ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

General Discussion on any topic relating to CPAP and/or Sleep Apnea.

Which do you prefer/suggest?

ResMed S9 AutoSet
24
52%
Respironics PR System One REMStar 60 Series Auto
22
48%
 
Total votes: 46

grillhead
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ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by grillhead » Thu Oct 11, 2012 6:18 am

I know this is debated ad nauseum, but I'm making myself a simple poll to elicit some feedback. So, vote for which one you suggest/prefer, and please leave some constructive feedback as to why. (And yes, these are my two choices, I'm not really entertaining any others) Thanks!

nanwilson
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by nanwilson » Thu Oct 11, 2012 11:15 am

Really...they are both the top of the line for each manufacturer...someone may "love" one and "hate" the other its entirely up to you. Which truck would you buy, a ford or a chev...same question. I won't buy anything Resmed since they became bullies and are manifpulating the market. I won't buy a chev neither, since they got money out the people by crying poor me and show up at the hearings in a private jet. They didn't need the money, they needed to work on better business practices and stop giving their head honchos such lovely bonuses.
Started cpap in 2010.. still at it with great results.

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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by Lizistired » Thu Oct 11, 2012 11:19 am

I don't think many here have the 60 yet, and even fewer have tried both.

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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by lazer » Thu Oct 11, 2012 12:24 pm

We just like Poles.....

Image
Image.....................................................ImagePress ESC if the animations BUG you!.....................................................Image

hyperlexis
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by hyperlexis » Thu Oct 11, 2012 12:29 pm

Many problems with this type of survey, the main one being that I would venture most people have not had the ability to try both machines to compare -- because the concensus has been that DME suppliers simply will not let patients test drive the different equipment before buying. It's more 'you try it, you buy it' kind of a deal. A horrible way to do business, but that's what most DMEs do. I called multiple DMEs and even ResMed and PR directly. None of them would let me test a machine for a week. None.

I picked the PR60 Auto for multiple reasons, including because: 1.) it is made/assembled in the USA and the S9 is imported (although the S9 may have some US parts); 2.) The replacememnt supplies (hoses/filters etc.,) for the PR60 are cheaper; 3. The PR60 hose port is on the top and swivel mounted, and the S9 port is fixed, at the back; 4. It's a newer design; and 5. The included PR60 humidifier chamber is 'openable' and dishwasher cleanable. I have since learned the PR60 has some other features the S9 lacks, including an audible mask leak alert, and 'OptiStart' which automatically adjusts the start pressure to match one's pressure needs as time goes by. Also, I have since learned the PR60 is virtually silent during use.

The S9 Autoset is still a great machine and has a very nice color display, which the PR60 lacks; it has a user-controlable screen backlight which the PR60 for some stupid reason does not (once operating); it also has a much easier to understand and use heated hose/humidity/temp control system compared to the PR60; and it was made to work with ResMed's masks, which, I have since found, are far more comfortable and seal better for me than PR's FF mask line. I cannot comment on the S9's noise level but most people say its quiet.

Beauty is in the eye of the beholder....

Pick what features are more important to you and you can't go wrong with either machine.

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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by hyperlexis » Thu Oct 11, 2012 12:33 pm

nanwilson wrote:Really...they are both the top of the line for each manufacturer...someone may "love" one and "hate" the other its entirely up to you. Which truck would you buy, a ford or a chev...same question. I won't buy anything Resmed since they became bullies and are manifpulating the market. I won't buy a chev neither, since they got money out the people by crying poor me and show up at the hearings in a private jet. They didn't need the money, they needed to work on better business practices and stop giving their head honchos such lovely bonuses.
Well being from Alberta, will you buy a car from a nice Canadian car company then, or just one from the Asians or Europeans who get all the government subsidies they need? Not to get off topic of course....

hyperlexis
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by hyperlexis » Thu Oct 11, 2012 12:34 pm

lazer wrote:We just like Poles.....

Image
We could use more poles like this.

nanwilson
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by nanwilson » Thu Oct 11, 2012 2:04 pm

hyperlexis wrote:
nanwilson wrote:Really...they are both the top of the line for each manufacturer...someone may "love" one and "hate" the other its entirely up to you. Which truck would you buy, a ford or a chev...same question. I won't buy anything Resmed since they became bullies and are manipulating the market. I won't buy a chev neither, since they got money out the people by crying poor me and show up at the hearings in a private jet. They didn't need the money, they needed to work on better business practices and stop giving their head honchos such lovely bonuses.
Well being from Alberta, will you buy a car from a nice Canadian car company then, or just one from the Asians or Europeans who get all the government subsidies they need? Not to get off topic of course....
Hyperlexis
We are a Ford family....they didn't ask for or need a bailout
Started cpap in 2010.. still at it with great results.

