Any experiences with a ResMed S8 AutoSet II vs. S8 Elite II

Hello all you hose heads,

I am relatively new at this having only started my OSA treatment on September 26, 2008. By October 1, 2008 I learned how to read my results on my ResMed S8 Elite II (and also how to change the settings, including the pressure). I have read everything I can get my hands on in the medical literature and many posts in this forum and others. I expect like many newbies, I have been trying different delivery devices (masks) to find one that is comfortable and works. So far I have tried ResMed's Liberty and Quattro (both hurt), F&P Oracle and I am currently using the Probasics Zzz-Mask (full-face). I have tried both the medium and large size Zzz-Mask and both seem to work for me with good results (the large leaks more) and no pain, sores or any other adverse effects. I have been using my CPAP a little more than 8 hours each night since I started so I am being good about trying to make this a positive experience. I have also learned that differing sleeping positions and just daily life events alter my numbers. I have only once obtained and AHI result under 5 and that was a 4.5 when I had a leak of 1.02 L/s. That same night my AI was 0.7 and my HI was 3.8. Every other night my AHIs have exceeded 5. In fact from October 1 thru November 2 my AHI numbers have been 6.7, 9.7, 9.3, 11.2, 6.2, 14.8, 9.3, 7.7, 7.4, 4.5, 7.3, 21.2, 7.5, 25.8, 14.8, 22.5, 7.7, 7.4, 6.5, 5.8, 9.7, 17.2, 15.6, 13.9, 7.9, 8.4, 6.0, 12.8, 6.4, 6.5, 8.2, 7.6, 5.3 and 10.8. I have noticed that my lowest AHI numbers correspond with my biggest leak numbers meaning the more I leak the lower my AHI number is. I have self-adjusted my pressure a few times from 7 cm H2O to 9 cm H2O to 13 cm H20 and back to 9 cm H2O but the increase in pressure did not really seem to lower my AHI, AI and HI numbers. Nor did I notice any real change in my comfort level when I adjusted my pressure (please don't post to tell me I should not self-adjust my pressure).

My conclusion based on my brief experience is that a constant pressure (CPAP) will not reduce my apnea events consistently nor will it reduce my AHI to less than 5 at 7 cm H2O or at 9 cm H2O or at 13 cm H2O. I have not tried pressure higher than 13 and I do not want to try leaving my pressure at a higher level all night.

Okay - now you know what has lead me to my question. I expect a ResMed S8 AutoSet II (which is almost identical to what I have) will maintain my pressure under 7 or 9 cm H20 for most of the night but adjust to prevent apnea or hyponea events to keep my AHI numbers under 5. If my assumptions are correct, does it make any sense for me to replace my CPAP with an APAP? If so, who do I convince my doctors and equipment provider to replace my S8 Elite II with an S8 AutoSet II. When I asked my doctor if I could try the APAP his response was that the APAP is only used as a diagnostic tool and not for treatment. I know that APAP treatment is an acceptable "optional" treatment and is prescribed by some doctors for treatment. I also know that as an "optional" treatment there is inconclusive or conflicting evidence or conflicting expert opinion. With all of this in mind, it seems to me that medicine has not caught up with technology as I see no downside to APAP treatment (except a slight increase in the equipment cost) but tremendous benefits (greater compliance, more comfort and enhanced success in reducing events).

Can anyone with experience using a CPAP and an APAP (but especially using a ResMed S8 Elite and S8 AutoSet II share their experience and thoughts?

