Resmed S8 II

To me, it looks like Resmed missed the boat, I would have liked them to have provided exhale relief in Auto Mode. The option would have helped their patients, that's what it's about.

To answer DSM's, why AUTO and EPR both, they are two diferent functions, Auto allows you the lowest pressure you need when you need it, EPR makes it easier to exhale against the machine pressure, both needed options in a XPAP.

Personally, for me it doesn't matter, I'll not own a Resmed, partically because of their Corporate decisions, also because Remstars offer exactly what I want in a XPAP, and I like the software better. So unless they shoot themselves in both corporate feet, (they already got one big toe, when they pulled their Encore Pro software, and moved to the "M"agic "M"), I will continue to be a supporter. If they shoot the other foot, I will move to a third brand , even though it has no expire relief, and this point in time I could live without it, but I would miss it.

As far as RG's testing of EPR against Bi-PAP, I've wondered if it was the same, her test seems to confirm, my guess, that there is a difference, Higher quality results usually comes with a higher price tag, as it should. Jim

dsm wrote: The 1st time I tried EPR I also tried comparing it with what I was used to (my Pb330). I felt it wasn't as nice as what I was used to & commented here in cpaptalk.

Exactly my point.

dsm wrote:I did though suspect that we all get used to particular setups & behaviors

Of course.

People on straight cpap experience that, too, when during the course of the night the pressure that felt like "a lot" when they first put the mask on, later feels like "Is the machine still running?"

The point of what I was checking was not to see if getting used to EPR would make it feel comfortable to breathe out against. I wanted to feel, in the first few breaths each time I switched machines, if EPR did, or did not, feel exactly like the exhale pressure relief of a bilevel machine. It did not.

The only way to judge that is in the first few breaths, because a person will get accustomed to the feel of pressure.

dsm wrote:I had previously concluded that the EPR 'rise' seems to push back compared to my PB330 (which is highly tunable)

That "push back" feeling EPR gave you... that resistance against breathing out easily... that's what I experienced also. That, and that alone was what I wanted to know about. I wasn't trying to find out whether I could "get used to it" or be comfortable with using a cpap with EPR, because I knew I could. I already knew I have no problem getting used to any machine I use. Even those without any exhalation pressure relief whatsoever.

dsm wrote:but when I had no choice & just used the S8 in EPR, by the end of the trip I was very comfortable with it & felt it worked great.

No surprise at all. I'd have expected that.

dsm wrote:I guess that what I am saying is that I am now a believer that we can and do get used to particular setups

I've always believed that. No argument there at all.

dsm wrote: & a lot of that is our own preconditioning vs the objective facts.

Well, the particular setup I put my bipap auto into was not at all the settings or mode of operation I normally use with that machine. So I don't think "preconditioning" had anything to do with my comparison.

That might have been a factor in your casual test of how EPR felt vs your PB 330, if you were still using your usual fine-tuned settings with the 330 when you made your comparison. Plus, you knew which machine you were using. I went to some lengths to be sure I was totally unaware of which machine was being used.

Interesting little test, anyway, since I really had expected EPR to feel just like bilevel. Was surprised when it didn't.

dsm wrote:I guess that what I am saying is that I am now a believer that we can and do get used to particular setups & a lot of that is our own preconditioning vs the objective facts.

Which makes me wonder just how much "rampant featuritis" is occuring on user side, with users demanding perceived "features" which have relatively small benefit in the overall picture of SDB treament! How much is that driving up the total-healthcare-system-cost of delivering xPAP therapy?!?

Anyway, back to the S8 II topic..... do you think the "high-resolution flow data (25Hz)" is something new?

Does the existing S8 Reslink module you have do this with your existing S8? Or is a product of the Reslink II module, or perhaps the Reslink II module + an S8 II flow generator?

Cheers,

Bill

In reply to Jim (& also RG),

The issue of exhale relief is very valid when it comes to CPAP and Auto-Cpap.
C-Flex was an innovation & A-Flex a further one.

EPR was a step beyond both these as it allows the machine to run as a limited BiLevel with a highly optimized set of values & no areas for confusion by way of complicated settings (a confusing reality with most other Bipaps & Vpaps etc: ).

EPR *does not need* to be fitted to Auto mode. It serves no general purpose & nobody yet has put forward any logical nor convincing argument to say why EPR must be fitted to Auto CPAP mode.

