Contrasting experience with PR One 560 vs A10

[Dafod]

My main machine has been a Resmed A10 (last 10mths). Over the past 18 days I have been traveling and I picked up a new PR560 (new) that I was able to buy relatively cheaply since its now a superseded model (for the trip and to be used as my backup machine). Contrasting the two machines my main observations have been:

The PR560 seems a lot more "gentle" than the A10 regarding changing pressure. On both of them I used the same P10 mask with a chin strap and essentially the same settings regarding the pressure ranges and EPR.

The result of using the PR560 is both positive and negative as I seem to have less disturbed sleep, have lower top-end pressures at the mask, which results in virtually no aerophagia (unlike the A10 which can be bad), and less mask/mouth leaks. The negatives is my AHI is higher, at around 0.5 to 3.5 with the PR560 picking up more hypopneas (although I get that the two machines are not necessarily directly comparable on incidents). While my noted hypopneas on the machines are not directly comparable the duration of the events with the 560 are typically 20-50 seconds while only being 10-12 seconds on the A10. Also, it seems that when I start to go to sleep the PR560 cuts off the end of my inhalation if I don't more forcefully inhale. Later when I somehow get in sypatico with the machine I don't notice this.
With the A10 I have had nights where I have mask/mouth leaks near and above 25. This didn't happen with the 560. Reviewing the occurrences in Sleepyhead I noted they virtually all occur when the A10 quickly ramps up pressure to manage or head-off an event.

The EPR on the A10 is 2 and my Flex A is 2 (I think) on the 560. Also pressure range on both machines is 6/7-16.

Just curious whether people have experienced similar things? Whilst both machines seem very good and manage my apneas they seem to go about it quite differently - more than I had expected.

[Ghost1958]

Epr and aflex work differently
EPR is a straight pressure drop.
Aflex is flow based.
Try setting your aflex to 1to lessen the "air cutoff" feeling.

[vsheline]

Try setting your aflex to 1 to lessen the "air cutoff" feeling.

Right.

ResMed EPR has only straight pressure drop which lasts the whole time between start of exhale to start of inhale.

A-Flex of 1, 2 and 3 all have 2 cm H2O of straight pressure drop but have different amounts of additional Flow-based pressure drop.

When actively breathing out, there is an additional amount of pressure drop based on how forcefully we are exhaling. This Flow-based additional pressure relief goes away as we stop actively exhaling, which makes it less easy to finish the last bit of our exhalation. But there is method in this madness, since the reduction in pressure relief as exhalation is ending reduces the pressure drop to 2 cm H2O just before inhalation starts; the most vulnerable time for an obstructive apnea to begin is just as inhalation starts, because of the suction created by breathing in.

With A-Flex of 1 (and even more so with A-Flex of 2 or 3) the pressure at the end of inhalation drops as our inhalation Flow is ending, which makes it less easy to finish the last bit of our inhalation. This means the high inhalation pressure will last longer (and finishing our inhalation will be easier) when A-Flex is 1. But the beginning of exhalation will be easiest when A-Flex is 3.

[OpalRose]

vsheline,
I really appreciate how you take the time to explain the difference in how pressure relief works between the different machines.

I never fully understood how the AFLEX setting was working on my APAP untill I was almost 8 months into therapy. I tried all three settings, and in the last few months have settled on AFLEX 2. It seems to work best for me, and reading your description confirms why. I always felt like my inhalation was being cut off just a bit when set to 3.

It's just a matter of trial and error.

Dafod,
I never used a ResMed machine, so can't give any input on the differences.

[under pressure]

You mention different leak rates, but they are measured completely differently between the two machines, one includes design vent rate of the mask, the other does not.......the 25 or so you mentioned on the Resmed is considered low or no leak so your real leak rates between the two machines is basically the same.

[Kadenz]

My own experience with these two machines is that I had much higher AHI scores with the PR1 machine and slightly more sleep disruption with the A10. The net result is that my sleep quality is significantly better with the A10. Hence I much prefer the A10 and have decommissioned the PR1. I find the A10 is also much easier to travel with.

[Dafod]

Thanks everyone for the interesting feedback. I will have to try the flex at 1 rather than 2. My thoughts is that Resmed has the advantage on the EPR as I find the flex approach with the 560 as somewhat crude.

Kadenz, your comment regarding what you now use is interesting. Where I am with this is I have put away the 560 since I am back home at the moment. I wondered since the 560 was slower/softer in responding to apparent apneas compared to the A10 whether the less disrupted sleep somewhat countered the longer apnea times. It did trouble me that my hypopneas really increased in duration (by apnea). I would think this could be more damaging than waking up more often. I guess if you can tolerate the spikes in pressure under the Resmed algorithm compared to the more gentle but possibly less effective approach by the PR1 it would seem to be preferable.

[Kadenz]

Thanks everyone for the interesting feedback. I will have to try the flex at 1 rather than 2. My thoughts is that Resmed has the advantage on the EPR as I find the flex approach with the 560 as somewhat crude.

Kadenz, your comment regarding what you now use is interesting. Where I am with this is I have put away the 560 since I am back home at the moment. I wondered since the 560 was slower/softer in responding to apparent apneas compared to the A10 whether the less disrupted sleep somewhat countered the longer apnea times. It did trouble me that my hypopneas really increased in duration (by apnea). I would think this could be more damaging than waking up more often. I guess if you can tolerate the spikes in pressure under the Resmed algorithm compared to the more gentle but possibly less effective approach by the PR1 it would seem to be preferable.

Dafod, my sleep is typically disrupted 1 to 2 times per night (sometimes 3 times, occasionally none) these days and that almost always occurs when the pressure has risen relatively sharply. That does influence how refreshed or not I feel the next day. But the bottom line is that I nonetheless feel less tired than I did with the significantly higher AHI with the PR1. I'm typically around 0.5 (sometimes 0.0 & rarely more than 1) with the A10 but it was more like 6 or 7 with the PR1.

I guess the algorythms used by each machine suit some folks well and others less well. We're very fortunate in being able to compare and choose between them.

[MtFallsTodd]

From my experience the PR560 suits me better. The A10 ramping speed kept waking me up. I had lower AHI with the A10 but I think it was because I don't obstruct when I'm awake!!!!!

[DanPrado]

vsheline,
I really appreciate how you take the time to explain the difference in how pressure relief works between the different machines.

I never fully understood how the AFLEX setting was working on my APAP untill I was almost 8 months into therapy. I tried all three settings, and in the last few months have settled on AFLEX 2. It seems to work best for me, and reading your description confirms why. I always felt like my inhalation was being cut off just a bit when set to 3.

It's just a matter of trial and error.

Dafod,
I never used a ResMed machine, so can't give any input on the differences.

Just saying thanks, newer user and thought that the initial short breath was due to "ramp up" or just putting up with things - read this post last night switched the machine to 2 immediately felt better, less stress.