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DiverCTHunter
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by DiverCTHunter » Thu Oct 11, 2012 2:41 pm

nanwilson wrote: We are a Ford family....they didn't ask for or need a bailout
I'll stick with my Pontiac Vibe. It may be an Asian immigrant from California, but at least it doesn't explode if you hit it from the wrong angle
When in doubt, open the case. Remember: If you can't open it, you don't own it!

Prescribed APAP range - 6-10 cm/H2O, titrated at 8.
Current range - 9.0-11.5 cm/H2O - still searching for the magic "zero night" but averaging 2.2 AHI

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Uncle_Bob
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by Uncle_Bob » Thu Oct 11, 2012 2:44 pm

I have both and to suggest or recommend on or the other is difficult without knowing

1) Is money an issue?
2) Do you preffer Resmeds auto algorithm or the Respironics one?
3) Are you new to CPAP therapy

for (1) When i got my Series 60 it was half the price of the S9.
(2) obvioulsy you don't know until you try both. personally i can't tell the difference.
(3) most newbies like to see their last nights leak and AHI score on the machines display. The Series 60 rather stupidly only displays the averages over time.

The Series 60 is slightly louder than the S9. Not with motor noise but with the sound of air movement.
The Series 60 has a cheap $25 DC cable to connect to a 12v power source.

Like others I was getting fed up with Resmed and their business attitute. I'm now Resmed free at half the price The S9 is a backup.
It was cool to buy something with a made in America sticker on it. But unfornately my first one was a lemon.

jdnaples

Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by jdnaples » Thu Nov 14, 2013 8:13 am

When I was having trouble keeping my mask on I went to a mask tech at the Mayo Clinic in Jacksonville Florida. The Mayo Clinic in Roschester saved my life once, and I have great respect for them. They do a lot of their own reach their. The books said odd were in my favor 80 to 20 to get rid of ITP by splenectomy. They told me "N0, 50=50". But they did it. So for whatever it's worth, the tech told that they write scrips for the Respironics at the clinic. Good enough for Mayo is good enough for me.

Additionally, all of a sudden my resmed auto set is not reading cards correctly. It is also awkward in many ways (So could the Respironics be, I don't know,it should be here today.) Main reason for purchases is age of resumed, I'm hoping for better algorithm since it is new, and praying that the mask alarm wakes me if the mask comes off. Resmed doesn't have one.

James

Furielsky
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by Furielsky » Fri Nov 15, 2013 12:55 am

Ive only ever tried the s9 but so far so good for me. I dont get alot of leaks with my full face mask. Provided I was it and my face before bed with ivory bar soap.. otherwise I get alot of leaks and the wipes dont help.

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Lazer1234
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by Lazer1234 » Sat Nov 16, 2013 6:32 am

I have used a S9 autoset for 2,5 year now. Next week i got a PR 560 wich i bought from a forum user here, STL Mark. In a couple of weeks i can tell you if there are any different of these two machine.
Everything I write I translate through Google Translate.
Hope you have patience with that, sometimes it can get a little crazy.
/Lazer1234

-tim
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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by -tim » Sun Nov 17, 2013 8:41 am

I have one of each. I use the S9 most of the time.
"Made in the USA" is subject to debate since most of the components aren't. The S9 might be made in Australia (or Singapore) from parts that might have been made in the USA. I've meet a guy who makes the plastic molds for the S9 and he lives near Sydney.
They both have major design flaws and I've looked inside both units. The 560 has some things that work better like the swivel on the hose but it comes with a shorter hose is that is a disadvantage. They both have odd sounds that anyone who deals with pipe organs would have fixed centuries ago. The S9 has a better display. The S9 is snap together so it is not reparable. The S9 has a pair of foam gunk collectors inside that you can't ever clean because they didn't use screws. The S9 has an SpO2 kit but it cost more than the machine. The S9 motor was balanced by a plate with drill holes that are in the air flow so each machine makes a unique racket. The 560 has a much better filter design. The 560 humidifier door design invites breaking beyond the ability to fix. The S9 has an odd power supply that has to talk to the unit so battery backup is far more complicated than it should be. The S9 has a very expensive module that fits between the two low cost modules to provide alarms but I'm not sure what is up with that since I've never seen it outside of a pictures. I had a review of both machines in the past if you want to hunt down old forum posts.

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Re: ResMed S9 AutoSet vs. Respironics PR System One REMStar 60 S

Post by robysue » Sun Nov 17, 2013 9:23 am

Edited to provide a web link to the paper on Auto algorithms (6/7/14)
Edited to reflect some new information about the PR System One Series 60 APAPs and I've also tried to add some basic information about battery back ups. I've also added some headers to make it easier to find features of interest.(4/21/14)

A short while back on a different board a user pm'd me asking for my opinion about which was the "best" APAP out there on the market. I took the time to copy, paste and edit things I'd written from a whole bunch of different posts into this rather lengthy response, which seems like it is relevant to this particular thread that's recently been dug up.

