Respironics did not respond quickly enough to apneas?

Guest · Post by **Guest** » Sun Jun 29, 2008 2:35 am

I read a review on Cpap.com and a customer was comparing these 2 machines:

Respironics Remstar Auto &
Resmed S8 Vantage EPR Auto
These 2 are not the latest models.

He said: "I felt that sometimes the Respironics did not respond quickly enough to apneas, and I would wake up needing more air. A clinician told me the Resmed had a better "more aggressive" algorithm for adjusting pressure, and I found a couple online journal articles that seemed to bear this out".

Would the above apply to the latest models as well, e.g. comparing
Respironics A-flex auto &
Resmed S8 Autoset II

Also, I have a snoring problem, so would the resmed be better for that problem?

Julie · Post by **Julie** » Sun Jun 29, 2008 4:21 am

Snoring is a sign of apnea and if you are still snoring while using a machine, then your pressures, whoever makes the machine, have not been titrated or set properly. There may be a slight difference between the machines, but in fact, both are known to be excellent and pressure setting (among other things) can be adjusted to compensate for the slight difference. The machine(s) are not responsible for your problems, the MD may be, or the DME who set you up with equipment, or your mask, which may not be well fitted and may be leaking overnight.

RipVW · Post by **RipVW** » Sun Jun 29, 2008 5:39 am

Ditto to what Julie said!

ozij · Post by **ozij** » Sun Jun 29, 2008 6:37 am

Respiration 2008;75:48–54

RR stands for Respironics Remstar, RS stand for Resmed Spirit, a precursor of the Vantage, having a different box, but the same algorithm.

Titration Efficacy of Two Auto-Adjustable Continuous Positive Airway Pressure Devices Using Different Flow Limitation-Based Algorithms
Katrien B. Hertegonne , Bart Rombaut, Philippe Houtmeyers, Georges Van Maele, Dirk A. Pevernagie

50 people who had been acclimated to fixed pressure for about 69 days, with an AHI of >20 and RDI >30 (pre cpap) were sutdied in a randomized, double-blind, cross over trial. The machine were boxed, the people had a split night PSG with the machines (half the night on one machine half a night on the other).

My emphasis.

Results:
No significant differences were found in sleep parameters, subjective sleep quality and snoring index. The use of the RR was associated with a significantly lower AHI in comparison with the RS [mean (SD) 6.9 (11.6)/h vs. 9.4 (9.2)/h, p = 0.004]. This result was obtained at significantly lower pressure levels [P95 9.2 (2.3) cm H 2 O vs. 10.2 (1.5) cm H 2 O, p = 0.001].

Does the Resmed raise it pressure faster: Yes.

The different titration performance of the two devices can be explained by their respective operational algorithms. Their reaction times which determine the rate of pressure adjustment (TP/Pt) are in fact dissimilar. In the RS, the slope of adaptation is steeper for increasing than for lowering the pressure in response to the presence or, respectively, absence of respiratory events. The time constant for pressure decrease is 20 min. The ensuing pressure decline is relatively slow and may result in overprescriptiion.

Is that good? Depends on who you are: how sensitive you are to pressure change, what you breathing disorder is.

Not mentioned in your question: who drops pressure faster after breating stabilizes? Turns out it's the Respironics. Resmed will keep you at high pressure for 20 minutes because that is its time constant (see page 52 of the article).

The observation that the use of the RS was associated with a higher residual AHI despite the maintenance of higher pressure levels is a paradox for which we have no direct explanation.

This has frequetnly been observed by members of this forum as well.

The machines respond differently - and the one that is good for you may be the one made by a third (or fourth...) company. Aggressive is not necssarlily always "best". A Formula One is pretty aggressive in its acceleration. A Rolls no doubt gives you a smoother ride. On the other hadn, You won't get where you want to be as fast with a Rolls as you will with a Formula One.

O.

OutaSync · Post by **OutaSync** » Sun Jun 29, 2008 8:21 am

I've noticed that, more times than not, my Respironics Auto does not even try to raise pressure for my apneas. I will have two or three in a row and the pressure stays down. But it will go up for FL or hypops. Since my apneas aren't preceded by FLs (how does that happen?), my Auto does not get them. I don't understand it.

That's why I was wondering if a SV back up would help me. I'm 10 months into this therapy and still wake up as exhausted as I was when I went down. Still fight to keep my eyes open at the red light. I need a bumper sticker that says "Honk to wake me up"

Bev

Slinky · Post by **Slinky** » Sun Jun 29, 2008 8:28 am

Whew! Then WHY are you STILL driving, OuttaSync? Especially w/the young 'un in your avatar?

Instead of pushing your luck every time you get behind the wheel WHY aren't you on your sleep doc's back to find the answer to improving your sleep or getting a new sleep doc? Have you INSISTED that your family doc and your sleep doc put their heads together and find out WHY your sleep is still so poor? Are there other causes than just OSA and what are they and what can be done for them? I sure would be! And I wouldn't be bashful about it.

Goofproof · Post by **Goofproof** » Sun Jun 29, 2008 10:07 am

It takes no knowledge, to write a review that people will read, only a little time. A review is just one persons opinion, informed or not. They may base their thoughts, on a flawed view of the results, based on their inability to set the correct needs of xpap treatment.

If you don't get the correct pressure set, control the leak rate, and many other variables, you can easily come to the wrong conclusions, which when posted, can be taken for fact, when in reallity, the review is just one persons flawed view, based on flawed input.

Or in "Computer Talk", garbage in, garbage out. Jim

OutaSync · Post by **OutaSync** » Sun Jun 29, 2008 10:26 am

Actually, I haven't had the grandchildren drive with me since I have been diagnosed. At all. Ever. I have to figure this thing out, but I still have to work.

