Introduction
I was first diagnosed with moderate obstructive sleep apnea (AHI=23) on April 4th following a precipitously scheduled split-night sleep study conducted on my last night of a five day admission to my local hospital’s cardiac care unit (CCU) following my first (and only) heart attack. I was titrated to a prescribed pressure of 10 cmh2o during that split-night study.
I was discharged and started on CPAP three days later with a Fisher and Paykel HC608 CPAP with integrated humidifier and integrated heated hose, set to my titrated pressure of 10cmh20. I was also issued a ResMed Activa with a large cushion. However, I visited my sleep clinic’s RT one week later and was switched to a ResMed Swift after I experienced difficulties adjusting to the Activa.
One month later, I switched from the Fisher and Paykel CPAP to a ResMed S8 AutoSet Vantage w/EPR (APAP) with pressures set to the range of 7-14cmh20, no EPR (EPR is NOT available in AutoSet modes in ResMed autos), Humidaire H3i humidifier set to 3.5. I therefore, had nearly three months experience in using the S8 every night before I acquired a Respironics RemStar Auto w/C-flex, which I have been using consistently and every evening since, again, in AFLEX mode, pressures set to 7-14cmh2o, C-flex set to 2, humidifier set to 2. I have therefore, 28 nights of experience with the RemStar and I’d now like to offer my impressions of these two benchmark auto-titrating CPAPs to the members of the CPAPtalk community. Please remember however, that what follows is completely anecdotal, has NO scientific merit and is therefore, absolutely NOT generalizable beyond me and my subjective experiences.
Human Factors
Beginning and becoming adjusted to xPAP treatment, while life-saving, is life-changing as well. Beyond the sensory experiences that arise from the noises, the feeling of sleeping with a mask on (which I believe arouses primal fears of suffocation and confinement), the feeling of dragging the hose around throughout the night, the sound of the exhaust on the masks, etc., there is the feeling of being reminded each and every evening that we have a sickness that needs peri-invasive care, and the concerns about how attractive or hideous this new experience makes us to our spouses/partners/dates or even to ourselves. It’s a REAL challenge that each of us face, and so, I’m thoroughly grateful for ANY thought or effort that a manufacturer puts into the design of it’s equipment that will help to ease the burden of becoming and adjusting to being a new lifelong xPAP patient. In this regard ResMed is the absolute hands down winner.
The S8 Vantage AutoSet has an odd form factor that makes it look a little like a miniature desktop sized canister vacuum cleaner, like our moms had. However, it is cased in bright colors that are various combinations of off-white, deep cobalt, and silver or green or blue accents depending on the model. The overall appearance gives a sort of “hip” presentation and it does not look particularly medical (its TOO funky looking to be medical). It has a bright, clear and easily readable back-lit dot-matrix LCD screen, and the back-light is invaluable when viewing settings in the dark, while also being on a timer to automatically dim itself so as not to disturb you as you try to fall asleep. The buttons are also large, illuminated and easily used. The Humidaire H3i integrates nicely on the front of the S8 and draws its power from the S8. Its reservoir is very easily filled by popping open its lid, with no need to disconnect any hose fittings. The humidifier is easily cleaned and seems to do an adequate job, though many have noticed that it seems to function as a pass through with settings below 4.0. The S8/H3i combo is TINY and well suited for traveling. The S8 (not H3i) operates directly off of 12 volts and has a switching power supply to adjust automatically to mains voltage throughout the world. It comes with a great, blue nylon fitted travel case the size and shape of a modern laptop briefcase. It’s an IDEAL travel machine.
The VERY BEST part of the human factors design of the S8 Elite and Vantage however, is the user’s ability to query and view efficacy data including 95% pressure, mask leakage, AHI, AI, and HI as well as usage/compliance data on a nightly, weekly, monthly, six-monthly and yearly basis DIRECTLY on the S8’s LCD screen without the need for any card-readers, software, computers or downloading. The user can, with a few simple keystrokes view this basic efficacy data instantaneously on his/her S8’s LCD screen. Having said this however, the more complete dataset reported by using ResMed’s AutoScan v5.7 software, if one chooses to purchase the odd form-factor card-reader and software, is MUCH more limited and less useful than the equivalent software for use with Respironics machines.
In contrast, the RemStar Auto W/C-flex, in terms of human factors design, is an ABOMINATION!!!! Its design is SO primitively bad that it reflects poorly on the American state-of-the-art in industrial design. It looks like some high schooler’s science fair project. Actually, it looks EXACTLY like a home aquarium air pump, on steroids. It’s an ugly shade of black. It has tiny buttons that aren’t well labeled and whose functions are NOT intuitive. The humidifier integrates in an odd way, and setting it is even odder. In order to refill the reservoir, you have to struggle with pulling off the air hose and then replacing that fitting, daily. Its LCD screen is tiny, is not a dot-matrix display, is NOT backlit whatsoever, but that’s OK because it doesn’t really display any useful information. It’ll sit there telling you the number of therapy hours that it has logged when its off, and it’ll tell you the pressure that its blowing at in 0.5cmh2o increments when its on, (but ya can’t read it in the dark, when its on).