If you are looking for information on comparing the S9 VPAP Auto to the System One BiPAP Auto, you'll want viewtopic/t97212/viewtopic.php?f=1&t=95 ... 11#p880411.


What's the best APAP out there---the Resmed S9 AutoSet or the PR System One Auto?
Both the Resmed S9 AutoSet and the PR System One Auto CPAP are nice machines. But asking, "Which is the better APAP machine?" is a bit like asking, "Which is better---Coke or Pepsi?" There are dedicated Coke and Pepsi fans who have a very strong preference and really dislike the other drink, but for the average consumer? The difference in taste is marginal and either one will do when the person is wanting a cold cola-based soft drink.

It's a similar situation with the APAPs. Both the Resmed S9 AutoSet and the PR Series 60 System One Auto CPAP are top notch machines and both are capable of delivering high quality therapy. But there are some real differences between the S9 AutoSet and the System One Auto and for a small minority of PAPers, these differences are quite important. But it's not like everyone prefers the S9 over the System One---just like there are people who prefer Pepsi to Coke, there are people who prefer the System One to the S9. But for the average new CPAPer? The average new CPAPer probably can't tell any real difference between the two machines and will adjust just fine regardless of which one they choose.

That said, if you've been recently diagnosed with OSA and you're trying to make a decision between which CPAP/APAP to get, it is still worth trying to make an informed, intelligent decision on what you think is going to work best for you. And there are some real differences between them.

The three big categories of differences, in my humble opinion are:
  • Price
  • The comfort features
  • The recorded data, the on-board data, and the software choices
  • The auto algorithm itself
Which machine to chose may depend on your own needs and preferences in each of these categories. So here are some things to keep in mind about the two most common APAPs on the American market:


Price
On-line prices for the PR System One APAP are quite a bit cheaper than on-line prices for the S9. That may be a consideration if this is an OOP purchase.


The Comfort Features
Humidifier and heated hose
Both machines come with integrated heated humidifiers and optional heated hoses. The System One's humidifier has two kinds of settings (a "smart" kind of setting and a "classic" kind of setting) when you are using the humidifier without a heated hose. The "smart" setting, the humidifier takes into account the ambient room temperature and humidity and adjusts the heat provided under the tank to minimize rainout. (This system works well in my very cold bedroom). The "classic" setting allows for much more humidity to be added, but at the risk of creating rainout problems.

The S9's humidifier kind of splits the difference between the two types of settings on the System One if you don't use a heated hose.

On the S9, the heated hose's default setting allows you to pick a temperature and the humidity is supposed to be set to 80% relative humidity. Some people find that's not enough humidity and others find it's too much. On the System One, in the default mode for the heated hose you've got a choice of "temp" and "humidity" settings where the humidity settings (1, 2, 3) seem to correspond to 70%, 80%, and 90% relative humidity respectively.

On both machines you can change the heated hose setting from the default mode to a completely manual mode, and this allows you to control the hose temperature and the humidity separately. (On the System One, the is accomplished by using the "Classic" settings for the heated humidifier.)

The S9's heated humidifier can be preheated and that's a plus. The older System One humidifiers cannot; but I believe the newer versions of the Series 60 machines that are using the most up-to-date firmware do allow you to pre-heat the humidifier. When I start out the night my nose always feels cold and damp until my (old Series 50) System One humidifier heats up---it only takes about 10 minutes, but it's still a long ten minutes on a cold night. Check that with the DME if the ability to pre-heat the humidifier is important to you.


Exhalation relief systems
Both machines come with an exhalation relief system. These are supposed to be patient comfort settings and they should be available from the patient set up menu, but the tech who sets the machine up can restrict access to the exhalation relief settings to the clinical menu. The two systems work differently and while most people cannot tell any real difference in how the two systems feel, some people can tell a big difference. And that difference can be important to some people.

EPR on the Resmed S9
The Resmed S9 system is easier to understand. With EPR there is a straight reduction in pressure that starts with the beginning of the exhalation and it lasts most of the way through the exhalation. The pressure is raised back up to the therapeutic setting just before (or just as) the inhalation starts. When I was using an S9, it seemed as though EPR kicked in before my inhalations started, but most people say that doesn't happen. The EPR setting equals the reduction in pressure. Hence if EPR = 3, there is a 3cm drop in pressure on every exhalation. This is sort of like a poor man's bi-level, but not really. (Or so says my airway---the switch to a real bi-level was important in conquering several of my adjustment problems.)

Flex on the PR System One
The PR Flex system is more complex to understand. It provides a variable amount of pressure relief with each exhalation. How much relief and how that relief is delivered depends on which type of flex (A-Flex, C-Flex+, or C-Flex), what the flex setting is, and how forceful the exhalation is. With A-Flex and C-Flex+, there is an initial drop in pressure right at the start of the exhalation, and about half way through the exhalation, the pressure is brought part way back up towards the therapeutic setting; when the inhalation starts, the pressure is further increased all the way back up to the full therapeutic setting. Some people swear by A-Flex or C-Flex and say that it makes breathing with the machine feel very natural. Others dislike it. (I'm one who turned Bi-Flex, the BiPAP version, off as soon as I got my BiPAP because it bugged me.)

