I'm being indecisive

I've wanted to get a second machine as a backup (and because I spend nights in two different places). I just came from my doctor's office. I started out at 8 for pressure, went to 9 after a few weeks, and he just upped me to 10 (I've been on the hose since March 6 of this year). We talked about my back-up being an auto and he suggested a setting of 7-14.

Right now I've got a s8 Elite II. My doc (who is also a DME for cpap) has a refurbished Auotset II for sale for $300 bucks with a humidifier. I've already got the resmed 3.7 software.

Any reasons why I should look at a new Sandman or Intellipap auto instead of taking this deal?

Well this may or may not make you even more indecisive.

If your sleep study showed that you are sensitive to central apneas, you may want to consider the Sandman. If on the other hand you are a straight-up obstructive apnea kind'a guy, you will be fine with any choice you make ... keeping in mind that the S8 II has better exhalation relief options that the other two do not (if exhalation reflief is something you like).

Thanks DreamStalker. I asked the doc about centrals and he said that there was no indication of centrals in my sleep study or in anything he has seen.

Are you SURE you're being indecisive, or do you just THINK you're being indecisive?

JNK, I'll need to think about that one.

Note: I wasn't indecisive about the EPr function on my elite II. I turned that off after a week, so that isn't a consideration in my decision.

I don't know anything about indecisive but the only thing I can add is that as I understand it the ResMed autos won't respond to apneas over the pressure of 10 cm/h2o. I will qualify this as I have not owned a Resmed but others on the board have posted this from the ResMed web site. I know it would be easier to have both the same so that the software would work on either one.

Jerry

raylo wrote:JNK, I'll need to think about that one.

Note: I wasn't indecisive about the EPr function on my elite II. I turned that off after a week, so that isn't a consideration in my decision.

If you are already using the humidifier, another ResMed would be the perfect travel machine, in my not-so-humble opinion, unless you just want to check out other machines. The nice thing about travel with a ResMed is the amount of info you get from the screen every day without using software on the road.

If the hours are within reason, that 300 dollar deal sounds good to me.

Thanks 6ptStar and jnk. I was originally titrated at 8cm, and my doctor didn't think that the over 10 thing would be a big issue - but I of course am unsure of that. I am not completely sure of how 7-14 works if it doesn't respond to apneas over 10. Does it respond to hypopneas/flow limitations above 10. Why else would it go up. Am I being dense?

remember.....

if you choose not to decide- you still have made a choice. (from rush:freewill)

You can always use the backup machine at fixed pressure, the way you use you non-backup machine...

Weight would be a consideration - both Sandman and Intellipap are lighter than the ResMed.

How much humidity do you use? Which humidifier will you be getting with the backup machine? (Resmed is now switching from the H3i to the H4i humidifier. What happens if the refurbished machine breaks (who did the refurbishing)?
O.

raylo wrote: Does it respond to hypopneas/flow limitations above 10. Why else would it go up. Am I being dense?

You're not being dense at all. You're absolutely right, raylo. Yes, the ResMed autopaps DO respond with more pressure to flow limitations that happen at any pressure the machine happens to be working at, at the time...even above 10 cm.

Below are links to some discussions where -SWS explains the "doesn't respond to APNEAS above 10" statement. True statement, as far as it goes...but what all autopaps do (in their different ways) is try to prevent apneas, by raising pressure in response to flow limitations and snores. Raising pressure as much as needed (even above 10 cm) in response to flow limitations and snores is any brand of autopap's way of trying to prevent obstructive apneas in the first place.

viewtopic.php?p=357581#p357581
-SWS wrote:
Since Resmed's A10 does not attempt to differentiate central from obstructive apneas, they take a statistical "hands off" approach above 10 cm when they see an apnea. Resmed will instead try very hard to prevent obstructive apneas by responding only to snores and FL above 10 cm. Additionally, Resmed's A10 will respond to apneas, snore, and FL below 10 cm.

That approach works very well for the majority of people.



viewtopic.php?p=367323#p367323
-SWS wrote:
Resmed is forthright, to this day, in describing to clinicians exactly which signals do and do not receive direct pressure responses:
Below 10cm- FL, snore, and A
Above 10cm- FL and snore only


viewtopic.php?p=367332#p367332
-SWS wrote:
I would add that wave shape flattening is also the main way that Respironics and PB/Tyco each detect flow limitation as well. Essentially an adequately "flattened" flow signal amounts to scored "flow limitation" for all three manufacturers. But they each have unique, patented mathematical signal-processing methods to recognize those "flattened" flow signals that score as "flow limitation".

