Resmed S9 or Respironics Something-or-other (confusing names

[Sleepy Pilot]

Ok, I’m a newbie, but I am a little upset that my DME has tried to sell me a Respironics 460P. It’s brand new and discontinued on all sites, even Repironics. They said I have to rent it for two months and then my insurance will purchase it. I told them I wanted the Resmed S9 and they said I had to take the 460P because that’s what my doctor ordered. I called my doctor and he didn't prescribe anything or care one bit. They finally said that I can return it during the rental period for a Resmed S9 if that is what I want to purchase. Is this true or did they lie to me? They seem full of excuses and nervous. Should I take it back right now? I wanted my sleep doctor to review a several weeks of data and prescribe a better suited machine, if necessary, CPAP vs APAP. I have to convince the FAA soon that my therapy is correct and working. If not, they will keep me grounded until I am fixed, maybe for several months. Now, that’s several months of no paychecks. So these DMEs are making me nervous! I just read an article about these DMEs and what the article warns about is exactly what they tried to do. I don’t want to get stuck with a good-enough CPAP machine because they need to sell their old stock when I can get better therapy and back on the job sooner.

The Resmed line seems to be very straight forward. The Respironics line…wow! Did my DME name it? Only they can decode the plus signs and flex names. They spent an hour trying to talk me out of the Resmed S9 (they didn't carry them). They even called the Respironics factory support line to ask about the heated hose just to convince me it’s just a gimmick. The factory guy told us the only reason Respironics came out with a heated hose was because the competition did. What? Do the heated hoses and climate control systems work as advertised? My issue is that I sleep in a flight crew dorm that is always at 60 degrees and I’m worried about rainout. I have been on a machine for only three nights and love it, but I can’t stand to cold air blowing on my nose. It appears to me, the Resmed S9 with Climate Control is what I should get. Please advise as to what I should do.

[cflame1]

What you've got isn't out of date, it's brand new... and you don't have a Plus (260P), you have a Pro (460P). A Pro is a straight CPAP with full data.

[Pugsy]

Actually the PR S1 model 460 has a lot more to it than you might think.
I believe that it comes with the 30 day auto (APAP) feature.

Where did you get the idea that it has been discontinued?
https://www.cpap.com/productpage/pr-sys ... chine.html

You have some APAP mode capabilities.. "The smart technology of Auto-Trial Mode and CPAP-Check Mode offer up to 30 nights of auto adjusting capability. During that period of use the system functions as an Auto CPAP delivering an adaptive pressure on a breath by breath basis. Following the set time of the Auto-Trial mode, the machine functions as a CPAP delivering the pressure that the patient was at or below 90% of the time. The CPAP-Check mode continuously verifies pressure requirements and makes adjustments after every 30 hours of use providing the user with more effective pressure levels over time. An Auto-Trial mode must be a minimum of 3 nights in length and the entire available 30 nights of Auto-Trial do not need to be used continuously. Visit the "Important Tips" tab of this product page to read an example of the Auto-Trial and CPAP-Check modes. "

Now as you might imagine with the internet there are usually some secrets...and one such secret is how to extend the 30 days of APAP capabilities in this model. It is not something I would suggest doing until the DME is no longer involved in any compliance issues though. Send me a private message if you want more information on that little trick.

Actually Respironics isn't all that difficult to follow the models if you just learn the model numbers and not worry about the names.

Model numbers below 400...not full data machines. For some reason there are no 300 number models.
None of the 200 numbers (or below) offer anything other than hours of use.

PR S1 Pro CPAP with cFlex...model 450
PR S1 60 series Pro CPAP...model 460 ....heated hose capable along with the 30 day APAP trial thing

PR S1 Auto CPAP with AFlex...model 550
PR S1 60 Series Auto CPAP...model 560......heated hose capable

PR System One machines have been in use since late 2009...these would be the 50 series machines and no heated hose.
Last spring Respironics decided to answer Resmed's Climateline heated hose with their 60 series machines but for some reason they made it an option and some DMEs dispense the 60 series machines without the heated hose equipment.
You didn't get a heated hose??? That can be fixed easily. You would need the heated hose, a different power supply and a different lid on the humidifier. Called an upgrade kit. DMEs can get it easily...cpap.com has it available for around $75.

I don't care which brand machine you use. I happen to own both brands (S9 and PR S1) in the bilevel model and my PR S1 is a 50 series without the heated hose and the heated hose of the S9 is a definite plus.
If your model 460 machine does not have the heated hose option it can be uncomfortable when the bedroom is cold. Been there myself. I got ice cube nose even with humidifier set at max. There are some things you can do to warm the air up to make it a little more comfortable.

