CPAPtalk.com

Justin Case wrote: The "new" advancement scares me somewhat in terms of tech. I was looking for "smarter" technology that would help lower my AHI which has always been in the low teens to high single digits. Too much pressure created centrals so it took a long time to find the "sweet spot". My new sleep doc at the time said just stay with the pressure I had 'tweaked". It wasn't perfect but it was a balance.

One VERY IMPORTANT piece of smarter technology that is available on both the Resmed S9 and the PR System One Series 60 is the ability to distinguish between obstructive apneas (OAs) and central apneas (CAs). And both the S9 AutoSet algorithm and the System One algorithm do NOT increase pressure when clusters of CAs are being detected. This may turn out to be a godsend to you since you have a documented history of pressure induced central apneas.

Finally, what is also holding me back on when to buy is in part the cost. If a new model is introduced in the near future (it does seem overdue) then the older models would [ideally) be reduced in price until completely discontinued. Nonetheless, my insurance company probably likes the fact I didn't jump on a new machine at the 5 year mark since that is when they will allow me to buy a new machine/cpap supplies.

It may still be possible to find a PR System One Series 50 machine at a steeply discounted price; they were "discontinued" about 2 years ago. The Series 50 and Series 60 machines use the same Auto algorithm and both detect central apneas. The biggest difference between the Series 50 and Series 60 machines is that the Series 60 machines have an optional heated hose feature. And the Series 60 has a bit more info available on the machine's LCD.

Drowsy Dancer wrote:

archangle wrote:

hyperlexis wrote:If you are doing well on the existing machine, can deal with the possible risk of needing a new machine (fed ex works great...) then I would wait. The next generation machines are long overdue and will likely add features and improvements worth waiting for.

The next generation machines will probably "copy protect" the data and make it impossible for us users to read our data or change pressure settings. In order to protect us, of course. Coincidentally, that will probably generate extra revenue by making doctors and DME's sign up for "cloud based" services to allow them to control the machines.

Wait, what? Why are you saying this? Surely jedimark will be able to find a workaround?

DMEs are increasingly setting folks up with modem equipped PAPs in order to download the compliance data without the need to "remind" the patient to bring the SD card in or mail it in. Right now these modems are "add ons"---i.e. they are attached to the back of an S9 or a PR System One machine. And the SD card slot is still there, and (most of the time) the SD card is still in the slot when the modem is attached.

But the manufacturers are pushing the DMEs to adopt cloud based software for monitoring compliance, and the sales pitch usually is strong on the idea that the DME will no longer have to nag patients to bring in the SD card. ("You can monitor compliance easily, quickly, and automatically every day. Our <insert name> software package will even generate reports of noncompliant patients to make it easier to identify patients in trouble ....")

Resmed's DME oriented cloud software is called EasyCare and I wrote a post about it a while back in this thread Re: ResMed S9 AutoSet Questions. You can read what Resmed has to say about EasyCare at http://www.resmed.com/us/en/healthcare- ... nline.html and http://www.resmedlc.com/elearning_us/eco/

PR's cloud software is called EncoreAnywhere. The clear intention is to regard EncoreAnywhere as DME/sleep doc software that is NOT supposed to be used by patients. You can read about EncoreAnywhere at http://www.usa.philips.com/healthcare-p ... t-software and http://www.healthcare.philips.com/main/ ... efault.wpd

Because the manufacturers are pushing cloud software and automated downloads of (primarily) compliance data, it is not a farfetched idea that once most DMEs have decided to use the cloud software and modems, that in a future generation of machines, the manufacturers will decide to make the modem the standard piece of equipment and create an "optional SD card module" to slap on the back of the machine for patients who live in a remote area with unreliable cellular networks.

And cracking into "securely transmitted wireless data" is a whole different kettle of fish than staring at unencrypted files on an SD card that can be looked at with the appropriate hex editor.

I used to be able to order Philips Respironics product through our hosts to ship to Canada. I had done this previously but now I must order Resmed and Philips Respironics both from Canada. Have used Clinical Sleep for this. Even considering the free shipping from them it is still considerably more money to purchase here in Canada from a Canadian supplier versus the USA suppliers.

Ranman

I used to be able to order Philips Respironics product through our hosts to ship to Canada. I had done this previously but now I must order Resmed and Philips Respironics both from Canada. Have used Clinical Sleep for this. Even considering the free shipping from them it is still considerably more money to purchase here in Canada from a Canadian supplier versus the USA suppliers.

Ranman

I used to be able to order Philips Respironics product through our hosts to ship to Canada. I had done this previously but now I must order Resmed and Philips Respironics both from Canada. Have used Clinical Sleep for this. Even considering the free shipping from them it is still considerably more money to purchase here in Canada from a Canadian supplier versus the USA suppliers.

Ranman

robysue wrote:

Drowsy Dancer wrote:

archangle wrote:

hyperlexis wrote:If you are doing well on the existing machine, can deal with the possible risk of needing a new machine (fed ex works great...) then I would wait. The next generation machines are long overdue and will likely add features and improvements worth waiting for.

