New CPAPer - Preping For First DME Interaction

I've been reading a lot of info and blogs as recommended. One of my initial "opinions" regarding CPAP machines is that I should strive to get a Resmed S9 Auto. Seems like the nicest of the bunch: Quiet, user friendly, etc.

Am I thinking in the right direction?

Personally I'd go with the Respironics DS560TS, but that's a Ford vs. Chevy kinda thing.

The Resmed is a good unit but be sure it's the S9 AutoSet and not the Escape Auto.

Bama Rambler wrote:Personally I'd go with the Respironics DS560TS, but that's a Ford vs. Chevy kinda thing.

The Resmed is a good unit but be sure it's the S9 AutoSet and not the Escape Auto.

I agree that it is ford vs chevy thing. Both the machines are great. And definitely don't get anything with the word escape. I have the Resmed Autoset, and I am very happy with it. I have never tried the Respironics machine, so I can't offer an opinion. I do hear great reviews about it from people here.

JCWarrior wrote:I've been reading a lot of info and blogs as recommended. One of my initial "opinions" regarding CPAP machines is that I should strive to get a Resmed S9 Auto. Seems like the nicest of the bunch: Quiet, user friendly, etc.

Am I thinking in the right direction?

You want to go with a full efficacy data machine. It doesn't really matter if you wind up with a Resmed S9 AutoSET or a Philips Respironics Series 60 System One Auto CPAP. But you do NOT want to wind up with the Resmed S9 Auto Escape model.

And if all you say to the DME is "I want an S9 Auto," there's a very high chance that they'll sell you an S9 Auto Escape.

The two biggest distinctions in CPAP and machines that you really need to watch are:

Full data logging vs limited or no data logging.
Auto adjusting vs manual only.

Fill data logging is by far the most critical. Data logging means the ability for you and/or your doctor to evaluate the quality of your treatment and adjust it as necessary. Without the log data not even your doctor can evaluate the effectiveness of your treatment at home. Why any doctor would allow that scenario is incomprehensible to me if they cared at all about following up on your treatment long-term.

Auto vs manual isn't as important. Auto will help compensate for a prescription that is two low to be effective, and it is nice for people figuring it out for themselves, but it really shines for people who regularly vary in their pressure needs. An auto machine can be set to stay at a lower pressure most of the time but increase temporarily when necessary (like when someone hits a REM cycle while sleeping on their back). But by analyzing the logged data you can adjust a manual machine to a single pressure that is the best compromise or average for you.

I think the other differences are nice, but not typically essential. The exhale pressure relief feels a bit different in different machines. Heated hose options are nice. S9s have a mask fit test feature. The noise they make is a little different in volume and tone. But you should still be able to get an effective treatment from the machine regardless.

Thanks everyone for the responses. Greatly appreciated!

Bama Rambler wrote:Personally I'd go with the Respironics DS560TS, ..........

So I have to ask.... why is that?

It's that Ford vs. Chevy thing. I have a PR System One 60 series, so it's what I know and I like it, so I can't see switching to something else. However, If I had gotten a Resmed S9 AutoSet I'm sure I'd feel the same way about it.

Most people haven't had a chance to actually use more than one brand/model of machine so they will tend to recommend the machine they use because they don't know about the other brands.

I have happened to use both the Respironics PR S1 and the ResMed S9. It is a Ford vs Chevy thing for the most part.
Minor pros and cons with either but none are deal breakers especially since the PR S1 now has the optional heated hose to compete against the S9 Climateline optional heated hose.
It's pretty much a toss up. I like both machines.

If your pressure needs are going to be in the teens though...I would lean towards the S9 as I think that the way that machine offers exhale relief might be of some special use at the higher pressures.
Not saying that the PR S1 Flex relief is crap because it sure isn't and in fact probably feels a bit more natural but the drop in pressure available with the S9 during exhale is more dramatic and from my own personal experience with it...at the higher pressures it might be a bit more comfortable to get adjusted to.

So when insurance is involved and pressures are in the teens..I would lean towards the S9 because of the exhale relief offered with higher pressure needs.
If insurance isn't involved and buying out of pocket...I would lean towards the PR S1 and it usually is significantly less expensive and the exhale relief is till great.
ResMed and Respironics go about the exhale relief differently and it's not so much a which way is "better"...they are just different.
Kind of like which is better "Steak or lobster"...depends on what you like the best.

I'll mention one thing since Pugsy brought it up. I turned exhale relief completely off after the first night because I didn't like it reducing the pressure. I have no idea if I'd like the AutoSet's way of doing it, but most likely I'd turn it off on that machine too.

P.S. While it's a Ford vs. Chevy thing, I drive a Cummins wrapped in a Ram!
Real trucks don't have spark plugs!

Bama Rambler wrote:I'll mention one thing since Pugsy brought it up. I turned exhale relief completely off after the first night because I didn't like it reducing the pressure. I have no idea if I'd like the AutoSet's way of doing it, but most likely I'd turn it off on that machine too.

The actual amount of reduction using the Flex option with the PR S1 machine is really minimal. Flex is more of a rhythm thing in terms of when the reduction starts during the breath than it is the amount of reduction.

Now the S9 and EPR..it can be a substantial reduction up to 3 cm and for some people it just makes the whole breathing against the wind thing so much easier to sleep with and adjust to.
Sometimes a little pressure adjustment is needed if that reduction allows some apnea events to slip past the defenses.

