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difference between Apex XT Auto and Resmed S9 Autoset
Have noticed the S9 is a well recieved machine and was wondering what the advantages there would be in having the S9 over the XT Auto, if any. I am asking both in regards to the machine itself and would also like a comparison between the Easy Compliance Software vs Sleepyhead.

Can there really be any real reason to consider the S9? And why? Can anybody guarantee that I would get better therapy than my XT Auto?
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A part of this question is to ask how you are doing on the XT Auto. If you are well rested, comfortable and feel the software gives you the feedback you need, then there is certainly no reason to consider the S9. The Resmed S9 Autoset would provide a faster response to obstructive clues like snores and flow limits, and would head off OA more effectively from a lower starting pressure. That could be good, or you might find it more disruptive. I'm not familiar with how the XT provides exhale pressure relief, but the S9 closely mimics a bilevel with a pressure support limited to 3 cm. That should provide a comfortable transition between inhale and exhale, and likely keeps you at lower pressure during exhale. The data differences are pretty obvious. The XT reports events and pressure, but does not give you the detailed flow record. I'm not sure if the XT differentiates between CA and OA.

No guarantees, other than many people use the machine successfully. It's really like upgrading your car or your house. Are you happy with what you have and getting acceptable results? If so, maybe you don't need the premium model.
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Here is my data for 88 days of use:

Average AHI : 2.46
Average Pressure : 9.0 cmH2O
Average 90th Percentile Pressure : 9.8 cmH2O
Average Leak : 55.1 lpm
Average Time with Large Leak : 0.2 min

The AHI for 88 days breaks down as follow:

Apneas: 54, Index: 0.09
Hypopneas: 1405, Index: 2.37
Vibratory Snoring: 4, Index: 0.01

Regarding leaks I discovered in a test that my two masks one having an exhaust flow of 24 lpm and the other having 20 lpm both at 8 cmH20, being tested at 8 on my machine while awake with my mouth closed and no leaks both averaged between 54-56 lpm. Notice my 88 day average is 55.1. This suggests to me that while there are ups and downs in my leaks wherever they come from, my mouth or mask leaks that I assume I'm doing quite well in this department.

As far as how I'm doing, I feel better by a lot since I have switched to an auto cpap compared to 16 years on a constant pressure cpap at 11 cmH20 while letting the mask leak on purpose to make it easier to breathe. Since I got my new cpap I have slowly gotten used to sleeping comfortably with the mask sealed as best as I can.

I still can have times when I feel not real good and also it is still common for me to have times where I feel sleepy. It's also common for me to fall asleep in the kitchen chair and sitting at my computer desk as well as sometimes have issues trying to stay awake while driving. But, in my case I think there are other factors that need to be considered. I have diabetes and when my sugar rises after eating that's when I feel sluggish and tend to fall asleep in a chair. Also, I had a pretty bad pulmonary embolism in 1982 which I suspect is not helping this. I started falling asleep in chairs etc after I got diabetes in about 1995 so i suspect this to be the major contributor to this issue. I didn't get my first cpap until 2000. My health care provider has recently ordered a lot of lab work to see how things look after I brought this up. Otherwise, through the years I have become accustomed to thinking this is just the way it is for me and try to work around it.

I have my pressure relief set to 3 cm which is so much more comfortable to me compared to the old constant pressure machine.

I don't think the XT auto senses CA but on the other hand it seems to me I have a super low apnea issue to begin with. So, maybe this is not an important issue??

Don't know what the flow record is all about as I don't believe I have that feature. What is that all about and is it really important with all the other known data that I do get?

The main thing is since I don't have any insurance I am trying to get the best cpap therapy I can on my own. Maybe this will change next year when I can get on Medicare.

It seems to me the software gives me the feedback I need to try and make adjustments along the way when my data gets less than optimal. But, I don't have any first hand ability to compare with anything else.

Basically I just want to make sure I'm getting the best cpap therapy I can and to feel as good as I can along with trying to deal with the blood sugar swings. Economics played a major role in the choice of my cpap. I did spend a lot of time reading reviews on suppliers websites realizing one has do read between the lines and that some give good accurate reports while others don't know what they are talking about and/or may not have the machine set right and any other number of factors. I also picked a supplier that was highly recommended on this forum. The owner is a respiratory therapist and in talking to him he is committed to helping people.
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Have you tried slightly higher minimum pressure to attack the hypopnea? Your AI is excellent. Your data says you're well treated, and might be able to improve if you eliminate hypopnea. The only tool in your box is pressure, so assuming the hypopnea is obstructive, we use that tool to address it. If it doesn't respond, then certainly pursue comfort as the top priority.

