Which of these 2 units would you choose?

[Djejdj]

I now have access to a Resmed S8 Autoset vantage system and a RemstarPro M series, both seem pretty darn complicated, if you had to keep one which one would you keep?

[rested gal]

I'd keep the ResMed machine.

[Djejdj]

I'd keep the ResMed machine.

Is it a better unit?

[rested gal]

I think it is, but that's just my personal opinion.

If both were autopaps, or if both were cpaps, I'd still choose the ResMed machine.

In this case, the particular ResMed machine you mentioned is an autopap, so it would be like having two machines in one... can be used in either CPAP mode or in Autotitrating mode.

The Respironics machine you mentioned is a straight CPAP machine. Can be used only in CPAP mode. Can't be used to autotitrate if you wanted to...if that makes any difference to you.

The ResMed machine can show overnight data in the LCD window, in addition to weekly, monthly data. It also breaks down the AHI into "AI" (apnea index) and "HI" (hypopnea) info.

The Respironics machine does not show "overnight" data in the LCD window. It shows only weekly, monthly data, and does not break down the AHI into "AI" (apnea index) and "HI" (hypopnea index.) There's a way to make it show overnight data, but that involves going into the clinical menu each night before you go to bed, and resetting the data to zero. Too many hoops to jump through, imho, when ResMed includes the overnight data as a matter of course.

[robysue]

Rested Gal says it all. I'd too keep the Resmed for exactly the same reasons that RG lists.

[msradar65]

I have to concur....Resmed...and autoset would be the preferably unit.

[Djejdj]

so it would be like having two machines in one... can be used in either CPAP mode or in Autotitrating mode.

Im fairly new to this so forgive me if im asking obvious questions, from what ive read about autotitrating, my understanding is I dont have to enter a certain pressure because it automatically figures out the optimal pressure with every breath I take?

[Pugsy]

Im fairly new to this so forgive me if im asking obvious questions, from what ive read about autotitrating, my understanding is I dont have to enter a certain pressure because it automatically figures out the optimal pressure with every breath I take

Well.... yes and no. The machine will raise the pressure in response to event triggers but if the pressure it starts out at is too low it may not have enough time to reach the pressure needed to prevent events. It doesn't go from 0 to 60 in a quick start. APAPs actually take some time to raise pressures because a sudden increase will often be disruptive and it also has to go through the motions of figuring out if the raise in pressure is effective. In other words it will raise the pressure a little, stop and see if the event trigger is still there, think about it and raise a little more, stop and see....

The key to APAP is to set the minimum low enough that it is close enough to the pressure needed to finally prevent the events so it gets there quickly enough. Example. I was titrated at 8 cm but still had a lot of events and the pressure wanted to go higher in response. APAP set at 8 cm allowed more events to sneak in but when I set the minimum at 10 cm it can get to 12 quickly enough to stop the events. At 8 cm it simply could not respond quickly enough and the events would happen.

Maximum pressure setting isn't as critical because the machine won't go there unless it thinks it needs to. Now some people, especially newbies, might find the pressure variations disturbing so having the maximum closer to minimum might allow for less disruptive sleep. These people need to use a more narrow range but still have that minimum fairly close to what the machine wants to go to. Also, leaks will drive the APAP pressure up so gotta have the leaks under control.
My minimum is 10 cm but my max is wide open. I rarely go above 15 and the pressure change doesn't bother me. I have minimal leaks but I also have nearly 2 years using this machine. I had a peak of 15 last night in response to a few snores. Never knew it till I saw the report.

So setting an APAP with the default of 4 minimum and 20 maximum won't work so well if a person needs minimum of 10 but would work if someone only needed a minimum setting of 6 or 7. It is all going to depend on what the individual needs to prevent the events.

[Jackie999]

I was titrated at 8 cm but still had a lot of events and the pressure wanted to go higher in response. APAP set at 8 cm allowed more events to sneak in but when I set the minimum at 10 cm it can get to 12 quickly enough to stop the events. At 8 cm it simply could not respond quickly enough and the events would happen.

Pugsy, Please help me understand. You were titrated at 8 cm but your minimum pressure is set for 10cm? I would have thought since you titrated at 8 cm your minimum pressure using APAP should be no more than 8cm.?

I am using a S8 in APAP mode. My morning reviews of details show I run about 10.4 cm during the course of the night. I have my minimum pressure set to 9 cm. I am experiencing more events (5-6/hour) than I would like to have but the majority of them are centrals. (example=> 5 AHI, with 4 central and 1 obstruction) My leaks seem to be under control as for mask fit but I find myself mouth breathing at times. I have tried taping which has reduced the leaks to near zero, but when I do that my events even go higher (~8/hour).
It's really crazy to me that when I tape or use a chin strap my leaks go to near zero but my events per/hour increase. After removing the tape, leaks will go up a bit, but events go down to the 3-6/hour level.

Going back to what you said about yourself titrated at 8 cm and running 10 cm minimum has me thinking. Do you think I could benefit by increasing my minimum. I am running EPR at a setting of 1.

Thank you for any advice!

[Pugsy]

Going back to what you said about yourself titrated at 8 cm and running 10 cm minimum has me thinking. Do you think I could benefit by increasing my minimum. I am running EPR at a setting of 1.

