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Actually, the Resmed auto has another downside, if your pressure is higher than 10:
The Resmed's algorithm is programmed not to raise your pressure if the apnea occurs at a pressure higher than 10. It will respond to snore and flow limitations at those higher pressures, but not to apneas.

If you know your Rx calls for a pressure higher than 10, and want a machine to adjust it pressure based on your breathing events, then the Respironics auto, which has a different algorithm (and does respond to apneas above 10), may be the better bet.

O.

DreamStalker wrote:APAP does EVERYTHING a CPAP can do (an APAP can be set in CPAP mode) so an APAP too IS - "the gold standard" ... PLUS.

I agree. APAP can be used as a CPAP or as an auto-titrating CPAP. Two machines in one.

MrGrumpy wrote:APAPs by contrast, dont have a ramp feature, unless you switch them to the CPAP mode.

There are at least two APAPs with a complete ramp feature that can be used in auto mode:

Puritan Bennett Goodknight 420E autopap
Respironics REMstar Auto with A-flex M series autopap

Those would be my choices in an autopap -- not only because of the machines themselves, but also because of the software they use.

Silverlining for the Puritan Bennett machine.
Encore Viewer for the Respironics machine.

ozij wrote:Actually, the Resmed auto has another downside, if your pressure is higher than 10:
The Resmed's algorithm is programmed not to raise your pressure if the apnea occurs at a pressure higher than 10. It will respond to snore and flow limitations at those higher pressures, but not to apneas.

- is that right?? So the therapy would be quite ineffective for people on pressures above 10? I'd never heard of this before, it comes as a bit of a shock... is there any more information about this somewhere?

Source: Moderated chat with a Resmed rep. in 2002. Despite inquries to Resmed by a forum member more than a month ago, we have not received info that the A10 algorithm has changed on newer machines, and at least one member (Pierre) has noticed this lack of response in a new machine - the Vantage. It would be nice to have some newer official info - but sometimes silence speaks for itself.

6. Why does AutoSet Spirit (and AutoSet T™) have the A10 algorithm?
ResMedSimon answers: The A10 algorithm increases pressure in response to Flow Limitation, Snore, and Apnea up to 10cm H2O. Above 10cm H2O, pressure response to Flow Limitation and Snore continues, but there is no response to Apnea. AutoSet Spirit and AutoSet T do not differentiate between obstructive and central apneas. Increasing pressures above 10cm H2O in response to apnea can lead to "runaway" central apneas.

Please note that the machine does respond to snores and flow limitations above 10. You should be concerned only if your sleep study shows you need apneas resolved at a pressure higher than 10. If that is the case, Resmed's auto mode is not for you.

Click on the blue bold text to link to the relevant messages.
O.

Slinky wrote:
Under the Red Ball w/the Question Mark at the top of the page is a subject on Mask Fitting. Scroll down to it and check it out so you have a good idea of how a mask fitting SHOULD be done. The mask fitting will give you a good idea of just how "into" CPAP therapy your DME supplier's RT really is. Keep in mind, CPAP is no where near as large a part of the DME supplier's business as the oxygen services. Many of their RTs are good w/oxygen therapy and not so hot w/CPAP therapy.

I should point out that DME supplier number one never met with me, and never wanted me to meet with an RT. They simply wanted to show up with my house with ONE machine and give it to me.

When I asked how long it would take they said, eh, less than 1/2 hour.

That was the final straw. I mean, one machine given to me by someone who I have no idea what their credentials are?

DME #2 has said they want me to come in to meet with an RT, which makes more sense.

What should the normal procedure be?

ozij wrote:
Please note that the machine does respond to snores and flow limitations above 10. You should be concerned only if your sleep study shows you need apneas resolved at a pressure higher than 10. If that is the case, Resmed's auto mode is not for you.

