Auto Shootout: ResMed Vantage v. Respironics M Series Auto

One of the factors that made Autos so attractive and still does, is the amount of data they record and make available no matter what mode you run them in

Not many straight Cpaps record the detail that Autos do and I regard the ability to get at detailed data to be a critical factor in my ongoing ease of mind and my ability to better understand my own therapy.

I believe I have proven how easy it is to be getting the wrong therapy results because the machine being used didn't record any nightly data & I had it on the wrong settings for me thus I was getting by on wishful thinking (which just wasn't working over time).

If there was no difference in the data people could get from Autos vs Cpaps, I might lean more to the argument that only the insightful experimenters might really get value from an Auto.


DSM

ZPAP wrote:Thanks to all who replied. I think I am going to get the Remstar Auto Pro with the software, especially after the advice here.

ZPAP, I think you've made a wise decision. Only thing is, be careful not to use the word "Pro" when ordering the Respironics REMstar Auto. Respironics uses "Pro" only in the names of their straight cpaps and bipaps. Not in the name of their autopaps. All these names get confusing, I know!

ZPAP wrote:I like the idea of having the option to use CPAP mode or auto mode, so if I were to experience many apneas or hypopneas in auto mode I could switch to CPAP mode.

Exactly. For that matter, you could very likely tweak the pressure settings and continue on in auto mode. Software will let you see what's going on pretty well.

ZPAP wrote:Is there any literature on the inability of auto machines to react quickly enough as Guest suggests?

Not really...not that I know of. There have been a few "studies" using an artificial breathing machine and various autopaps, supposedly testing their responses when presented with artificially generated sleep disordered breathing patterns. But those kinds of tests cannot demonstrate how autopaps in general, or specific brands of autopaps, would actually perform with a living breathing person giving the feedback autopaps use to "decide" what to do next.

[quote="ZPAP"]Thanks to all who replied. I think I am going to get the Remstar Auto Pro with the software, especially after the advice here.

As far as APAP v. CPAP, my pressure is only 9cm based on the titration done this week, but I think my current CPAP machine is set higher (of course, I can't check it because no one will trust a simple PATIENT to check his own purchased equipment that merely blows air in his face [but don't get me started on THAT issue!]). I tolerate CPAP pretty well, but before I got this new mask I would often pull the mask off in the middle of the night w/o even realizing it, so I thought an auto machine might be better.

I like the idea of having the option to use CPAP mode or auto mode, so if I were to experience many apneas or hypopneas in auto mode I could switch to CPAP mode.

Is there any literature on the inability of auto machines to react quickly enough as Guest suggests?

Michael

A good discussion. Since my 90% pressure is very close to Michael's,
I thought I might chime in. Also, I have never used a ResMed machine so I cannot comment on them.

My pressure is at 9.0 cm/H2O most of the time. However, I do experience a couple of times a week, a higher number of "events" being recorded by the software. On these nights, my pressure will increase to 11.0 for a short time, then return to 9.0 cm?H2O cm/H2O.

I have had two sleep studies, one 2000 and one in 2006. The titrations were 10 cm/H2O and 8.0 cm/H2O. Therefore, I might say:

Reason number 1 for using a RemStar Auto is the Encore Pro software.
Reason number 2 for using a RemStar Auto is the C-Flex in Auto mode.
Reason number 3 for using a RemStar Auto is the correct pressure at the correct time.
No more gas...priceless..

I am still a newbie, so I hope these questions don't sound too stupid for words.

Suppose while using APAP an apnea occurs that the machine cannot anticipate because the pressure cannot increase quickly enough. Say, for example the apnea needed 15 cms but only 13 cms were accomplished by the machine. Will the lower pressure eventually open the airway? Will it take a long time to do so? Will it open the airway quicker than not having the therapy at all? How dangerous is the apnea in that case?

I understand that some small number of apneas occur for most people. Are those numbers more dangerous for those of us who would normally have more without having the therapy?

I am eager to learn all I can, so if someone feels these questions are too simple, please forgive my lack of understanding.

Catnapper

oldgearhead wrote:A good discussion. Since my 90% pressure is very close to Michael's,
I thought I might chime in. Also, I have never used a ResMed machine so I cannot comment on them.

My pressure is at 9.0 cm/H2O most of the time. However, I do experience a couple of times a week, a higher number of "events" being recorded by the software. On these nights, my pressure will increase to 11.0 for a short time, then return to 9.0 cm?H2O cm/H2O.