The next generation machines will probably "copy protect" the data and make it impossible for us users to read our data or change pressure settings. In order to protect us, of course. Coincidentally, that will probably generate extra revenue by making doctors and DME's sign up for "cloud based" services to allow them to control the machines.

Wait, what? Why are you saying this? Surely jedimark will be able to find a workaround?

DMEs are increasingly setting folks up with modem equipped PAPs in order to download the compliance data without the need to "remind" the patient to bring the SD card in or mail it in. Right now these modems are "add ons"---i.e. they are attached to the back of an S9 or a PR System One machine. And the SD card slot is still there, and (most of the time) the SD card is still in the slot when the modem is attached.

But the manufacturers are pushing the DMEs to adopt cloud based software for monitoring compliance, and the sales pitch usually is strong on the idea that the DME will no longer have to nag patients to bring in the SD card. ("You can monitor compliance easily, quickly, and automatically every day. Our <insert name> software package will even generate reports of noncompliant patients to make it easier to identify patients in trouble ....")

Resmed's DME oriented cloud software is called EasyCare and I wrote a post about it a while back in this thread Re: ResMed S9 AutoSet Questions. You can read what Resmed has to say about EasyCare at http://www.resmed.com/us/en/healthcare- ... nline.html and http://www.resmedlc.com/elearning_us/eco/

PR's cloud software is called EncoreAnywhere. The clear intention is to regard EncoreAnywhere as DME/sleep doc software that is NOT supposed to be used by patients. You can read about EncoreAnywhere at http://www.usa.philips.com/healthcare-p ... t-software and http://www.healthcare.philips.com/main/ ... efault.wpd

Because the manufacturers are pushing cloud software and automated downloads of (primarily) compliance data, it is not a farfetched idea that once most DMEs have decided to use the cloud software and modems, that in a future generation of machines, the manufacturers will decide to make the modem the standard piece of equipment and create an "optional SD card module" to slap on the back of the machine for patients who live in a remote area with unreliable cellular networks.

And cracking into "securely transmitted wireless data" is a whole different kettle of fish than staring at unencrypted files on an SD card that can be looked at with the appropriate hex editor.

I would make the case that the data generated from your CPAP is yours. You may be required to share it with the insurance company for payment but under HIPAA regulations, you have the right to request it. Now, the timeliness of receiving the data may be another thing all together.

ranman wrote:I used to be able to order Philips Respironics product through our hosts to ship to Canada. I had done this previously but now I must order Resmed and Philips Respironics both from Canada. Have used Clinical Sleep for this. Even considering the free shipping from them it is still considerably more money to purchase here in Canada from a Canadian supplier versus the USA suppliers.

Ranman

I admit I have only priced them for masks. I bought my latest machine from STL Mark, a member who sometimes has machines for sale.

BlowingWithTheWind wrote:

robysue wrote: Because the manufacturers are pushing cloud software and automated downloads of (primarily) compliance data, it is not a farfetched idea that once most DMEs have decided to use the cloud software and modems, that in a future generation of machines, the manufacturers will decide to make the modem the standard piece of equipment and create an "optional SD card module" to slap on the back of the machine for patients who live in a remote area with unreliable cellular networks.

And cracking into "securely transmitted wireless data" is a whole different kettle of fish than staring at unencrypted files on an SD card that can be looked at with the appropriate hex editor.

I would make the case that the data generated from your CPAP is yours. You may be required to share it with the insurance company for payment but under HIPAA regulations, you have the right to request it. Now, the timeliness of receiving the data may be another thing all together.

I would agree with you about the data generated by my machine being mine, but hacking into a secure data transmission process for which I am NOT an authorized user is still likely going to be frowned on from a legal point of view.

Right now both Resmed and PR believe they have granted patients sufficient access to their cpap data through the (braindead) web apps SleepSeeker (Resmed) and SleepMapper (PR). Both of these web apps provide basic summary efficacy data: Overnight AHI that is NOT broken down as far as OAI, CAI, and HI. And very limited leak data. And the ever present usage data.

And yes, the DMEs and sleep docs will be happy to process HIPAA requests for the more detailed data because they can charge you for it. But how practical will it be to tell a DME that you want the detailed data graphs for every day and you want them in real time---i.e. you want July 30's data available to you on July 31? My guess is that they'll laugh in your face and tell you they'll be happy to charge you for a printout of the data for a one week period and that they can either snail mail it to you (so you might get it next week) or that you can drive out of your way to pick it up that after noon.

Finally:

Here's a screen shot of the typical "detailed" SleepSeeker report:

Note the fact that there's no way to tease apart the OAI and the CAI from this data. And God and Resmed only know whether that "leak" data is the 95% leak level (which I suspect it is) or the average leak level or the median leak level. Inadequately labeled leak numbers are not very useful.

And here are some screen shots the way SleepMapper shows the data:
Home screen after logging in with "long term usage data":

Note how there is no numerical scale on this graph. Which means the graph is next to useless from a mathematical point of view.

