01-30-2018, 04:56 AM
Resmed S9 VPAP Auto and Respironics PR760 BiPAP Comparison
I own and have used both the Respironics PR760 Auto BiPAP and the Resmed S9 VPAP Auto. As many questions have been asked about the suitability of both machines and their newer siblings on this forum I thought I’d share my thoughts and experiences. While there are newer versions of both machines, essentially the differences between them and the ones I’m reviewing are mainly cosmetic and the majority of what I’m going to say should probably cover both generations. I use a Dreamwear mask with nasal gel pillows.
Size: Both about the same. Respironic's travel bag is a better and much more compact option than the Resmed. Fortunately, I can get the Resmed into the PR bag.
Humidification: The S9 and the PR760 both come with detachable humidifiers and proprietary heated tubing. They both have removable water chambers that are easy to fill through a hole provided for the purpose. Cleaning the S9 tank is much easier than the PR760 as the latter has a variety of nooks and crannies whereas the Resmed tank is a simple rectangular chamber. Resmed suggests a water temp setting for humidification and the 760 has numbered settings. Both work well. The swivel tubing connector at the top of the humidifier of the 760 is a great idea. The S9 tubing may have to bend to be used properly, depending on machine placement.
Start Up: Simply putting on your mask and taking one deep breath kicks the S9 into life. Not so for the 760 and in the end I opted to turn it on manually every night. The S9 will also shut down 5 or so seconds after you take your mask off. It’s easier to hit the stop button on the Respironics or it could keep blowing away for over a minute.
Display: The S9 has a colour display and by simply pressing the “i ” (for information) button in the morning it will give you instant feedback on AHI, mask leaks and hours of usage for the previous night. The 760’s b&w display will give you far more than that but you have to turn the dial to INFO, press and then scroll down. AHI, which is what I really want to know, is well down the list. You also have access to mask fit, ramp time and mask type on both machines. Both machines have a slot for an SD card. No problems for the Philips but with the S9, if you are using W10 on a PC then the card will want to reset itself every time you put it back into the machine. Ignore that as it drops everything into your PC anyway so you won’t lose data for compliance. (I have a Mac so no issues).
Clinical Menu: Easily accessed on both machines and reasonably intuitive. I found the PR much easier to navigate than the Resmed but it’s not that complicated for either.
Setup Differences for BiPAP: Both machines allow you to set IPAP max and EPAP min. Where they differ is in how they use pressure support. The PR760 allows a range of PS which means that IPAP doesn’t necessarily rise in conjunction with a rise in EPAP. For example, on Jan 1st on my PR760 machine (settings IPAP max 20. EPAP min 10.5 and PS range 2.5 to 5.0) when my IPAP went up to 15, it was covered by the PS range so the EPAP stayed the same at 10.5. With the Resmed, there is a single PS setting and a rise in IPAP is mirrored exactly by the EPAP. If I have PS of 4.0 it maintains this between IPAP and EPAP. If my IPAP goes up then so does my EPAP. So an IPAP of 15 will mean that EPAP rises to 11. I think Respironics got something right here, especially for those with higher pressure settings.
Respironics gives you choice of using BiFlex or Rise Time. Rise Time is the time it takes to change from IPAP to EPAP and is an adjustable setting. I could not get it to work for me so I reverted to BiFlex which I discovered is just some extra pressure relief.
Resmed has Ti and cycle settings. Ti max determines the maximum time in inspiration before spontaneously changing to expiration. The default is 2.0 secs for max and 0.3 for min. I upped the max to 2.5 as I do inhale quite deeply and it seems to be working. With the lower 2.0 setting the S9 wanted me to exhale before I was ready. The trigger and cycle settings don’t seem to be an issue for me so I left them at medium. I might go back to them later when I understand them a bit better.
Algorithms: Much has been said about how both machines respond to ‘events’. The commonly held idea is that Respironics responds much more slowly (gently?) to events than Resmed but also takes time to go back to normal. For some, the aggressive approach of the Resmed causes arousals as it rises sharply to treat events and falls sharply when they seem to be over. For me, this is not an issue. Looking at my Sleepyhead charts, I can see many instances where the PR760 responded after I’d had an event. The Resmed seemed to tackle the event head on and possibly minimized it. Having used both machines, the Resmed algorithm seems to suit me better and the last two weeks of figures seems to support that.
Noise: When I use the 760 the sound of the motor rises in pitch when I inhale. This doesn’t happen with the S9. This could be a problem for users of the PR760 when flying or in other public places where you have to use your machine. It also may not make your sleeping partner very happy.
Final Thoughts: From a personal perspective there is something about the Resmed that suits me. Firstly, I feel that I had to breathe much harder when I used the PR760. Occasionally, I’d feel somewhat claustrophobic and struggling to breathe and had to make adjustments to the nasal pillows to alleviate it. This hasn’t really been an issue with the S9 and I seem to have far less issues with leaks but I don’t know why. My first ever auto machine was a loaner, an S9 APAP. I remember how much easier breathing was when I used it. I also remember taking the mask off to check if it was actually working – that’s a good level of comfort.
Secondly, one change I did make was to drop EPAP min to 9.0 (10.5 with the 760) and maybe this has helped. I feel so much more comfortable with the S9. That said, the PR760 was a good step up from the PR560 APAP that I still have and being able to use the benefits of Pressure Support has significantly improved my therapy. The Respironics PR760 is a very good machine so I'm not knocking it.