Some additional notes on both exhalation systems
These are supposed to be patient comfort features and they are not supposed to affect the efficacy of the therapy. In practice? A small minority of patients find that they do need to increase their pressure setting to compensate if they are using EPR or Flex, particularly if they're using EPR = 3. Another thing peculiar to Flex is that many people are very sensitive to which Flex setting they use: They may find A-Flex wonderful, but C-Flex awful. They may find A-Flex = 2 very natural, but when A-Flex = 3 it feels as though the machine is rushing them to inhale. PR seems to understand this sensitivity and they make it easy to play with the Flex settings in real time with the mask on your face and that's a very useful feature.


Ramp
Many experienced users discount the importance of the ramp. Indeed, many old hands at PAPing will routinely tell newbies that their problems are all due to overuse of the ramp. While there may be some truth in that, it's also true that many people, newbies in particular, do find the full force of 10+ cm of air blowing down their throat just as they are trying to get to sleep enough to make them more awake and less sleepy. While a improperly set ramp can indeed add to a newbie's adjustment woes, a properly set ramp can be a godsend---particularly in the first several weeks or months of PAPing when everything about the whole "sleep with a mask on my nose while having air pumped down my gut" is new and somewhat disturbing.

On both machines, the RAMP feature is disabled if the minimum pressure setting is set to 4 cm since the minimum starting ramp pressure is 4cm. On both systems the RAMP feature allows the user to start the session at a pressure below the minimum pressure setting. The pressure will slowly ramp up (in a linear fashion) to the minimum pressure setting over a fixed amount of time that can be controlled through the settings.

Many DMEs will typically use 4 or 5 cm as the default starting ramp pressure and 30 or 40 minutes as the default ramp time. For many newbies, this does provide some real measure of comfort if they feel overwhelmed by the airflow at their prescribed pressure settings. But many other people have real trouble breathing at 4 or 5 cm of pressure because at this low of pressure there is a sensation that there's not that much air coming through the mask. (In reality, there's still plenty of air being blown through the system even at 4 or 5 cm.) As a consequence many people find the ramp a double-edged sword. It may help during the first few weeks or months, but it may make things more difficult because the feeling of "not enough air coming in through the mask" can lead to a sense of panic.

Ramp on the Resmed S9 Auto
The starting ramp pressure on the Resmed S9 must be set from inside the clinical menu. It can be set from 4cm to anything less than the patient's minimum pressure setting. The ramp time can be set from the patient's set up menu and it can be set in 5-minute increments from anywhere between 5 minutes and 45 minutes. The longer the ramp time, the gentler the increase in pressure will be. The smaller the gap between the starting ramp pressure and the minimum pressure setting, the gentler the increase in pressure will be.

Any time the S9 is turned off and then back ON during the night, the machine will start at the beginning of a full ramp period and there is no way to easily disable this in use. In other words, it is impossible to use a 45 minute ramp at the beginning of the night and then allow yourself to turn the machine off and back on for a bathroom break in the middle of the night. without restarting the ramp.

During the ramp up period, the S9 will NOT record flag any events and it will NOT respond to any events. If you fall asleep well before the end of your ramp period and start having apneas or hypopneas because the pressure is still far below your therapeutic pressure, these "ramp period" apneas will NOT show up in the data---regardless of whether you look at the data on the LCD, in ResScan, or in SleepyHead.

Because the ramp cannot be temporarily disabled on the S9 and because the S9 does not flag or respond to events that occur during the ramp period, it is critical that S9 users who chose (or need) to use the RAMP feature be conscious of the following things when setting up their ramp settings:
  • The ramp time should be set to approximate the user's most typical latency to sleep. If the ramp period is set much longer than the typical latency to sleep, the user may have long periods of sleep where the machine provides inadequate protection AND the events during these ramp up periods will NOT be flagged.
  • The starting ramp pressure should be set as close to the user's minimum pressure setting as possible for comfort. (And the minimum pressure setting should not be too far below the user's titrated pressure needs.) This will insure that during the time the patient is sleeping during the ramp period, the pressure will at least be something closer to therapeutic, and hence of some therapeutic use in preventing at least some of the user's typical OSA events
Ramp on the PR System One Auto CPAP
Both the starting ramp time and the starting ramp pressure can be set from the patient's set up menu if the clinician gives access to the ramp settings in the clinical menu. The ramp time can be set in 5-minute increments from anywhere between 5 minutes and 45 minutes. The ramp pressure can set anywhere between 4cm and the patient's minimum pressure setting. The longer the ramp time, the gentler the increase in pressure will be. The smaller the gap between the starting ramp pressure and the minimum pressure setting, the gentler the increase in pressure will be.

