Finally made the decision on my Bi-level machine ...

After weighing and reweighing and reweighing the pros and cons of both the ResMed VPAP Auto 25 and the PR System One BiPAP Auto, I finally told CPAPXpress to order the PR System One machine this afternoon. At my prompting, they did investigate and find out that the VPAP Auto 25 was indeed a bi-level machine and they would have ordered it for me if I'd chosen it.

My decision was a hard one because with going either the the VPAP Auto 25 or the PR S1 BiPAP Auto would mean I have to give up certain features of my current ResMed S9 Auto. But the aerophagia and air-in-eyes-from-inside-my-head and the fact that I keep waking up feeling like I've run a marathon because breathing out against my (not very high) pressure remains difficult and leads to me feeling exhausted and tired all day forced the issue. And since the letter of medical necessity was provided by my sleep doctor this week, I just couldn't see putting off the inevitable decision any longer.

The PR S1 BiPAP won for the following reasons and in this order of importance:

1) The fact that PR S1 has a standard SD data card instead of a proprietary card and the VPAP doesn't. I just was too worried that I would not be able to get the card reader. I had located a web-based CPAP retailer in Australia that reportedly still ships the dang card readers to the US, but since another company had gone from "ships to US" to "only ship to Australia" for the card reader in the last couple of weeks, I just didn't want to risk it. It also seemed a bit ridiculous that it would cost me around $130--$150 bucks for just the card reader.

2) A viable work around the fact that the PR S1 doesn't display overnight numbers has been suggested to me: Simply erasing the data every day causes the 7 day average to be a one-day average, which is exactly what I want. Now, I'll likely have to be very careful for the first month because it looks like my insurance company is going to demand compliance data for a month on the new machine. But a month is a SMALL FINITE amount of TIME. So I can live with it. Moreover since I'm a college professor and I have a long break at Christmas, I will be able to download the data every day during that time that I have to worry about compliance data. But once that compliance period is over, I'll happily erase the data every night as part of the getting Kaa ready for me to go to bed. And then I'll have those overnight numbers that are so important to me in morning.

3) Going with the VPAP would have meant giving up on looking at the flow/waveform data for five years or more since my insurance won't likely replace the machine for five years or more. I'm not 100% sure, but I also think going with the VPAP would have meant giving up on any kind of flow limitation data as well. Going with the PR will let me look at the waveform data when my husband and I get Encore Pro installed. And if it takes a while, well I can always decide to throw some money at Encore Viewer in the meantime. Also, the System One will record "flow limitation events", and while I still don't understand how "flow limitation" can be an "event" given that I'm used to looking at it as a continuous function of time, some discrete data is better than no data at all.

4) The data reports from Encore Viewer and Encore Pro that others have shared with me clearly indicate that most of the data that I want is there. And there's some intriguing additional data on RERAs that PR's algorithms are supposed to be able to detect. The more I looked at the actual Encore reports and the more I had a chance to analyze them, the more I realized that the software trade-off goes both ways: There are things that Encore does better and there are things that ResScan does better. I'll embrace the positives of Encore as a way of minimizing my focusing on the negatives. Many, many thanks to those Encore users who took the time to respond to my other thread about this issue.

5) Since the VPAP is based on the S8, I would not be able to use a Slimline hose anyway. With the PR S1, there's a chance that it might be a late enough model to allow PR's new 15mm hose. If not, well, I'll still be no worse off than I'd be with the VPAP. And the DME wrote down a note on my file to specifically ask about this when they order the PR S1 on Monday. So here's hoping that I'll get one with a 15mm choice on the hose setting menu.

6) The fact that the PR S1 has Humidity Control for rainout prevention is intriguing and sounds similar to the stuff that's built-in to the Hi5 humidifier even though I did not opt for the Climateline hose with my S9. Rainout has not been a big problem for me, but there are nights where it is a minor annoyance. The VPAP's humidifier seems less high tech and more likely to have rainout problems. [During the titration study I had with a VPAP Tx machine, I did have some rainout problems that were worse than any I've had with my S9.]

7) The fact that cpap.com has battery packs that work with the PR S1 without the need for an additional converter cable/box is also nice.