KengEsq wrote:Hello all you hose heads,

I am relatively new at this having only started my OSA treatment on September 26, 2008. By October 1, 2008 I learned how to read my results on my ResMed S8 Elite II (and also how to change the settings, including the pressure). I have read everything I can get my hands on in the medical literature and many posts in this forum and others. I expect like many newbies, I have been trying different delivery devices (masks) to find one that is comfortable and works. So far I have tried ResMed's Liberty and Quattro (both hurt), F&P Oracle and I am currently using the Probasics Zzz-Mask (full-face). I have tried both the medium and large size Zzz-Mask and both seem to work for me with good results (the large leaks more) and no pain, sores or any other adverse effects. I have been using my CPAP a little more than 8 hours each night since I started so I am being good about trying to make this a positive experience. I have also learned that differing sleeping positions and just daily life events alter my numbers. I have only once obtained and AHI result under 5 and that was a 4.5 when I had a leak of 1.02 L/s. That same night my AI was 0.7 and my HI was 3.8. Every other night my AHIs have exceeded 5. In fact from October 1 thru November 2 my AHI numbers have been 6.7, 9.7, 9.3, 11.2, 6.2, 14.8, 9.3, 7.7, 7.4, 4.5, 7.3, 21.2, 7.5, 25.8, 14.8, 22.5, 7.7, 7.4, 6.5, 5.8, 9.7, 17.2, 15.6, 13.9, 7.9, 8.4, 6.0, 12.8, 6.4, 6.5, 8.2, 7.6, 5.3 and 10.8. I have noticed that my lowest AHI numbers correspond with my biggest leak numbers meaning the more I leak the lower my AHI number is. I have self-adjusted my pressure a few times from 7 cm H2O to 9 cm H2O to 13 cm H20 and back to 9 cm H2O but the increase in pressure did not really seem to lower my AHI, AI and HI numbers. Nor did I notice any real change in my comfort level when I adjusted my pressure (please don't post to tell me I should not self-adjust my pressure).

My conclusion based on my brief experience is that a constant pressure (CPAP) will not reduce my apnea events consistently nor will it reduce my AHI to less than 5 at 7 cm H2O or at 9 cm H2O or at 13 cm H2O. I have not tried pressure higher than 13 and I do not want to try leaving my pressure at a higher level all night.

Okay - now you know what has lead me to my question. I expect a ResMed S8 AutoSet II (which is almost identical to what I have) will maintain my pressure under 7 or 9 cm H20 for most of the night but adjust to prevent apnea or hyponea events to keep my AHI numbers under 5. If my assumptions are correct, does it make any sense for me to replace my CPAP with an APAP? If so, who do I convince my doctors and equipment provider to replace my S8 Elite II with an S8 AutoSet II. When I asked my doctor if I could try the APAP his response was that the APAP is only used as a diagnostic tool and not for treatment. I know that APAP treatment is an acceptable "optional" treatment and is prescribed by some doctors for treatment. I also know that as an "optional" treatment there is inconclusive or conflicting evidence or conflicting expert opinion. With all of this in mind, it seems to me that medicine has not caught up with technology as I see no downside to APAP treatment (except a slight increase in the equipment cost) but tremendous benefits (greater compliance, more comfort and enhanced success in reducing events).

Can anyone with experience using a CPAP and an APAP (but especially using a ResMed S8 Elite and S8 AutoSet II share their experience and thoughts?

Hi Ken.

Welcome to the forum.

I'm not a user of ResMed machines, but I do use their masks. However there are some similarities to how Autos (APAPs) work.
Convincing some doctors (and/or insurance providers) that an Auto/APAP is desired always seems to be one of the great challenges to get good therapy. (I purchased mine out-of-pocket)
There are many arguments for using an Auto......one is that it can be switched to CPAP mode if that therapy mode works better than the range of pressures. And, obviously, a CPAP can't be run in a range of pressures.

One thing in your post that I bolded is about the Auto "preventing" events. The Autos "respond" to events when they detect them. This may or may not prevent them or additional ones. Much has to do with the way the Autos are configured. In order to prevent events, the minimum pressure needs to be set to where it is high enough to stop as many events as possible. Since the Autos tend to increase pressure cautiously (read that "slowly"), it can take too long for a machine to get from say "8 cm." to "12 cm.") if that's the pressure needed to clear an event.....and the event takes place anyway.

For some people, the pressure changes during the night can disturb sleep.....it does for me.