In order to use the ramp, the patient must both turn the machine ON and press the RAMP button, which is a small button with a triangular icon on it. The RAMP button may be pressed at any point when the machine is ON during the night. When the RAMP button is pressed, the machine will lower the pressure to the starting RAMP pressure and will increase the pressure back up to the minimum pressure setting over the RAMP time period. If the patient turns the machine off during the night and then back on without pressing the RAMP button, the machine will start with the pressure set to the minimum pressure rather than the starting ramp pressure.

The System One will record and respond to obstructive apneas, hypopneas, snores, RERAs, and flow increases during the RAMP period with an appropriate increase in pressure as dictated by the System One's Auto Algorithm. For example, if the machine detects two or more apneas in close proximity, the machine will increase the pressure by 1cm and continue the ramping up of the pressure to the minumum pressure setting from there. The events detected during the RAMP period will show up in the data when you look at it in Encore and SleepyHead. (They'll also be part of the averages on the machine's LCD averages.)

Overall, the Ramp is a bit more flexible on the System One. But even so, it is important for a new user to still be aware that continually hitting the Ramp button to lower the pressure below the minimum pressure setting may not be a good idea----particularly if the ramp time is extremely long and if the starting ramp pressure is much lower than the minimum pressure setting.


Auto On/Off
Both machines offer these things. On the PR System One, they are controlled separately through the Auto On and Auto Off settings. On the Resmed S9, you have to turn them on (or off) together with the SmartStart setting. From what I've seen, they can be a bit touchy----particularly for people using low pressures and nasal pillows. Me? I turn my machine on and off manually---it's just not that hard to hit a very large button.


Mask fit, mask alarm, and leak data
PR has a "Mask off alarm" that's not loud enough to actually wake most of us up. It's pretty much useless; Resmed doesn't have a "Mask off alarm"

Resmed has Mr. Green Smiley and Mr. Red Frowny to let you know if the mask fit was "good enough." But Mr. Red Frowny only shows up if you are in Large Leaks for at least 30% of the night.

The leak data on the LCD of the System One is pathetic. You have to have SleepyHead or Encore to track your leaks with a System One.


Using the machine with a battery
Both machine's specs say they can be used directly with a battery, but ...

Using the S9 with a battery
The S9 seems to be very, very picky about its power supply. Directly plugging an S9 into a 12 volt battery (such as the typical car battery or marine battery) seems to be problematic; in order to use a 12 volt battery, it appears that you must purchase the DC Converter 24V 90W For S9™ Machines for $84.95. Of course, since this cable is a converter, it does eat into battery life.

The proprietary battery from Resmed that is guaranteed to work with the S9 lists for $699 at cpap.com (See https://www.cpap.com/productpage/resmed ... hines.html). The $699 package includes a (relatively lightweight) lithium ion battery and the DC cable needed to hook the machine to the battery. As a cheaper (but heavier) alternative to the Resmed battery pack, you can also purchase the Respironics Battery Kit for S9 Machines from our hosts at cpap.com for $379.95, which includes a lead acid battery and the DC Converter 24V 90W For S9™ Machines.

Using the System One Series 60 with a battery
The PR System One Series seems to be much less picky about the power supply. The PR DC power cord for System One Series 60 machines can be bought from our host for $29.95 and it can be used to to directly connect the PR S1 Series 60 machine into a 12 volt battery (such as as the typical car battery in something like a DieHard Platinum Portable Power source and jump starter) without the use of an inverter.

You can also buy a Respironics Battery Kit for PR System One 60 Series Machines from cpap.com for $328.95, which includes a lead acid battery and the DC power cord. Or you can buy the CPAP.com Battery Kit for PR 60 Series System One Machines, which includes a lightweight lithium ion battery and the DC power cord for $269.95.

REQUESTING HELP: If you use a Resmed S9 with a battery setup OTHER than the Resmed Battery Pack, please PM me with any corrections to the errors that I have undoubtedly made in describing what it takes to run an S9 off a battery. Likewise if you use a PR System One Series 60 machine with a set up other than the PR Battery Pack, please PM me with any corrections to the errors I may have made in describing what it takes to run a System One Series 60 off a battery.



The on-board data, the software choices, and the detailed data
On-board data
The S9 shows an incredible amount of detailed summary data right on the LCD; the System One does not.

S9 AutoSet
The on-board data on the S9 AutoSet is excellent: You get nightly, weekly, and 30 AHI numbers broken down by type of event. You get 95% unintentional leak rate figures. And there's a mask-fit feature that may be useful. The overnight data is available within a minute of turning the machine off. But you do have to view the overnight data before noon local time. And you can set the clock through the clinician's menu.

Finally, you can change the clock in the clinical menu of the S9 and nobody can change the clock on the System One. Both machine's have some problems with clock drift over time. There are some bugs in ResScan where clock drift was apparent back when I was still using an S9.

