Comparison Resmed S8 AutoSet II vs Remstar M Series

jnk wrote:-SWS sums up the problem with the repetitions of the A10 statement when he says:

-SWS wrote:I'll restate what I think the inherent problem really is: A10's statistically-based pressure response above 10 cm is sufficiently counterintuitive to lead newcomers and some old timers to the wrong conclusion about A10's overall effectiveness.

So, then, why repeatedly state something counterintuitive to new ones, without explanation, to them, when it is much more likely to lead to wrong conclusions than it is to be actual helpful information?

Jeff, are you under the impression that I have repeatedly stated what A10 does without plenty of additional qualifying information?

-SWS wrote:To recap:

1) Resmed's A10 algorithm will directly respond to FL above 10 cm (according to Resmed)
2) Resmed's A10 algorithm will directly respond to snores above 10 cm (according to Resmed)
3) Resmed's A10 algorithm will not directly respond to any apneas above 10 cm (according to Resmed)
4) Pressure-response strategies one above (FL) and two (snore) above can and will help prevent many apneas occurring above 10 cm

-SWS wrote:A10 had some darn good epidemiology backing it up in 1999 for obstructive etiology (not inherently mixed, central, or complex etiologies). Human physiology hasn't changed one bit, with respect to that 10 cm statistical barrier...Statistical observance of the A10 barrier was epidemiologically smart then, and it's just as statistically savvy now.

-SWS wrote:People on this message board often have very strong preferences about APAP brands and models. I would personally take either the Resmed S8 AutoSet II or the Remstar M Series Auto without any qualms. The Resmed "physical build quality" is better than Respironics' IMHO.

-SWS wrote:All the APAP algorithms have some minority of patients for whom the pressure-response strategy is not suitable. That situation is not at all unique to A10.

-SWS wrote:That worst-case will happen for statistically-anomalous patients who are not a good match for A10. Again, all APAP manufacturers have statistically-anomalous patients who are not a good match for their algorithm. It's just a reality of APAP treatment regardless of brand.

-SWS wrote:It's a statistical rarity. If it was a common occurrence, then Resmed would have abandoned epidemiologically-based A10 long ago....The odds of being poorly treated by another manufacturer's algorithm are similar IMO.

-SWS wrote:That's a darn good algorithmic strategy IMHO. But let's nail it down for exactly what it is.

-SWS wrote:That statement is also true about the Remstar M Series and DeVilbiss AutoAdjust APAP machines that were mentioned in this thread---not just the Resmed S8 AutoSet II or its A10 algorithm.

-SWS wrote:But let me add to my statement above by saying that under those somewhat uncommon OA/FL/snore circumstances, I would also avoid the Respironics algorithm and just run a BiLevel or CPAP [graph of failed Respironics treatment shown]

So what else am I missing above, Jeff? Resmed's very own words about what happens both above and below 10 cm with OA, FL, and snore can and should be very openly discussed here----as we have done for all the manufacturer's algorithms. And you want to know what folks? To virtually quote Resmed's own description is not spinning words IMHO. And to refuse to adopt the "word spins" that other people vehemently insist that every should use is also not a crime of word spinning.

Why is it that no one accused me of word spinning when I discovered that turning off IFL1 on the PB/Tyco 420e algorithm prevented a lot of pressure runaway? Nor am I ever accused of "word spinning" when I highlight or discuss a Respironics algorithmic failure (above graph is but a single example). I wasn't even accused of "word spinning" when I said that SV algorithms have temporal or very narrow-window shortcomings. However, openly discuss Resmed's own words about A10, on the other hand---with all the balancing statements I have above----and I'm a deceptive word spinner.

The only reason A10 took the lion's share of discussion in this thread, was because of a statement way back on page one that incorrectly claimed that if just the right precursor happened in front of an apnea, then that apnea would receive a pressure response. Lordy knows, when I attempted a correction with the very wording provided by Resmed, of all sources, ... all hell broke loose for my not adopting the word spin that even Resmed fails to adopt.
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My Advice: Anybody who wants to discuss any strengths or weaknesses about any manufacturer's algorithms should feel free to do just that. Forget about adopting suggested word spins by any word committee around here. And it's not a word-spinning crime to say exactly what Resmed says----self-appointed word committees be damned!