In order to get useful data out of it, the user has to acquire the Respironics software EncorePro as well as a compatible smart-card reader, But, having done so, the user will be acquainted with a VASTLY more useful suite of data and information than is available from ResMed either in its LCD screen or via its software. But, NO DATA is available from RemStar Autos without software, though I’m told that the new M series Auto and Pro will report 7 and 30 day average AHI and leakage on its LCD screen.
The RemStar Auto is much large and clunkier than the ResMed S8 and therefore, is much more poorly suited to travel than is the ResMed S8, in my opinion.
Clinical Experience (Results)
Here comes the meat of the matter. I’d like to offer my impression of the experiences that I had with the two, and some speculations of why I experienced those differences. Again, these impressions are borne of three months experience with the ResMed S8 AutoSet Vantage w/EPR and 28 days with the RemStar Auto w/C-Flex.
Simply put, I sleep MUCH better with the RemStar Auto w/C-flex. Though until very recently, I was NOT successful in sleeping through the night with either machine, I nonetheless had fewer and shorter awakenings with the RemStar Auto w/ C-flex than I did with the ResMed S8 AutoSet Vantage w/EPR. I also felt more rested and refreshed upon awakening after therapy with the RemStar than with the S8, and I experienced my first series of dreams that I could remember in a long time when using the RemStar.
For the last 11 days, I have been taking alprazolam (Xanax™) 0.5 mg at hour of sleep, and have consistently slept through the night without awakenings. I never attempted this with the S8 so I don’t know whether it would have worked as well with the S8 or not. But I did try taking Ambien CR™ 12.5 mg at hour of sleep with the S8 and found that it did NOT work to produce any desirable effect for me.
In terms of numbers, my average AHI during my time with the S8 was 3.22, and it operated at an average 95% pressure of 8.68. In contrast, my average AHI with the RemStar Auto was 2.0 (a 38% reduction from that achieved with the S8 ), and it operated at an average pressure of 8.0, and an average 90% pressure of 9.4.
Discussion
Here’s how I understand the dramatic differences in the clinical experience I had with these two well tested, well used and well respected auto-titrating CPAP flow generators/humidifier combinations. I generally found that the RemStar offers a “kinder and gentler” experience than does the ResMed S8. When using the S8, I was often aware of awakening on several occasions during the night with my first conscious thought being aware of the sensation of torrents of high-pressure air blowing through my nose. These arousals and awakenings were often unsettling enough that I’d fully awaken and then be unable to get back to sleep. So, my sleep architecture was certainly fragmented, and I was awfully tired. This has not happened with the RemStar.
Now, I’m not trying to suggest that the ResMed operated at higher pressures consistently. To the contrary, as I reported earlier, my average 95% pressure with the S8 was considerably (8%) lower than the average 90% pressure with the RemStar. However, I do believe that the difference in clinical experiences that I had is directly attributable to algorithmic differences between the two.
As is demonstrated in the Eiken and McCoy article http://www.sleepreviewmag.com/pdf/AA_Report.pdf , the ResMed S8 demonstrates a much sharper attack of a scored event with a much faster rise time of its treatment pressure
than does the Respironics Remstar Auto
Additionally, the Resmed demonstrates a much slower decay of its increased treatment pressure response and so, it is blowing at higher pressures longer than the RemStar which settles back to its baseline pressure in about half the time that it takes the S8 to settle back to baseline. It is my belief that the combination of sudden attack time and slow decay lead to much more frequent cortical arousals for me with the ResMed, and that the RemStar, with its more temperate response algorithm, provides me as, or more effective treatment with far fewer arousals resulting in a better and more restful night’s sleep.
I did so want to like the ResMed better because of the almost monolithic allegiance to Respironics demonstrated on this forum (and when it comes to human factors, there’s no question but that I do like ResMed FAR better), but I’ve reported my honest impressions.
Remember, these are ONLY MY IMPRESSIONS, so don’t waste my time with flamethrowers. And, these are only MY impressions and they mean absolutely nothing for anyone else.
Hope this helps someone.
Chuck
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, activa, hose, fisher and paykel, C-FLEX, swift, Awakening, CPAP, AHI, Power, auto, Travel
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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, activa, hose, fisher and paykel, C-FLEX, swift, Awakening, CPAP, AHI, Power, auto, Travel