Now if you index the severity of that flattening, as Resmed does, then you have a great way of algorithmically ascertaining severity of that slight "flow limited" closure. So Resmed will respond uniquely, according to just how flat or not-so-flat any given "flow limitation" happens to be. Respironics and PB/Tyco each have some nifty flow-limitation signal processing detection methods and pressure responses as well IMHO. They each also have their share of patients for whom their proprietary algorithms are not well suited.



viewtopic.php?p=367344#p367344
-SWS wrote:
all three manufacturers focus very heavily on wave shape toward detecting "flow limitation". While Respironics and PB/Tyco issue a single pressure response for any and all detected FL,.... Resmed issues a unique/commensurate pressure response, depending on just how flat or severe that detected "FL" happens to be.
---
I would add that "flattening" is specifically severity-indexed "flow limitation" according to Resmed. Respironics and PB/Tyco each maintain their equivalent statistical index for FL as well. So their algorithms are also very preoccupied with their own proprietary wave shape analysis and complex FL indices.



viewtopic.php?p=357738#p357738
-SWS wrote:
How much clearer could I have possibly described exactly what A10 is doing with snore and FL above 10 cm, based on Resmed's own very clear wording. in 1999, 2000, 2004, and 2008. Resmed keeps saying the same exact thing about what snore, FL, and apnea do both above and below 10 cm.

Thanks folks, Ozji those are some good questions. I have a call in to get more detailed info about the machine they have. I have an H4i humidfier now and need to check which one comes with the machine. I only set mine on 2 ususally, so volume isn't a huge concern.

Rested Gal, thanks for coming through with the info and links, as I have seen you do so often.

I am sure I am overthinking this, but I want to get the most out of therapy that I can. I don't believe I am seeing full benefit yet, and still have had some bad days, but I wouldn't give up my cpap for anything. The doc gave me samples of provigil for bad days, but I would prefer to not go there if I don't have to. My numbers aren't bad, generally in 5-9 range with a resmed (but AIs run from.8 to 2.5 per hour), but sometimes it just isn't all clicking together as well as it could.

Does the intellipap or Sandman offer much more flexibility in options or data to make a real difference?

I wish there was a way to know in advance which of the machines/algorithms would suit us individuals best, I would rather made a reasoned, therapy-based decision than a guess, but is guessing or tossing a coin what we are stuck with in making these kinds of decisions?

Ah, I knew it. The Autoset, which has 250 hours on it, does not include the humidifier, or any warrantee.. That makes the cost closer to $480. The intellipap auto with humidifier, software, and three year warrantee is only $600. Is saving 180 bucks and interchangeability worth giving up a 3 year warrantee (that comes with a completely new toy).

Given that you have a relatively low pressure titration of 8 cm, why is it you want the APAP? Are you getting good results with your current CPAP at the current 8 cm setting? Do you have a wide variation between AHI and positional sleeping? Do you want to double check your tirated value of 8 cm?

DreamStalker wrote:Given that you have a relatively low pressure titration of 8 cm, why is it you want the APAP? Are you getting good results with your current CPAP at the current 8 cm setting? Do you have a wide variation between AHI and positional sleeping? Do you want to double check your tirated value of 8 cm?

Thanks, Dreamstalker. I have had my pressure changed by my doc twice since I started in March - I'm now at 10 cm. He and I agree that despite strict compliance (all but 6 sleeping hours in a little over two moths), I should be getting a little more out of therapy. He sent me home with Provigil, which I do not want to take.

I need a second machine due to work travel and such (my fiance and I live about an hour apart and I have two of almost everything until we figure out a better solution with housing/commutes). I figure one of them should be an auto to give some flexibility for changes (I have been slowly, but steadlily losing weight).

There was variation between side and back sleeping in the sleep study. My ahi really isn't that "bad" for being calculated by a resmed, but not squeaky clean either. I am still having a pretty good number of "bad" days though and would like to make sure that I am maximizing my therapy. I have the money in my HSA account to do it, without it stinging too much.

Also, I must admit there is a piece of me that would just like to try out the technology see the difference. But I will park it in cpap mode if that turns out best for me. I can't put a cpap into apap mode.