-SWS wrote:
<snip>

The only reason A10 took the lion's share of discussion in this thread, was because of a statement way back on page one that incorrectly claimed that if just the right precursor happened in front of an apnea, then that apnea would receive a pressure response. Lordy knows, when I attempted a correction with the very wording provided by Resmed, of all sources, ... all hell broke loose for my not adopting the word spin that even Resmed fails to adopt.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------

My Advice: Anybody who wants to discuss any strengths or weaknesses about any manufacturer's algorithms should feel free to do just that. Forget about adopting suggested word spins by any word committee around here. And it's not a word-spinning crime to say exactly what Resmed says----self-appointed word committees be damned!

I thought JNK was supporting you ? - didn't he imply that on its technical merits the points you made stand up. I read JNK as highlighting the issue of using technical information selectively.

Why not quote from the Resmed Clinical manual that Wulfman posted - that information is understandable & I am sure even a newbie would follow the descriptions.

SWS why is it I still feel you are playing games with us over this ? - it just seems to me you latched onto the technical aspect of the A10 quote & are playing it for every inch you can squeeze out of it - you have never acknowledged in any minute way that it can be very confusing despite us reading here just how confused some people got by the technical aspect of the A10 mantra. Georgio's post repeatedly show how that confusion found a home.

Your protestations seem to me to be very hollow and shallow.

DSM

Anyone who would like a copy of the Respironics Auto patent, please PM me & I'll email you a copy. It is in PDF format. I have the 2004 version.
I also have the 2005 Respironics patent for detecting apnea/hypopnea which I believe was added to the original invention. It too helps explain
the way the Respironics probes events. These can be a bit fiddly to read 1st couple of times around, but if you persevere it starts to fall into
place.

It is great reading & if there are any parts you want explained I have enough confidence that myself, SWS, RestedGal, Ozij, Wulfman etc: can explain the particular aspect you need clarified.

What you do glean from it is how much ingenuity the designers have built into the algorithms used.

DSM

PS I don't have the patent for the Resmed Auto & if anyone does have a copy please could they email it to me.

dsm wrote:I thought JNK was supporting you ?

I may have read Jeff wrong. I thought he was commenting that the contents of this thread contain repeated A10 gripes without adequate clarification. It reads that way to me. This thread has plenty of clarifying discussion. I may have read jnk wrong since I'm very accustomed to being read (and accused) wrong in this thread even now:

dsm wrote:Why not quote from the Resmed Clinical manual that Wulfman posted - that information is understandable & I am sure even a newbie would follow the descriptions.

I was the first one in this thread to quote from that 2008 manual. Remember? I only quoted the relevant part because you protested that 1999 Resmed text didn't include changes. So I quoted the part showing absolutely no apnea-response changes above 10 cm in 2008.

dsm wrote: SWS why is it I still feel you are playing games with us over this ? - it just seems to me you latched onto the technical aspect of the A10 quote & are playing it for every inch you can squeeze out of it - you have never acknowledged in any minute way that it can be very confusing

I don't understand this comment either. You seem to have completely missed my post when I said that A10 is apparently "counterintuitive" and that can be cleared up with discussion. You might have missed jnk quoting my comment about A10 being "counterintuitive". Then I went on to include no less than nine -SWS quotes where I clearly describe how statistically smart A10 is and how the other APAP manufacturer algorithms have similar shortcomings. What squeezing?

Those were just eight pages of us going around and around about why we should or wouldn't adopt your favorite A10 wording.

dsm wrote:despite us reading here just how confused some people got by the technical aspect of the A10 mantra. Georgio's post repeatedly show how that confusion found a home.

