itchysmom wrote:Snoredog wrote:rested gal wrote:j.a.taylor, I've used both manufacturers' autopaps:
Respironics REMstar Auto with C-flex
ResMed's S8 Vantage with EPR
I got good treatment from both.
Two reasons I personally prefer using the Respironics machine:
1. C-flex (Respironics' exhalation relief feature) can be used in Auto mode as well as in cpap mode.
ResMed's EPR cannot be used in auto mode. EPR can be turned on only in cpap mode.
2. I like the Encore Pro software much better than the Autoscan software.
I'd thank the RT for "letting" me try the Vantage -- then I'd plunk it back on her desk and tell her I wanted to try the brand I had requested in the first place. Respironics REMstar M series Auto with A-flex. Then you could really decide which machine you wanted to continue using.
and when EPR is enabled in CPAP mode, it disables it during certain SDB events, so you might as well save some money and just get a straight CPAP.
I like the reference to the "more expensive" machine like it is high end or something, we all know why it is "more expensive", you used to be able to buy that machine for about 40% less.
Wonder why it is that Vantage Users always end up disabling EPR?
If you subtract the Resmed employees on break here, and search elsewhere you don't see many praises for EPR at all.
EPR was obviously more an after thought by Resmed only to address the competition from Respironics who was eating their lunch with their patented CFlex, BiFlex and now AFlex.
It is obvious from these recommendations they are for Resmed no matter if the machine is a door stop or not.
All I can say is try them both, even better try AFlex and compare, I doubt many would still select the Vantage over AFlex especially if the cost is out of your pocket with its inflated price.
In AutoSet mode the S8 responds exactly as the older S7 Spirit, can be a very agressive machine with its response especially if you snore or if you experience any CA's or onset CA's it can go nuts.
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I have to disagree with this.
When I first started therapy my first DME provided me with a Respironics straight CPAP with C-Flex set at my prescribed pressure of 12.
It was easily the most miserable week of my life. I slept no more than 5 hours that entire week.
After getting much appreciated advice, I took that machine back and "fired" that DME after getting referred to another DME through the sleep lab.
When I called the new RT at the new DME I was VERY specific about what I wanted and I went so far as to have my doctor write me a specific prescription for the Respironics Auto with A-Flex, including specific settings.
When I got there at the appointed time, John the RT had the Respironics machine all set up and ready for me, all he had to do was fit my mask and go over use instructions.
Then we started talking and he was wondering why my doctor had written such a specific prescription. So I told him about this message board and all of the great advice I had been given here.
He is also a CPAP user and understands what it is like to be a patient. He gave me lots of information on both companies and on both machines. He told me that he preferred the ResMed and WHY he preferred it. He doesn't have a contract with ResMed...he also sells Respironics and F&P machines and masks. He just personally prefers the ResMed machines.
So, I told him after he gave me all of the information that I would like to try the ResMed with the understanding that if it wasn't working for me I could bring it back and swap it for the Respironics. Deal.
Well, I have been using the ResMed S8Vantage for over a month now and I can tell you that it is an AWESOME machine. I love it. It is quiet, it is easy to use, I love getting my data easily every morning when I wake up AND the thing I was most concerned with giving up was the A-Flex because the Resmed doesn't have that.
But, what I have found is that I don't miss it AT ALL. I will wake up in the morning and think that the machine isn't even on! I have NO aerophagia, which I was having a terrible problem with on the Remstar C-Flex. I'm not using a ResMed mask, I have an F&P Opus nasal pillow, which the DME recommended OVER the Resmed brand because he thought it worked better overall.
So, I think it is highly personal. Also, I don't think for my DME money is the issue. There is only one ICD9 code for CPAP. It doesn't matter how much the machine costs because the insurance will only pay a certain amount for a cpap machine guided by the ICD9 so it is actually the DME that loses money by supplying you with a more expensive machine. My $20/month copayment is the same as it would have been even for the bottom of the line CPAP machine.
I would say try it for several weeks. See if it works for you. If it does and you are happy with it, keep it. If it doesn't, take it back and request the Respironics machine. But if you decide not to keep it I would make sure you return it by day 29.
Good Luck!!
Great testimonial but you miss the whole point. You have been on therapy now what 1 month? 2 months? Not long from my reading of your posts,
So you had that CFlex machine for 1 week
then it was set up by someone else, most likely the typical DME we see here that was flipping burgers the week before. We all know how machines come setup from the DME you are not telling us anything new.
From reading your past posts, I'd be willing to bet you had no idea how that Cflex machine was set up much less how it functioned. I've used these features for years and owned both brands and others during that period.
I've always set them up myself not relying on someone else to do it for me. If your DME is a Resmed dealer they will make damn sure you can't tolerate CFlex. It wouldn't surprise me if Cflex was disabled during that week you tried it, just because it said Cflex on the top doesn't mean it was working or setup for you correctly, then I don't think you have the experience with it to know the difference (with all due respect).
But you can count them up from reading past posts and I've read a lot of them, from that reading there are more people that go from the S8 to a Cflex machine than you see going the other way around, and I suspect that will only continue at a greater pace now since the introduction of AFlex machine because it is even better than it was before.
In fact, when CFlex first came out, Resmed went out of its way to spent thousands (if not millions) on hap-hazard studies in an attempt to disprove Cflex wasn't as effective as CPAP. Some of the senior members here remember that Mom & Pop 3-bed Vancouver study. Well guess what, time has proven that study to be all Resmed smoke and mirrors.