With the ResMed machines (that tend to score high in Flow Limitations and Hypopneas), getting the AHI below 5.0 can be challenging. If the AI number can be kept near 0.0, that's good sign that the pressure is adequate to very close.

Den

Welcome. You are at the right board. This board is all about taking charge of your own therapy.

The problem with prescribing APAPs is that insurance doesn't like to pay for them. If you "fail" CPAP therapy, then APAP may be recommended by the doc. The feeling of many doctors and the insurance industry (if I may be very broad and sweeping) is that manufacturers are pushing the machines without having the science to back up their claims.

I pushed to get an auto, myself. Autos can be run in non-auto mode, so it's not like there is a reason to choose--buying an auto gets you both, if you can afford it.

The autos are interesting beasts. If your breathing matches the algorithm, an auto can do magic in how it raises pressure to address snoring and flow limitations. But many find that the autos don't quite do as advertised, especially when the minimum pressure is set too low. Most here end up raising the lower pressure to just a few cm below their sleep-study-titrated pressure. An auto is still somewhat useful in that you can see if it is consistently hitting a certain pressure of just staying at the minimum. That can tell you if you need to tweak. But you can do the same thing in a non-auto by occasionally trying other pressures and noting the effect on the numbers.

Try one pressure for at least a week before trying another pressure. Our sleep and breathing vary too much from night to night for us to be able to tell much with only a night or two at a certain pressure. The body needs time to get used to a pressure before you know how the body would deal with that pressure in the long run.

The reason you have lower numbers when you have higher leak is that the machine cannot properly score events when you have a high leak. That is why getting the right mask and getting leak under control is step one. I wouldn't play with pressures until I had settled into a mask and had low leak. Then the numbers would be worth using to find my optimal pressure.

Keng,

Welcome (though I think you have been with us awhile). What Den & JNK have posted is very sound advice and encapsulates the commonsense needed to understand AUTOs. These are not miracle machines, just CPAPs that vary their pressure slowly so they can try to preempt apneas but starting from lower pressures than what straight CPAP machines are normally set to.

A sleep study titration normally proceeds down a regular track to arrive at your titration number. 1st they try to arrive at a CMs number that basically clears all obstructions (no-flow apneas) - lets say 11 CMs, then they adjust again to find a higher pressure that reduces the slow-flow apneas (hypopneas & flow limitations + snore noise), lets say 13 CMs. That second number is then noted as your titration CMs.

But as is obvious, that pressure is not needed all night, only when you are in a period of flow lims, hypopneas & snoring. Many people find it difficult to start therapy breathing out against their titration pressure & 13 is a challenge for new cpap users. Exhale relief (C-Flex & EPR) help address this problem and RAMP feature allows most to start with a low pressure & get to sleep & the machine ramps up to normal pressure.

The AUTO was designed to allow people to start at lower pressures and the machine was designed to monitor for the signs of apneas and to adjust the applied pressure such that it hopefully prevents apneas occurring. The reality is that many doctors send the patients out the door with the AUTO set at its lowest pressure (4 CMs) and the high end set to max (20 CMs). But in practice the AUTO is very slow to change pressure & if the user is prone to clusters of apneas that occur quickly (REM sleep or sleep disturbance etc: ) then the machine may well be too late to the apnea party enough that the user is not getting good therapy.

The wise heads who have used Autos for a few years will typically choose a CMs setting round about 2-3 CMs below titration. As a rule-of-thumb, it works pretty well.

As already mentioned if you have Resmed machine be prepared to see HI numbers that are higher than what you would see on other brands. I regard 3.0 as quite acceptable on my S8 Vantage. My AI is what I look at & it is typically 0.2 to 0.6 and that is very acceptable.

Good luck

DSM

My suggestion:

1. I don't think getting the AutoSet II will improve your therapy any. You already have a
machine that reports AHI and leak data. With that, you can adjust your pressure for optimal
therapy.