System One Auto CPAP
The on-board data on the PR System One Auto CPAP is very, very limited. The new Series 60 machines give you AHI numbers for the last 24 hours, 7 days and 30 days and the AHI is not broken down at all by event type. And the System One's on-screen "Percent time spent in Large Leak" data are virtually meaningless: PR doesn't seem to define or describe what constitutes a Large Leak anywhere. And there's the annoying fact that the System One updates its data at noon Greenwich Meridian Time. And that you can't change this. And that you can't change the clock setting---even in the clinical menu.


Software
Both machines work well with SleepyHead. It is possible to get your hands on the "official" software from Resmed and PR if you want it. The newest version of ResScan will work with the S9 AutoSet. Encore Basic and Encore Pro will both work with the Series 60 System One Auto CPAP.


Detailed Data--General comments
Both machines record full efficacy data, including the wave form, events, and leak data. There are some differences in how the two machines record the efficacy data however.

The Resmed S9 overwrites the wave flow data on the SD card every seven days and the other "detailed" daily data every 30 days. If you want all the data, you must download it at least weekly. The PR does not ever seem to overwrite the detailed data, so when you download to SleepyHead you'll see everything that's been written to the card. (But Encore will only download the last night's wave form for some silly reason.)

If you forget to put the SD card back into the S9, the machine will write the summary data to the card when you insert it, but all the detailed data will be lost. If you forget to put the SD card back into the System One, the machine will write all the data except the wave flow to the SD card when you put it back in to the machine. (Both machines write the wave flow data directly to the SD card.)

The Resmed S9 is very picky if anything is written to the SD card by the computer system---this is a problem if you use a Mac or a Windows 8.1 machine and you forget to "lock" the card before inserting it into the computer. The PR System One doesn't seem to care much about things the computer might write to the card. I routinely forget to lock my System One's SD card when inserting it to my Mac and I know the mac writes some hidden .files when I do that. The System One doesn't care.

Finally, you can change the clock in the clinical menu of the S9 and nobody can change the clock on the System One. Both machine's have some problems with clock drift over time. There are some bugs in ResScan where clock drift was apparent back when I was still using an S9.

Leak data
The ResMed S9 AutoSet records only the excess leak rate, and, like all ResMed machines, a Large Leak is defined as anything over 24 L/min. The PR System One Auto CPAP records the total leak and PR has no official published definition of how bad the leaks have to be to get flagged as a Large Leak.

Efficacy data
Apneas and hypopneas: Both machines flag apneas (and classify them as OAs or CAs) and hypopneas. The proprietary algorithms for deciding whether a given apnea is a CA or an OA are different. The Resmed S9 uses a Forced Oscillation Technique (FOT) and the PR System One uses a Pressure Pulse (PP) system. The FOT consists of many very small oscillations in pressure; the PP consists of one or more very short 1 or 2cm "bursts" of increased pressure that last for a very short time.

Flow limitations: Both machines record flow limitations, but the way they record it is very different. The S9 AutoSet presents the flow limitation data as a continuous graph with respect to time. The PR System One Auto CPAP records "flow limitation events" as tick marks on the flow wave graph. Each method has advantages and disadvantages But the System One Auto CPAP records flow limitations only when it is running in Auto Mode. If you use the System One in fixed CPAP mode, the machine simply doesn't record the flow limitation tick marks. (Editorial Comment: It seems like a really stupid decision on PR's part to suppress the Flow Limitation data when the machine is running in fixed mode. It's an even dumber decision to report FLI = 0.0 day after day in Encore.)

RERAs: The System One flags RERAs (respiratory effort related arousals) using a proprietary algorithm. The S9 AutoSet does not try to score RERAs. The problem with accurate detection of RERAs, of course, is that neither machine has an EEG for measuring the sleep state and a RERA requires an EEG arousal. The PR RERA algorithm has to be based on statistical analysis. My guess is they've identified changes in the flow wave shape that statistically correspond to the shapes of RERAs scored on PSGs. How good the PR System One algorithm is at scoring RERAs is a good question. Clearly Philips believes the algorithm is good enough to include in their commercially released products.

Periodic Breathing: The System One Auto CPAP also flags what it believes to be periodic breathing, including Cheyne-Stoakes breathing patterns. The S9 AutoSet does not flag these areas of the flow wave, but if you know CS breathing is an issue, you can often spot it by zooming in on the wave flow .

Snoring: Both machines record snore data, but the way they record it is very different. The snore data and the flow limitation data are recorded as continuous functions on the S9; they are discrete tick marks on the System One. (SleepyHead's version of the snore data is very different than Encore's version of the snore data from a System One machine.)The snoring data is presented quite differently on the two platforms.

Snoring on the S9 AutoSet
The S9 AutoSet presents the snoring data as a continuous graph with respect to time. The scale seems to be a 0 (no scoring) to 3 (Loud snoring), but exactly what the scale is measuring, nobody knows.

