Resmed Vantage vs. Respironics M

[josephnyc]

I'm sorry if this is basic, and prior posts lead me to suspect this is an ongoing debate, so I apologize if this fuels any fires, but I'm brand new to OSA and could use some guidance.

I need to purchase a system and have narrowed the choices to Resmed Vantage S8 (auto cpap with humidifier) vs. Respironics Remstar Auto M.

My initial sleep study resulted in AHI of 35 (31 hyponeas and 4 apneas) and a low ox sat of 80%.

I failed the follow up study (the one where I wear I'm connected to an auto cpap) because I woke up in the middle of the night in a minor panic.

So now my Dr/sleep lab and insurance say at best I'm covered 50% of the cost.

Regardless, what's important (I believe -- still trying to get up to speed on the issues here), is that the machine is auto and that I can download the data myself for long term recording and sharing with the Dr.

I went to the sleep lab today for a "fitting" and will start with a nasal pillow. I found it a little difficult to exhale, but the tech said it would be fine while I sleep. Should I be interested in a bi-pap (I believe that's the term for different pressure levels on inhale/exhale)?

So, I'd very much appreciate hearing the pros/cons of each of these two units, and any other recommendations.

Thank you,

Joseph

[Slinky]

Well, having pressure relief on expiration helps many to adjust to xPAP therapy. Often once one has gotten used to mask and xPAP that relief isn't needed.

That's the nice thing about the Resmed w/its EPR "and" the Respironics w/its C-Flex, both can provide varying degrees of relief on expiration. The drawback to the Resmed is that it can NOT provide expiration relief when set to Auto, only when used as a straight CPAP. Whereas the Respironics' C-Flex can be utilized in both Auto and straight CPAP mode.

But then again, BOTH have the Ramp feature and Ramp starts out at a lower pressure and gradually builds up to your set pressure over a set period of time (you usually set it for however long it USUALLY takes you to fall asleep.) And, for many that is sufficient. (And again, many utilize it at first until they adjust to mask and xPAP and then turn that option off too).

The Resmed software is easier to install and easy to use. I found the Resmed AutoScan 5.7 software printouts easier to understand than the Respironics EncorePro software. The Respironics gives you more options and support to their EncorePro software via so many users in this forum w/the Respironics AND due to the free MyEncore and EncorePro Analyzer software developed by "private" individuals to complement EncorePro.

The Resmed's have a larger, easier to read LED screen and provide MORE information via the LED screen than the "classic" Respironics Auto w/C-Flex. I understand the M Series Respironics Auto w/C-Flex has a larger LED screen and more info available than the "classic" (also referred to as the "tank" tho it is scarcely larger than the M Series as far as space it takes up at bedside).

The M series, being relatively new, seems to still have some "bugs" if you keep reading the forum.

The Resmed's integrated heated humidifier seems somewhat less capable than the Respironics integrated heated humidifer of providing adequate humidity when the air in the house is really dry during the more extreme weather, but the Respironics also seem to have that problem but to a somewhat lesser degree. The stand alone heated humidifiers don't seem to have any problem providing enough humidity during any extremes. But they would be compatible w/either the Resmed or the Respironics.

Those are all the pros and cons of each I can think of. I'm sure there are others here w/more experience who can add additional pros and cons.

Ooops! I failed to address the bi-level PAP issue. Bi-PAP is a proprietary name so bi-level is the more correct term. This provides a SET pressure for inhalation and another SET pressure for exhalaltion. They are considerably more expensive than the straight CPAPs or the AutoPAPS and have their own separate HCPCS code for billing and insurance purposes. I seriously doubt your insurance would underwrite their share of a bi-level UNLESS your data confirmed the need for one. It doesn't sound like your insurance would even consider a bi-level given their refusal to pay more than 50% of a CPAP because you didn't sleep long enough during your titration study.

AND about your titration study: most insurances follow Medicare guidelines for CPAP qualification meaning a minimum of 2 hours sleep out of at least 6 hours lights-out bedtime during the titration study. If you experienced less than two hours sleep your sleep lab really should provide a second titration study at 1/2 price or at no charge.

