Comparison Resmed S8 AutoSet II vs Remstar M Series

dsm wrote:Another summary that avoids the 'apnea' double entendre...

dsm wrote:'Apnea' has 2 meanings

Resmed clearly described apnea as not snore and not flow limitations---but as apneas.

There was absolutely no monkey business in my also referring to an apnea as just that. I don't think the statement that received reproach and correction earlier in this thread referred to an apnea as anything but an apnea either.

But now an apnea in this conversation is both: 1) an apnea, as well as 2) an entire mix of things that fall under the OSA spectrum?

Personally I found Resmed's own statements, as well as the statement that got incorrectly reproached earlier in this thread, to have agreed very nicely. And that's no monkey business on my part then or now. I still don't see what the big correction was all about when those words corroborated what Resmed put in print----and without apnea double-speak!

Just so that I understand... so far you have accused ME of being the one delivering "swirling dances", "artful dodging", and "monkey business". And yet you were the one administering reproachful corrections without a shred of Resmed proof... and then went on to introduce a brand new and second apnea definition that no one else in the thread was using. They were using Resmed's terms instead.

In light of all that, will everyone please pardon all my "swirling dances", "artful dodging", and "monkey business".

dsm wrote:Don't you just love word plays

You sure seem to.

Care to change this round of dance to a a twist or something else, the whirling dervishes might be good at spinning but I'm not

DSM

Oooops - we may have already been doing that dance from the start

To re-recap with "swirl-free" words:

-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

And to add:
5) claims in this thread that Resmed will directly respond to some apneas (as long as they are preceded by FL or snore) are so-far unsubstantiated.

I think the above wording stands about as plain and simple as it gets. Can I state it any simpler?

SWS....what happened to you.....you don't look the same...you're not using a ResMed are you?.......That goatee is coming in nicely....but I don't know about the George Burns glasses......and you've got to stop that smoking!

OSA = Obstructive Sleep Apnea

So what does one do when diagnosed with it. Get a cpap machine because they work to prevent OSA. But SWS is emphasizing that a Resmed Auto won't respond to Apnea over 10 CMs - now why would anyone get confused about that ?. Because any one with normal reasoning is going to read that repeated 10 year old remark as meaning Resmed machines won't respond to OSA over 10 CMs which we know is patently false. But it sure scares a lot of folk.

Hammer away at the word apnea all you like my old friend but the intention is clear.

DSM

Now someone please tell the band to go home

Georgio wrote:SWS....what happened to you.....you don't look the same...you're not using a ResMed are you?.......That goatee is coming in nicely....but I don't know about the George Burns glasses......and you've got to stop that smoking!

Please allow a fashion-conscious gentleman some stylish eye wear, good sir! Did I ever mention what my good friends unexpectedly stumbled across down at the beach...

Some crazy planet, man... Wonder where that came from! Also, notice that CPAP machine in the sand left-of-center.

I knew they were lying to us about how bad global warming really is......just like how the banks are still solvent! Yes, I use my machine on the beach, whenever I'm sleeping there!

This discussion probably should have it's own thread....but we need to eventually arrive at a recommendation for Bangy104. I'm now feeling like an instigator, however, at a pressure of 14......if Bangy is buying a machine.....would bi-pap or other be a consideration?

Georgio

Georgio wrote:This discussion probably should have it's own thread....but we need to eventually arrive at a recommendation for Bangy104. I'm now feeling like an instigator, however, at a pressure of 14......if Bangy is buying a machine.....would bi-pap or other be a consideration?

Georgio

The advantage of the Resmed S8 Autoset II is that is can alternately be configured as a BiLevel machine---delivering an IPAP of 14 cm and EPAP of 11 cm. So Bangy would get a very nice two-banger there in my opinion. That pressure relief can even be set up in APAP mode as well.

Respironics A-Flex will also give pressure relief during exhale. But the pressure drop will be relative to flow-pattern "parameter variations". That means Bangy would not be able to set an exact relief setting. Still, many people love that A-Flex feature.

