Time for New Machine -- Overthinking it?

[hschlossberg]

History: Over the 15 years I've been using CPAP, I've had just two machines: Resmed S7 Autoset and Resmed S8 Autoset Vantage. Current mask is the Mirage FX nasal mask. Things used to be great, but over the past year or so I've been often waking up not feeling "refreshed" and I feel it might be time for a new machine and/or mask. The other issue (or maybe it is "the" issue) is that I just found my original prescription, which was for 12 cm max pressure, but my pressure is currently set for 10.2. There are probably multiple reasons I'd lowered it at some point to 10: The Mirage FX seemed to leak a lot at pressures much over 10, lowered it slightly for camping trips where I needed to stretch battery use, and I get really dry over about 10.4 because I don't have a humidifier. I can't get a new humidifier at this point for the S8, and it seems I have read that the algorithm improved with release of S9, so it makes sense to me to upgrade.

Humidifier Need: I want a humidifier for the higher pressure, but I do not at all like the idea of it being heated (or maybe very, VERY slightly heated). So I want a machine that allows for passive humidity, and I see no real reason for a heated hose.

Data Needs: S8 provides data, which I only found interesting for about two weeks after I got it. Access to "great data" is not a priority for me in getting a new machine. I may want to look at the data at some point, but I am going to consider all modern machines about equal and sufficient in this regard.

Cost Considerations: As you might guess from my history, I don't have any cost reimbursements and so am very price sensitive (though I realize that it MUST be properly balanced against therapeutic benefit).

The Machines: After much research I am set on getting one of three machines, but I have concerns on each:
• Resmed S9 Autoset: would provide same basic algorithm methodology and therapy as my past S7/S8 success (maybe even improved over S8?); I like that it responds quickly to apneas (I've often felt that it doesn't respond quickly enough!), but I don't like that it holds at such a high pressure all night; still the same high $883 price as A10, even though it is an older model; newer A10 should be better but reviews/forum comments seem to suggest the opposite;
• Respironics PRS1 REMStar 60 Series Auto: Clearance priced at only $439; great reviews; concern that its different algorithm and therapy model may not be for me since I'm used to the Resmed; concerned that it won't react quickly enough to apneas; read that humidifier can be used in non-heated passive mode;
• Respironics DreamStation Auto: Price likely around $650; if I decide PRS1 algorithm is acceptable, then so should this; newer than PRS1 but not sure of any improvements other than looks, so doesn't seem worth the extra money.

Any thoughts on this, or feedback/arguments to my logic would be much appreciated...

Howard

[TonyG]

I use the PR System0ne 561 and would highly recommend the 60 series.

[big_dave]

All three machines provide comparable therapy. I noticed a huge difference going from an S8 Autoset II to a System One 60-series Auto (DS-560).

Any humidifier can be used without heat. Just put water in but leave it turned off.

You are comparing pricing with a humidifier for the S9 with pricing without humidifiers for the Respironics machines. The 60-series is $518 with a humidifier, and the DreamStation is $828. (The picture for the S9 does not show the humidifier, but it is included in the $883 price.)

[hschlossberg]

Thanks Big_Dave for the feedback, but...

I noticed a huge difference going from an S8 Autoset II to a System One 60-series Auto (DS-560).

I assume you mean by this a huge improvement in your therapy? Were you previously content with the S8?

You are comparing pricing with a humidifier for the S9 with pricing without humidifiers for the Respironics machines. The 60-series is $518 with a humidifier, and the DreamStation is $828.

No, all prices I quoted are with humidifier. Humidifier (non-heated hose) on our host's site is only $20 extra with purchase of the on-sale DS560. You are correct on DreamStation list price, but coupons and discounts generally take it down to the price I mentioned with humidifier.

[big_dave]

It felt like the S8 almost got the job done but wasn't 100% effective. The System One was a vast improvement.


Oops, my bad. I didn't take the time to read it. That $439 price is a great deal!

[archangle]

There's no clear winner of one vs. another between those models. They all have good data.

The A10 AutoSet is good as well. There are not a lot of problems with it in my opinion. You'll hear a few complaints, but I'm not sure there are more problems with it than any of the others.

I'd recommend the S9 or A10. You're used to ResMed, and to me, they feel better.

As for new vs. old model, there aren't really great differences. You'll probably be able to get major parts like a replacement humidifier longer and easier for the new model, but you don't have to replace things like that that often, anyway.

I could nitpick about any one of those machines or sing its praises.

You can also machines on craigslist, but you might have to wait a while to find a good price. Lots of folks want way too much, but you can find good deals there if you can wait. Use the usual precautions for craigslist.

There's more info in the Useful Links in my signature line at the bottom of this post.

[palerider]

Data Needs: S8 provides data, which I only found interesting for about two weeks after I got it. Access to "great data" is not a priority for me in getting a new machine.

ignore the data only if you don't care to make your therapy better.

