Autoset to replace Elite

avi123 wrote: you need to trust the machine to be your doctor. I would not trust it especially b/c it uses a still unproved technology. But many in this forum do. IMO, most posters who do it are sort of Sleep Doctors' impostors.

So my doctor prescribed an Autoset machine and by listening to him i am impersonating a doctor? I have NEVER had a problem with my S8 Autoset II. it has always been comfortable and has greatly improved my quality of life.

To be clear, I do not agree with avi123 in the slightest.

That said, I want to point out that the S9 AutoSet uses an algorithm that is significantly different from that used in the S8 and prior autos. The biggest difference between the algorithms is seen at pressures above 10 cm H20. The new algorithm factors in the S9's ability to differentiate between obstructive and open-airway (central) apneas. This allows the new algorithm to be more agressive with pressure increases at pressures above 10, because the chance of inducing central apneas by increasing pressure in response to centrals is greatly reduced.

So the S9's algorithm does not have many years of proven performance in the field.

Jeff, I was thinking about this. Different machines have different methods of data analysis and treatment algorithms. They may not match up the numbers exactly with other machines or the in lab PSG, but that doesn't mean you don't get effective titration and treatment. Within a particular machine's parameters, you can get overall good therapy.

If you look at the studies I quoted, they don't base efficacy on the data from the machine per se. They look at symptoms and judge efficacy of autotitration by subjective and objective measures of the degree of symptoms in the subjects.

And the conclusions are that auto-titration is a safe and effective method of titration and treatment for OSAH's. That refutes Avi's blanket statement that auto-titration is unproven and unsafe.

Janknitz wrote:

I think that you're mistaken. S9 Elite will give you any pressure up to 20 cm H2O on inspiration. On expiration the EPR could drop the pressure by 3 cm H2O within one cm steps. One thing it does not do is to change pressures on its own upon detection of Apneas. Doing so (using a S9 Auto Set) you need to trust the machine to be your doctor. I would not trust it especially b/c it uses a still unproved technology.

Avi, there are many evidence-based studies that disagree with your conclusive statement. Auto-titration IS "proven technology" and is becoming very common with the same machines we use at home. The studies show that the accuracy of auto-titration is equal to or superior to in-lab titrations and these are the machines we use. For example:

Reply,

Santa Rosa girl, I am surprised that you do not understand that I am not referring to the "auto titration at home" issue but to the FOT and CSAD ("central sleep apnea detection") and automatically acting upon these detections .

Check this:

The ability to detect central apneas is a useful addition
to an automatic algorithm used in the treatment of OSA.
Automatic algorithms respond to the presence of apneas
(assumed to be obstructive) by raising delivered pressure
because, although this does not treat the apnea that is
detected, the pressure increase reduces the likelihood of
further obstructive events occurring. If the apnea, however,
is central an increase in pressure is inappropriate
and may increase the chance of further central apneas.
This may potentially lead to the device “running away”
with progressive increases in pressure causing increasing
numbers of central apneas. To prevent this from occurring
the previous AutoSet algorithm would not increase pressure
in response to apneas beyond 10 cm H2O. While this
prevents the device from “running away” it is not ideal as
obstructive apneas above 10 cm H2O are not responded to
and central apneas occurring at pressures less than 10 cm
H2O cause inappropriate increases in pressure. It is for this
reason that APAP devices are generally not recommended
for patients known to have conditions, such as congestive
heart failure, that predispose to central apneas.

As to :The studies show that the accuracy of auto-titration is equal to or superior to in-lab titrations and these are the machines we use.

For which you posted so many sources is also silly. How are you going to check the Sleep Architecture with the stages including REMs at home as is done in the lab?

Also, any chances that some of those reports in "medical" magazine are written by "Doctors" who have financial interests in pushing those products? Why should a doctor (or any person) write that at- home- titration is more accurate than if it is done in a lab? Think about it.

avi123 wrote: Santa Rosa girl, I am surprised that you do not understand that I am not refering to the "auto titration at home" issue but to the FOT and CSAD ("central sleep apnea detection") and acting upon these detections .

