Sleep doctor told me Resmed algorithm less aggressive

Disgusted wrote:I saw my old sleep doctor today and was complaining that the Resmed S9 Autopap I got from my DME six months ago is not as effective. He explained to me that Resmed is claiming the older S8 algorithms were too aggressive at detecting and scoring apneas and hypopneas, so the current S9 is not as aggressive. And I feel it too. Im on the same pressure as I was on the S8, but my shortness of breath has come back and my sleep has become nonrestorative again.

All of this is with an extremely low AHI of between 2 and 3! According to my sleep doctor, my sleep apnea is under control because I have a low AHI. But I feel worse!

My sleep doc claims this is all due to Resmed making their algorithm less aggressive. I dont understand why they would do that, it seems that would make the equipment less effective than what I was used to. My sleep doc raised my minimum pressure .5 points today to try to compensate and improve my therapy "back to normal" as he said.

What is going on at Resmed?

Disgusted

When did you notice the return of your shortness of breath and feeling worse? Has the shortness of breath started within the last three or four months?

Disgusted wrote:What is going on at Resmed?

Disgusted

Sound familiar? Could this be EricinNC trying to come back?

idamtnboy wrote: Sound familiar? Could this be EricinNC trying to come back?

That was my first thought, too. Apologies to Disgusted if this is not the case.

Maybe ResMed found that the old algorithm was giving too many false positives?

Not sure if there isn't some truth in this. I have both an S8 II and an S9, and due to circumstances (two warranty repairs on the S9), the S8 became less of a backup machine and was used continuously throughout February until late March. Since then I've used the S9, and lately I've been feeling dissociative and headachey. Now, I've had a cold/flu for about a month that seems to come and go, so this is almost certainly clouding my observations, but out did seem to me to be the case that I felt "less worse" on the S8.

Of course, subjective experience is a poor substitute for experimental data. Still, next week I'm down the coast and I'll be taking my trusty S8, so I'll see what that does.

There are two sides of any xpap machine: the part that records data and the part that provides therapy. The algorithm used to provide therapy may not have changed very much between the S8 and the S9, even if the routines that record data have. (I don't know one way or the other.) Every machine design has quirks and bugs. When I used the M-Series, it was the 28-day missing-data bug. Now that I have the S9, it's a skew bug in the data. In both cases, it's generally the data side that has flaws. As far as I know, neither Respironics nor Resmed has needed to recall machines for bugs in therapy firmware. If the data were just plain wrong, it might be enough for a recall, but a missing day or two every month or a skew in a graph aren't enough that the user or the doctor could grossly misinterpret available data when titrating based on data from the machine. So long as therapy is being provided, that's what really matters.

Less aggressive recording of hypopneas doesn't mean it's less aggressive in supplying therapy.

There are going to be differences in how you titrate from brand to brand, model to model, even perhaps machine to machine. My settings for the M-Series were a merely starting point for figuring out what my S9 autoset shout be set at. I had to tweak my settings for optimal therapy. Likewise, it's more productive to recognize that settings for the S8 are only a starting point for what your settings should be on the S9. I'll bet if you were to switch out your current S9 for a new S9, you may find that some tweaks are still necessary due to tolerances and variances even between machines.

To recap: this is cooking - not chemistry. Optimal therapy numbers are going to be different even from machine to machine. We're looking for a recipe for success. It's more about how you feel. Find the optimal range of settings for any particular machine. If I cannot find optimal settings that work for me, it may be time to consider a different brand with a different therapy algorithm.

You're EricInNC. Or Mikey. Probably Both.
Go away, pest.

DreamDiver wrote:You're EricInNC. Or Mikey. Probably Both.

Ditto

DreamDiver wrote: There are two sides of any xpap machine: the part that records data and the part that provides therapy.

Excellent point. Well said, IMO.

Although I personally don't like the idea of the low HI scores the S9 gives (for convenience reasons only, because of how I use S8 scoring for my trending), I have no doubt the S9 gives great therapy.

And the inconvenience (in my opinion) of the low HI scores is more than counter-balanced by the depth of the information the S9 provides when used with the software--including flow-limitation information and actual flow curves for each breath.

DreamDiver wrote: . . . Less aggressive recording of hypopneas doesn't mean it's less aggressive in supplying therapy. . . .

IMO, well said again.

DreamDiver wrote: this is cooking - not chemistry.

Perfect! I've never heard it put quite that way, but that sums it up beautifully, I think. The properties of every brand and model of oven differ. The trick is to monitor what you bake every night and to develop an eye for when all is going well in the oven! A good cook will use the tools at hand to make things work out the best with whatever oven is at hand so that every night is baked consistently so life can be as tasty as possible.

I'm hungry now.

Thanks, DreamDiver.

WRONG! They are two totally, completely different algorithms and this is coming directly from a very reputable sleep medicine doctor's mouth. Yesterday I was told very specifically that Resmed changed not only the scoring system but also their detection to crank up the pressure while you are in your sleep. Resmed has intentionally desensitized their algorithm because in my sleep doc's words, "Resmed claims the old algorithm was too aggressive at detecting and treating events."

Right and your sleep doctor is an engineer working for Resmed and has seen the detailed and probably patented specs and can read and understand them?

So buy another machine already!

You're EricInNC. Or Mikey. Probably Both.
Go away, pest.

Yes probably

Guest wrote:I smell a class action lawsuit against Resmed.
Disgusted

Compare to viewtopic.php?f=1&t=62121&st=0&sk=t&sd= ... ass+action.

Any more need to point out who Disgusted really is? I think he just blew his second chance to become an acceptable member of this forum, a member who would and could be helped if he would have exhibited a less confrontational attitude. Sad, really sad.

.

Like what sleep doctor knows or understands diddley-squat about these PAP features and how these PAPs work??? Snort!

I love my S9 Autoset; nobody gonna change my mind.
Uh-oh, got to keep on breathin'.

idamtnboy wrote:

Guest wrote:I smell a class action lawsuit against Resmed.
Disgusted

Compare to viewtopic.php?f=1&t=62121&st=0&sk=t&sd= ... ass+action.

Any more need to point out who Disgusted really is? I think he just blew his second chance to become an acceptable member of this forum, a member who would and could be helped if he would have exhibited a less confrontational attitude. Sad, really sad.

Actually, this will mark his third attempt. Before he was EricinNC, he was Mikey (avatar: ResmedUser). He's also had several other incarnations that were relatively low key, comparatively speaking. Now he using anonymizing software to keep his IP from being logged as one of his previous avatars. He won't log in because he'll be banned by Carolyn again.

He doesn't want help. He wants to rail. He broke his machine because he whacked it off the nightstand by the hose while turning over. I wouldn't be surprised if the machine actually went airborne over the width of the mattress and hit the wall on the opposite side of his nightstand. It might be fun to calculate the speed at which the machine hit the wall, and what size the dent would have been in the wall board.

He's been using a System One for months, but he hates that he can't get his money back from ResMed and thinks that by coming here and pestering end users, he will get ResMed to acquiesce and give him his money back. What is it they say about people consistently repeating the same actions while expecting a different outcome?