My Dreamstation replacement arrived

Sleep2Dream wrote: ↑

Mon Dec 20, 2021 7:44 pm

I am curious as to why people think ResMed's algorithm is superior to Philips.

Based on the reports of the vast majority of people who've tried both Resmed and Respironics, it just *works* better for them, and they report feeling better, with lower average pressures. If you look at the pressure curves from a Resmed Autoset vs Respironics Auto, you'll see that the Resmed responds quicker than the Respironics, and tends to head off apneas sooner.

Here's a comparison of the respective algorithms, (which are the same in the latest version of the software): https://www.youtube.com/watch?v=lzCCgNLya_g

Sleep2Dream wrote: ↑

Mon Dec 20, 2021 7:44 pm

Is it just because it makes us look better?

If you mean "I don't look as tired and run down" yes, that too. If you mean "because the AHI is lower" then well, yes, but the AHI is lower because the machine prevents more apneas.

Sleep2Dream wrote: ↑

Mon Dec 20, 2021 7:44 pm

I know I really like seeing an AHI of under 1 as opposed to an AHI of under 5. But it does make me wonder how much is just a numbers game.

between 5 and 1.5 is *significant*, but then you start a game of diminishing returns, I can't really feel any difference if my AHI is 0.5 or 1, but if it's 2, I feel worse the next day.

Sleep2Dream wrote: ↑

Mon Dec 20, 2021 7:44 pm

Why do people assume that respiratory therapists, or whatever, they're called, are wrong when they call "normal" anything under 5?

because those numbers are established by people who don't care about you, they just don't want to pay anything more (insurance) or they want to get you out of their office (doctors).

Think about it, an AHI of 5 means that, on average, you're getting your sleep disturbed every 12 minutes... do you really think you're going to sleep well if someone sits by your bed and pokes you with a sharp stick every 12 minutes? That's what's "good enough" according to the medical establishment,

Sleep2Dream wrote: ↑

Mon Dec 20, 2021 7:44 pm

And why would my results be so different with the same masks/headgear and two different but both highly regarded machines? (And do I care? I haven't felt any difference in terms of how tired I feel when I wake up in the morning.)

It depends on the machine. If you're talking about an Autoset vs a Repironics Auto, I wouldn't say that that's *two* 'highly regarded' machines. I've long said that Respironics was a solid #2, and with the massive recall of everything they've made in the last 12 years, I think that #2 is more appropriate than even I thought.

Look ma, almost no snark!

Your choice but if you want to use the new DS2....consider trying it with a couple more cm baseline pressure if you are using the auto adjusting mode.....just to see if it brings down your AHI a bit or not. When I used the Respironics I had to use minimum of 10 cm to get AHI between 1 and 2. When I made the switch to ResMed auto adjusting I found that I could get by with 7 cm minimum and still get that AHI between 1 and 2.
You may or may not be like me but it doesn't surprise me that with the same settings you used on the Respironics that your AHI is improved.

The lack of detailed data and Respironics being hard asses and doing the revolving encryption thing to keep us out of the detailed data....that's the one thing I cannot tolerate. When I first started cpap back in 2009 Respironics even sold Encore Pro to patients....now they want to permanently lock us out and even simple things like turning auto on or auto off feature on requires doctor/DME doing it. Totally unacceptable in my book. I cannot recommend their products for that reason.
They have really pissed me off.

Now your situation...I would keep the DS 2 as a back up but not use it unless I had no other choice.
Everyone should always have a back up anyway.

Sleep2Dream wrote: ↑

Mon Dec 20, 2021 3:07 pm

It's a new Dreamstation 2. My old one was the recalled Dreamstation 1. Since the recall, my DME switched me to the ResMed Airset 10 Autosense. I seem to remember people not liking the Dreamstation 2 as much as the original. But since this replacement is all paid off, and I'm only four months into monthly payments on the new machine, I'm wondering if I should return the ResMed and keep the new Dreamstation. I like the ResMed fine, except I hate the MyAir app and those stupid smiley faces. On the other hand, no doubt due to differing algorithms, my AHI tends to stay below 1 most of the time with the ResMed (except lately, but that's another story) while my old Dreamstation had me below 5 all the time, but rarely as low as 1. Naturally I like the lower number, lol. So...any thoughts on machine comparisons?

My apologies to OP for that detour earlier, as I wasn't expecting a (mostly humorous) short line comparing the software on two makes of machines to raise so much ire in the community, alas here we are, it is what it is and I'd like to respond to your concern, as a patient who has had active and current experience with both makes.

Resmed algorithm tends to report an overall lower AHI than DS machines. That is just a well known fact when I discuss it in other forums with other CPAP communities worldwide.
However this is NOT necessarily because Resmed machines deliver more effective therapy than others, but rather in "how" resmed monitors apnea events and reports on them, Vs how DS algorithm does the same.

In my experience of using my resmed machine for about four months, I found that my average sleep quality in comparison to when I used my DS, was significantly lower even though ASV machines do not normally require much titration due to the fact that all respiratory parameters are set wide open from Min to Max, so the algorithm can monitor each breath and deliver suitable pressures at any given time.

