ResMed s9 Elite v. ResMed s9 AutoSet

[rebe]

I am new to this and was even newer 3 weeks ago when I got my S9 Elite . I realize that Elite is a fine machine but also realize that it is not the top one like S9 AutoSet.

I am on Medicare and also have supplimental insurance - so rental for the top machine would have been paid.

I wonder why the doctor/vendor would have been so adamant about steering me to the Elite? They never asked for my preferences.

Your thoughts appreciated

[Bama Rambler]

Profit! Plain and simple.
The DME gets paid the same no matter which machine you get, and the Elite costs them less than the AutoSet.

[rebe]

Is it worth the trouble to try to exchange the machine for an AutoSet?

Thanks

[Pugsy]

The only difference between the ELite and the AutoSet is the Autoset offers auto adjusting pressure (APAP) mode.
Everything else is the same.

If you have no need or desire to use auto adjusting pressures then there is no critical need to have it available.

There are some situations where a higher pressure might be needed for part of the night (like REM sleep or supine sleeping) and other parts of the night a person can get by with lower pressures. Having the APAP mode available will allow the pressure to fluctuate as needed.
Otherwise higher pressures have to be used all night to cover REM or supine sleeping pressure needs..if there is much of a difference and it isn't always going to make a big difference.
Higher pressures all night vs part of the night can make aerophagia worse or just adjusting to the pressure harder.
Using APAP mode isn't always the best thing for everyone though...sometimes people find that the pressures going up and down during the night to be a disruptive factor to sleep quality.

Having APAP available is a nice thing to have but it isn't the end of the world if we don't have it. It can be an inconvenience sure..but not the end of the world. One of those things where it is better to have it and not need it than need it and not have it. So that's why we steer people to the APAP capable machines when we can. So they have it available in case they need it.

I am someone whose pressure needs vary a lot in REM sleep some nights and other nights don't vary much at all. Don't know why...I did some experiments to see if staying totally on my side seemed to matter and it didn't so I don't think supine sleeping is a big factor in my situation.
When I was using the APAP machine my most of the time pressure was around 11 cm but on occasion I would see 18 and 19 cm for 30 minutes or so in what would likely be REM stage sleep. I sure wouldn't want to use 18 cm all the time just to cover 30 to 60 minutes of worst case scenario...so I benefit from auto adjusting pressures. Not everyone sees such a dramatic difference in pressure needs.

Also when using auto adjusting mode and the pressures vary a lot..that can make leak management more of a challenge.

So if you are doing well and your pressure needs don't trigger aerophagia....it isn't the end of the world that you don't have APAP mode available with your Elite.
APAP mode is the ONLY difference between the Elite and the AutoSet.

[rebe]

Thanks Pugsy - you're the best!

I don't have aerophagia at all but was concerned because the AHI went up to 11 (usually at 4 or 5).

My pressure is set at 8 and the max used in the lab was 9.

[Pugsy]

I don't have aerophagia at all but was concerned because the AHI went up to 11 (usually at 4 or 5).

What is the breakdown of the AHI?
How much was the central index?
Obstructive index?
Hyponea index.

Often newbies have a higher central index which may be from being awake for a period of time and the machine recording awake centrals by mistake because it doesn't know if you are awake or not.
So if you are spending much time awake on the machine...that might explain the higher AHI.

When you get your software up and running we can look to see if the bulk of the events are in clusters which might be at the beginning or ending of the night..which might mean awake breathing.
If awake breathing events we have to mentally remove those events from the AHI evaluation.

If you are having a lot of obstructive apneas during the night when you are for sure asleep then your pressure maybe isn't optimal..are you using EPR and if so at what setting? Sometimes the slight drop using EPR allows some obstructive apneas to sneak past the defenses...easily fixed if that is happening with a minor increase in pressure or a reduction in EPR.

If you are seeing centrals in excessive numbers all throughout the night....we don't treat those with more pressure and if consistently seeing more than 5 centrals per hour throughout the night then maybe a talk with doctor about the centrals is in order.

[sleeplessinaz]

I personally would go ahead and exchange it for the Autoset. You never know when you may want to try a range of pressures instead of a straight CPAP pressure. I started out on CPAP at a pressure of 7. Then I started not feeling so good, so the sleep center I went to, suggested and used a range of pressures. I now have a pressure range of 6 to 12. Sometimes I am at a 9.2 and other times lower. It's just nice to have it on case your needs change down the road. I feel so much better using the auto set.

[Pugsy]

OP just got ResScan this morning and once we see some reports we will have a better idea what is going on with the AHI.

It may be that he needs more pressure for short periods of time during the night for whatever reason and APAP mode might be an advantage to have available. With a pressure of 8 cm though...he has some wiggle room to use a higher pressure (if needed) and the pressure still not be so high as to maybe cause an issue.