Another option to consider at 14 cm, would be one of the auto-adjusting BiLevels. There you get a fixed pressure relief during exhale, as well as a lower mean pressure via the auto algorithm. They can be configured as ordinary BiLevel machines as well. I think that machine in the sand, just below the torch, may be an auto BiLevel. So with that intermediate pressure of 14 cm, I'd get one of the first two APAP models suggested, or I'd get an auto BiLevel machine instead. Be careful to remove any sand.

I too would lean toward an Auto Bilevel because they not only gather the best data that can be gathered (better than a straight Auto) but because at 14 CMs the potential for mask leaks & mask troubles starts to kick in.

The two choices for the Auto Bilevel are the M series Bipap Auto with Biflex & the Resmed Vpap Auto (also Resmed Vpap Auto25 which can go a bit higher than the original model).

I have used the 'tank' version of the Respironics Bipap Auto & it is another machine that will be remembered as a Respironics great. I haven't tried the Vpap Auto so can't comment on it from a use perspective.

One interesting difference between them is they both take a quite different approach to managing the ipap / epap gap. The Respironics machines sets the epap/ipap gap itself based on sampling OSA events during the night. The Vpap Auto allows for a fixed gap to be set & when in Auto mode varies both epap & ipap together while maintaining that fixed gap. Can't say that one approach is better than the other but most people who have discussed either are both very enthusiastic about the way each works.

DSM

-SWS wrote: The advantage of the Resmed S8 Autoset II is that is can alternately be configured as a BiLevel machine---delivering an IPAP of 14 cm and EPAP of 11 cm. So Bangy would get a very nice two-banger there in my opinion. That pressure relief can even be set up in APAP mode as well.

Respironics A-Flex will also give pressure relief during exhale. But the pressure drop will be relative to flow-pattern "parameter variations". That means Bangy would not be able to set an exact relief setting. Still, many people love that A-Flex feature.

Another option to consider at 14 cm, would be one of the auto-adjusting BiLevels. There you get a fixed pressure relief during exhale, as well as a lower mean pressure via the auto algorithm. They can be configured as ordinary BiLevel machines as well. I think that machine in the sand, just below the torch, may be an auto BiLevel. So with that intermediate pressure of 14 cm, I'd get one of the first two APAP models suggested, or I'd get an auto BiLevel machine instead. Be careful to remove any sand.

The text I colored refers to automatic machines (APAP), both of which give exhale relief. They go about it differently.

The major problem with buying a machine that is formally recognized as a bi-level is that you need an Rx that specifies bi-level (or bipap or bpap).
On the other hand, you can buy an automatic machine like the Resmed S8 Autoset II or the Respironics A-Flex online, when your Rx simply says CPAP.

Bangy, I assume you were hoping for a simpler, more specific answer -- but things are too complex for that...



O.

FWIW , here is some recent info I copied off of the Resmed site about how the auto machines work.

Breath-by-Breath Monitoring and Flow-Time Curve Analysis

AutoSet devices monitor breathing on a breath-by-breath basis and deliver only the pressure that patients need--when they need it.

AutoSet devices actually act preemptively by monitoring the patient's inspiratory flow-time curve. A flattening of the inspiratory flow-time curve typically precedes an upper airway obstruction, which will cause an apnea, hypopnea, or snoring.

By monitoring and responding to the flow-time curve, AutoSet devices reduce the number of respiratory events and arousals, enabling better sleep quality.

Studies suggest that using the flow-time curve is preferable to responding to apneas and hypopneas directly and that clinicians should use the flow-time curve to achieve optimal pressure during titration.3,4

Apneas may occur suddenly, without being preceded by flow limitation or snore. These sudden apneas are generally associated with sleep onset, change in body position, or rapid eye movement (REM) onset.

riverdreamer wrote:FWIW , here is some recent info I copied off of the Resmed site about how the auto machines work.

Breath-by-Breath Monitoring and Flow-Time Curve Analysis

AutoSet devices monitor breathing on a breath-by-breath basis and deliver only the pressure that patients need--when they need it.