2. All you need to do is understand what to look for with your current machine and it
will do everything the Autoset can do. Use the AI indice displayed on the machine,
try and get AI down to 1 or less ignoring HI until you do. Leak plays an important
role in that number, if leak exceeds what the machine can compensate for it
simply stops counting. That can be one reason when high leak is reported AHI
is lower. General rule is leak is considered first to determine if the data
you are looking at is accurate. If leak is within the range for the mask/pressure
combination then you can assume the data you are looking at to be
fairly accurate.

3. Once you get the AI down to 1 (.8 and .6 are ideal), then start looking at HI
data, if HI is at 7-12, bump pressure by .5 cm it should come down.

Next, once you nail down your pressure for the lowest AI and HI your overall
AHI will be the lowest.

Next, if your pressure is higher than you currently like to obtain that to
where it is difficult to fall asleep, then set up a Ramp pressure and timer, use
something like 6.5 Ramp pressure with a 30 minute time then it will
drop pressure when trying to fall asleep, wake during the night, use
that Ramp button again.

Note: Your AHI is going to flucuate night to night, some nights you will be above
AHI 5, others below, don't worry about it. Try and keep it on a weekly
average at 5 or below, once you do you are getting all you can expect
out of the machine.

Now, if you purchase a Autoset you will only be moving its Minimum pressure
up to control AHI just as you did with the Elite, since both report sleep
data you are not gaining anything. Now if your pressure requirement was 12
or 13 cm, I'd say get a Sandman Auto, it will go on above 10 cm to respond
to those apnea where the Autoset won't. And if you are looking for
better quality reports the Sandman is another reason to move to it. The
Sandman is fully adjustable so you can make it do almost anything you
want. So if I was trading in that Elite, that is what I'd trade it for.

KengEsq wrote:Can anyone with experience using a CPAP and an APAP (but especially using a ResMed S8 Elite and S8 AutoSet II share their experience and thoughts?

If it is a choice between those two machines... go for the AutoSet II.

The AutoSet II is essentially two machines in one in that it can be set to run in CPAP -or- APAP modes. This gives you options... and it is always good to have options.

Thank you all for the information. I am still trying masks but I think that so far the Probasics Zzz-Mask (full-face) seems best for me. Uning the medium Zzz-Mask my leak rates have been 2.40 L/s, 0.18, 0.36, 0.42, 0.40, 0.26, 0.46, 0.14, 0.24, 0.74, 0.34, 0.46, 1.96 and 0.54. I have no pain or soreness using the Zzz-Mask. I have ordered and will try the Innomed Hybrid and see if it is better or worse. I started out with the ResMed Liberty but that caused too much pain between my nose and upper lip so I could not use it for more than the first three nights. The ResMed Quattro caused a sore on the bridge of my nose and the F&P Oracle caused sores inside my mouth and limited all my breathing to mouth breathing. I have found that most often I breathe through my nose but from time to time breathe through my mouth (a chin strap is not for me since I tried one on and off for years to stop snoring and just could not wear one).

Using the Zzz-Mask my AI levels have been 1.9, 1.7, 1.8, 0.2, 2.0, 4.6, 4.3, 3.9 and 2.6 at 7 cm H2O and after I increased my pressure to 9 cm after turning on the EPR to full-time, level 2 and inhale to fast, my AI levels have been 0.7, 1.0, 1.7, 0.6, 0.4, 1.3 and 3.0.

Assuming my scheduled first appointment with my sleep doctor for January 16, 2009 is not advanced by a cancellation (I'm on that list) then I have a lot of time to see how my therapy is doing between now and then so I will have a better idea of what I might need to improve my therapy results. I do know the mask is the number one priority and now I know I have to get one that leaks least. However, how do I know my S8 Elite II is giving me valid leak numbers using different masks since my understanding is that the S8's leak number is simply a calculation that is based on the expected release of air from a particular mask (the mask settings allow you to select a particular ResMed mask or a "regular" mask) and the measure of the air that is released (leaked) so it simply deducts the "expected" amount from the "measured" amount and reports the difference as a "leak." I believe that if the leak is being reported accurately I want to get it down to a consistent 0.40 L/s or less with the target being 0.20 L/s or less.