Nice of the sleep lab tech to tell you that since you "found it a little difficult to exhale" w/the nasal pillows, the tech would tell you "it would be fine while I sleep". The tech has no way of knowing that. Especially since you woke up during your titration study "in a minor panic" PLUS the fact that a good fitting, comfortable mask is SO VERY KEY to xPAP therapy and compliance. You really need to talk to your sleep lab about trying several different masks until you find one you can be comfortable with and get a good fit.

What do you remember about that "minor panic" you experienced during your titration study? That could be key to helping you adjust to xPAP therapy and to finding the best mask for you. And this is just about the BEST place to find that assistance - from those who have had a similar experience!

[NightHawkeye]

I'm sorry if this is basic, and prior posts lead me to suspect this is an ongoing debate, so I apologize if this fuels any fires, but I'm brand new to OSA and could use some guidance.

If you could try only one machine, then the clear hands-down favorite to get is the Remstar-auto. Even a few folks here who had previously been touting the virtues of ResMed machines converted when they tried Remstars. I don't recall any folks moving the other way (but I'm sure that has happened). The advantages for the Respironics machines seem to be a gentler attack (i.e., when raising pressure), and C-flex which is operational in both APAP and CPAP modes, unlike EPR which operates only in CPAP mode.

Of course, if you have lots of time and good rapport with your DME, then you should take each unit for a test drive. (Good luck with that one.)

So now my Dr/sleep lab and insurance say at best I'm covered 50% of the cost.

Say what? Sounds awfully fishy to me.

Regardless, what's important (I believe -- still trying to get up to speed on the issues here), is that the machine is auto and that I can download the data myself for long term recording and sharing with the Dr.

I'm almost in full agreement with you, but don't get your expectations too high with the sharing part. Many folks find their physicians have little interest in seeing the data, and conclude they know more about interpreting the data than their physicians do.

Should I be interested in a bi-pap (I believe that's the term for different pressure levels on inhale/exhale)?

Therapeutically, either APAP or BiPAP-auto should work for you. Depending on your insurance, it might be more likely for them to cover the BiPAP-auto than an APAP, but the doc would probably have to justify it to them. A lot of the docs won't, unless you fail CPAP first.

Good luck. Hope this helps a little.

Regards,
Bill

[josephnyc]

Slinky & Bill,

Wow, thank you both so much for the detailed insights and information!

Sounds like the Respironics M Series Remstar Auto with C-Flex and heated humidifier (model DS500HS) is the way to go.

Not clear on whether I need to purchase Encore Pro (model 1009583) or if one of the "privately" developed applications will work.

Suppose I'll need a reader (1003543) and cable (1000814).

Filters, carrying case, longer tubing (all 40 years of my life I've been rolling over at night quite a bit).

Hopefully the ramp up and right mask will address the exhalation difficulties.

I don't think the insurance company (Guardian/Healthnet NY Charter POS)'s 50% coverage is a function of the failed titration study. I believe it's just what they cover -- in network (Apria) or out of network (glad I don't have to use Apria, from the sounds of it here) -- from what Healthnet told me directly.

As I suspect will likely be similar to many of the readers here, I've had my share of experience with the medical/health profession, so I'm no stranger to working my way through misinformation.

My panic was waking up after an hour of sleep, having just hit REM (which I found out afterwards) and which coincides with a vivid dream and not knowing where I was, feeling confined (while the room, I'm told, is not small or otherwise claustrophia causing by sleep study standard, it felt pretty jail cell-like to me).

I then looked around for a window and for orientation, couldn't find a window (didn't exist) and couldn't get oriented in time and got, basically, scared.

I'm going to try a nasal pillow. Any recommendations for the one to provide the most tossing/turning and least constrictive?

Thanks again very much.

[Bookbear]

At the risk of lighting fires , I will say that, now having had the opportunity to try an RemStar Auto to compare with my Vantage S8, I can say that I found no difference in my numbers or how I felt (although I only had a week's experience with the RemStar). The machines were set the same: EPR/Flex off, same range of pressures, Settling/Ramp set for 5 min., humidifiers on. It may well be a wash for you, too; although some insist that the machines differing algorithms make a difference in treatment. I DID miss being able to read my numbers directly in the morning on the Vantage when I was using the RemStar. Having to use a card reader and computer to get basic information was a mild pain. I found both humidifiers provided adequate moisture at their midrange settings.