Auto mode has its own set of problems for cpapers who often will revert to cpap mode after a while (some months) when they find the roaming pressures cause more problems than they fix. I am sure we all agree that Auto mode is great for level setting. Cpap mode is better for consistent therapy. BiLevel mode is a very popular alternative to straight Cpap with Exhale relief.

When we get into the heart of the real benefits of Autos, the best that most people can come up with is that an Auto allows someone to work out their optimal therapy CMS. And that is without doubt a great benefit to any of us *willing* to take therapy into our own hands & not be dumb bunnies relying on inadequate DMEs etc:.

The other historical fact that gets mixed in in a confused way in many discussions on benefits of Autos, is that in 2004 an Auto was really the only affordable machine that allowed a user to collect their nightly data and to analyse it using software on a home PC. Most BiLevels didn't provide this type of data and the few that did (The BiPap Pro 2 fro example) was too expensive.

In 2007, all this has changed. Now straight Cpaps will allow users to gather data. With Autos, users can still do their own level setting but without doubt the most effective therapy is either straight cpap (greatly improved with exhale relief such as A-Flex) or BiLevel mode (now affordable as EPR).

The trend in cpap machines is for the cheaper models over time, to add more of the really beneficial features we are seeing deployed in the Vpap Adapt and Bipap SV class machines.

The hardware is improving. The move to low inertia blowers with high torque brushless motors is having an impact. It allows for quieter operation, something current M series owners understand.

The move to add mask training features will allow the machines to build an internal profile of fixed and non fixed leak data for any brand mask & thus provide far more accurate HI & AI numbers than we get to day from current models. In this area Respironics have done a lot of work in improving Auto-Trak while Resmed have added a mask seal test that anyone can do themselves. In time both companies can be expected to get this aspect to work a lot better than is the case today.

I expect to see machines in the near future that mimic the servo ventilation machines much more while keeping costs down (SV machines are very expensive & still being refined). I would go as far as to say that SV machines will be the 'Autos' of the future in that they will completely displace them, but there is no reason why an upmarket machine can't offer Auto mode and SV mode so the user gets the best of both features. Respironics appear to be moving in this direction with their Bipap SV.

Coming back to EPR (Bilevel) being added to Auto mode. No one has provided any convincing argument that it does anything beneficial to put BiLevel mode (EPR) onto the Auto mode. The only thing it seems to achieve is to satisfy a posters notion of what 'should be' vs what is useful but that helps no one.

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): auto cpap, respironics, resmed, bipap, C-FLEX, CPAP, seal, auto

dsm wrote:Coming back to EPR (Bilevel) being added to Auto mode. No one has provided any convincing argument that it does anything beneficial.

Comfort. Comfort. Comfort. Comfort. Comfort.

Different strokes for different folks.

Some people really do like pressure relief each time they exhale, no matter what pressure they are at.

If they like a more natural feel to breathing out, and it helps them use a machine more comfortably, they are more likely to accept and stick with this kind of therapy. That's a beneficial thing in my mind.

dsm wrote:Cpap mode is better for consistent therapy.

Whoa. Pretty sweeping generalization there. For some people, yes. For others, autopap is better. Same is true of all the types of machines -- some people do better on one type than another.

dsm wrote:When we get into the heart of the real benefits of Autos, the best that most people can come up with is that an Auto allows someone to work out their optimal therapy CMS.

"Best [real benefit] that most people can come up with?" Hardly.

That is certainly a primary use of autopaps. Often the only use in the minds of doctors/DMEs. Few of them are actually using cpap themselves, though.

Surely you've been reading the message board long enough to have noticed that people who have more apneas and hypopneas when sleeping on their back, and fewer or none when on their sides, just might benefit from a machine that can vary the pressure... using higher pressures only when needed.

There are also the people who have most of their events when in REM, few in other stages of sleep. They don't need a single "worst case scenario" pressure all night either.

Some people do sleep better with one steady pressure. No doubt about it. Others sleep better when lower pressures are used most of the time and higher pressures only when necessary.

If autopap suits a person at all, there are at least two benefits to using lower pressures most of the time:

1. Less chance of a mask springing leaks.
2. Less chance of aerophagia (bloating.)

Since the mask is the real key (in my opinion) to whether most people drop out of therapy, anything that cuts down on the chance of mask leaks is a major, major benefit.

dsm wrote:but without doubt the most effective therapy is either straight cpap (greatly improved with exhale relief such as A-Flex) or BiLevel mode (now affordable as EPR).