Resmed S9 Autoset: would provide same basic algorithm methodology and therapy as my past S7/S8 success (maybe even improved over S8?);

there's a rather large gulf between the performance and abilities of a s8 and a s9/air10 machine.

the difference is non-trivial.

[robysue]

History: Over the 15 years I've been using CPAP, I've had just two machines: Resmed S7 Autoset and Resmed S8 Autoset Vantage. Current mask is the Mirage FX nasal mask. Things used to be great, but over the past year or so I've been often waking up not feeling "refreshed" and I feel it might be time for a new machine and/or mask. The other issue (or maybe it is "the" issue) is that I just found my original prescription, which was for 12 cm max pressure, but my pressure is currently set for 10.2.
....
Data Needs: S8 provides data, which I only found interesting for about two weeks after I got it. Access to "great data" is not a priority for me in getting a new machine. I may want to look at the data at some point, but I am going to consider all modern machines about equal and sufficient in this regard.

Seems to me that you need to look at some of the data that your S8 does provide. And it also sounds like it's been a long, long time since you looked at the data.

It is quite possible that the reason your are not waking up refreshed is that too many events are getting through because you've set the machine almost 2cm lower than your titrated pressure. So how high is your current treated AHI with the S8?

You also write:

it seems I have read that the algorithm improved with release of S9, so it makes sense to me to upgrade.

Yes, the Resmed Auto algorithm was significantly tweaked between the S8 and the S9. In particular, the S9 AutoSet can distinguish between CAs and OAs, and hence will react more appropriately when clusters are apneas are scored. The scoring of Hs was also tweaked, and fewer "false" Hs are recorded and that also makes the machine respond more appropriately. The S9 still responds quite aggressively to FLs and snoring along with clusters of OAs and Hs. So the "feel" of the machine should be similar to your S8.

Humidifier Need: I want a humidifier for the higher pressure, but I do not at all like the idea of it being heated (or maybe very, VERY slightly heated). So I want a machine that allows for passive humidity, and I see no real reason for a heated hose.

You can always put water in the humidifier tank and chose to NOT turn the humidifier on. You may find that in winter you'll appreciate the ability to add a bit of heat by turning the humidifier on to its lowest setting.

The Machines: After much research I am set on getting one of three machines, but I have concerns on each:
• Resmed S9 Autoset: would provide same basic algorithm methodology and therapy as my past S7/S8 success (maybe even improved over S8?); I like that it responds quickly to apneas (I've often felt that it doesn't respond quickly enough!), but I don't like that it holds at such a high pressure all night; still the same high $883 price as A10, even though it is an older model; newer A10 should be better but reviews/forum comments seem to suggest the opposite;
• Respironics PRS1 REMStar 60 Series Auto: Clearance priced at only $439; great reviews; concern that its different algorithm and therapy model may not be for me since I'm used to the Resmed; concerned that it won't react quickly enough to apneas; read that humidifier can be used in non-heated passive mode;
• Respironics DreamStation Auto: Price likely around $650; if I decide PRS1 algorithm is acceptable, then so should this; newer than PRS1 but not sure of any improvements other than looks, so doesn't seem worth the extra money.

If you want to stick with the Resmed family, but you don't want to pay $833 for an S9 AutoSet, you might try finding a gently used Resmed S9 AutoSet or a gently used Resmed AirSense 10 AutoSet from a place like secondwindcpap.com. Secondwindcpap has at least one S9 AutoSet on their inventory list right now with a price as low as $379 (without the humidifier). They also have a new in the box S9 Autoset + humidifier for $699. If you order a machine from them, just be sure you choose the S9 AutoSet or AutoSet for Her rather than the Resmed Escape Auto, which is somewhat cheaper, but does not have the new Auto algorithm. Secondwind also has some gently used Resmed AirSense 10 AutoSets and AutoSets for Her listed for $599.

If you change to the PR family, you do need to be aware that the PR Auto algorithm is based on a somewhat different design philosophy. The PR Auto algorithm has a "Search" subroutine that kicks in approximately every 10 minutes that tests whether your breathing improves with a modest 2 cm increase in pressure. If improvements are seen, the baseline pressure is reset for a while; if no improvements are seen, the pressure is lowered back down. The PR machines also respond to clusters of OAs and Hs, flow limitations, snoring, and RERAs by increasing the pressure, but the PR machines increase the pressure more slowly than the Resmeds. Unlike the Resmeds, the PR Auto algorithm does NOT start lowering the pressure as soon as a cluster of events ends. Rather it keeps the pressure at the current (new) level for a while and then it starts doing period test decreases: If any deterioration in the shape of the flow rate curve is seen, the pressure is increased back up to where it was. The net result is that the pressure tends to vary less with the PR machines, even with the period Search algorithm's test pressure increases.