As to your original question, I think you're making the most of this and any incremental benefit of the S9 is probably very small, thanks to your very diligent effort to work with the machine and data you have and optimize things. I do think the S9 would more aggressively apply pressure in response to the volume reductions of the hypopnea events, and you can do this for the XT Auto by increasing minimum pressure.
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Thanks, Sleeprider. That's good to hear. Actually a relief to be more certain my therapy is going well. I really appreciate your expert advice.

No, I have not increased my minimum for that reason. Well, maybe I did and didn't fully realize it as part of the reason I raised the minimum to 8 was after reading the comparison between the different brands you posted. I did increase it along with my initial pressure both set the same to make it easier to breathe more comfortably especially when I first turn on the machine.

I do know I have hypopneas when my pressure rises too. But I assume you mean if I raise the bottom some I will get less of them in the low end. It also seems that no events take place when my leak rate rises higher than usual. I suppose that could be just the way it really is or I understand that all the machines could possible miss events if it goes to a range higher than it can react.

What would you suggest I should start raising it to? After having 11 cmH20 for 16 years I can tell you that I am pretty comfortable with higher pressures. So, I could probably handle going up more than the .5 increments I hear about quite often.

The only thing that has me a little puzzled though about my cpap is something I've just recently noticed. Very occasionally I have noticed in the graph a spike down in pressure. It seems that when that does happen a hypopnea shows up. Again, I just noticed this this week and I have seen it go down around 2 cm in a minutes time, about the same time I notice a hypopnea and then the pressure rises the next minute. The other night I had two of those. I don't notice it while sleeping though as far as I know.

But, I am watching this more closely now as very occasionally when I first turn on the machine and am enjoying the pleasant feeling like it's almost breathing me and I will feel like a wall comes up and feels hard to breathe in or out. I wondered if it sensed an event and shut off the exhale relief as the manual states it does until things are corrected. But the other night I noticed on the graph that it dropped around 2 cm for a minute. In the little I have been checking this out I did notice it dropped I think it was 3.6 cm in a minutes time and went back up in a minute also I will watch out for this now if I experience it while falling asleep and see if there is a connection. For all I know it could be me falling asleep, starting to relax completely and my throat closing off. Or, maybe it's simply a software glitch. Either way I am going to be monitoring this. In the end if it is a little glitch that actually is occurring then I'm thinking an extra one or two hypopneas once in a while is no big deal. Maybe this is not uncommon in any cpap? I also have wondered if it is picking up the 3 cm exhale relief that I have it set to.
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I would try raising minimum pressure by .5 cm increments and giving at least a 3-day trial before additional changes. What I saw in your stats is your average and 90% pressure are very close together, and the average is just 1-cm over your current minimum. I think the algorithm in the XT Auto is very conservative, and you almost need to treat it like fixed CPAP. I think the hypopnea will disappear before you get to 9.5. So it's very possible a pressure of 9 will lower the AHI to 1 or less total.

Since we don't see this machine very often, and can't compare on Sleepyhead data, it's hard to know how it is programmed to respond to events. I don't have a guess regarding the pressure fluctuations you are observing, but if it's dropping below the minimum pressure isetting, then that doesn't seem right.
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Thanks, Sleeprider, I will give that a try starting tonight. As for the other issue I will start paying attention to that to see what's happening when and see if we can see if it is anything of significance.
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Would I be correct in assuming that turning my exhale relief down or off will not help my situation?

And is it safe to say with my data that I do not need to consider a chin strap or FFM unless the FFM was used if my sinuses where stuffy with a cold or allergy?
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I don't know the Apex pressure relief feature. In Resmed and Respironics, the transitions from EPAP to IPAP occur in milliseconds, and are settable. If the Apex machine is noticeable slower to "spool up" this would affect therapy. I just don't know how fast the machine transitions from EPAP to IPAP and vice versa. On Respironics machines the rise time can be set from 1-3. I always had problems with slower rise time (2-3) compared to the faster rise time of 1. Resmed seems to rise to IPAP pressure pretty quickly, and that is even visible on a bar graph on the front display with the machine in use.
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Lanco, I just saw the S9 Autoset for her on #Supplier #1 for only $439. In spite of the horrible color, that machine seems like an awfullly good deal. I have been trying to wrap my mind around the value of that Apex XT for someone with limited financial means, but with deals like this, it's really hard to accept a lesser product.
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