Check this:

The ability to detect central apneas is a useful addition to an automatic algorithm used in the treatment of OSA. Automatic algorithms respond to the presence of apneas (assumed to be obstructive) by raising delivered pressure because, although this does not treat the apnea that is detected, the pressure increase reduces the likelihood of further obstructive events occurring. If the apnea, however, is central an increase in pressure is inappropriate and may increase the chance of further central apneas. This may potentially lead to the device “running away” with progressive increases in pressure causing increasing numbers of central apneas. To prevent this from occurring the previous AutoSet algorithm would not increase pressure in response to apneas beyond 10 cm H2O. While this prevents the device from “running away” it is not ideal as obstructive apneas above 10 cm H2O are not responded to and central apneas occurring at pressures less than 10 cmH2O cause inappropriate increases in pressure. It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas.

As to :The studies show that the accuracy of auto-titration is equal to or superior to in-lab titrations and these are the machines we use.

For which you posted so many sources is also silly. How are you going to check the Sleep Architecture with the stages including REMs at home as is done in the lab?

This is precisely why the S9 AutoSet uses an enhanced autoset algorithm which does NOT increase pressure in response to a central apnea and also does adjust above 10cmH2O. While I agree that the detection of the central is perhaps new and not as well proven technology, this in no way reflects negatively on the machine since the pressure is increased due to flow limitations, snoring, and apneas determined to be obstructive. Centrals and unknowns are not responded to, only flagged and recorded for future reference if wanted.

I have more concerns with the in-lab PSG where the sleep technician does NOT look at each and every event in real time, and may actually be on break or attending another patent for part of the time. The machine's algorithm takes no such breaks and is only concerned with my data and on that night. Quite frankly I have less trust in the educated wild-ass-guess of a prescription pressure setting based on a single night's lab titration than I ever will with an ongoing and dynamically changing pressure in response to actual data and under closed loop control such as is used in the S9 AutoSet machine.

As for the sleep architecture, that is not a significant concern in simply treating OSA for which the machine was prescribed in the first place. The additional data is used to augment the original diagnosis and provide insight into other potential sleep disorders but is not significantly relevant to ongoing treatment for OSA. In addition if there had been any contra-indication such as congestive heart failure I am quite sure CPAP would not have been prescribed in the first place making those points moot.

The issue is not to diagnose the sleep disorder with the autoset machines but rather effective ongoing treatment of something already diagnosed, something the machines are designed and treatment prescribed for.

The best thing about all of this in the end is that we ALL have our own choices to make, and if you don't trust something you don't have to use it, this does not make it wrong for others to do so however.

imtired wrote:

avi123 wrote: you need to trust the machine to be your doctor. I would not trust it especially b/c it uses a still unproved technology. But many in this forum do. IMO, most posters who do it are sort of Sleep Doctors' impostors.

So my doctor prescribed an Autoset machine and by listening to him i am impersonating a doctor? I have NEVER had a problem with my S8 Autoset II. it has always been comfortable and has greatly improved my quality of life.

But it's not sure that it will improve other's quality of life. When you post the above and brag about it why should a naive newbee who suffers from ailments that you don't have, not be mislead by your statement? In such a case you have been impostering a mavin (Doc) that since your Doc prescibed it for you should be OK for others.

Where did i claim that it will work for any problem that she may have? I said that it helped me and has never caused a problem for me, and you said i am impersonating a doctor? I did not tell her to buy it, i did not tell her that it will never cause a problem for anyone. She is researching her options which includes the opinions of people who use an Autoset machine and i told her of a positive experience.

avi123 wrote:

imtired wrote:

avi123 wrote: you need to trust the machine to be your doctor. I would not trust it especially b/c it uses a still unproved technology. But many in this forum do. IMO, most posters who do it are sort of Sleep Doctors' impostors.

