"please keep me updated about oximeters "
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ResMed Peculiarities
Hi Mike,
Congratulations with your new machine. Resmed Autoset is standard equipment here in Denmark and I am convinced that it is a very good machine.
At a time when I had some problems with my treatment, I spoke several times with Resmed and I got some information’s that you can't find in the manual.
Unfortunately, we here in Denmark use this machine usually with an open window at 4-20 cmH2O. I think this is mainly due to the Resmed Autoset automatically corrects the pressure for leaks.
But I agree with ink, that the machine should be set to +/- 2 cmH2O compared to measured need pressure. As ink mention the machine in some cases doesn’t set up the pressure quickly enough to avoid an apnea.
But another problem is that when the pressure is set up the machine will maintain this pressure for 20 minutes. So a single leak can give an exaggerated press for 20 minutes.
Resmed is altso known to over count Hypopneas. I have spoken with Resmed about that, and they recognize this. But they told me that I should not even think about Hypopneas since the machine will always treat Hypopneas.
At one point I bought a card reader and the diagnosis program to the machine, and I can clearly see that Hypopneas always is treated well, unlike the apneas where the machine can’t do anything and just wait until the apnea is released and then set up the pressure.
So the answer from Resmed is that you only have to look at the AI.
Henning
Congratulations with your new machine. Resmed Autoset is standard equipment here in Denmark and I am convinced that it is a very good machine.
At a time when I had some problems with my treatment, I spoke several times with Resmed and I got some information’s that you can't find in the manual.
Unfortunately, we here in Denmark use this machine usually with an open window at 4-20 cmH2O. I think this is mainly due to the Resmed Autoset automatically corrects the pressure for leaks.
But I agree with ink, that the machine should be set to +/- 2 cmH2O compared to measured need pressure. As ink mention the machine in some cases doesn’t set up the pressure quickly enough to avoid an apnea.
But another problem is that when the pressure is set up the machine will maintain this pressure for 20 minutes. So a single leak can give an exaggerated press for 20 minutes.
Resmed is altso known to over count Hypopneas. I have spoken with Resmed about that, and they recognize this. But they told me that I should not even think about Hypopneas since the machine will always treat Hypopneas.
At one point I bought a card reader and the diagnosis program to the machine, and I can clearly see that Hypopneas always is treated well, unlike the apneas where the machine can’t do anything and just wait until the apnea is released and then set up the pressure.
So the answer from Resmed is that you only have to look at the AI.
Henning
Views: 22
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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jnk I disagree with the event by event statement. We have experiemented with most of the machines in the lab and have found that the Resmed machines will react to a single event imitated by holding your breath for 10 seconds one single time. We have done this experiment with many different machines all to the same effect. This would be an event by event situation. The Respironics will also react but after more event simulations. I also belive that the Resmed algorithm is inferior to the Respironics. According to your own post the rules by which the Resmed Auto algorithm follow are not as strict or aggressive as the competition.
http://www.sleepguide.com/forum/topics/in-laymans-terms-someone?x=1...
j n k said:As I understand it:
Nothing peculiar about ResMeds.
Leak is adjusted for automatically, like most machines, but the machine knows the difference between leak and a change in breathing and reacts accordingly and appropriately.
ResMeds are known for lowering treatment pressure gradually compared to some brands, but gradual is generally considered a good thing when it comes to allowing sleep architecture to remain undisturbed.
No machine "overcounts" or "undercounts" hypopneas. All machines count them differently because of each brand using its own definition. Machines give estimates only, since they do not monitor brain arousals, blood O2, or heart rate, in reporting hypopnea events.
Machines don't really treat events event-by-event. They monitor breathing in order to find what pressure is most likely to prevent events from occurring, while attempting to keep pressure as low as possible when breathing seems to have normalized.
I agree that the AI is the most important number from a ResMed. Once you get AI below one, you decide how to tweak from there if you want to address the lesser events as well. If your AI is below one and you are not desaturating overnight, as confirmed by a recording oximeter, you are doing well. I would only tweak further if I felt my sleep wasn't as refreshing as it could be.
jeff
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jink I am not saying that the Resmed machine is bad. just peculiar. We are debating schemantics here. Both are great machines. This experiment was done quite a few times with several different Resmed machines. So it is my opinion thta the Resmed machine will react and raise the pressure due to a single event. I would say that attacking/ reporting flow limitation at an 80% reduction in effort over 75% would make one machine more aggressive than the other. Just my opinion though. I am not a PAP user though I just get paid to organize and present the data.
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It is my findings that if you take both an S8 II and a Pro M on auto mode with wide open ranges that the resmed units will be more likely to over titrate than the respironics. I will retract that the resmed is inferior to the respironics. They are both the best available machines out there. I believe that the Resmed algorithm requires a shorter leash in auto mode.
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But it is a debate jnk. What you are saying is that a human is more likely to make a mistake than the machine. Which may be correct. This does not mean that the machines are perfect. It is the overall goal in PAP therapy to find the LOWEST pressure that prevents events from happening. Whether a human or a machine goes over this point it is considered an over titration. The Resmed machine will over titrate with a range of 4-20cmwp more oftern than the respironics version.
When you are talking comfort and compliance "overtitrating " could be the difference between a good therapy and a failed one.
If we could get 2 volunteers representing each of the new machines by each company. These people would have to have relatively the same optimal titratration level say 10cmwp as a median. If these people set thier low end to 9cmwp and their top end at 20 for 2 weeks. i would bet my pay check that the Elite would over titrate more than the Pro M. Based on my findings that the Resmed will score awake event as well as single ones. Maybe my findings were wrong. Maybe not.
Any volunteers?