Clicking "Therapy" gives a tool tip with numerical info on the bar graph:


Here's the Mask Fit data:

Again, there's no numerical scale on the graph. And you'll notice that there's no explanation of what "Mask Fit" means; as near as I can tell, Mask Fit is simply the percent of time when there is NOT an official PR Large Leak. Again, if you click on any one of the days, you get a tool tip with the numbers for that particular bar.

Here's the AHI data:

Yet again, there's no numerical scale. Clicking on an individual day brings up a tool tip with some numerical information, but that numerical AHI is not broken down by types of events.:


I'll end by saying this: I am very worried that the brave new world of wireless data transmission by modem will eventually lead manufacturers to NOT include SD card slots as the default mechanism for recording CPAP data. I believe that SD card modules will become an add-on device only available to patients using PAP machines in remote areas with poor cellular service. I also believe that once the default set up is a wireless modem instead of an SD card, that it will become very difficult, if not impossible, for us mere patients to get our hands on the kind of detailed data we currently have when we pop our SD card into the computer and import the data into SleepyHead, EncoreBasic, or ResScan.

robysue wrote: DMEs are increasingly setting folks up with modem equipped PAPs in order to download the compliance data without the need to "remind" the patient to bring the SD card in or mail it in.

It's quite odd. No one has asked me for compliance data for over two years. My machine does not have a modem. Apria still charges Aetna twice a year for their bogus "service contract," for which they do exactly zero, but neither Aetna nor Apria have any interest in my data.

Drowsy Dancer wrote:

robysue wrote: DMEs are increasingly setting folks up with modem equipped PAPs in order to download the compliance data without the need to "remind" the patient to bring the SD card in or mail it in.

It's quite odd. No one has asked me for compliance data for over two years. My machine does not have a modem. Apria still charges Aetna twice a year for their bogus "service contract," for which they do exactly zero, but neither Aetna nor Apria have any interest in my data.

Whatever Apria is charging Aetna for, it's not going towards the purchase price of the machine. You met your compliance over 2 years ago, and apparently Aetna is content to continue paying for your consumable supplies.

Hubby and I continue to get nagging automated phone calls every month or two asking us to punch into the phone's keypad how long each night we're using the machine and how many nights per week we're using the machine. But there's been no insistence that we provide the SD cards for "proof" since Hubby met his second and final formal compliance check.

The wireless modem "problem" affects newbies who still have to prove compliance OR people who have to reprove compliance when their insurance company authorizes purchasing a new machine to replace one that is 5+ years old.

My fear is that in the next couple of machine generations a wireless modem will become the standard equipment used to gather compliance data and that the "smart card" used to record the data and its card slot will simply vanish from the standard version of all PAP machines. Once that happens, it is not clear to me how PAPers who want immediate access to all the data will be able to get it: Neither SleepMapper nor SleepSeeker provides anywhere near the same data that we've become accustomed to seeing in SleepyHead.

robysue wrote: My fear is that in the next couple of machine generations a wireless modem will become the standard equipment used to gather compliance data and that the "smart card" used to record the data and its card slot will simply vanish from the standard version of all PAP machines. Once that happens, it is not clear to me how PAPers who want immediate access to all the data will be able to get it: Neither SleepMapper nor SleepSeeker provides anywhere near the same data that we've become accustomed to seeing in SleepyHead.

If this happens it will first be done by one ( or two ) of the industry leaders (Resmed / PR). When and if it happens may be time for market-share-catch-up by the one or more of the other xpap manufacturers such as FP, Devilbis, Puritan Benit, etc. Surely, any cpaper who values his/her data will be inclined to buy only from those who sell machines that will provide it. And maybe one of these other companies will realize that they can capitalize on this niche market by attempting to become our favorite supplier!

Yes, I know that we are a minority of the market. But I have to believe that there would be room for a niche market supplier (or more than one) in this still-growing industry.

the "smart card" used to record the data and its card slot will simply vanish from the standard version of all PAP machines

The technology may change, but I can't imagine the data not being available. Most of the planet is moving toward openness and personal freedom and responsibility.

DeadlySleep wrote:The technology may change, but I can't imagine the data not being available. Most of the planet is moving toward openness and personal freedom and responsibility.

What planet are you living on? I might like to move there, because that's certainly not the planet I'm living on.

What planet are you living on? I might like to move there, because that's certainly not the planet I'm living on.

It's happening in all modern societies. (N. Korea, Syria, many countries in Africa, some in L. America, etc. are different.)

This forum, which reaches many countries, is an example.

Sorry you are missing out on it. Maybe it is not where you are living. Maybe it is your mindset?

I have been away on holidays and I noticed just last night my APAP is sounding a bit "different" than before. The time might be coming afterall.

Looks like I will be leaning toward PRS1 60 series Auto; however, the hose appears to be a custom hose, not a universal fit. Can anyone confirm that I can use my older hose and buy inexpensive generic hoses to work with it?

Additionally, it was posted the older 50 series use the same algorithm as the 60 to detect centrals and OSA so I am willing to consider looking at that model too. I am not sure if I have found the correct machine on cpao.com. Is this the discontinued 50 series auto cflex: https://www.cpap.com/productpage/respir ... -flex.html.

Once again, thanks for your opinions everyone.