I also feel that the more I am able to sleep on my side compared with sleeping on my back, the better my AHI and AI numbers are but trying to put something on to prevent me from sleeping on my back will also not work for me so I really can't seem to control my sleeping position. I do try to fall asleep sleeping on my side but then my mask moves as I do and my leak is increased eventhough I am using a CPAP pillow to reduce the mask movement.

Paul56 wrote:If it is a choice between those two machines... go for the AutoSet II.

The AutoSet II is essentially two machines in one in that it can be set to run in CPAP -or- APAP modes. This gives you options... and it is always good to have options.

I agree....it's good to have options. As Paul pointed out, any autopap machine can be set to run in straight cpap mode. If a person finds he/she does better on one straight pressure, the autopap can be used as a straight "cpap."

Regarding mask leak and ResMed's leak reporting:

KengEsq wrote:I want to get it down to a consistent 0.40 L/s or less with the target being 0.20 L/s or less.

Your target is right.

Other than when using a very specialized ASV machine, I personally wouldn't worry much about whether a mask from another manufacturer matches the expected leak rate of a ResMed machine's built-in mask leak calculation. Most masks of any brand have approximately the same leak rate as others. There's not enough difference in the normal exhaust rates of most masks to make a significant difference in the reported leak rate of a ResMed machine. Even the ResMed masks offered in the "mask selection" on the machine are very close to each other in expected vent flow, so I don't think it even matters if a person using a ResMed mask picks the "wrong" mask choice in the setting.

The only important choice (imho) to make in a ResMed's mask selection feature is if a person is wearing a Full Face mask. If wearing a FF mask of any brand, FF should be selected. Guessing at any other mask setting with non-FF masks is probably ok.

The important thing to watch in the leak rate data shown by a ResMed machine is to be sure (just as you noted, Ken) that leaks do not exceed 0.40 L/s. Zero leak rate is the ideal with a ResMed machine, but simply achieving a fairly low leak rate will let a person get perfectly effective treatment. Even if another brand of mask is used. In my opinion, anyway.

KengEsq wrote:. . . Uning the medium Zzz-Mask my leak rates have been 2.40 L/s, 0.18, 0.36, 0.42, 0.40, 0.26, 0.46, 0.14, 0.24, 0.74, 0.34, 0.46, 1.96 and 0.54. . . . Using the Zzz-Mask my AI levels have been 1.9, 1.7, 1.8, 0.2, 2.0, 4.6, 4.3, 3.9 and 2.6 at 7 cm H2O and after I increased my pressure to 9 cm after turning on the EPR to full-time, level 2 and inhale to fast, my AI levels have been 0.7, 1.0, 1.7, 0.6, 0.4, 1.3 and 3.0.
. . . I also feel that the more I am able to sleep on my side compared with sleeping on my back, the better my AHI and AI numbers are but trying to put something on to prevent me from sleeping on my back will also not work for me so I really can't seem to control my sleeping position. . . .

It can help to rig up some kind of hose hanger to keep the hose from pulling on your mask. I use the old rubber-band-and-safety-pin-from-the-roman-shade method myself. Something is causing those leaks on some nights, and trial and error may be the only method for trouble-shooting the root cause.

Untl your leak is consistently where it should be, your numbers won't tell you much. Leaks can wake you up and cause events in that way too. But if you use the same mask every night with low leak, then you know what your real numbers are and are in a position to begin seeing what a small adjustment in pressure does for a week.

My understanding is that inhale speed and the like are mostly comfort adjustments, although they can have a slight effect on numbers sometimes and are worth messing with as fine-tune tweaks. They shouldn't have a big effect on therapy, though.

If you are trying to titrate, hey, go ahead and sleep on your back. You want to be titrated so that you don't have apneas on your back anyway. Most of us end up on our backs from time to time, whether we know it or not, I believe. Starting out on your side is about all you can do. But if it is uncomfortable, it is more important to sleep comfortably than to try to lock yourself in one position.