I am using a S8 in APAP mode. My morning reviews of details show I run about 10.4 cm during the course of the night. I have my minimum pressure set to 9 cm. I am experiencing more events (5-6/hour) than I would like to have but the majority of them are centrals. (example=> 5 AHI, with 4 central and 1 obstruction)

My situation is/was probably a bit different from yours. I was/am worse in REM (52 per hour) sleep but didn't have a particularly good night at the titration study. Not quite 3 hours and not much REM. I didn't have the best night to gauge the pressure well. They said 8 cm but it quickly became apparent that 8 cm wasn't quite enough for me to get the REM event clusters. My AHI was between 8 to 10 at 8 cm minimum. I also felt like total crap. I have never had any history of centrals so I was comfortable with changing my pressure. I have always had probably mainly obstructive apneas, never even many hyponeas. I changed the pressure on my own with the advice of some members here. I did eventually get the sleep doctors blessing when I showed why I had done what I did.

You are having predominately centrals? Upping the pressure might not be the best thing to do because the centrals are a different breed and it usually is not advised to increase pressure because it sometimes will actually make them worse. You are using APAP? What is the maximum? Does the machine want to go up very much when there is no leak driving it up much past the 10.4?

If you had plain vanilla OSA like I do, then yeah, increase the pressure a bit but with the centrals.... I don't know. Since they have you on APAP they are already allowing a range...and since it wants to run at about 10.4 anyway, it probably wouldn't hurt but I am not sure it will even help. You actually might do better at straight cpap. Have you tried straight pressure of 9 or 10? Then we have to also wonder if what the machine is calling a central is a turn over in bed central or sleep onset central, which are common. Did you have centrals on your sleep study?

I know I sound wishy washy but anytime I see someone mention centrals I prefer to be extra cautious till we get a bit more history.
If a true central, increasing the pressure won't help it. It might help to see a copy of one of your detailed reports to see where and when the centrals are occurring. Then another question, is your doctor aware of these centrals?

You could also effectively increase you pressure a bit if you turned off EPR. Don't know how much you rely on EPR but an EPR of 1 reduces the pressure on exhale by 1 cm..

And finally how are you feeling? Better, worse, same? You joined here late Feb, was that when you started on the machine or has it been longer and you just found us?

Lots of things to consider and I think that further detective work might be advisable in your situation.
So these questions.
Were there any centrals in your sleep studies?
Minimum pressure is 9, what is the maximum?
Do you feel better, worse or the same?
How many hours of sleep are you averaging?
Can we see one of the detailed reports that shows all the graphs to maybe get idea when the centrals are being flagged?
How long on the machine?

This is probably one of those situations where I would tell someone not to do what I did without carefully considering all factors very closely. Centrals warrant caution.

[Jackie999]

I know I sound wishy washy but

Not at all. I totally understand that this is not an exact science. I now learned and understand that central "hits" can be for erroneous reasons such as a "turn over".
I have been thinking of trying straight CPAP just to see what the results would be regarding centrals. My last sleep study was over 20 years ago (I know, I know) but my insurance deductible is such that I would have to foot the entire bill so I am putting off a new study if I can. As far as my doctor knowing of my centrals, No, he is not aware because I just recently went to this new smartcard machine (S8 auto set II) and got the software and card reader myself. Prior to this S8, I was using a dinosaur. I joined this forum when I obtained my new S8 (totally out of pocket $) and wanted to learn/understand the reports/software cardreader now available to me.

Actually most mornings I feel pretty good and the mornings I feel terrible, the detail info on computer show I should feel terrible. Prior to using and learning of CPAP, my life was unbearable.
I am going to give straight CPAP a shot just to see what the detail reports show. I am new at using the S8 and still reading and learning every day. I just wanted to try and optimize everything I could (mask, leaks, pressure, EPR, software etc) to lower my AHI to what would be considered ideal or lower it to a point of diminished returns. My Max APAP pressure is set to 15 cm. I average 7.5 hrs of sleep a night.

Your reply to members threads are always so informative and helpful. Thank you for sharing your knowledge.
Once I get a grip on using this machine & software to the max, I will post some of my detail reports.

[Pugsy]

S8? How did I miss that? Must have been the 2 AM response. S8 didn't show centrals.. Same class as my M Series machine which doesn't show centrals. So is it S8 or S9?

just recently went to this new smartcard machine (S8 auto set II) and got the software and card reader myself.

[Guest]

S8? How did I miss that? S8 didn't show centrals.. Same class as my M Series machine which doesn't show centrals. So is it S8 or S9?

It is a S8 autoset II for sure. On my summary graph page there is a AHI & AI graph. The height of each bar can be both white and red in color. The legend says the White area is AHI and the Red area is AI (events per hour).

I thought the AHI was the combination of apnea and hypopnea events, with hypopnea being probably central.
Am I totally off base with that assumption.

[Pugsy]

I thought the AHI was the combination of apnea and hypopnea events, with hypopnea being probably central.
Am I totally off base with that assumption

Hyponeas are baby apneas for an over simplified definition. Not central at all. The S8 historically seems to be aggressive with Hyponea scoring. Disregard all I said about centrals. We can safely play with your pressure a bit to see if we can get you feeling a bit better. While the HI index is probably technically "OK" you report not feeling so great so we will see what we can do. Can you get me a copy of that detailed report I asked for? I want to look at possible groupings and pressure trend.

AHI is Apnea plus Hyponea divided by number of hours slept. Centrals no part of that number. Sorry I missed your machine listed when I wrote my long novel. It was late and I just didn't see it or I would have questioned you straight away about it.

[Jackie999]

Your kidding me!.. A baby apnea. I hope it doesn't expect me to support it until it's 18 years old.

I am sorry to put you on a wild goose chase. Yes, I will get you a detailed report.
As far as novels go,,, "Novel away"!. I enjoy reading and learning from all your relies even when they don't relate to my own personal thread!.