Is it worth it to switch from Resmed S8 to S9 autoset

jnk wrote: I'm curious, if you don't mind my asking: Do you consider the "0.0 AHI" reports to be a good thing, or a bad thing, for self-dial-wingers like us?

That's a tough one. I don't think there are enough details to know for certain, Jeff. Some sleep techs were of the opinion that the S7/S8 over-scored hyponeas by their labs' standards. But, rhetorically, what exactly WERE those extra hypopneas with respect to sleep, oxygenation, pathology, etc.? Was it ALWAYS a good thing for individual patients to blindly chase those unknown HI metrics? Why?

BTW, a friend of mine says (claims?) he got 0.0 on his S8 II the other day , although he has not yet produced photographic evidence of it.

Is that the same friend who vacationed in Scotland last summer with Nessy... and even has the T-shirt to prove it?

-SWS wrote:

jnk wrote: I'm curious, if you don't mind my asking: Do you consider the "0.0 AHI" reports to be a good thing, or a bad thing, for self-dial-wingers like us?

That's a tough one. I don't think there are enough details to know for certain, Jeff. Some sleep techs were of the opinion that the S7/S8 over-scored hyponeas by their labs' standards. But, rhetorically, what exactly WERE those extra hypopneas with respect to sleep, oxygenation, pathology, etc.? Was it ALWAYS a good thing for individual patients to blindly chase those unknown HI metrics? Why?

BTW, a friend of mine says (claims?) he got 0.0 on his S8 II the other day , although he has not yet produced photographic evidence of it.

Is that the same friend who vacationed in Scotland last summer with Nessy... and even has the T-shirt to prove it?

Thanks, -SWS.

I guess I'm just addicted to seeing data, whether I know exactly what it represents or not, and whether it is clinically significant or not. I keep an eye on the trends and use it to tweak up or down, so the thought of seeing 0.0 just weirds me out somehow. It would make me think the machine was hiding something from me. But I guess that's just one of my many personal problems--I've always been overly suspicious of machines. I could swear that robots are constantly trying to steal my luggage at the airport, for example.

I used the ResMed S8 AutoSet II for the 1st 5 months of my cpap therapy, and switched to the S9 AutoSet 2 months ago. I feel I got good therapy on the S8, but prefer the S9 because of the Climate Control Hose. Also, I was uncomfortable on the S8's apap mode, and used cpap only. The changing pressures disturbed my sleep and I got aerophagia.

On the S9, I use apap with no problems.

One other consideration is the data:

S8 reports: Leaks, AHI, Apneas (but does not differentiate between Obstructive and Central Apnea, Hypopneas

S9 reports, in addition to the above: Central Apneas , Flow, Flow Limitation, Minute Ventilation Rate, Snore Index. Of these, I find Central Apneas the most useful.

Also, check on the availability of the S8 Card Reader, as it is no longer for sale in the U.S. The S9 uses a generic SD Card Reader.

carbonman wrote:

jnk wrote: My opinion:
If your present machine gives you leak and AHI data that proves that therapy is going well, and you are comfortable, you might as well stick with the machine you have.

I keep trying to come up w/a good reason to get an S9.

...but....the S8 IIs just won't let me.
They're paid for.
They're quiet.
They're ergonomically correct for my topology.
They're easy to configure and operate.
Rainout is controlled w/Ozzy heated hose in winter,
PadaCheek cover in summer.
Card/software interface has become seamless and transparent.
Data is accurate and reliable.
They're easy to travel with.
I like them.
They provide excellent therapy.

If I was new to all this, I would get an S9.


.....are you no longer a newbie when you can
control de lure of de'machine?

. . . and no power brick!

hobbs wrote: . . . and no power brick!

YEAH! That dang power brick turns me right off. *sigh*

Respironics gets "burned" w/their M Series integrated humidifier and over reacts w/the new PR S1 integrated humidifier and Resmed gets "burned" w/a bad power connection and over reacts by going w/a freaking power brick! Grrrrrrrrrrrrrrr!! Sheesh!

jnk wrote: I could swear that robots are constantly trying to steal my luggage at the airport, for example.

Not to fret, my friend! My understanding is that's just a silly Gypsy's myth anyway...

It's those nanobots hiding in the airport toilets that work my ire up every time.... Hate 'em I do.

Quick question about the S8 and S9 autosets:

On either machine, is it possible for the user to change the minimum and maximum pressure? I'm thinking of switching from my M series APAP, which allows me to set the min & max pressure, something that's been important to me to achieve comfortable therapy.

Thanks!

(sorry about the slightly OT question, just not sure it warranted its own item)

Best,
Ron

roncron wrote:Quick question about the S8 and S9 autosets:

On either machine, is it possible for the user to change the minimum and maximum pressure? I'm thinking of switching from my M series APAP, which allows me to set the min & max pressure, something that's been important to me to achieve comfortable therapy.

Thanks!

(sorry about the slightly OT question, just not sure it warranted its own item)

Best,
Ron

Yes. To the best of my knowledge, all APAPs allow you to set the minimum pressure and the maximum pressure.

Oh, yeah, it is entirely possible to change the pressure ranges on the S8 and S9 AutoSets. They wouldn't be autos if we couldn't. You will LOVE the Resmed data as compared to the Respironics data, and also the ease of access to that data via the LED screen. AND if you go so far as to get the software - I like the ResScan software MUCH better than the EncorePro software and its easier to install as well.

I haven't experienced that the actual therapy provided is any better w/Resmed or Respironics - but when it comes to data Resmed has Respironics beat all to heck.

I like the way Encore Pro presents data more than how ResScan presents S8 data, if you don't have ResLink. But then again, I like the manly, square M-series look, too. So what do I know?