Snoring on the System One Auto CPAP
The System One Auto CPAP records snoring data in two different ways, although this was not known to users until JediMark released an early version of SleepyHead. In Encore Viewer, the snoring data is all lumped together as tick marks on the Events table and there is a "VSI" number. Although exactly what that number is, I have not been able to determine. (Editorial comment: Given the snore "counts" available in SH, it's clear that VSI is NOT equal to (# of snores)/(time machine was on) *sigh*) In Encore Pro, the snore data is split between the snores that pop up on the Events table and those that pop up as tick marks superimposed on the wave form. In SH, the snores that show up on the wave form are called VSs. The snores that show up only in the Events table are called VS2's.

And like flow limitations, the VS snores are recorded only when the machine is in Auto mode. (Editorial note: This too is a dumb decision on PR's part.) In SH, JediMark has restricted the VSnore index to VSs; unfortunately that means that users of PR machines run in fixed pressure mode see a VSnore index of 0.0 night after nigh regardless of the loudness or persistence of their snoring. JediMark is aware of this problem and I think he means to change it to NA or not report it at all in some future release of the software.

JediMark has also discovered that the System One does record enough snore data for SleepyHead to provide a snore graph as well as the tick marks. The SH snore graph is based on the VS2 data, if I recall correctly. What the vertical scale measures is not known, but in general, the higher the number, the more intense the snoring seems to be. But I have no idea what "level" corresponds to "freight train" snoring and what "level" corresponds to "cat purr snoring".

JediMark does present the VS2 snore data as ticks in the Event table as well as the snore graph that he draws based on that data.


The Auto Algorithms
Finally, when most people are asking "which is better---the S9 AutoSet or the System One Auto?" they really are asking about the auto algorithms the machines use to respond to events during the night.

And it is important to realize that the Auto algorithms of the S9 and System One do differ. But they are both fine machines with auto algorithms that have been thoroughly tested. And both machines can provide top-notch therapy to a patient. But, while the algorithms are not the same, it's impossible to say one is somehow better than the other. It's rather like debating whether Coke or Pepsi tastes better: It all depends on who you ask. And rather like Coke vs. Pepsi, some folks have very, very strong preferences, but for the most part, most people can't really tell enough of a difference to for it to matter.

As for the S9 vs System One APAP choice: It's the same thing---for a handful of people with very sensitive bodies, the differences between how the S9 AutoSet and the System One Auto feel in use matter a great deal, and one of the two machines will feel substantially more comfortable; but which one feels better is largely a matter of how the highly sensitive individual person's body reacts. For the average new PAPer? There's usually not enough of a difference in how the two machines feel for the new PAPer to tell any difference.

Still there are some real differences in the algorithms and for a small minority of patients, the subjective way the two machines feel will make a difference in their comfort while using the machines. So here's the run down on how the two machine's Auto algorithms work so that you can factor that into your choice of machine.

Both machines will respond to snoring, flow limitations, and clusters of OAs and Hs by increasing the pressure. Both machines will attempt to determine whether a given apnea is a clear airway apnea or an obstructive apnea. Both machines will lower the pressure back down after the algorithm is satisfied that your breathing is now stable.

Both machines use proprietary algorithms to determine the patency of the airway when the airflow has dropped to 0 L/min for at least 6 seconds or so. The S9 uses FOT, which is a series of rapid small oscillations in pressures, and the System One uses PP, which is a short "pressure pulse" of a rapid, short lived increase in pressure by about 2cm. In both cases, the machine analyzes what happens to the back pressure when the change in pressure is applied. Most people don't notice either the FOTs or the PPs, but some people are bothered by them. A few people are bothered by them enough to be woken up by them (at least occasionally), although the usual problem is when the machine decides to send some FOTs or PPs out while you are still barely awake, but in the transition to sleep your breathing is just a bit ragged. Some people are more bugged by the FOTs than the PPs since they last longer; others are more bugged by the PPs than the FOTs because they're bigger changes in pressure.

The S9 algorithm tends to respond to events by rapidly increasing pressure and then, once it is happy with the shape of the wave flow, it immediately starts to slowly decrease the pressure back down. And it will keep decreasing the pressure until the machine detects snoring, flow limitations, OAs, or Hs. If more events occur, the machine once again will rapidly increase the pressure. This gives the S9's pressure curve a characteristic "wave" appearance where the fronts of the waves are steep and the back sides of the waves are much more gently sloped.