So wish me luck when I make the switch later on this week. And I'll keep people posted on how I like it.

Robysue,

I am sure that will turn out to be a good choice. After nearly a year of using both a Respironics BiPAP and a Resmed VPAP, I can hardly tell the difference between them when using these machines, and I seen to get very similar AHI numbers from each machine. The SD card alone is a pretty compelling reason to go with the PR1 machine.

-john-

Congrats on making a decision, Roby Sue. I hope that you adjust to the new machine quickly and end up liking it.

I don't think I'd have picked a PR if I had a choice, but not having a choice I'm happy enough with it. The most important thing is that it works and from that standpoint the PR's are very good machines.

That's a tough decission. Looks like you made it with data. I hope it works well for you. If you do start getting rainout and covering your hose doesn't work you can always try the aussie heated hose. Haven't had a drop of rainout since I started using it and I have a fairly high humidity setting.

robysue, You had tough choices to face in getting your new machine. You did good research, and asked great questions. I know the switch will bring annoyances since you were used to the data benefits of the other machine.

But one of them is not suffering a month with worrying about compliance data. You wrote:

I will be able to download the data every day during that time that I have to worry about compliance data. But once that compliance period is over, I'll happily erase the data every night as part of the getting Kaa ready for me to go to bed. And then I'll have those overnight numbers that are so important to me in morning.

If you reset the machine when the card is popped out, only the machine memory is wiped. You can bring your card to prove compliance, or print the results to show your doctor. Also, if you write down the data off the screen before resetting it, include the compliance check number along with the hours on your notes. It shows up in the "phone in" menu on screen. That number is based on a formula which relates in part to the actual hours used each day, so proves enough to whoever is checking on you, if you've written down everything in that phone-in screen each day. The only glitch might be in cases where the wireless modem is grafted on by a local DME -- I think that blocks the card slot (I ended up going online rather than use my local DME at this moment of time, so I don't have direct experience but I'd seen it). But it sounds like you're getting yours online too, so no local-DME wireless unit will be in the way of the card.

I wish you the very best luck and will be sending good thoughts your way. Your posts should be archived. I only hope that with time and effort, I will be as half as smart as you about this over time. As I have had a stomach flu since my first night, I am hoping the stomach cramps I have are caused by bacteria and not air gulping.

I know I am not the only one who will follow your choice and experience closely. You are a blessing to this community, and I hope you have some well-deserved luck with this choice in addition to your usual sound thinking. Warm regards,

Namaste,
MoonBear

Many thanks to those who responded with best wishes and also to those who took the time to read this thread and others I've posted.

I will keep folks updated once I make the switch sometime this week.

And SleepyCPAP, I'll be sure to check out your suggestion to see it will work for me during the compliance period. I know the DME will only want the SD card sent in for compliance, so I'm not worried about the data card being disabled. One thing I really like about CPAPXpress is that they first and foremost only provide full data machines to all their customers and second their RT's set them up so that you do have access to the data from the LCD. They don't tell you about the clinical menu and how to get into it, but then they are a DME and they do have to worry about their own liability insurance.

Good luck, RS, and thanks for your erudite posts.

In case you missed it, there is, on a parallel thread, a method of obtaining from PRS1 a graphic display of individual respirations.

viewtopic.php?f=1&t=55722&p=546741#p546741


I previously believed that this information was not accessible unless you use EncorePro, so this is to correct a misleading statement I posted on one of your prior threads.

Thanks for the tip. I appreciate you taking the time to make the correction M.D.Hosehead!

I think you will like the Respironics machine. I used a Respironics CPAP and BiPAP for many, many years. I am personally encouraged by their effort to use standard cards and easily accessible software to monitor the therapy. This is no different than a diabetic, who needs to track their therapy. Same benefits. That the manufacturer is making it straight forward is the correct approach.

Though the Resmed unit is somewhat easier to breathe against, it is only a matter of degrees. Both are easy. By BiLevel therapy in itself will make it easier for you to breathe. The Bi-FLEX technology makes the sudden surge of pressure easier. The Resmed approach on that is a bit easier ... but not all that much.'

So, it sounds as if you made an excellent choice. Best wishes!