(Please don't yell at me for that, Slinky. )

jnk wrote:I keep an eye on the trends and use it to tweak up or down, so the thought of seeing 0.0 just weirds me out somehow. It would make me think the machine was hiding something from me.

Well, as it turns out, I think the S9 case is the OPPOSITE of hiding data...

Anyone with ResScan 3.10/3.11 can explore the S9 overnight reports. Just launch ResScan and open a new patient. However, don't select from the DEFAULT patient group. Rather go into the EXAMPLES patient group instead. Once there, select the third patient from the bottom----since that's an S9 download example. Once you have that S9 example up and running, you can see how that person fared using her S9.

But go to the detailed graphs for all three nights available. Keep the top window panes in 8 hour resolution... But change the bottom window panes to perhaps 5 minute resolution. Scroll or adjust so that the top window panes show all snore, FL, A, and H sleep events. Click immediately prior to a cluster of sleep events that you would like to examine in detail. Now go down to the bottom 5-minute window panes and look at the flow graph (not flow limitation graph).

There you can see that nothing is hidden, Jeff! It's all right out in the open. Here's an on-line training module so that you can either score or unscore hypopneas to your heart's content. That hypopnea data can run from you, but it can't hide! Same with my slight periodicity patterns... Won't THOSE be interesting for a tweaker to experimentally track and improve?

-SWS wrote:

jnk wrote:I keep an eye on the trends and use it to tweak up or down, so the thought of seeing 0.0 just weirds me out somehow. It would make me think the machine was hiding something from me.

Well, as it turns out, I think the S9 case is the OPPOSITE of hiding data...

Anyone with ResScan 3.10/3.11 can explore the S9 overnight reports. Just launch ResScan and open a new patient. However, don't select from the DEFAULT patient group. Rather go into the EXAMPLES patient group instead. Once there, select the third patient from the bottom----since that's an S9 download example. Once you have that S9 example up and running, you can see how that person fared using her S9.

But go to the detailed graphs for all three nights available. Keep the top window panes in 8 hour resolution... But change the bottom window panes to perhaps 5 minute resolution. Scroll or adjust so that the top window panes show all snore, FL, A, and H sleep events. Click immediately prior to a cluster of sleep events that you would like to examine in detail. Now go down to the bottom 5-minute window panes and look at the flow graph (not flow limitation graph).

There you can see that nothing is hidden, Jeff! It's all right out in the open. Here's an on-line training module so that you can either score or unscore hypopneas to your heart's content. That hypopnea data can run from you, but it can't hide! Same with my slight periodicity patterns... Won't THOSE be interesting for a tweaker to experimentally track and improve?

If I send those graphs in to the lab every morning, will they score the graphs for me by that evening for free? And can they score them based on how my S8 scored "hypopneas"/"flow limitations" so that I could use the info for trending the same way?

And while we're at it, could someone do me a favor and use their graphs to figure out how the ResMed S9 estimates "hypopneas"? (Or do we know that already? I haven't found the definition being used now.) Inquiring contrarian minds like mine want to know. Uncle Bob? . . .

Dear contrarian mind:

The S9's data management guide

Hypopnoea
A hypopnoea is an episode of shallow
breathing during sleep. A hypopnoea
is scored when there is a reduction in
breathing by 50% of baseline breathing
with partial upper airway obstruction for
10 seconds or more. The event is scored
after 10 seconds of the hypopnoea.

This is quite different from the S8:

From the S8 clinical guide:
A hypopnea is defined as a 50 to 75% drop in ventilation. A hypopnea is scored
if the 8-second moving average ventilation drops below 50%, but not below
25%, of the recent average for 10 consecutive seconds. In order to avoid falsely
responding to central hypopneas, the AutoSet algorithm does not respond to
hypopneas but rather to the associated snore or flow limitation.

If I were a newbie and had to choose between a machine that showed my scores and one that did not, I would without doubt go for the one that showed my snores. The S8 does not. The S9 does.

O.

ozij wrote:Dear contrarian mind:

The S9's data management guide

Hypopnoea
A hypopnoea is an episode of shallow
breathing during sleep. A hypopnoea
is scored when there is a reduction in
breathing by 50% of baseline breathing
with partial upper airway obstruction for
10 seconds or more. The event is scored
after 10 seconds of the hypopnoea.

This is quite different from the S8:

From the S8 clinical guide:
A hypopnea is defined as a 50 to 75% drop in ventilation. A hypopnea is scored
if the 8-second moving average ventilation drops below 50%, but not below
25%, of the recent average for 10 consecutive seconds. In order to avoid falsely
responding to central hypopneas, the AutoSet algorithm does not respond to
hypopneas but rather to the associated snore or flow limitation.

If I were a newbie and had to choose between a machine that showed my scores and one that did not, I would without doubt go for the one that showed my snores. The S8 does not. The S9 does.

O.

Thanks, ozij.

I guess the S9 must define baseline very differently from how the S8 does, somehow. To me, the definitions seem pretty similar, except the S8 definition explains how it figures baseline and the S9 definition does not. And the S9 definition points to indications of obstruction, which I would assume has something to do with the shape of the flow curve. But maybe it means something else.

Good point on snores. I liked seeing that the time I tried Encore Pro with an M for a while.

I thank you. And my contrarian mind thanks you too. I hope its contrariness makes for good discussions, even when it is just spouting off. Hopefully we can all keep it in line if we continue to work on its contrariness, together.

One thing our S9 users should be capable of telling us:
When you have hypopneas, do you see a rise in pressure? Or even more to the point -- do you have hypopneas that the S9 does not repond to with a rise in pressure?


I've put the following in a thread of its own -- ResMed did indeed change it's hypopnea scoring:

viewtopic/t52858/Resmed-S9-hypopnea-sco ... g-gun.html
O.