You can add a hose cozy. You can also change humidification modes so that more heat is added. The PR S1 comes with the default humidification mode set to the new system one mode but there is also another mode called "classic mode". It will warm the air more...uses more heat...unfortunately uses more water and the chances of rain out increase.

My thoughts about the heated hose....everyone should have it just in case they need it.. Better to have it and not need it than need it and not have it. People can always use a regular hose if they don't like the heated hose.
My bedroom temps are COLD and my nose like lots of added moisture. That's a recipe for rain out for sure. It's a lot easier to manage rain out and comfort with the heated hose.

The S9 machines are great machines but your 460 Respironics machine isn't total junk by any means.

[4betterO2]

@Sleepy Pilot

Before you finalize your choice on a machine, I would recommend getting the clinical significance of the 3% periodic breathing you mentioned in another post (if I'm correct?). And especially, to monitor if it is increasing along with your CPAP therapy.
You might want to read posts mentioning CPAP-induced complex apnea in this thread:
"ASV users: the everything ASV thread"
here is one link,

viewtopic.php?f=1&t=65791&p=781851#p781851
I'm not sure if I'm allowed to post links so if it does not show, you may need to look for the thread; if so, go to page 26.
Your therapy is very important for both your health and your career.
The Respironics System One Advanced ASV machine 950 is very effective, and a lot more comfortable than CPAP, when the settings are right!
So as it looks like you could afford it, even if the clinical significance of your periodic breathing is null, you might want to go ahead with an ASV machine. But in the first place, the medical issue of periodic breathing is to be looked at...

[archangle]

The 460 is a current model. It's a fine machine other than the fact it's a manual CPAP, not a real auto, despite the "AutoIQ" function. The 560 is better because it's an auto.

The 460 machine will work with a heated hose, as long as you get the right humidifier. There are two versions of the humidifier. One will work with a heated hose, one won't.

Heated hoses are a godsend for those who have rainout problems. Some people do, some don't depending on humidifier level, machine setup, and room temperature. They're NOT a gimmick, but not everyone needs one.

PRS1 (Philips Respironics System One) vs. ResMed S9 is mostly a tossup. The important thing is to get the correct model within the line. Insist on the data capable models. There's some info in my signature line.

If you get an S9, be sure it's NOT an Escape or Escape Auto, they have very poor data capabilities. Elite is the data capable model, AutoSet is the auto. There is NO such thing as an "S9 Auto."

Remember, if it's midnight and a DME says it's dark outside, go check for yourself.

[-tim]

A 460 is a 560 with software bribery feature turned on. I would take it back. I would print out a copy of this page and take it back and tell the DME to get more ethical suppliers.

[Sleepy Pilot]

@Sleepy Pilot

Before you finalize your choice on a machine, I would recommend getting the clinical significance of the 3% periodic breathing you mentioned in another post (if I'm correct?). And especially, to monitor if it is increasing along with your CPAP therapy.
You might want to read posts mentioning CPAP-induced complex apnea in this thread:
"ASV users: the everything ASV thread"
here is one link,

viewtopic.php?f=1&t=65791&p=781851#p781851
I'm not sure if I'm allowed to post links so if it does not show, you may need to look for the thread; if so, go to page 26.
Your therapy is very important for both your health and your career.
The Respironics System One Advanced ASV machine 950 is very effective, and a lot more comfortable than CPAP, when the settings are right!
So as it looks like you could afford it, even if the clinical significance of your periodic breathing is null, you might want to go ahead with an ASV machine. But in the first place, the medical issue of periodic breathing is to be looked at...

Thank you, 4betterO2. That thread is very interesting. I have noticed last night's readings have gone up to AHI 5.0 and PB is 4% and 27 Obstructive Apneas. I'm still learning about these readings and their meanings, but I do believe I need to be far more proactive in my therapy than to blindly follow the doctor and DME. I'm trying to learn all I can before I go meet with my doctor to review my readings. Anything you guys can suggest I bring up, I will and greatly appreciate the help.

[4betterO2]

I have noticed last night's readings have gone up to AHI 5.0 and PB is 4% and 27 Obstructive Apneas. I'm still learning about these readings and their meanings, but I do believe I need to be far more proactive in my therapy than to blindly follow the doctor and DME.