I always figure a person has to get the sleep first...that's the primary goal and if they can't breathe comfortably then they aren't going to sleep well. Some people think that 5 cm pressure is like trying to exhale against a category 5 hurricane wind and some people start off at 15 cm and think it's a gentle breeze and don't need or want exhale relief in any form.

Since we never know which way a person is going to lean...I figure better to have something and not need it than need it and not have it.
I have used both EPR and the Flex exhale relief. At the higher pressure needs EPR is likely to be a bit more comfortable for those people who have difficulty exhaling against the pressure...so that's why I suggest it...to have it available if needed.
It's more like a bilevel machine in terms of relief.

I actually used my S9 VPAP in cpap mode with EPR to 3 and again in fixed bilevel mode with PS of 3 at settings that were identical for inhale and exhale in either mode...and EPR of 3 felt almost identical to using bilevel pressures and PS of 3. Timing was just a bit different but most people probably wouldn't notice and I did because I knew it might be a little different.

Flex relief...I thought CFlex was useless and turned it off...then I got a machine that offered AFlex and I fell in love immediately. I didn't need the relief but I sure liked how it felt and my AHI never suffered and I actually slept better using AFlex. So since I slept better with it...that's my primary goal...get good sleep first and worry about AHI second.
AHI of 0.0 doesn't mean squat if the overall sleep quality is in the toilet.
Anything that helps us get to sleep, stay asleep or get better sleep ...is fair game to use or try IMHO.

Pugsy wrote:
Now the S9 and EPR..it can be a substantial reduction up to 3 cm and for some people it just makes the whole breathing against the wind thing so much easier to sleep with and adjust to.
Sometimes a little pressure adjustment is needed if that reduction allows some apnea events to slip past the defenses.

I always figure a person has to get the sleep first...that's the primary goal and if they can't breathe comfortably then they aren't going to sleep well. Some people think that 5 cm pressure is like trying to exhale against a category 5 hurricane wind and some people start off at 15 cm and think it's a gentle breeze and don't need or want exhale relief in any form.......

This was my biggest issue/complaint during my titration sleep study. I hated having resistance when exhaling. The tech stated it was on the lowest setting until I could get to sleep. Still wanted it lower.

JCWarrior wrote:This was my biggest issue/complaint during my titration sleep study. I hated having resistance when exhaling. The tech stated it was on the lowest setting until I could get to sleep. Still wanted it lower.

Ahh..then you may be one of those people who think 5 cm is a hurricane.
These machines normally can't go below 4 cm..not sure what the tech was using but it was likely 4 or 5 cm to start with.
Believe it or not but people do get used to exhaling against the hurricane but for some people it takes a lot longer for that adjustment than for others.
Also, what seems like a hurricane when we first turn the machine on will feel like a gentle breeze in the morning or middle of the night to the point that you think the machine isn't working. Happens all the time.

Respironics and ResMed machines...4 cm is as low as they will go.

Not sure if you can tell from this pic I took before my test but the unit is in upper right corner.

Pugsy wrote:The actual amount of reduction using the Flex option with the PR S1 machine is really minimal.

The manual for my machine states that the max reduction for C-Flex+ is 3 cmH2O same as the S9 EPR. But, not having used both I can't say how the algorithms differ.

Pugsy wrote:I always figure a person has to get the sleep first...that's the primary goal and if they can't breathe comfortably then they aren't going to sleep well.

Totally agree. Whatever it takes to get you there.

Pugsy wrote:... and some people start off at 15 cm and think it's a gentle breeze and don't need or want exhale relief in any form.

That's me. I breathe into 15 cmH2O just fine and think I'm being starved for air if there's a reduction.

Pugsy wrote:Flex relief...I thought CFlex was useless and turned it off...then I got a machine that offered AFlex and I fell in love immediately.

Since I have my machine currently running Auto-Trial mode I decided to try A-Flex and didn't like it either. I guess I'm just one who doesn't like the pressure relief at all. That also reinforces that everyone is different.

Pugsy wrote:AHI of 0.0 doesn't mean squat if the overall sleep quality is in the toilet.
Anything that helps us get to sleep, stay asleep or get better sleep ...is fair game to use or try IMHO.

We fully agree on that too.

As a side note; I worked for many years on a hazardous spill rescue team and we were constantly wearing SCBA's. They provide constant pressure no matter what. That may be the reason I don't like the pressure reduction, as I equate it to either running out of air or equipment malfunction. Neither of which are good.

I used to have a good friend that always said "It's better to have it and not need it than to need it and not have it."

Bama Rambler wrote:

Pugsy wrote:The actual amount of reduction using the Flex option with the PR S1 machine is really minimal.

The manual for my machine states that the max reduction for C-Flex+ is 3 cmH2O same as the S9 EPR. But, not having used both I can't say how the algorithms differ.

Are you sure about this??? If so, can you scan in the page that says that when C-Flex+ is set to 3, you get a 3cm reduction in pressure on exhalation?

The reason I ask is that I've just reviewed both the user and clinical manuals for my System One BiPAP Auto. And while both indicate the maximum exhale relief is achieved with a Flex setting of 3, neither of them makes the claim that the Flex setting is equal to the amount of pressure relief measured in cm H20. In other words, there are no units attached to the Setting number. A setting of "3" just provides more relief than a setting of "1" does, but the amount of relief in both settings depends on the force of the exhalation.