If Georgio's confusion found a home from the wording that Resmed persists in using from 1999 to 2008, then let's clear that confusion up with discussion rather than a self-appointed word-committee insistence on which phrases really ought to be used around here.

dsm wrote:Your protestations seem to me to be very hollow and shallow.

I honestly feel the same way about your views in this thread. If you disagree with a technical point, then debate it. But forget about this message board coming to a consensus about which version of A10-speak needs to be adopted. The wording in the 2008 clinician manual that I discovered and first quoted (you seemed to have forgotten) works just fine for any message board discussion.

Here's a link to the ResMed patent:

United States Patent 6,988,498
Berthon-Jones , et al. January 24, 2006
Administration of CPAP treatment pressure in presence of apnea
Inventors: Berthon-Jones; Michael (Leonay, AU), Farrugia; Steven Paul (Lugarno, AU)
Assignee: Resmed Limited (New South Wales, AU)
Appl. No.: 10/958,854
Filed: October 5, 2004

http://patft.uspto.gov/netacgi/nph-Pars ... %2F6988498


Den

Wulfman wrote:Here's a link to the ResMed patent:

United States Patent 6,988,498
Berthon-Jones , et al. January 24, 2006
Administration of CPAP treatment pressure in presence of apnea
Inventors: Berthon-Jones; Michael (Leonay, AU), Farrugia; Steven Paul (Lugarno, AU)
Assignee: Resmed Limited (New South Wales, AU)
Appl. No.: 10/958,854
Filed: October 5, 2004

http://patft.uspto.gov/netacgi/nph-Pars ... %2F6988498


Den

Wulfman

Do you know who Remmers et al work for - I keep finding patents of his etc: but can't pinpoint the parent company

I know that RIC is Respironics (Investment Corp I think)

DSM

Do you know who Remmers ...

He is inventor of the REMstar and other sleep-related technology such as this:
http://www.21stcenturydental.com/Remmers.htm

Smart man. My understanding is that he left Respironics, though.

Interesting, That Resmed patent describes an Auto but has them using 4HZ FOT like probing to determine if the airway is open
so they can differentiate a central !.

I can believe that this technique is used in the Vpap Adapt SV - am wondering if it is in the S8 Autoset. I am sure
SWS in a past post suggested FOT might be employed in the Vpap Adapt SV.

DSM (thinking out loud - am guessing FOT isn't in the S8 Autoset. I may need to back track from that patent)

-SWS wrote:

Do you know who Remmers ...

He is inventor of the REMstar and other sleep-related technology such as this:
http://www.21stcenturydental.com/Remmers.htm

Smart man. My understanding is that he left Respironics, though.

SWS

Thanks - I found a patent for an Auto under his name - will try to get a pdf copy & save it....

I have put the patents I have plus any more I find here ...

http://www.internetage.ws/cpapdata/patents/

-SWS wrote:

jnk wrote:-SWS sums up the problem with the repetitions of the A10 statement when he says:

-SWS wrote:I'll restate what I think the inherent problem really is: A10's statistically-based pressure response above 10 cm is sufficiently counterintuitive to lead newcomers and some old timers to the wrong conclusion about A10's overall effectiveness.

So, then, why repeatedly state something counterintuitive to new ones, without explanation, to them, when it is much more likely to lead to wrong conclusions than it is to be actual helpful information?

Jeff, are you under the impression that I have repeatedly stated what A10 does without plenty of additional qualifying information?

-SWS wrote:To recap:

1) Resmed's A10 algorithm will directly respond to FL above 10 cm (according to Resmed)
2) Resmed's A10 algorithm will directly respond to snores above 10 cm (according to Resmed)
3) Resmed's A10 algorithm will not directly respond to any apneas above 10 cm (according to Resmed)
4) Pressure-response strategies one above (FL) and two (snore) above can and will help prevent many apneas occurring above 10 cm

-SWS wrote:A10 had some darn good epidemiology backing it up in 1999 for obstructive etiology (not inherently mixed, central, or complex etiologies). Human physiology hasn't changed one bit, with respect to that 10 cm statistical barrier...Statistical observance of the A10 barrier was epidemiologically smart then, and it's just as statistically savvy now.