There's that sweeping generalization of "fact" again, when it's simply your opinion. I do agree about the value of exhalation relief being added as being an improvement to xpap treatment in general. Oh, btw, "A-flex" is found only in one particular brand of autopap. You probably meant to write "C-Flex."

RG

Re A-Flex, I wasn't singing the praises of one company - just commenting in general. A-Flex on C-Pap or an Auto mode is a great feature. We all know A-Flex is a Respironics innovation

Re Autos, I believe that the bulk of people here who have been on xPap more than 2 years will agree that Autos are great for level setting and Cpap & BiLevel are great for day-to-day therapy.

This notion that the best therapy is to always be in Auto mode is a fallacy. The original dream sounded great, the reality has shown it is not adequate as a sustained therapy mode. I consider this view is also a widely held one in the respiratory (medical) profession.

Certainly the wise heads here and elsewhere to a person will suggest setting an Auto to a very narrow pressure range (typicall max 4-5 CMS) and this has been as we learned about the complications of setting them low plus too high & also as we woke up to the respond-on-the fly fallacy which really was wishful thinking by people who just didn't know better and got into the habit of parroting the wishful thinking.

Auto cpaps are in reality SV wannabees (except with Auto mode you can self titrate if you are so disposed & that is something a lot of people here like doing). All the wild claims attributed to how Autos would provide the best of all therapies by preventing all OSAs by changing pressure, on-the-fly, was so much wishful thinking that wasn't backed up by the hardware nor algorithms. SV machines *can* deliver that promise and they are proving it.

As always, cpaptalk is a great place to air our views & perspectives. & we have a variety don't we

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, CPAP, auto

dsm wrote:This notion that the best therapy is to always be in Auto mode is a fallacy.

I've never said that. Never thought it. Not sure where you think you've seen that "notion."

I (and many others on this message board) have often said that an autopap is useful in that if auto-titration doesn't suit someone and "cpap" would suit them better, they already have a "cpap" machine right there. Just switch the autopap's operating mode to cpap mode. Simple.

They can also turn off exhalation pressure relief features if that doesn't suit someone. Simple.

I've often said, different machines suit different people. Simple.

You've probably said that too, although you don't seem to be saying it now.... since....

You sweepingly state your opinion as if it were research proven fact:

dsm wrote:Cpap mode is better for consistent therapy.

and this:

dsm wrote:With Autos, users can still do their own level setting but without doubt the most effective therapy is either straight cpap (greatly improved with exhale relief such as A-Flex) or BiLevel mode (now affordable as EPR).

(bold red emphasis mine)

Well, if you want to put forth fallacies and notions....

Now now

D

dsm wrote:Certainly the wise heads here and elsewhere to a person will suggest setting an Auto to a very narrow pressure range (typicall max 4-5 CMS)

To a person? Not me. Not that I'm a "wise head."

Many people do say that. You may have missed it, but what I've often suggested, repeatedly, about setting an autopap's range is this:

Setting the maximum pressure quite high (at 20 cms, for example) doesn't matter if the machine is not going to be using pressures up there for a person anyway. Un-used pressure up above is just that...not used. Doesn't matter that plenty of ceiling room that never gets used is sitting up there.

What I've also often said (as have others) is that the minimum pressure is the important one to "get right"...to set the minimum enough in the first place to ward off most events ahead of time.

rested gal wrote:

dsm wrote:This notion that the best therapy is to always be in Auto mode is a fallacy.

I've never said that. Never thought it. Not sure where you think you've seen that "notion."

I (and many others on this message board) have often said that an autopap is useful in that if auto-titration doesn't suit someone and "cpap" would suit them better, they already have a "cpap" machine right there. Just switch the autopap's operating mode to cpap mode. Simple.

They can also turn off exhalation pressure relief features if that doesn't suit someone. Simple.

I've often said, different machines suit different people. Simple.

You've probably said that too, although you don't seem to be saying it now.... since....

You sweepingly state your opinion as if it were research proven fact:

dsm wrote:Cpap mode is better for consistent therapy.

and this:

dsm wrote:With Autos, users can still do their own level setting but without doubt the most effective therapy is either straight cpap (greatly improved with exhale relief such as A-Flex) or BiLevel mode (now affordable as EPR).