It seems you are having trouble with CPAP (that's what you are using, correct, not BiPAP?)
I could not tolerate CPAP, it felt so unnatural to exhale against incoming pressure, felt like it confused my brain.
Your stats are a concern, your level of comfort is important too.
My experience is that doctors and DME RT's cannot guess what you are experiencing, you need to tell them, and waiting for the spaced schedule visits for them to look at the data report from your machine does not cut it. Worse, if you complain first to your DME they might just reply "you need to get used to the machine, it takes some patients 3 months". I would take your concerns straight to your doctor, and request a BiPAP/ASV titrating sleep study, where the first part would be BiPAP, which would document the untreated periodic breathing CNS events, then switched to ASV, which would document how these are treated. Some patients get their prescriptions for their machine from a general practitioner, but to get proper insurance coverage if you are going to get an ASV machine you need to see a board-certified neurologist in a sleep center, and have the appropriate sleep study.

Edited: not time to rewrite this, but I'm adding a very important alert in a post further below

[Pugsy]

Take a look at the EncoreGuide and terminology. It should help a bit with overall understanding.
For a different machine than yours but the basics are the same.
http://www.healthcare.philips.com/pwc_h ... _Guide.pdf

Overall Glossary of terms...look in my signature line for that link along with the SleepyHead half done tutorial. Read those items and I think some of your questions may be answered.

Periodic Breathing might mean something exciting and it might not. You need to be able to see the actual wave form graphs and any associated events with the PB before getting too excited.

Evaluating the data you see means being able to look at the whole picture.
How many hours of sleep are you averaging? Is that sleep fragmented? Wake up often? Spend much time on the machine laying there wide awake?
It's very common for newbies to spend quite a bit of time awake and when that happens it is also common for the machine to flag awake breathing irregularities as apnea events.

Without seeing a few detailed reports it is impossible to offer anything more than general thoughts.
Can you post a couple of images of your detailed reports so we can see what you are seeing? It would make explaining things go a whole lot easier...especially if you tell us what you are having trouble understanding.

Don't know how to post an image of your report? Here's a thread where we talked about it.
viewtopic.php?f=1&t=81072&p=737779#p737779

It's way too soon to be thinking ASV machine based on numerical PB values only.

[Janknitz]

They finally said that I can return it during the rental period for a Resmed S9 if that is what I want to purchase. Is this true or did they lie to me?

Well, this DME already lied to you once about your doctor ordering a specific machine, and yes, they are most likely lying again. I'll bet you a doughnut that at the end of the 2 month period they will refuse to get you the S9. Why would they want to take back a now used machine and replace it with a more expensive special order machine AND humidifier and hose for no additional money? They have NO incentive to please you.

While the 460 is a great machine, it does have it's limitations--as Pugsy explained you have to play around with the settings to keep it in automatic mode. And since you may have the FAA reviewing your data, I wouldn't want something you have to monkey with to keep it working for you. A real APAP makes much more sense. It's not clear to me that you need a BiPAP or ASV machine at this point.

Does your insurer cover other DMEs? Is it worth it to you to pay out of pocket for your own machine and bypass all the baloney that this DME is feeding you? I would run, not walk away from this scummy DME.

[4betterO2]

I have noticed last night's readings have gone up to AHI 5.0 and PB is 4% and 27 Obstructive Apneas. I'm still learning about these readings and their meanings, but I do believe I need to be far more proactive in my therapy than to blindly follow the doctor and DME.

Thinking again about your overall situation, - the increase in your CNS% and your career, I would caution you strongly to act both very quickly and, very prudently.
If I'm correct, the threshold of CNS events that dictates a complex apnea diagnosis is 5%, (not sure if equal to or only greater than). At 4% you are close! Seems your use of CPAP causes an increase in your CNS events %. You are at a junction where you need to choose very prudently what to do. Obtaining an ASV machine will give you the most responsive treatment possible these days, as it makes a change after examining 4 breaths, while the BiPAP machine will wait 20 min to do so. But if you are getting your ASV machine paid by insurance, you will have to wait until you pass the 5% threshold, and get a Dx of CSA (complex sleep apnea).
But do you want to do that???
Having a diagnosis of CSA might cause you much more dire consequences careerwise, than a simple OSA Dx! For instance in parts of Canada, once you have it, the Dr. must reported it to the DMV, and your driver's license is revoked immediately, you have to go through loops, paying for medical studies and evaluations out of your own pocket, and wait until your case is reviewed before you can drive again, then you have to do yearly medical reviews!
So if you are indeed using CPAP, which is the main cause of secondary CA, I would instead switch ASAP to BiPAP, got to see your Dr ASAP, - hoping that by getting off CPAP, with BiPAP the CNS events will stay stabilized at 4% and you won't get to a Dx of CSA... you can still buy an ASV on your own later, (without insurance), after that, it should treat you even better than the BiPAP - and this way, you will avoid having to wait for a 5% CNS rate and the dreaded Dx that comes with it...
Plus, if switching to BiPAP wil get your CNS stabilized under 5%, that would be a great medical benefit!