Is it worth it to try to get the AutoSet....always nice to have but sometimes DMEs/Docs dig in their heels so it they aren't always so agreeable to swap it out. Then the hassle factor comes into play.
Technically the CPAP mode will work...in docs/DMEs eyes and they don't like to give up the extra profit. Which really isn't all that much but multiply it by 100 people and it adds up.

[chunkyfrog]

Anyone can lose (or gain ) weight while on cpap.
If the change is 30 pounds or more, pressure changes may be necessary.
Saving the expen$e of an additional titration in the lab is worth the trouble of getting the auto machine.
Your doctor may not be aware that auto machines can be run on straight pressure;
or that some people are more comfortable with a moderate pressure range --as opposed to using maximum all night.
This is the case for me--I had minor residual aerophagia for the 9 months that I used my original Elite.
It vanished completely with my Autoset.

[apw5746]

When I visited with my sleep doctor yesterday, he wasn't concerned with the breakdown of the AHI. As long as the AHI was in the acceptable range, he considered everything else a mute point. My AHI is mainly comprised of centrals. More than 80%..

Medicare has so many hoops to jump through it's not funny. As an example, my DME is LINCARE. Any RX my local DME gets has to go to their main office to make sure as i's are dotted and t's crossed. If the RX isn't just so, then it's back to square one.

My sleep doctor realized I wasn't leaving his office without him writing a script that met Medicare requirements. Either he did, or I was off to see the VA, who will write a script for about anything that moves. (if their in a good mood)

Unfortunately he wrote the wrong RX, so local LINCARE is going to call his sleep techs and tell them exactly what need to be on the RX to get a new machine. Actually in this case to swap.

[Pugsy]

As long as the AHI was in the acceptable range, he considered everything else a mute point. My AHI is mainly comprised of centrals. More than 80%..

I wouldn't be concerned either if the AHI was within acceptable range which is normally considered less than 5.0.
OP in this situation reported as high as 11 and AHI in the 4 to 5 range which technically is "acceptable" but I still would want to understand the category breakdown as it might give someone peace of mind..

All to often I see people with AHI of 4 or 5 who go into dial a winging mode with pressure changes and wonder why the AHI doesn't change with the increases and come to find out their AHI is mainly awake centrals (or even real centrals) and pressure changes won't fix them.

That's why I harp on the event category breakdown so much. Before trying to fix something...let's figure out exactly what needs fixing and if we even can fix it with current machine.

Newbies tend to get fixated on the AHI number and not get educated on the basics of how the AHI is evaluated and what to do about it. They see AHI of 6 and think "I need AHI of 2" and go increasing the pressure but it doesn't help if the AHI is predominantly central in nature.
They don't understand centrals and they don't realize that awake breathing can falsely elevate the AHI.

[rebe]

Thanks Pugsy for the link to download ResScan .
I did it in Windows - seldom used here.
So for one day when I did not manage to sleep even 4 hours, I got: 3.38 hours,
Apnea Index 11.8, Obstructive 10.7, Central 1.1;
Hypopnea Index :1.9; AHI: 13.7.

[robysue]

Thanks Pugsy for the link to download ResScan .
I did it in Windows - seldom used here.
So for one day when I did not manage to sleep my 4 hours, I got: 3.38 hours,
Apnea Index 11.8, Obstructive 10.7, Central 1.1;
Hypopnea Index :1.9; AHI: 13.7.

Rather than focus on the one day when you did NOT manage to get at least four hours of sleep, you may want to focus on over all trends.

What kind of AHIs are you looking at over the longer term? On nights where you do think you get some real sleep, what's the AHI look like?

And since you say you "did not manage to sleep my 4 hours", that begs this question: Are you typically using the mask for four hours, waking up and taking the mask off and then going back to sleep without the mask? If so, then it may be more important to focus on getting to where you're sleeping with the mask all night long, rather than the machine scored AHI for a partial night's sleep.

Now, if the AHI is always or almost always as high as it was this night AND if the distribution of events is usually contains far, far more OAs than anything else, then that may indicate that a slight pressure increase is warranted. But before starting to dial wing, you really do need to think in terms of what the long term data says instead of what the data for any one bad night says.

[Pugsy]

Like Robysue I would be much more interested in a typical night's report and not a fluke night.

Heck I toss out fluke nights when I get normal number of hours of sleep..

How long have you had the S9 Elite?

[StuUnderPressure]

Profit! Plain and simple.

Yep, the DMEs think about profit.

But a lot, if not most Sleep Doctors, think that NO one should have an Auto.
They just don't believe in them!