AutoSet devices actually act preemptively by monitoring the patient's inspiratory flow-time curve. A flattening of the inspiratory flow-time curve typically precedes an upper airway obstruction, which will cause an apnea, hypopnea, or snoring.

By monitoring and responding to the flow-time curve, AutoSet devices reduce the number of respiratory events and arousals, enabling better sleep quality.

Studies suggest that using the flow-time curve is preferable to responding to apneas and hypopneas directly and that clinicians should use the flow-time curve to achieve optimal pressure during titration.3,4

Apneas may occur suddenly, without being preceded by flow limitation or snore. These sudden apneas are generally associated with sleep onset, change in body position, or rapid eye movement (REM) onset.

Very good points. But be aware that the 'apneas' in your second quote are yet a 3rd definition of a meaning for apnea that is unrelated to the 'apnea' we are debating in the A10 debate. They refer to 'Central Apneas' which are a totally different event to an 'obstructive apnea'.

This is why I am giving SWS such a hard time over his insistence on a 10 year old reference to 'apnea' in the interview with Dr Berthon-Jones. SWS just will not confirm that the Resmed S8 II machines address OSA events over 10 cms (the really important issue) - he prefers to rely on the utter confusion of newcomers to the fact that few outside the profession have clear understandings of the various meanings of the word apnea unless spelled out in detail for a particular context. Why would SWS do this - I don't know, we all have to figure that oddity out for ourselves. So yes, SWS is playing down the analysis of the flow time curve because to admit it undercuts his position on the old A10 doesn't treat apnea over 10 cms quote.

But debates like this attract a lot of interest and are the times we all learn the most. I sure do & I truly hope others participating do too. This is a moving target when it comes to clear understanding of the important issues. They just keep evolving. In other words a highly dynamic and exciting field of interest.

So the day that SWS comes clean and states 'yes DSM, the S8 II machine does address 'OSA events' above 10 cms' is the day hell will freeze over cause SWS just ain't gonna admit it He would rather stick to his technical position that Berthon-Jones knew exactly who his audience was when he made the comment quoted back in 1999/2000 & later in 2004 - (Note: after that Resmed muzzled him because people like SWS were exploiting double meanings in his answer. ) - Berthon-Jones is a simply open uncomplicated man who does not expect others to manipulate his comments for commercial or other reasons).

DSM

Now this is about the time RG chimes in and either says what a wonderful guy SWS is on matters of xPAP or smacks me upside of the jaw with her handbag (or her cheerleader baton, or whatever ) never let a decent proveable fact get in the way of a timely rescue

D

I notice, dsm, that you are still intent on protecting ResMed by attacking -SWS, and you stll have no ResMed references to support your position.

An apnea is an apnea. The ResMed Autoset algorithm scores apneas. It reports them. It does not respond to them when they appear above a pressure of 10 cm /h20, because ResMed's inventors assumed their preemptive response is good enough.

-SWS wrote:To re-recap with "swirl-free" words:

-SWS wrote:To recap:

1) Resmed's A10 algorithm will directly respond to FL above 10 cm (according to Resmed) (edit by ozij: attemp to preempt apnea)2) Resmed's A10 algorithm will directly respond to snores above 10 cm (according to Resmed) (edit by ozij: attemp to preempt apnea)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

I think the above wording stands about as plain and simple as it gets. Can I state it any simpler?

I too think that is about as clear and unconfusing at it can get. FL stands for flow limitation, by the way.

When you find ResMed source anouncing a change in the Autoset algorithm, please link to it, dsm. As long as the algorithm hasn't changed, a 10 year old description is fine.

O.

dsm wrote:Now this is about the time RG chimes in and either says what a wonderful guy SWS is on matters of xPAP or smacks me upside of the jaw with her handbag (or her cheerleader baton, or whatever ) never let a decent proveable fact get in the way of a timely rescue

[Today's role of RG will be played by SAG]

Gad, you are such an idiot.

SAG