So my doctor prescribed an Autoset machine and by listening to him i am impersonating a doctor? I have NEVER had a problem with my S8 Autoset II. it has always been comfortable and has greatly improved my quality of life.

But it's not sure that it will improve other's quality of life.

Nor is it in any way sure that what's good for you is good for anyone else.
"Sure" is a non-issue on a forum, and only good when a person wants to score debating points.

The statistics used to analyse the evidence in medical studies assumes that a single case does not exist. It is descriptive of populations, and will be wrong for about 5% of the population by definition. Which means that for any real living person, who happen to belongs to those 5%, the study will be 100% wrong.

Let's assume for a minute that only 5% of the population gain tremendous benefit from APAP. And let's assume the OP is one of them. If she didn't try an APAP she would never get good therapy. A 5% failure rate may acceptable from a doctor's point of view, or an insurer's. A 100% failure rate is unacceptable from a patient's point of view.

A forum is about sharing opinion, information, and the anecdotes of personal experience. Anecdotes may be misleading, but they may also be highly relevant to those of us who belong to the 5% (or for that matter, 1 in a thousand) who are different. We choose what to try -- always knowing that there is no promise of success.

There's nothing more dangerous about the Enhanced Autoset than there is about any other auto adjusting algorithm. At worst, it won't work.

avi123 wrote:When you post the above and brag about it why should a naive newbee who suffers from ailments that you don't have, not be mislead by your statement? In such a case you have been impostering a mavin (Doc) that since your Doc prescibed it for you should be OK for others.

Now that sounds familiar... a person misleading by making himself sound like a mavin.. ah, I've got it: mavin posturing.

And I seem to remember some bragging too, about how great my doctor is, the best in my hometown... etc.

Do we all make mistakes? Yes we do. Do we admit them? Some do. Others simply continue to pose.

By the way, speaking of evidence based medicine, here is my all time favorite:

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
Gordon C S Smith, professor1 and Jill P Pell, consultant2
BMJ. 2003 December 20; 327(7429): 1459–1461.
doi: 10.1136/bmj.327.7429.1459. PMCID: PMC300808

ozij wrote:By the way, speaking of evidence based medicine, here is my all time favorite:

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
Gordon C S Smith, professor1 and Jill P Pell, consultant2
BMJ. 2003 December 20; 327(7429): 1459–1461.
doi: 10.1136/bmj.327.7429.1459. PMCID: PMC300808

LOL where did you find that?

Parachutes reduce the risk of injury after gravitational challenge, but their effectiveness has not been proved with randomised controlled trials

ozij wrote:By the way, speaking of evidence based medicine, here is my all time favorite:

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
Gordon C S Smith, professor1 and Jill P Pell, consultant2
BMJ. 2003 December 20; 327(7429): 1459–1461.
doi: 10.1136/bmj.327.7429.1459. PMCID: PMC300808

LOL, I love it!

I have been investigating the Autoset, specifically the Resmed S9 Autoset because of the features that it contains which is the Ramp up so that I have a chance to fall asleep before have air blowing in my face. I have a PR SystemOne with Humidifier and I was able to use it for a while in the beginning after being diagnosed with OSA but lately, I cannot go to sleep with it with all that air blowing at me. I also had issues with dried nasal passages. I was given a full face mask, I tried the nasal mask and nasal pillows. I had a new test done for sleep apnea and the team at clinic have yet to schedule me to get a new machine and they say I get what they give me so I am considering purchasing on my own. I need to know how much better it will be to use Autoset versus manual before I decide to purchase or wait for my clinician to give me their machines, whatever it is. I got tested in August and have yet to receive and appointment for machine of discussion. I see that people in this forum have a good support system with clinicians which I feel I have been lacking through my insurance and would like input from people that actually use this machines for assistance.

Thank you ahead of time for any input to assist me.

You would be better starting a new thread with your questions , so it will get the attention of people who can answer your questions .... rather than resurrection of this old thread.