As to the nasal pillow mask, I use and like the Breeze with the large pillows. Very light weight, unobtrusive, zero leaks (for me). Many here like the Aura (or whatever it is called these days ) as well. A setup where the hose exits over your head will be the best choice if you are one who side sleeps or turns in their sleep a lot. Rigging a hose support at the top of your bed / headboard / wall will also help a lot. Note that the Swift, while it can be connected at either side, has the hose exiting at one side or the other, so alternate side sleeping can be a problem. If you sleep with a partner, you may find mask exhaust to be a problem for them. That is (for me, anyway) the only negative for the Breeze....your partner really does get a 'breeze' when you face them!

One other thing: the Breeze has a rather hard plastic piece that sits at the base of your skull. If you back sleep with a hard pillow, this can be uncomfortable. With a soft pillow, much less so. Since I don't sleep on my back, it's not a concern.

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[snoregirl]

Joseph,

Since your insurance only covers 50% you may want to purchase online.

The local DME prices may be double what you would pay online, and then you are saving nothing through the use of insurance and paying for it in grief (usually).

If you can find a DME to let you test drive the machines for a rental price then it might be worth it, especially since you don't seem to have a titration. Without a good titration I doubt that you know if you need CPAP or BiPap.

Just watch your wallet and communicate with your insurance and get quotes from DMEs and most importantly get your prescription and keep it. Give a copy to the DME and hold a copy of your sleep studies too.

[Coolhandace]

I tried the Resmed S8 for 30 days and then switched to the Respironics Auto M for 30 days and then went back to the Resmed again for a couple of days, then finally settled on the Respironics Auto M for my permanent machine. I must say that the difference between the two is very minor.

The Respironics is a quieter machine. The Respironics lets me breath a little more naturally because of the C-Flex. I like being able to buy the software for it. I assume you can get the Respironics for less money.

The Resmed seemed to sometimes wake me up in the night. I say go with the
Respironics. But both machines worked good for me and I had the same numbers on both. The differences were very minor.

Have Fun.

[dsm]

[quote="Coolhandace"]I tried the Resmed S8 for 30 days and then switched to the Respironics Auto M for 30 days and then went back to the Resmed again for a couple of days, then finally settled on the Respironics Auto M for my permanent machine. I must say that the difference between the two is very minor.

The Respironics is a quieter machine. The Respironics lets me breath a little more naturally because of the C-Flex. I like being able to buy the software for it. I assume you can get the Respironics for less money.

The Resmed seemed to sometimes wake me up in the night. I say go with the
Respironics. But both machines worked good for me and I had the same numbers on both. The differences were very minor.

Have Fun.

[dsm]

[quote="Coolhandace"]I tried the Resmed S8 for 30 days and then switched to the Respironics Auto M for 30 days and then went back to the Resmed again for a couple of days, then finally settled on the Respironics Auto M for my permanent machine. I must say that the difference between the two is very minor.

The Respironics is a quieter machine. The Respironics lets me breath a little more naturally because of the C-Flex. I like being able to buy the software for it. I assume you can get the Respironics for less money.

The Resmed seemed to sometimes wake me up in the night. I say go with the
Respironics. But both machines worked good for me and I had the same numbers on both. The differences were very minor.

Have Fun.

[Slinky]

One thing I did forget to mention, tho it doesn't have anything to do w/the pressures/pressure relief of either brand, but rather to accessing information: it is so EASY to access the basic data of the night's average pressure, leak rate, AHI, AI, HI, total nights of usage, total hours of usage and that night's hours of usage via the Resmed S8's LED screen w/just a button combination; its a bit of a PITA to get much info off the "classic" or M Series Respironics' LED screen because you have to unplug it, then plug it back in whilst holding down a button or buttons.

MyEncore and EncoreProAnalyzer both require that you first have EncorePro. They work "off" of EncorePro and just refine and improve the info provided by the RemStars and EncorePro.