Strange then that they recommend the Resmed APAP machines at sleep clinics/hospitals then (and yes, the pressure is definitely higher than 10)
Maybe the algorithm has changed? They now refer to it as the "AutoSet Algorithm". On their technology factsheet, resmed also explicitly quote a journal article that says:

"We conclude that among patients requiring higher CPAP (10cm H2O or more) there are improvements in CPAP use, OSAHS symptoms, and quality of life domains when using auto-titrating (AutoSet) as opposed to fixed pressure CPAP".

No mention of the machine not responding to apneas once the pressure goes above 10.

This is all very strange

The important thing is that the RT knows the machine and is the one who sets up and shows you how to use and care for your machine and does the mask fitting. It really isn't all that important whether the RT comes to your home or you go to the office to meet w/the RT - as long as it will be a one on one session. At least one of our members related her appointment to pick up her equipment and taught how to use it turned out to be a GROUP training session.

Slinky wrote:.......... the RT knows the machine ........

Their fist auto was called Autoset, and the don't have a "improved autoset algorithm" nor do they have a "new autoset algorithm".

The majority of people do not need a pressure above 10 to handle apneas -which is why they got those results.
Snores and flow limitations are something else, they are responded to. And I notice they mention improvements in: Quality of Life (less snoring qualifies), CPAP use (it feels better to have lower pressure if possible) and Symptoms (once. again, snoring qualifies).

As for hospitals etc. recommending: the doctors in my country consider the machines a technical issue, for technicians to handle. It is my impression (after 3 years on the forum) that not many doctors elsewhere make it their business to know the machines algorithms either.

O.

rooster wrote:

Slinky wrote:.......... the RT knows the machine ........

Hey, Rooster.......

Don't take Slinky out of context ......she said:

Slinky wrote:The important thing is that the RT knows the machine and is the one who sets up and shows you how to use and care for your machine and does the mask fitting.

Some do.....some definitely do not!

The BEST ones come here.....to share and to learn.

With all the rest, you rolls the dice and takes your chances.


Den

Wulfman wrote:.
Hey, Rooster.......

Don't take Slinky out of context ...............

Den

Oh Den, I definitely and intentionally lifted that out of context!

No slam at Slinky intended!

[quote="DreamStalker"]APAP vs CPAP?

Grumpy is ... well, grumpy, and knows not what he mumbles about as grumpy people often do.

APAP does EVERYTHING a CPAP can do (an APAP can be set in CPAP mode) so an APAP too IS - "the gold standard" ... PLUS. APAP offers same exact treatment as CPAP with significantly more options (the PLUS part). Since your insurance pays 100%, the cost difference is a non-issue for you which should make your choice that much easier. Even if you paid 100% out-of-pocket, the APAP would still be the one to get if you had the cash flow to afford it.

As for blue lights, they don't bother me cuz I sleep with my eyes closed .... yes, I know, I'm weird that way. You can alway put a sock over the lights or do what Snoredog did and open the thing up and put electrical tape under the buttons on the inside.

HH, just go with the integrated. If you find you need more then get the HC150 off the auction site ... I got a spare there for less than $50 w/ shipping included.

Yeah, uh huh, Rooster. Sure. Like I believe that!

Thanks, Den.

And, thanks, Ozij, for clarifying the situation. You are soooo RIGHT, about the docs leaving knowledge of the xPAPS to the techs and RTs. Its too bad so many don't deserve that reliance!

[quote="ozij"]Actually, the Resmed auto has another downside, if your pressure is higher than 10:
The Resmed's algorithm is programmed not to raise your pressure if the apnea occurs at a pressure higher than 10. It will respond to snore and flow limitations at those higher pressures, but not to apneas.

If you know your Rx calls for a pressure higher than 10, and want a machine to adjust it pressure based on your breathing events, then the Respironics auto, which has a different algorithm (and does respond to apneas above 10), may be the better bet.

O.

rooster wrote:

Slinky wrote:.......... the RT knows the machine ........