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Permalink Reply by Judy on
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The number of Puritan Bennett GoodKnight 420Es out there is miniscule compared to the number of Respironics and Resmed APAPs out there and in use - but - of the number of PB 420E users taking part in these online apnea support forums who sing the praises of their device and the lack of complaints of any kind leads me to believe that the PBs are a superior brand xPAP. Whether that will hold true now that Covidien has taken over PB - we shall see.
I think that the Covidien Sandman Auto is worth keeping an eye on for those wanting an APAP.
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I happen to disagree jnk. the median would be the pressure that the machine chose for optimal titration. the machines are basically held to the same sets of rules for scoring that a human is. they however do not measure all of the same parameters.
If overtitration is not a factor then the auto machines by your standards should not be bookended with a max. They should be allowed to go as high as the algorithm deems fit. That is what i am getting from your statements. The machines are not smart enough to understand limits without rules. One of the reasons that an all out range of 4-20cmwp is bad is that sooner or later they will reach 20cm whether it is optimal for your treatment or not.
j n k said:My point is that the machine is not well-designed to give a set number for treatment. That's what a PSG is for, in my opinion.
If someone decides to use a home auto machine in an attempt to find a number for a set treatment pressure, that is something a human is doing, to my way of thinking, not the machine, since the machine can only report a centile, and isn't smart enough to report a number that is as useful for fixed-pressure treatment as the PSG number would be.
So no, I'm not saying a human is more likely to make a mistake than the machine. I am saying the human is the one doing that kind of titrating, really, not the machine. The machine's form of titrating that it is good at is titrating for the moment. The human form of titrating is trying to find the one pressure that will get rid of events. So it takes a human to guess that based on the humans interpretation of what the machine reports.
I know some use the machines that way. But that is because they are choosing to use the 95% pressure, or the 90% pressure in that way. And manufacturers encourage that, I know. That pressure is not really a titrated pressure, though, it is a number the human can use to choose to use, or misuse, in that way.
So my point is that no machine overtitrates, because no machine actually says it has found a single pressure to use. It is designed to run without being set at one pressure. If the human fails in that the human chooses a pressure higher than the PSG titration would have found, that is a failing of the human, not the machine, in that the human misunderstood, in my opinion, the meaning of the 90% pressure, or the 95% pressure, depending on the brand.
Auto-titrating machines do not automatically find a single pressure that the machine recommends for treatment. Not really. Humans sometimes collect data from a machine so that the human can choose what the single treatment pressure should be according to that humans judgment. That is why I am saying "machines don't overtitrate, humans do." That is because, for that definition of titrate, auto-titrating machines don't titrate at all. I think a PSG should be used for that. A home machine can be used that way, but if one lands on a higher pressure than another, all a human has to do is adjust the reported number accordingly.
In that respect, I am disagreeing with the manufacturers who say their machines make PSGs obsolete. I agree that the 95% pressure or the 90% pressure can be used as a starting point for finding a good fixed pressure. But I view that as a starting point only, since my thing is the patient tweaking using data.
Rock Hinkle said:But it is a debate jnk. What you are saying is that a human is more likely to make a mistake than the machine. Which may be correct. This does not mean that the machines are perfect. It is the overall goal in PAP therapy to find the LOWEST pressure that prevents events from happening. Whether a human or a machine goes over this point it is considered an over titration. The Resmed machine will over titrate with a range of 4-20cmwp more oftern than the respironics version.
When you are talking comfort and compliance "overtitrating " could be the difference between a good therapy and a failed one.
If we could get 2 volunteers representing each of the new machines by each company. These people would have to have relatively the same optimal titratration level say 10cmwp as a median. If these people set thier low end to 9cmwp and their top end at 20 for 2 weeks. i would bet my pay check that the Elite would over titrate more than the Pro M. Based on my findings that the Resmed will score awake event as well as single ones. Maybe my findings were wrong. Maybe not.
Any volunteers?
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I think that Puritan is involved in to many different aspects to stay competitive in the CPAP. Did you know that they also produce some of the best house hold apliances on the market. Our DME does not stock their units anymore.
Judy said:The number of Puritan Bennett GoodKnight 420Es out there is miniscule compared to the number of Respironics and Resmed APAPs out there and in use - but - of the number of PB 420E users taking part in these online apnea support forums who sing the praises of their device and the lack of complaints of any kind leads me to believe that the PBs are a superior brand xPAP. Whether that will hold true now that Covidien has taken over PB - we shall see.
I think that the Covidien Sandman Auto is worth keeping an eye on for those wanting an APAP.
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Yes, I"m aware that they are big into household appliances - or is it Fisher & Paykel that is big into household appliances??. There are plenty over at cpaptalk that have had the opportunity to use most of the major brands' models and they swear by the PB 420E as the best of the lot. I have yet to read a complaint about a 420E. Maybe your DME just never provided the 420E since it is an auto.
And Philipps (Respironics) is big into men's razors ... *wicked grin*
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I agree with pretty much everything that you have said jnk. You are pretty great at stimulating this techs mind. I think that we are going to have to agree to disagree on the overtitrating theories. I do still think that both machines will eventually overtitrate if given a chance. the Resmed more often than the respironics. Maybe one day someone will do my experiment. I also have a different view of median pressures as they do not fluctuate to much from night to night making them optimal pressures for that machine. An optimal pressure chosen by that machine based on man-made rules.
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jnk I owe you an apology. the Resmed unit's algorithm is actually more aggressive at attacking apneas. Not by much, but facts are facts. Resmed attacks apneas at a 75% reduction in respiratory effort while the Respironics is at 80%. For some reason I was doing the math from 100% rather than 0%. Confused myself. I do still think that the Respironics algorithm is a little more advanced, and that the Resmed will score individual events long before it's competition. Tha t extra 5% may level the field though.
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