentler decrease in pressure going back down to baseline, and a stronger effort to use the min pressure setting as the target baseline pressure.

Finally, Robert McCoy and Ryan Diesem have written a scholarly paper that discusses the Resmed and Respironics auto algorithms, along with auto algorithms from several other manufacturers. The paper is a bit dated: The machines being looked at are the Resmed S8 and the Repironics M-Series. This generation of machine was not capable of distinguishing between CAs and OAs. But the two companies overall choices in the design of their auto algorithm have not changed and so the stuff in the paper about how and when pressure is increased and decreased pretty much applies to the current S9 AutoSet and the PR System One Auto. The link to this paper is given below.

Link to A Bench Comparison of Five Auto-Adjusting Positive Airway Pressure Devices, Response to Apnea, Hypopnea and Flow Limitation, by Robert McCoy BS RRT FAARC, Ryan Diesem BA, Valley Inspired Products Inc. (December 1, 2008)

[redcoat]

Thanks everyone - appreciate the feedback.

Turns out the DME was great. Asked for the S9 AutoSet and was no problems giving it to me. Came with the H5i and dishwasher safe chamber that comes apart. They didn't have the Climate hose, but have ordered it for me.

I tried the nasel pillow mask, but opted for the Mirage FX - have a question about it but will post separately.

Tonight's the first night using it...

[Chikorita]

Hope it goes well for you. I'm still learning about all this before I get my machine.

[teachcsg]

Robysue, EXCELLENT answer! I have downloaded the link to the paper and will be reading/studying it today. Thanks! I am an RT and I did not know the difference in the S1 and the S9 algorithms. Great job.

[robysue]

teachcsg,

Thanks for the compliment

[Vlad - Who is ResScan software available from for free?]

There are several threads on this.
There are some advantages to the PRS1 550:
The hose attaches on the top and swivels, on the S9 it comes out the back and has to do a sharp 90 deg turn where hoses tend to fail. Not a deal breaker but something to consider.
PRS1 has separate on and off settings for auto start & stop. The S9 has one setting that controls both. I like auto on for convenience but if I take the mask off in the middle of the night I don't want the machine to turn off because I won't hear it blowing and put the mask back on. So I can't use "smartstart".
Resmed ResScan software is readily available for free, easy to use. The color LCD screen is bright and clear and gives you more information than the black and white PRS1 screen. Now that Jedimark has made "sleepyhead" available that isn't such a big deal.
Style: S9 is silver and has a fat Bose look and the PRS1 is earthtone but kind of bulky looking, though I don't think the footprint is really any bigger. I only mention this because I know some people care way too much about decor.
I love my S9, but they are both good machines. Others know more about the difference between the S9 EPR and the PRS1 A&C flex, exhale relief.
But really, you will be happy with either one.
I think PR has a 60 model now but we haven't heaqrd much about it yet, so I can't comment on that.

Where can I get a free ResScan software?