The System One algorithm is slower to respond to events and is slower to start decreasing the pressure back down once it is happy with your breathing. The System One also uses a "hunt-and-peck" algorithm for determining the optimal pressure: About every ten minutes or so, the System One will increase the pressure by 2cm over something like a four minute period while checking for improvements in the wave flow pattern. If improvements are found, the baseline pressure is reset to the pressure that gave the optimal wave flow. If no improvements are found, the pressure is then dropped back to the baseline setting over the course of a minute or two. And the machine waits for about 5-6 more minutes before starting the new hunt-and-peck cycle. To decrease the pressure, the System One does a reverse "hunt-and-peck": It temporarily decreases the pressure slightly looking for any deterioration in the shape of the wave flow. If it sees any deterioration, no matter how minor, it bumps the pressure back up to the current setting. But if no deterioration is seen, then the machine continues to lower the pressure at a rate of about 0.5 cm per minute until either the min pressure setting is reached OR deterioration in the wave form is detected. When deterioration is detected, the machine bumps the pressure back up by about 0.5 cm and sets this as the new "baseline" pressure for future "hunt-and-peck" test pressure increases. It's the "hunt-and-peck" algorithm that Respironics uses that gives the pressure curve for a PR System One the characteristic saw tooth appearance.

The net result is that both the ResMed and PR Auto algorithms allow the machine to gracefully respond to a need for a modest increase in pressure and hence improve patient comfort by reducing the overall pressure needed to splint the airway open. Both the S9 and the System One have some problems providing high quality therapy if the minimum pressure setting is way, way below what the person needs. (Hence running the machine wide open with a pressure range of 4--20cm usually does not improve patient comfort.)

But each has its own strengths and weaknesses in terms of therapy:

The S9 can respond very quickly to a nasty cluster of events (in an effort to "bust the cluster up" as it's often put around here). And that quick response to events is a real strength of the S9 algorithm. But it can be very slow to lower the pressure back down. And if the min pressure is set far too low, it can lower the pressure back down to a pressure level that is clearly not high enough, which can then trigger another cluster of events. The fact that the S9 increases pressure only in response to snoring, flow limitations, OAs, and Hs also means that it always waits until something happens to increase the pressure and it always tries to lower the pressure all the way back down the minimum pressure setting.

The System One is much slower to respond to clusters of events. Judging from the pressure curves I've seen it appears that the System One will raise the pressure in 1-2 cm increments once a minute in response to snoring, flow limitations, OAs, and Hs. And then it waits to see if things clear up before it increases the pressure again by a 1--2 cm increase. So that can make it less effective at "busting up" clusters of events. But the System One is less likely to lower the pressure too much after the events are over. And theoretically that "hunt-and-peck" algorithm proactively raises the pressure before the flow wave deteriorates to the point of where snoring, flow limitations, OAs, and Hs can take place. In other words, the "hunt-and-peck" algorithm is supposed to help the machine figure out the appropriate pressure level even in the absence of event clusters.


As for comfort? Again there are strengths and weaknesses of both algorithms:

The S9's rapid pressure increases disturb some folks and wakes them up. Those rapid pressure increases can also trigger leaks. But except for when the machine is actively increasing the pressure in response to clear events (including snores and flow limitations as well as OAs and Hs), the machine is running at a stable or slowly decreasing pressure. And if the min pressure is pretty much set to what you need for at least 50%-60% of the night, you'll have nice long periods where the pressure is not changing at all.

The System One's pressure increases are not dramatically fast. And that means they are less likely to wake you up. And they're less likely to trigger a leak. But that hunt-and-peck algorithm is constantly kicking in. And so every 10 minutes or so there is a pressure increase. And that's enough to bother some people. But that hunt-and-peck algorithm is also going to help keep the machine from decreasing the pressure below a therapeutic level when the min pressure setting is set too low: Once the pressure is suboptimal, the subtle differences in the wave flow combined with the hunt-and-peck algorithm will prevent the machine from further decreasing the pressure much of the time.

Overall, there is some evidence that the System One's algorithm provides less overall variation in pressure and a quicker return to the baseline pressure after a series of "events" and attempts to locate a meaningful baseline pressure through the hunt-and-peck algorithm. The S9's algorithm provides a quicker response to clusters of events, a gentler decrease in pressure going back down to baseline, and a stronger effort to use the min pressure setting as the target baseline pressure.

Finally, Robert McCoy and Ryan Diesem have written a scholarly paper that discusses the Resmed and Respironics auto algorithms, along with auto algorithms from several other manufacturers. The paper is a bit dated: The machines being looked at are the Resmed S8 and the Repironics M-Series. This generation of machine was not capable of distinguishing between CAs and OAs. But the two companies overall choices in the design of their auto algorithm have not changed and so the stuff in the paper about how and when pressure is increased and decreased pretty much applies to the current S9 AutoSet and the PR System One Auto. The biblographic information for this paper is:

A Bench Comparison of Five Auto-Adjusting Positive Airway Pressure Devices, Response to Apnea, Hypopnea and Flow Limitation, by Robert McCoy BS RRT FAARC, Ryan Diesem BA, Valley Inspired Products Inc. (December 1, 2008)

Here's a link to the paper: http://www.rtmagazine.com/2009/08/auto- ... -pressure/
Last edited by robysue on Sat Jun 07, 2014 8:41 pm, edited 7 times in total.