I have had two sleep studies, one 2000 and one in 2006. The titrations were 10 cm/H2O and 8.0 cm/H2O. Therefore, I might say:

Reason number 1 for using a RemStar Auto is the Encore Pro software.
Reason number 2 for using a RemStar Auto is the C-Flex in Auto mode.
Reason number 3 for using a RemStar Auto is the correct pressure at the correct time.
No more gas...priceless..

Wow, your stats are almost identical to mine (we even had studies at the same time!) Thanks for the advice.

Michael

Catnapper wrote:I am still a newbie, so I hope these questions don't sound too stupid for words.

Suppose while using APAP an apnea occurs that the machine cannot anticipate because the pressure cannot increase quickly enough. Say, for example the apnea needed 15 cms but only 13 cms were accomplished by the machine. Will the lower pressure eventually open the airway? Will it take a long time to do so? Will it open the airway quicker than not having the therapy at all? How dangerous is the apnea in that case?

I understand that some small number of apneas occur for most people. Are those numbers more dangerous for those of us who would normally have more without having the therapy?

I am eager to learn all I can, so if someone feels these questions are too simple, please forgive my lack of understanding.

Catnapper

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Catnapper,

Think in terms of time passing (in seconds) - Using your example, machine is at 13 cms an apnea occurs that would not have occurred had the machine been at 15 cms (this is more likely an exception but is possible).

So the issue we already face is that the machine did not adequately anticipate this apnea. Most times it will have (again this type of situation is an exception rather than common).

So what does the machine do at this instant ?. You have an apnea. Well the machine is going to go through a slow cycle of increasing the pressure - usually 1 cms at a step in 30 or so seconds, sample the airflow & then decide if it needs to repeat the cycle. Depending on the brand, and what the current cms is already, it may repeat this pattern 3 times.

But that apnea will most likely be gone because you were aroused & moved due to the time it was taking the machine to adjust the pressure BUT the machine will be primed & ready for any repeat and apneas tend to come in patterns, they are not normally random events. The machine will normally wind the cms back down over time if there are no repeats.

Again, the point is that apneas tend to show up as part of a particular breathing pattern (usually preceded by snores or air vibration or flow limitations). The Auto senses these disturbances plus some brands keep memories of similar patterns in your breathing, and try to adjust the pressure in anticipation of an apnea.

So to emphasize, autos don't zap random apneas, they preempt patterns that include them.

DSM

Thanks, DSM. So the bad part is that the apnea will wake me up. Is that it? I know that can be uncomfortable but lots of times I never knew it was happening even though it messed up my sleep.
I still am wondering if those of us who have OSA are more likely to have a worse apnea event than others who don't have OSA. Sounds like it takes the auto a long time to respond to a random event, but if it is the beginning of a series, it would recognize the need to increase the pressure for the rest of them and I would be safe again with the auto on the alert.
I must still be missing something. If I still have fewer than 5 events, it sounds like the auto is taking care of the situation, with the exception that I could wake up to an apnea. So the 5 is per hour, right? I guess I wouldn't want to wake up even every hour. How likely is the random apnea that wouldn't be caught by the auto?
Lots to understand about the mystery of sleep.
Thanks again for your patience. Your explanation was clear. I just have too many questions at this stage of the game.
Catnapper

DSM wrote:Again, the point is that apneas tend to show up as part of a particular breathing pattern (usually preceded by snores or air vibration or flow limitations). The Auto senses these disturbances plus some brands keep memories of similar patterns in your breathing, and try to adjust the pressure in anticipation of an apnea.

So to emphasize, autos don't zap random apneas, they preempt patterns that include them.

Just a few random thoughts to build on that, and hopefully add small bits of clarity. The part about preventative pressure serving as the APAP's primary treatment method is true in my opinion. And that is because when an apnea does manage to get through that preemptively heightened pressure the APAP will address that renegade apnea with a slow pressure increase (e.g. around 1 cm per minute for Respiroinics). If the APAP is lucky enough to be within preemptive "striking range" some of those apneas will resolve a little sooner rather than much later. My understanding is that there is no one-to-one correlation between individual apnea events and sleep disturbances. Not all apneas, and especially not all short-duration apneas will disturb your sleep. That means that your sleep may be disturbed by a few, some, many, or none of those "renegade" apneas that managed to get through.