Also when I compare certain critical parameters like Flow Rates, Tidal Volume, etc on OSCAR between the two machines, I find that my resmed graphs are not nearly as smooth and stable as they are when the same settings are used on a DS machine. Given that the patient (myself) remains unchanged here, one would expect similar results from two different machines with same parameter settings, which is unfortunately not the case for me.

Notice resmed snapshot shows flow, mask pressure and Tidal Volume in a 5 minute window when there is no event. The breaths are uneven and tidal volume not so smooth: Now look at the same non-event 5 minute window on a DS. Breaths are smooth and mask pressure steadily rises and falls while tidal volume is absolutely stable throughout: My suggestion is that if your sleep quality is better on your resmed, then continue to use that machine and keep the DS as a backup.
In my case I am keeping my resmed as a backup and personally I have no skin in the game for either company, so I don't really care which one is better than the other., other than the fact that one gives me a consistently great sleep and the other does not....where my bias lies.

Hope you have a great therapy with the machine that gives you most peace.

The reason that most people get a lower AHI with a ResMed machine is that the machine actually PREVENTS the apnea events from happening in the first place.
It's not because there is a difference in the criteria or definition of events between the machine brands except that one brand uses a 40 to 79% reduction in air flow for a hyponea and the other brand uses 50 to 79% reduction for hyponeas...and I forget which and the difference is so small it's not going to be numerically all that critical.
Both machines use the minimum 10 second duration.

For Obstructive apneas....80 to 100% reduction in air flow that lasts at a minimum 10 seconds...same definition between all brands of cpap/apap machines.

Event criteria for earning a flag....the same no matter what brand...ResMed, Respironics, F&P, Devilbiss,...even the Chinese knock off use the same flag earning criteria.
How they go about preventing stuff from happening....that's why AHI numbers are different even if same settings are used.

All machines use the same criteria for earning a flag once something happens.
The ResMed just prevents more of the events from ever happening in the first place and that's why the AHI is often less.
The algorithm is simply more effective or "doing a better job" if someone wants to look at it that way.
Now it doesn't mean that someone can't get just as good AHI with a Respironics with some pressure tweaking to compensate for the algorithm difference.

The reason ResMed AHI numbers are often lower is simply because the apnea events didn't happen so often.
Has nothing to do with event criteria/definitions to earn a flag.
They just didn't happen to need to be counted.

Now do some people simply sleep better with the Respironics machines....sure.
There's a huge YMMV sticker on everything cpap related.
But most people who have had a chance to try both brands will end up preferring ResMed....not everyone but most people will but there are always outliers in anything.

Many people tend to think the same way about why Resmed reports less AHI numbers across the board than DS algorithm does.
After all both algorithms MUST use the same criterion that define various apnea events such as hypopnea and obstructive events, and since one machine averages lower on AHI, then that machine MUST be delivering better therapy.
I get that.
But that is in fact not the case here.
For one thing Resmed algorithm does not monitor certain important parameters that DS algo does.
Take Breath Rate(BR) for example. Resmed claims to monitor the "last 90 seconds" of breathing pattern to calculate its own BR.
This means that Resmed algo primarily relies on an "actual breath rate" which in the case of people with pulmonary deficiencies or just various degrees of apnea, could be wildly different throughout one session, to what they "need" their breath rate to be so other parameters such as "Tidal Volume" can be stabilized by the machine. In short just relying on the last 90 seconds worth of breathing, is not a reliable measure of determining breath rate.
Therefore events such as hypopnea can not possibly be determined with a high degree of accuracy by Resmed algo which of course means they are not reported as often as they perhaps should be.

The DS range of BiPaps allow a manual setting for BR and solve that problem, making the machine act more like a Ventilator. Not only that, the DS also allows for Inspiratory time assignment PLUS a separate "Rise Time" in transition between IPAP to EPAP. These parameters are essential in the assignment of a Hypopnea event and thus DS will report a more "accurate" event count and naturally a higher number too.

The DS is also equipped with "vibration" sensors that monitor and register Snore events in not one but two different forms, which also contribute to higher AHI reports.
Resmed does not monitor snoring the same way.

Either case, people with apnea would rather have a great sleep without arousals and discomfort and an "accurate" reporting on their apnea events, than they do otherwise.
In my case, my AHI on Resmed is almost always below 1 and on DS it is almost always between 3 and 5.
BOTH numbers are great and fall within the "normal range", except that the DS provides for a much better sleep for the reasons that I argued in my previous post, except for an AHI that is FIVE times higher on average than Resmed.

GearChange wrote: ↑

Mon Dec 20, 2021 11:43 pm

The DS range of BiPaps allow a manual setting for BR and solve that problem,

Your superficial level of knowledge on the subject is showing.

Hopefully, everybody will know to discount your commentary.

SOME of the Respironics bilevel machines have a manual setting for backup rate, most DO NOT.

And guess what, SOME of the Resmed bilevel machines have a manual setting for backup rate... most DO NOT.

You *continue* to derail this thread with your superficial 'knowledge' about something that is, in fact OFF TOPIC.