Please feel free to add comments, question any of my statements or provide extra enlightenment. I’m hoping that this thread will help those looking to choose a new machine. I apologise if I've contravened any forum rules with this thread though I think I haven't.
Size: Both about the same. Respironic's travel bag is a better and much more compact option than the Resmed. Fortunately, I can get the Resmed into the PR bag.
Humidification: The S9 and the PR760 both come with detachable humidifiers and proprietary heated tubing. They both have removable water chambers that are easy to fill through a hole provided for the purpose. Cleaning the S9 tank is much easier than the PR760 as the latter has a variety of nooks and crannies whereas the Resmed tank is a simple rectangular chamber. Resmed suggests a water temp setting for humidification and the 760 has numbered settings. Both work well. The swivel tubing connector at the top of the humidifier of the 760 is a great idea. The S9 tubing may have to bend to be used properly, depending on machine placement.
Start Up: Simply putting on your mask and taking one deep breath kicks the S9 into life. Not so for the 760 and in the end I opted to turn it on manually every night. The S9 will also shut down 5 or so seconds after you take your mask off. It’s easier to hit the stop button on the Respironics or it could keep blowing away for over a minute.
Display: The S9 has a colour display and by simply pressing the “i ” (for information) button in the morning it will give you instant feedback on AHI, mask leaks and hours of usage for the previous night. The 760’s b&w display will give you far more than that but you have to turn the dial to INFO, press and then scroll down. AHI, which is what I really want to know, is well down the list. You also have access to mask fit, ramp time and mask type on both machines. Both machines have a slot for an SD card. No problems for the Philips but with the S9, if you are using W10 on a PC then the card will want to reset itself every time you put it back into the machine. Ignore that as it drops everything into your PC anyway so you won’t lose data for compliance. (I have a Mac so no issues).
Clinical Menu: Easily accessed on both machines and reasonably intuitive. I found the PR much easier to navigate than the Resmed but it’s not that complicated for either.
Setup Differences for BiPAP: Both machines allow you to set IPAP max and EPAP min. Where they differ is in how they use pressure support. The PR760 allows a range of PS which means that IPAP doesn’t necessarily rise in conjunction with a rise in EPAP. For example, on Jan 1st on my PR760 machine (settings IPAP max 20. EPAP min 10.5 and PS range 2.5 to 5.0) when my IPAP went up to 15, it was covered by the PS range so the EPAP stayed the same at 10.5. With the Resmed, there is a single PS setting and a rise in IPAP is mirrored exactly by the EPAP. If I have PS of 4.0 it maintains this between IPAP and EPAP. If my IPAP goes up then so does my EPAP. So an IPAP of 15 will mean that EPAP rises to 11. I think Respironics got something right here, especially for those with higher pressure settings.
Respironics gives you choice of using BiFlex or Rise Time. Rise Time is the time it takes to change from IPAP to EPAP and is an adjustable setting. I could not get it to work for me so I reverted to BiFlex which I discovered is just some extra pressure relief.
Resmed has Ti and cycle settings. Ti max determines the maximum time in inspiration before spontaneously changing to expiration. The default is 2.0 secs for max and 0.3 for min. I upped the max to 2.5 as I do inhale quite deeply and it seems to be working. With the lower 2.0 setting the S9 wanted me to exhale before I was ready. The trigger and cycle settings don’t seem to be an issue for me so I left them at medium. I might go back to them later when I understand them a bit better.
Algorithms: Much has been said about how both machines respond to ‘events’. The commonly held idea is that Respironics responds much more slowly (gently?) to events than Resmed but also takes time to go back to normal. For some, the aggressive approach of the Resmed causes arousals as it rises sharply to treat events and falls sharply when they seem to be over. For me, this is not an issue. Looking at my Sleepyhead charts, I can see many instances where the PR760 responded after I’d had an event. The Resmed seemed to tackle the event head on and possibly minimized it. Having used both machines, the Resmed algorithm seems to suit me better and the last two weeks of figures seems to support that.
Noise: When I use the 760 the sound of the motor rises in pitch when I inhale. This doesn’t happen with the S9. This could be a problem for users of the PR760 when flying or in other public places where you have to use your machine. It also may not make your sleeping partner very happy.
Final Thoughts: From a personal perspective there is something about the Resmed that suits me. Firstly, I feel that I had to breathe much harder when I used the PR760. Occasionally, I’d feel somewhat claustrophobic and struggling to breathe and had to make adjustments to the nasal pillows to alleviate it. This hasn’t really been an issue with the S9 and I seem to have far less issues with leaks but I don’t know why. My first ever auto machine was a loaner, an S9 APAP. I remember how much easier breathing was when I used it. I also remember taking the mask off to check if it was actually working – that’s a good level of comfort.
Secondly, one change I did make was to drop EPAP min to 9.0 (10.5 with the 760) and maybe this has helped. I feel so much more comfortable with the S9. That said, the PR760 was a good step up from the PR560 APAP that I still have and being able to use the benefits of Pressure Support has significantly improved my therapy. The Respironics PR760 is a very good machine so I'm not knocking it.
Please feel free to add comments, question any of my statements or provide extra enlightenment. I’m hoping that this thread will help those looking to choose a new machine. I apologise if I've contravened any forum rules with this thread though I think I haven't.