I can't speak for the M Series Respironics Auto BUT I have used both the Resmed S8 Elite (not an Auto) and the "classic" RemStar Auto w/C-Flex and found that BOTH of them are noisier in the EPR and C-Flex mode and quieter w/them turned off. I found the "classic" RemStar Auto noisier run as an Auto than the Resmed S8 Elite which is a straight CPAP. But, frankly, I didn't find the noise of either bothersome. However, if one has trouble GETTING to sleep that might be a factor. It wasn't for me.

It sounds like the CPAP therapy, and even the mask, had little to nothing to do w/your mild panic but rather was the result of the dream and waking during the dream. My understanding is that you only remember the dreams that you awaken during, but not the dreams you sleep thru to the finish, unless you awaken almost immediately at the end of that dream.

As far as an interface choice, you might want to consider the ComfortLite 2. The hose swivel is at the top of the head and therefore less subject to shifting & creating leaks when you turn from side to side or back or even tummy. In addition, a very nice feature is that it comes w/two options: EITHER BOTH the nasal pillows AND a simple nasal cushion, OR BOTH the nasal pillows AND nasal seals. The nasal seals rest against the bottom outside of the nares w/almost no protrusion into them whilst the nasal pillows enter a short distance into the nostrils. AND you can separately purchase the "parts" of the opposite option at a relatively reasonable cost so that you could actually get "two masks in one" plus for a small extra cost (assuming you are buying online rather than thru a local DME) "three masks in one". I found early on that if I had some minor irritation w/the pillows blowing so directly into my nose, it was nice to have the option to switch to the nasal cushion OR if I encountered some minor discomfort on the bridge of the nose w/the nasal cushion I could switch to the pillows. And then a little later on realized that altho in the other nasal masks I had tried I needed the Small, with the CL2 simple cushion I needed the Medium.

I also found that if you encounter ONLY MINOR irritations w/a mask or pillows when first starting out being able to switch to an alternative for even just a couple of days you have less irritations when you go back to the original. That mostly it is just an adjustment to having ANYTHING on your face. It took about 7-10 days for the Fisher & Paykel HC 407 nasal cushion to cause some minor bruised feeling at the bridge of the nose so I switched to the CL2 nasal pillows. When I got some minor irritation inside my nostrils w/the pillows (about 7-10 days again) and switched back to the 407 nasal cushion I alternated every 2-3 days. Now BOTH work great w/no irritations at all, but I like the CL2 nasal cushion the best because it is somewhat shorter in length than the 407's. I guess its kind of a matter of "toughening" up.

On the other hand if you get quite a bit of discomfort from a mask or nasal pillows right from the get-go or w/in just a couple of days, FORGET IT! Its not the interface for you.

At least this has been "my" experience, YMMV.

[rested gal]

You don't need cflex like functionality if you use EPR this is a fallacy repeated regularly here on cpaptalk for reasons best know to those who peddle the line. Requiring EPR in auto mode is like having nipples on a bull - serves no useful purpose.

If "useful purpose" includes comfort, then a drop in pressure when starting to exhale is a rather useful feature, imho. Quite a few people do seem to like using C-Flex in auto mode. I do. Respironics is the only manufacturer who provides any kind of exhalation relief feature at all in their autopap. Some people don't need, like, or do well with it, in which case it can be turned off. But I wouldn't discount the comfort that C-flex adds to the treatment for a great many autopap users. A little additional comfort can often mean the difference between sleeping well or not.

Cflex in auto mode is a useful feature & the Resmed machine doesn't have that feature.

Yes, I agree that C-Flex in auto mode is a useful feature. I think resmed missed the boat when they brought out their S8 autopap and didn't include an exhalation relief feature in auto mode.

So what I am saying is the either machine is a great choice but any comparisons of Cflex and EPR are naive. Both achive quite different effects & to rabbit on about EPR not being available in auto mode on the Resmed is truly naive (and that is being genuinely kind).

LOL!!! Ohhhh-kayyyy....