I had it out with my sleep DR. last Monday. He looked at my report and said, I see you are doing fine. Your numbers are good. I wish all of my patients were like you.
When I explained to him that I was not doing fine. My stomach and gut filled up with air all night and I was wakened all during the night with gas, mask leaks, etc. He just said to turn down my pressure, the machine I have is doing its job. So why doesn't the Auto increase the pressure when I have an apnea. How can I go straight to an apnea without a pressure increase, but a FL will make it go up? Wouldn't it help me if I have a back up SV kicking in when I stop breathing? I was reading that post that SWS and DSM were discussing the benefits of the Auto SV. Very interesting and I wanted to try it.

The Doctor said
1. A BiPAP Auto SV won't help me at all
2. Insurance won't pay for it if it is not a medical necessity and in his opinion, it's not.
3. I'd be wasting my money if I bought one.

He reluctantly wrote me a prescription saying that it was against his medical judgment BUT, he also said that if he were I, he would want to try anything he could to get a good night's sleep. End of discussion. Don't need to come back to see him for a year.

Not much help there. That is why I come here. For real help.

Bev

DreamStalker · Post by **DreamStalker** » Sun Jun 29, 2008 10:33 am

What ozij said.

The auto algorithms are different for each and I'm pretty sure that the newer models maintain the same difference. ... and on top of that, everyone responds differently to each algorithm.

You should concentrate on mitigating apneas and hypopneas as they are what actually do damage to your health. Snores should be a much lesser problem to attend to if at all.

Having said that, the ResMed algorithm responds and adjusts pressure based on detection of snores. Thus the algorithm may chase snores and run away if it is not capped off at the proper maximum pressure. The more rapid or agressive behavioure of the ResMed auto algorithm may actually cause micro-arousals that bump you out of REM and keep you from getting needed deep sleep even though it may reasonably take care of your apneas and hypopneas..

Again, everyone is different ... you may just need to try each of the autos to see what works best for YOU.

Snoredog · Post by **Snoredog** » Sun Jun 29, 2008 12:10 pm

[quote="OutaSync"]Actually, I haven't had the grandchildren drive with me since I have been diagnosed. At all. Ever. I have to figure this thing out, but I still have to work.

I had it out with my sleep DR. last Monday. He looked at my report and said, I see you are doing fine. Your numbers are good. I wish all of my patients were like you.
When I explained to him that I was not doing fine. My stomach and gut filled up with air all night and I was wakened all during the night with gas, mask leaks, etc. He just said to turn down my pressure, the machine I have is doing its job. So why doesn't the Auto increase the pressure when I have an apnea. How can I go straight to an apnea without a pressure increase, but a FL will make it go up? Wouldn't it help me if I have a back up SV kicking in when I stop breathing? I was reading that post that SWS and DSM were discussing the benefits of the Auto SV. Very interesting and I wanted to try it.

The Doctor said
1. A BiPAP Auto SV won't help me at all
2. Insurance won't pay for it if it is not a medical necessity and in his opinion, it's not.
3. I'd be wasting my money if I bought one.

He reluctantly wrote me a prescription saying that it was against his medical judgment BUT, he also said that if he were I, he would want to try anything he could to get a good night's sleep. End of discussion. Don't need to come back to see him for a year.

Not much help there. That is why I come here. For real help.

Bev

Snoredog · Post by **Snoredog** » Sun Jun 29, 2008 12:36 pm

[quote="Anonymous"]I read a review on Cpap.com and a customer was comparing these 2 machines:

Respironics Remstar Auto &
Resmed S8 Vantage EPR Auto
These 2 are not the latest models.

He said: "I felt that sometimes the Respironics did not respond quickly enough to apneas, and I would wake up needing more air. A clinician told me the Resmed had a better "more aggressive" algorithm for adjusting pressure, and I found a couple online journal articles that seemed to bear this out".

Would the above apply to the latest models as well, e.g. comparing
Respironics A-flex auto &
Resmed S8 Autoset II

Also, I have a snoring problem, so would the resmed be better for that problem?

OutaSync · Post by **OutaSync** » Sun Jun 29, 2008 1:25 pm

Snoredog,

You are on! I'm going to lower to 6.5 to 13 tonight and see how I do for a couple of nights. My 90% runs at 13.5. It seems like ( in my foggy memory) that I did that before and it would take so long to get up there that I had a lot of NRs followed by lots of apneas while it was going down in pressure.

You're right.
At this point, I don't have anything to lose.

Bev

Banned · Post by **Banned** » Sun Jun 29, 2008 2:55 pm

OutaSync wrote: The Doctor said
1. A BiPAP Auto SV won't help me at all
2. Insurance won't pay for it if it is not a medical necessity and in his opinion, it's not.
3. I'd be wasting my money if I bought one.

He reluctantly wrote me a prescription saying that it was against his medical judgment BUT, he also said that if he were I, he would want to try anything he could to get a good night's sleep. End of discussion. Don't need to come back to see him for a year.

Not much help there.

I'm guess I'm having trouble understanding why you say your Dr. was not much help. You asked him for an order for an SV, and he wrote you an order for an SV. Did I miss something?

Banned

OutaSync · Post by **OutaSync** » Sun Jun 29, 2008 3:26 pm

I did feel as though I had triumphed when I got the script, but I had really hoped that he would listen to me and work with me. I went in knowing what I wanted and left being not so sure. Of course I don't want to waste $5000, but I do want to get good sleep. I get so much conflicting advice and I want to be sure that I have tried everything before I spend the money.

Respironics did not respond quickly enough to apneas?

Respironics did not respond quickly enough to apneas?

Re: Respironics did not respond quickly enough to apneas?