-SWS wrote:People on this message board often have very strong preferences about APAP brands and models. I would personally take either the Resmed S8 AutoSet II or the Remstar M Series Auto without any qualms. The Resmed "physical build quality" is better than Respironics' IMHO.

-SWS wrote:All the APAP algorithms have some minority of patients for whom the pressure-response strategy is not suitable. That situation is not at all unique to A10.

-SWS wrote:That worst-case will happen for statistically-anomalous patients who are not a good match for A10. Again, all APAP manufacturers have statistically-anomalous patients who are not a good match for their algorithm. It's just a reality of APAP treatment regardless of brand.

-SWS wrote:It's a statistical rarity. If it was a common occurrence, then Resmed would have abandoned epidemiologically-based A10 long ago....The odds of being poorly treated by another manufacturer's algorithm are similar IMO.

-SWS wrote:That's a darn good algorithmic strategy IMHO. But let's nail it down for exactly what it is.

-SWS wrote:That statement is also true about the Remstar M Series and DeVilbiss AutoAdjust APAP machines that were mentioned in this thread---not just the Resmed S8 AutoSet II or its A10 algorithm.

-SWS wrote:But let me add to my statement above by saying that under those somewhat uncommon OA/FL/snore circumstances, I would also avoid the Respironics algorithm and just run a BiLevel or CPAP [graph of failed Respironics treatment shown]

So what else am I missing above, Jeff? Resmed's very own words about what happens both above and below 10 cm with OA, FL, and snore can and should be very openly discussed here----as we have done for all the manufacturer's algorithms. And you want to know what folks? To virtually quote Resmed's own description is not spinning words IMHO. And to refuse to adopt the "word spins" that other people vehemently insist that every should use is also not a crime of word spinning.

Why is it that no one accused me of word spinning when I discovered that turning off IFL1 on the PB/Tyco 420e algorithm prevented a lot of pressure runaway? Nor am I ever accused of "word spinning" when I highlight or discuss a Respironics algorithmic failure (above graph is but a single example). I wasn't even accused of "word spinning" when I said that SV algorithms have temporal or very narrow-window shortcomings. However, openly discuss Resmed's own words about A10, on the other hand---with all the balancing statements I have above----and I'm a deceptive word spinner.

The only reason A10 took the lion's share of discussion in this thread, was because of a statement way back on page one that incorrectly claimed that if just the right precursor happened in front of an apnea, then that apnea would receive a pressure response. Lordy knows, when I attempted a correction with the very wording provided by Resmed, of all sources, ... all hell broke loose for my not adopting the word spin that even Resmed fails to adopt.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------

My Advice: Anybody who wants to discuss any strengths or weaknesses about any manufacturer's algorithms should feel free to do just that. Forget about adopting suggested word spins by any word committee around here. And it's not a word-spinning crime to say exactly what Resmed says----self-appointed word committees be damned!

-SWS,

No, Sir. I am not under that impression at all. In fact, after I quoted what was, for me, your words that put forth the perfect summary of the core issue, I was trying to use you as an example of the right approach. Because, I think your good example has been overlooked in this and related issues and threads. I was not asking you "so why then repeatedly state . . ." I was attempting to use your words, and exapmle, as an authority, to raise that question to others who use the information differently from the proper way you use it. I apologize for how sloppily I did that. I can see how my phrasing could be misread as a challange to you instead of using your words as a challange to others, which is what I meant. Sorry.

DSM, as I read him, has taken issue with the way some, not you, keep referring to the A10 algorithm as to imply that it is a complete deal-breaking, lame approach to treating SDB. You have never said that, implied that, or caused any problems along those lines. You have been an undying, clear voice of reason in all of this. My impression is that the reason you have been that is that you actually understand more of the ins and outs of these machines than I, and perhaps most here, will ever understand. The amazing thing is that you humbly and unfailingly qualify your own take every time you even hint at a personal opinion about such things. That is rare to the point of being almost unheard of on any board, I believe. And I thank you for it sincerely. I mean that with utter respect, bordering on awe, so I don't mean to embarrass you with my take on your posts, but they are awesome work and a testament to scientific method in action and polite scientific discussion.