If you use EPR on your S8, you also need to be aware that A-Flex on the PR machines is not designed the same way as EPR. And some people can tell a difference in how EPR vs Flex feels when they're lying in bed trying to get to sleep.

Cost Considerations: As you might guess from my history, I don't have any cost reimbursements and so am very price sensitive (though I realize that it MUST be properly balanced against therapeutic benefit).

If cost is a real concern, I strongly suggest wandering over to secondwindcpap.com and checking out their gently used machines.

[Susie Kay]

secondhandcpap.com

secondwindcpap.com

[robysue]

secondhandcpap.com

secondwindcpap.com

Thanks for point this out. I've edit my post to correct this (rather embarassing) typo.

[Susie Kay]

A perfectly logical typo.

[Thatgirl]

One thing that you may consider, that I don't see mentioned yet, is an S9 Autoset for Her. It's pink, but otherwise functionally completely the same as the S9 Autoset- a fantastic machine. The difference is, it comes with the humidifier, and it is often on sale brand new SUBTANTIALLY cheaper than the silver S9 Autoset. There is a website that sells skins for the S9 series that can cover up the pink, if that's bothersome.

Also,you say your prescribed setting was a 12, but you've been using it at a 10.2 due to leaks and dryness without the humidifier. You may consider trying a newer mask and seeing if you can clear up the leaks, and trying adding a general in room humidifier to help with the dryness.

I haven't heard of passover humidifiers being sold in years. What concerns do you have with a heated humidifier?

[hschlossberg]

One thing that you may consider, that I don't see mentioned yet, is an S9 Autoset for Her. It's pink, but otherwise functionally completely the same as the S9 Autoset- a fantastic machine. The difference is, it comes with the humidifier, and it is often on sale brand new SUBTANTIALLY cheaper than the silver S9 Autoset. There is a website that sells skins for the S9 series that can cover up the pink, if that's bothersome.

I have noticed that the pink ones are less much less expensive, while people on this board seem to prefer its data output. I kind of do have a problem with the pink and I like the skin idea...but it looks like SkinIt no longer has the skins for Resmed. Too bad.

Also,you say your prescribed setting was a 12, but you've been using it at a 10.2 due to leaks and dryness without the humidifier. You may consider trying a newer mask and seeing if you can clear up the leaks, and trying adding a general in room humidifier to help with the dryness.

I have simultaneously been considering a new mask like the Dreamwear (I don't think I can deal with a pillow mask) and I recently tried a couple nights with a cold mist room humidifier near the cpap intake...but it kind of turned into a mess (don't ask). But regardless, I figure the better algorithms of the S9/A10 over the S8 (or the different algorithms of the PRS1/PRDS) would make it somewhat worthwhile.

What concerns do you have with a heated humidifier?

My main concern is being hot, having moisture/sweat build up around my mouth, especially in the summer. Maybe not an issue with nasal pillows (which I don't want) or the new Dreamwear's design. But I've just never found the CPAP air to be cold, so I can't imagine why I would want to warm it up.

Howard

[palerider]

One thing that you may consider, that I don't see mentioned yet, is an S9 Autoset for Her. It's pink, but otherwise functionally completely the same as the S9 Autoset- a fantastic machine. The difference is, it comes with the humidifier, and it is often on sale brand new SUBTANTIALLY cheaper than the silver S9 Autoset. There is a website that sells skins for the S9 series that can cover up the pink, if that's bothersome.

I have noticed that the pink ones are less much less expensive, while people on this board seem to prefer its data output. I kind of do have a problem with the pink and I like the skin idea...but it looks like SkinIt no longer has the skins for Resmed. Too bad.

what? these: http://www.skinit.com/create-your-own/c ... ins/resmed

looks like:

but you'd always know it was that emasculating pink underneath

[hschlossberg]

what? these: http://www.skinit.com/create-your-own/c ... ins/resmed

I did a search on that site for Resmed and for S9 -- nothing. I looked in the menu under Skins > Medical Devices -- nothing. Didn't think to look under "custom", but it is there! Something to bookmark should I decide on the pink!
==========================================================================================================================

I noticed a huge difference going from an S8 Autoset II to a System One 60-series Auto (DS-560). It felt like the S8 almost got the job done but wasn't 100% effective. The System One was a vast improvement.

there's a rather large gulf between the performance and abilities of a s8 and a s9/air10 machine. the difference is non-trivial.

the Resmed Auto algorithm was significantly tweaked between the S8 and the S9.

I'd recommend the S9 or A10. You're used to ResMed, and to me, they feel better.

So now that a few of you have chimed in with helpful advice and the prices are a little closer between the Respironics and the (pink) Resmed, the question is whether to stay with the improved version of the Resmed algorithm that I am used to, or to go with Respironic's different and perhaps more helpful algorithm.

Thanks to all who have responded so far!

Howard