[Pugsy]

Talk to your doctor about any of your concerns.
PB doesn't always equal a problem with central nervous system centrals which we normally might see with Cheyenne Stokes Respiration.
Periodic breathing is a general waxing and waning of the breathing flow that lasts for 2 minutes or more. That's PB.
Cheyenne Stokes Respiration is a form of periodic breathing but it is not the only form of PB. There's more than one form of PB.

There's zero way we can hazard any sort of educated guess as to just what your episodes of PB might mean based solely on a % number. And in all my reading I have never seen where the % of PB is ever given a line defining measurement that above so and so equals a problem with central apneas.
PB % is just the percent of time spent in Periodic breathing. No guarantee that it is even related to centrals based on the number.

Now I have seen where central apneas averaging greater than 5 per hour will buy you the diagnosis but not % of time in PB.

[4betterO2]

PB % is just the percent of time spent in Periodic breathing. No guarantee that it is even related to centrals based on the number

In the literature PB% may be properly separated from a count of CNS events, but AFAIK the Respironics machines use the terminology "PB" for CNS events regardless of what they are or of their origin, am I correct?
The detailed data report from the machine, available through the DME or by using your own software to read the SD card, may better differentiate those events as to whether they are centrals or not, (I don't know, I'm fairly new and have just begun to look at it), but as far as looking at the stats on the screen of the machine, you do not see separate entries for periodic breathing and central nervous system apnea, you only see your event stats as AHI and PB. I have quoted in the ASV thread an admission by Respironics, that for some patients, complex sleep apnea is caused by CPAP use. And by definition, complex apnea includes central apnea and that's where it directs towards the use of an ASV machine.

[Pugsy]

In the literature PB% may be properly separated from a count of CNS events, but AFAIK the Respironics machines use the terminology "PB" for CNS events regardless of what they are or of their origin, am I correct?

The definition of PB in the Respironics manuals is simply this....
Periodic Breathing is a Respironics data feature defined as a persistent waning and waxing breathing pattrn which repeats itself between 30 and 100 seconds. The nadir of the breathing pattern is characterized by at least a 40% reduction in airflow from an established baseline flow. The pattern must be present for several minutes before it can be identified as periodic breathing. No therapy adjustments are made in response to periodic breathing.

It is reported as a percentile number meaning percent of the time spent in periodic breathing...so many minutes in PB.
Not all PB is related to central events. Not all central events result in PB.
Did you know that awake breathing can fool the machine real easy and flag green PB bars all over the place and it means nothing because the person was awake? Did you know that not all PB green flags even have any events any them?...



I am under the weather and not able to think nearly as clearly as I need to think to answer your questions but you are doing what a lot of people do when they see a PB percetage...knee jerk reaction..."OMG it must be centrals and I must have CSR and I must need ASV". Unnecessary panic to bestow on to a newbie with 4 nights on the machine and we haven't seen one report to have any idea what might be going on. Periodic breathing....if someone has a concern...first thing they should be told is ....Talk to your doctor about it....

Periodic breathing does not automatically equal centrals, CSR when gathered from the Respironics machines.
It's one piece of data that warrants looking at in conjunction with all the other data. Jumping to recommending ASV at this stage of the game is way premature.

[Pugsy]

The detailed data report from the machine, available through the DME or by using your own software to read the SD card, may better differentiate those events as to whether they are centrals or not, (I don't know, I'm fairly new and have just begun to look at it), but as far as looking at the stats on the screen of the machine, you do not see separate entries for periodic breathing and central nervous system apnea, you only see you event stats as AHI and PB. I have quoted in the ASV thread an admission by Respironics, that for some patients, complex sleep apnea is caused by CPAP use. And by definition, complex apnea includes central apnea and that's where it directs towards the use of an ASV machine.

I see nothing in OP previously mentioned data values to point to centrals being a problem one way or the other. Either with or without cpap or cpap making them worse. The PB % alone does not warrant it.. AHI of 5...doesn't warrant it. Especially since the breakdown in category of events points to primarily obstructive.

PB alone isn't scary and isn't a big deal unless some of the other scary stuff is going along with it or unless there is a whole truckload of PB.

And yes....there are indeed separate entries for PB and central apneas. They are 2 separate categories. If you aren't seeing them then it is because you aren't having them...not because they don't exist for the entire population.