Now that you know where I stand on that, let me say that, for me, where this thread took a turn was, to a large extent, in the way DSM raised his objections to what some wording seemed to imply. And I think DSM has apologized for that. You replied, and rightly so, by pointing out the facts. But that still didn't address DSMs objections about the implications being given to newbies. I believe you then later summarized DSM's main point better than he did in the statement you made that I then quoted in my post. I think you said in a few words what DSM had been trying to say all along, but you said it accurately and without misleading anyone.

People like DSM and I can be pretty sloppy with what we say here sometimes. And DSM and I both need to be more careful in talking off the tops of our heads. I think DSM and I should both work on that. Don't you, DSM?

Anyway, I probably wouldn't even have bothered reading this thread if it hadn't been for your posts, -SWS. The thing I think happened here is that some argued against implications by attacking the facts, and you defended the facts. And then they mistook that as an attack of their being offended by implications. It still amazes me how you managed to stand firm on the facts and then, as easily as you did, encapsulate the core issue in one sentence. I didn't want that sentence to be missed. Or rested gal's similar words, either.

I didn't mean to step in it here. I have a tendency to grab the ears of the dog sometimes. But I think anyone accusing you of spinning words is name calling, and you are owed a particular apology for that. That accusation against you is laughable, at best. I've recently, since being diagnosed OSA, read and reread many of the posts you've made here over the years. I would be hard-pressed to find one statement from you I could take issue with on fact or opinion. You are skillful at reeling DSM in when he needs it. It is a service to him, the board, and the google searchers out there. All I ask is that you reel me in when I need it too. And feel free to point out when my post is misreadable, as the last one was. I appreciate it. And, sorry about that, my friend.

jeff

This one (of several) came up when I did a Google search of "Remmers et all".

http://jap.physiology.org/cgi/pdf_extra ... =mfc&rss=1


Den

Wulfman,

That patent linked to actually doesn't show in the list of covered patents for the S8 Autoset II.

http://cpaphelp.internetage.ws/manuals/ ... Manual.pdf - (listed on 1st page)

I was working thru the patents shown but not getting anything useful.

DSM

dsm wrote:Interesting, That Resmed patent describes an Auto but has them using 4HZ FOT like probing to determine if the airway is open
so they can differentiate a central !.

I can believe that this technique is used in the Vpap Adapt SV - am wondering if it is in the S8 Autoset. I am sure
SWS in a past post suggested FOT might be employed in the Vpap Adapt SV.

DSM (thinking out loud - am guessing FOT isn't in the S8 Autoset. I may need to back track from that patent)

An older and very uncommon Resmed AutoSet II Plus model employed that FOT. But Resmed didn't seem to employ their trial version of FOT elsewhere.

_______________________________________________________________________________________________

Jeff, very sorry I read your post the wrong way.

Thanks for speaking up WHATEVER your opinion happens to be. It's important for people to speak up... and God how I honestly hate groupthink with every essence of my fiber.

Anyway, I agree that there has been waaaay too much Resmed bashing on this board. And unfortunately, I think the vestiges of those old let's-pile-on-Resmed gripe sessions hamper good, open, thorough discussion. I still think Resmed is darn brilliant with their technology. Honestly always have.

I believe this patent is the most recent A10 reference

http://patft.uspto.gov/netacgi/nph-Pars ... =6,817,361

DSM

dsm wrote:Thanks - I found a patent for an Auto under his name - will try to get a pdf copy & save it....

I have put the patents I have plus any more I find here ...

http://www.ineternetage.ws/cpapdata/patents/

Doug,

You misspelled your website link. I couldn't figure out why I was getting taken somewhere else trying to advertise domains.

This one seems to work.

http://www.internetage.ws/cpapdata/patents/

Den