But the S8 in Auto mode is no different than other Autopaps on the market that don't offer exhale relief such as the 420E or Devilbiss, in fact my experience with those machines is their algorithms are much more advanced. Granted the A-10 algorithm was good when it first came out as their wasn't much in the way of autopap competition at that time to compare it to.
But those days have since long gone, you can build a new box to wrap it in which is what they did going from the S7 Spirit to the S8 Vantage, but inside the function is identically the same as the first autoset that came out. In fact if you ask some of the old timers they prefer that older machine to even the S7 model. The only thing improved or added since was the adding of EPR then that feature was only added to the CPAP "mode". But to understand that, you have to know the history of how they even came to that.
So if you are using it in the AutoSet mode, your S8 is the same as the old S7 or even the older S6 models it replaced.
But if you want to get down to the nuts and bolts of EPR, all you have to do is look at how it functions, there is a reason they automatically disable that feature during periods of apnea events. That feature functions bss aackwards of how it should function to maintain same effective therapy of CPAP (where's that vancouver study).
By comparison sake, if you were on say a auto Bilevel (Bipap Auto) machine and an apnea appeared; a Bilevel machines proper response to that apnea seen would be to increase EPAP pressure to eliminate the event. Proper response by the bilevel in the presence of a flow limitation or hypopnea would be to maintain and/or increase inhale or IPAP pressure. Now if you don't manipulate pressure on inhale or exhale you have a single constant pressure of CPAP.
Now, if EPR drops EPAP pressure based upon the setting used, the higher the setting used, the more it drops EPAP pressure, complete opposite of what a auto bilevel machine would want to do in the presence of events. Keep in mind now you are using a machine with the minimum pressure needed to keep all events at bay.
If you want to preemptively address and hold events at bay you wouldn't want to drop EPAP pressure any as that is what actually maintains the baseline support pressure. We've all been to the arcades with our kids where they puppet pops up from under the table and you take the club and whack it as they pop up, if you are good enough to keep those at bay your score will be much higher.
Now most people can tolerate higher IPAP pressure than they can EPAP pressure. That is why people that have difficulty with tolerating CPAP pressure or aerophagia end up on a Bipap, with careful manipulation of pressures you can offer relief while still maintaining effective therapy. By alternating pressures from inhale to exhale, you can sometimes end up with a lower pressure producing a similar result. When you may have needed 10 cm pressure to keep your SDB events at bay, you may be able to get by with 8 cm on exhale with a Bipap.
Baseline splint pressure (or pressure that holds your airway patent) with EPR enabled is in essence now the IPAP pressure, it drops EPAP pressure on exhale. Or another way to look at it is EPR drops the baseline splint pressure with every breath you take on exhale, the lowest of that drop on exhale is the minimum support pressure. Pressure never actually drops to zero with any of these machines, even with EPR using the examples above of 10, lowest splint pressure seen (assuming there are no leaks) is 7.0 cm if using EPR=3.
So if you wanted to keep Flow Limitations at bay and prevent it from becoming more severe you would hold IPAP pressure constant, but if those events went beyond the pressure's ability to eliminate them, EPAP pressure would have to rise (or in this case be disabled) to prevent the event and that is what EPR does and why it disables it during apnea events.
So the next question becomes
if the EPR feature didn't drop EPAP on exhale, would the event that triggered the disabling of EPR in the first place even be present IF the EPR were not used? Because it is the bottom or baseline pressure that keeps your apnea at bay.
Now you have a S8 that records AHI events to the LCD. You are in EPR mode, let's say 10 cm pressure was found by the lab to keep all your apnea events at bay. At 9cm pressure there may have been Hi, at 7cm pressure apnea was seen.
So now armed with your PSG results you be-bop down to your local Resmed dealer and they set you up with that EPR at 10 cm pressure. You say oh this is terrible and increase EPR to 3. Now on Inhale you are at 10 cm and on exhale you are at 7 cm. What will happen on the LCD display? Most likely the AHI will be much higher than what the lab had seen because you were at 10 cm not 7 cm. So from day one you have received a machine with less-than prescribed therapy pressure.
It is probably why most that own that machine don't end up using that feature for very long. To use it properly and maintain similar AHI as was obtained in the lab with CPAP you would need to increase the pressure by the EPR setting used. If you want 3 cms of relief, you would have to increase your overall pressure by 3cm to maintain the same AHI. Most users cannot tolerate that, they are looking for exhale relief not an increase to pressure.
The bottom line is you don't really get any relief from EPR when you consider the efficacy of it. I would love to see that Vancouver study done over with EPR and CFlex head to t head. Cflex is totally different, reason it is patented reason Resmed lost their patent challenge years ago. Relief offered by Cflex is unique it does it so it can maintain pressure support throughout the breathing cycle.
If Cflex wasn't such a big deal Resmed wouldn't have expended so much effort to disprove it. First Resmed attempts to disprove Cflex therapy not as effective in their Vancouver study, but time has now proven that study bogus, and there have been subsequent studies proving otherwise, next it files a patent lawsuit to have it invalidated in court (and loses), then it does a complete about face from those failed attempts and comes out with its own feature in EPR.
Sorry, you are not going to convince me EPR is superior, if you don't know any better or simply naive you might swallow that story, but not here. If they could have, and there wasn't a patent protecting it, they would have implemented EPR the same as Cflex because it works when set up correctly.