(bold red emphasis mine)

Well, if you want to put forth fallacies and notions....

RG,

Lets get this back on the road where it belongs

Please don't take general comments here that were clearly not aimed at you and paint them as if they were a direct criticism of you ? - that derails the debate as quickly as an express train hitting a truck on a crossing.

Let us debate the points being made. Focus on what we know & avoid turning the points in to personal issues. We can surely disagree without it being personal, can't we

We can all believe what we like and we should be able to discuss our views freely without the concern that someone will turn a point into a personal matter (thus appearing to avoid debate on the topic).

Now can we get back to discussing Autos and their effectiveness ?

Cheers

Doug

dsm accidentally guested wrote:Now now

D

LOL!! Yeah, keep going back to your posts and squashing out what you realize might have been a fallacy or notion. Makes a discussion a bit hard to follow, but oh well.

Hint to readers:

When you see this phrase more than once at the bottom of posts in this thread:

"CPAPopedia Keywords Contained In This Post (Click For Definition):"

That means the person went back and edited their original post.

rested gal wrote:

dsm accidentally guested wrote:Now now

D

LOL!! Yeah, keep going back to your posts and squashing out what you realize might have been a fallacy or notion. Makes a discussion a bit hard to follow, but oh well.

Hint to readers:

When you see this phrase more than once at the bottom of posts in this thread:

"CPAPopedia Keywords Contained In This Post (Click For Definition):"

That means the person went back and edited their original post.

RG

That is being quite unfair - I have edited my posts where I made typos or clarified an ambiguity. I am a poor typist.

Please stop getting personal. If you have a concern PM me - I won't bite & if you have a legitimate issue will happily correct it and publicly.

Thanks

DSM

Sorry about that. I misread your "now now" as "not now"... LOL!!

I apologize for that comment. I edit my posts often for misspellings or grammar, so I do understand your doing that.

My apologies, Doug.

By the way, I've not taken anything you've said in this topic as a personal criticism. I hope you don't take my disagreement with some of your opinions stated as if "fact" personally, either.

rested gal wrote:Sorry about that. I misread your "now now" as "not now"... LOL!!

I apologize for that comment. I edit my posts often for misspellings or grammar, so I do understand your doing that.

My apologies, Doug.

By the way, I've not taken anything you've said in this topic as a personal criticism. I hope you don't take my disagreement with some of your opinions stated as if "fact" personally, either.

RG,

No worries, please PM me if you believe there is something that needs sorting out.

This thread is a very interesting one (sure is to me) & I am more than happy to debate my own views on the effectiveness of various therapy approaches & where I think the therapy is heading. I am sure I won't get it all right but I believe with smart folk like we have here at cpaptalk we can improve all our understanding of what these machines can and do do for us.

Cheers & thanks

Doug

billbolton wrote:

dsm wrote:I guess that what I am saying is that I am now a believer that we can and do get used to particular setups & a lot of that is our own preconditioning vs the objective facts.

Which makes me wonder just how much "rampant featuritis" is occuring on user side, with users demanding perceived "features" which have relatively small benefit in the overall picture of SDB treament! How much is that driving up the total-healthcare-system-cost of delivering xPAP therapy?!?

Anyway, back to the S8 II topic..... do you think the "high-resolution flow data (25Hz)" is something new?

Does the existing S8 Reslink module you have do this with your existing S8? Or is a product of the Reslink II module, or perhaps the Reslink II module + an S8 II flow generator?

Cheers,

Bill

Bill,

I am betting (from what I have already seen) that Resmed (and I am sure the other mfgs) are going to offer a real time streaming capability that allows any cpap machine to deliver the data in real time over the Internet.

I have seen somewhere on Resmed's web site (Slinky can you remember the link) where they already have a wireless link that allows the data to be streamed.

Slinky & I both obtained Reslink modules & tried to get a matchinf SpO2 probe (cheap ) but as yet I have to confess to being too busy to have set up my reslink & tried it.

The Probes we bought turned out to be an advanced version that delivers more data than the Reslink can handle so we are still keeing our eyes peeled for a cheap XPOD probe that does fit the Reslink (The Reslink SpO2 probe is in fact a NONIN XPOD with data format #2).

So if Resmed have mentioned a faster data transfer rate, I'll bet the brooklyn bridge that it is a prelude to some near future net transfer of real time data.

DSM