The OP had a DS Auto, and got a Resmed AutoSet.

All over your gibbering about the ASV is IRRELEVANT to the OP's issues.

Also, just for funzies: https://www.google.com/search?channel=f ... d+the+cpap

Snores aren't part of any AHI that I have ever seen.
Neither are flow limitations.
The fact that ResMed doesn't confuse people with VS2 and VS snores is a positive and not a negative in my book.
I don't know why Respironics even reports VS2 snores because it doesn't do a damn thing about them except report them.

Besides comparing apples and oranges here....regular auto adjusting machine algorithms (both brands) to ASV algorithms which simply aren't the same. Different machines...different jobs...different way of doing things even if a person stayed in one brand. Irrelevant comparison as to functions available like rise time or whatever.

Last I heard AHI is composed of
apneas (either central or obstructive) plus hyponeas...and averaged out to a per hour number.
Never seen snores increasing anyone's AHI...never, ever.
They do make for ugly looking detailed reports though.

The DS is also equipped with "vibration" sensors that monitor and register Snore events in not one but two different forms, which also contribute to higher AHI reports.
Resmed does not monitor snoring the same way.

I have a Dreamstation but bought a Resmed 10 Autoset For Her because of the recall. I am happily SHOCKED at how much better I feel using the Resmed! From the very first night I have slept like a baby! To me the difference is night and day. I guess there are some who feel better with the Dreamstation, but it is clear that most who have used both like the Resmed way better. If and when I receive a Dreamstation 2, I will keep it as backup, and hope that I never need to use it.

Pugsy wrote: ↑

Tue Dec 21, 2021 12:05 am

Snores aren't part of any AHI that I have ever seen.
Neither are flow limitations.
The fact that ResMed doesn't confuse people with VS2 and VS snores is a positive and not a negative in my book.
I don't know why Respironics even reports VS2 snores because it doesn't do a damn thing about them except report them.

Besides comparing apples and oranges here....regular auto adjusting machine algorithms (both brands) to ASV algorithms which simply aren't the same. Different machines...different jobs...different way of doing things even if a person stayed in one brand. Irrelevant comparison as to functions available like rise time or whatever.

Last I heard AHI is composed of
apneas (either central or obstructive) plus hyponeas...and averaged out to a per hour number.
Never seen snores increasing anyone's AHI...never, ever.
They do make for ugly looking detailed reports though.

The DS is also equipped with "vibration" sensors that monitor and register Snore events in not one but two different forms, which also contribute to higher AHI reports.
Resmed does not monitor snoring the same way.

The most recent, detailed comparison of Auto (not ASV) algorithms that I'm aware of is here this applies to both apap and auto bilevel machines where available. Not, of course, to ASV and the Respironics gimpy clone AutoSV, which is,as you know, a whole 'nother beast entirely.

palerider wrote: ↑

Tue Dec 21, 2021 8:08 am

The most recent, detailed comparison of Auto (not ASV) algorithms that I'm aware of is here this applies to both apap and auto bilevel machines where available.

OMG ....you do realize that my eyes permanently glazed over when I looked at that chart....and geez...someone else calling the AirSense 10 the S10.

Pugsy wrote: ↑

Tue Dec 21, 2021 10:17 am

palerider wrote: ↑

Tue Dec 21, 2021 8:08 am

The most recent, detailed comparison of Auto (not ASV) algorithms that I'm aware of is here this applies to both apap and auto bilevel machines where available.

OMG ....you do realize that my eyes permanently glazed over when I looked at that chart....and geez...someone else calling the AirSense 10 the S10.

I hope it's not *PERMANENT* permanent Kudos to Robysue for digging that out.

palerider wrote: ↑

Mon Dec 20, 2021 8:32 pm

Here's a comparison of the respective algorithms, (which are the same in the latest version of the software): https://www.youtube.com/watch?v=lzCCgNLya_g

Considering the OPs second question was "I am curious as to why people think ResMed's algorithm is superior to Philips." ; I believe my question is still on topic.

The youtube video that you linked to is very nice, but seems to lack any citation or credit as to what University or medical college performed this side-by-side comparison. Yes, I see that it was posted by cpapsupplyusa,com, but did they conduct the test and produce the video?

(BTW, as Pugsey has suggested, citations are courteous and useful (to understand origins)

We could tell you, but not only is there no chance of you comprehending it,
but we might still have to take extreme measures to maintain security.
I cannot say what those measures would be, but you would not see it coming.

chunkyfrog wrote: ↑

Tue Dec 21, 2021 10:53 pm

We could tell you, but not only is there no chance of you comprehending it,
but we might still have to take extreme measures to maintain security.
I cannot say what those measures would be, but you would not see it coming.

HA … very funny…”we could tell you but then we’d have to kill you”

Seriously, what are the origins of that video?

(Still on the topic of comparison of machines)

Question for the OP (or anyone else): I just got a FedEx delivery notification. Can you confirm where your unit was shipped from? FedEx doesn't provide any real shipper information. I'm just curious if my replacement has finally shipped--still waiting on my DME to get units for replacement with a ResMed.