Yes, C-Flex and EPR work differently. That's not the point. Again....if a person using an autopap in auto mode would like to have exhalation relief each time they start to breathe out, Respironics is the only manufacturer offering exhalation relief of any kind -- the C-Flex in their autopap. A very nice comfort feature for many autopap users.

Hardly a naive observation, imho.

Since product descriptions of the resmed S8 Autoset Vantage (autopap) often include the mention of that machine having "EPR" as an exhalation pressure relief feature in that machine, I think it's always helpful to point out to new people that you can't turn on that feature when using the Vantage in auto mode.

I'd sure hate to be looking at various autopaps, and buy the Vantage thinking, "Oh good...it has an exhalation relief feature...EPR!" only to find out after I had bought it, "Sorry, you can't use our exhalation relief except when you switch our autopap to straight cpap mode."

[NightHawkeye]

OK, a summary:

ResMed APAP advantages:
- Convenient summary data
- Mini-BiPAP capability
- Flow rate compensation tailorable to ResMed masks

Respironics APAP advantages:
- Summary data (maybe not as convenient)
- C-flex in APAP mode
- More comfortable pressure transitions
- Much less expensive if purchased on-line
- Data monitoring software available in U.S.

Did I get it all?

Regards,
Bill

[Bookbear]

Nighthawkeye, I'd add under the ResMed heading:

Ability to tailor the machine to a specific (ResMed only, of course) mask and its vent flow raite, thus making the machine's therapy and data a bit more precise.

[NightHawkeye]

Nighthawkeye, I'd add under the ResMed heading:

Ability to tailor the machine to a specific (ResMed only, of course) mask and its vent flow raite, thus making the machine's therapy and data a bit more precise.

It is done! .

Regards,
Bill

[dsm]

<snip>

So what I am saying is the either machine is a great choice but any comparisons of Cflex and EPR are naive. Both achive quite different effects & to rabbit on about EPR not being available in auto mode on the Resmed is truly naive (and that is being genuinely kind).

LOL!!! Ohhhh-kayyyy....

Yes, C-Flex and EPR work differently. That's not the point. Again....if a person using an autopap in auto mode would like to have exhalation relief each time they start to breathe out, Respironics is the only manufacturer offering exhalation relief of any kind -- the C-Flex in their autopap. A very nice comfort feature for many autopap users.

Hardly a naive observation, imho.

Since product descriptions of the resmed S8 Autoset Vantage (autopap) often include the mention of that machine having "EPR" as an exhalation pressure relief feature in that machine, I think it's always helpful to point out to new people that you can't turn on that feature when using the Vantage in auto mode.

I'd sure hate to be looking at various autopaps, and buy the Vantage thinking, "Oh good...it has an exhalation relief feature...EPR!" only to find out after I had bought it, "Sorry, you can't use our exhalation relief except when you switch our autopap to straight cpap mode."

Rested Gal,

Fair comment, but the issue of EPR vs Cflex is no different to say Bilevel vs Cflex & that is my point. I don't believe anyone with any expertise in xpaps would compare cflex feature to bilevel function.

EPR is a Bilevel mode. It allows the user to set 1-3 cms gap & 3 cms is a very good level of exhalation relief as Bilevels go. Not even the Bipap auto allows the user to do that (as we know it starts at 2 cms (which when measured by a pressure guage shows more like 1.25 cms) then free ranges as it sees fit. The Bipap Auto machine is a very innovative design, but for those who want to have some control over the ipap epap gap, it doesn't offer it.

EPR goes even further than any BiLevel in that if the machine detects air flow problems (obstructions) it will adjust epap up to ipap until the situation has passed. That is very innovative & goes beyond what even normal Bilevels offer let alone any comparison with cflex.

Cflex, is a great feature and many among us attest to that. Some folk do report air control issues at higher cflex settings & pressures but as with any 'feature' it will have its ups & downs.

To compare EPR to Cflex is IMHO no comparison. Also to compare Bilevels to Autos is a dubious comparison - they go about therapy in quite different ways - if we need a debate on that I am happy to participate.

So I understand we will have different perspectives on the Cflex vs EPR, what I hope to do is bring the comparisons back to something more objective.

Cheers

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, bipap, C-FLEX, cflex, CPAP, auto