"Renegade" or "random" apneas that happened to get through those preemptive pressures will also be scored on the APAP's overnight dataset. So if what Doug describes happens to be problematic for you, then you will observe an unacceptable residual AI when looking at your overnight data. Bear in mind there are plenty of other reasons that can also cause a residual AI to be too high. Fortunately, anybody with a good AI score does not have to worry about those "random" or "renegade" apneas. Your residual AI bears out what DSM is describing very nicely. No second-doubt guesswork is even necessary if you are lucky enough to have a nice, low residual AHI on your APAP.

I agree that straight CPAP is an excellent (who knows, perhaps even the best) treatment platform. I'm still trying to figure out exactly why I sleep and feel a little better on APAP than CPAP. My best guess is that APAP's lower mean pressure probably accounts for less uncomfortable aerophagia (which I can get at 10 cm) and perhaps even a little less machine and mask-related noise. Maybe it's the placebo effect. .

If you have an AHI lower than 5 you are doing well (mine last night was 2.8 with the AI showing as 2.6 and the AI showing as 0.2) I am very happy with such a result (very).

AI is the Apnea Index (blockage) and my last nights stats chart show only one occuring within 30 mins of going to bed & only lasting 10 secs. My machine is in CPAP mode so what this tells me is that particular apnea needed more than 13 cms to prevent it but it was very shortlived and is in the overall scheme of things an irrelevant event.

My HI (Hypopnea Index) shows approx 7 occuring during the night, all relatively minor ones, they reflect (assuming the machine data is accurate) me slowing my breathing. None of these hypopneas ended up as apneas so the general indication is that 13 cms is treating me well.

Re random apneas. They are really rare. Have a think about how a random apnea might occur. The most likely scenario is if you change position from being on your side to rolling onto your back. Being on your back, for most people, is increasing the likelihood of an apnea.

If your auto is doing its job it will detect changes in your breathing (vibration, snoring, flow limitations etc: ) and already be increasing the cms in anticipation of an apnea. But if on the rare occasion one happens quickly after rolling onto your back, the machine may be just a bit on the low side (cms) to prevent it and an apnea can follow. That in itself may not be that big a deal as to have rolled over anyway implies you were already aroused.

The ideal situation is that the Auto will always be ready in advance of an apnea because it is always sampling the patterns of your breathing and looking for apnea pre-cursor signs.

When set up well and all things being normal. An auto should always have anticipated an obstructive apnea. If your auto can keep you under 5 AHI then that is not bad.

We can work on the general assumption that centrals or mixed apnea are the rare forms of SA and that for the majority of people an auto will work well.

DSM

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This is a very interesting thread. I just posted what a fantastic positive result I had from my new Respironics M series Auto Cflex etc. I have been strictly a Cpap patient for at least 13+ years now. Tried bipap years ago, but did not like it. My old Cpap, setting was 11. I had been having a problem over the last few years with waking up several times during the night, with what seemed to be a 5hr sleep time, sometimes less, and then not being able to go back to a deep sleep. This type of sleep disturbance, even with my machine set at 11, is unbearable, depression, memory loss, my work suffered etc.

Today, after using this Apap for only 1 night, I feel like a totally different person. I have not felt this good in several years. It has to be this Apap, there is no other explanation. I feel like I felt when I first got my Cpap those many years ago. The Encore Data shows my AHI at 4.2, with only 1 OA. There were Hypopneas, which must be why the AHI is a bit high, and those happened along with the 1 OA, when the pressure dropped to around 5, along with a snoring episode and a mask leak. But as dsm posted as well as restedgal, that if your AHI is 5 or below, that is considered successful. It could be that my old Cpap was not working properly, but I doubt it. I don't think I tolerated the normal Cpap very well. I attributed my not feeling well these last years to depression because of a family death. I now think that the lack of good sleep contributed to this depression and forgetfulness etc. It will be interesting to see how I do going forward, but if I feel this good all the time, then it has to be because of this new Apap and how it responds to my breathing needs throughout the night.

Rested gal, I think I am going to take your advice and reset my min to at least 7 or 8, which is close to 10, which is the 90% # that my Apap used. That way, I won't have any of the Hpopnea's that happened at the lower settings. Last night, it was set at 4-20, hence the hyponeas and the OA, which happened at the lowest setting of the night, 5. I have never like or used the ramp feature, so a higher min setting on this Apap is not going to be a problem.

This is a great forum and I am glad I found it. I wish I had found it a few years ago!

I feel so much better, it's incredible, especially after feeling so bad for such a long period of time.

John D.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, cflex, CPAP, AHI, Ramp, auto, APAP