[Equipment] S9 Autoset, RIP

[PaulaO2]

3 - I'm not super fussy about noise, but yeah, last night I noticed that the PRS1 was definitely noisier than the S9 Autoset. I didn't notice anything about the rhythm, though. I also see that Resmed advertises the A10 Airsense as producing 26 db, which is not bad. But the Respironics web site claims that the Dreamstation is the quietest on the market, although they give no specific numbers. I'd like to see some real numbers for the Dreamstation.

Thanks for the input.

Sorry, I wasn't referring to the noise as the difference between the two. The quiet was just a comment on how nice the A10 is to me.

Did you notice a difference in the rhythm of the machine (algorithm) between the Resmed and the PR?

[JJJ]

Hi, JJJ, glad you're active again. Like you I'm KP covered. Unlike yours, my sleep medicine facility uses ResMed for sleep study & titration and I wound up with an AS10 AutoSet to replace my broken S9 Escape (which, like your S9 AS, served me reliably if not well since 2012/10).

I'm curious in what part of the country you found your KP repair facility. (It hadn't occurred to me to look to KP for repairs.)

Just a suggestion: if you really want to consider a Dreamstation, it would be prudent to try-before-you-buy; I don't have personal experience with them but have read several threads of folks who weren't happy with Dreamstation after using AirSense 10s.

I'm in the US, zip 97217. KP has two sleep centers in this city (unfortunately both are located a long way for me), and at each one they offer walk-in 'repair service.' Since using the repair service I have discovered that they have no tools or knowledge of how these machines work. Their idea of 'repair' is to replace a leaking hose or water tub. Yeah, I've been with KP for a year and a half now and I have more to say about them, but that belongs in a different thread.

Re KP and machines: Thanks for the comment about KP in your area using Resmed. That's really interesting. KP has 13 million members, so I just assumed they would buy everything from one supplier to increase the number they order and thus maximize their bargaining clout.

Re other comments: It appears that the Airsense is more popular than the Dreamstation. Still, I am leaning toward the Dreamstation. The main advantages are that I can get it for the $298 co-pay (with all the optional add-ons), and my local KP can read the data. As for noise level, Resmed says 26 db for the Airsense and Respironics says 25 db for the Dreamstation. That doesn't square with comments from real-world users here, so there may be something else going on. Still, I am not super fussy about noise, so that doesn't matter much to me. Yet, I really dislike the screen on the end. I wouldn't ever need to look at it while lying in bed, only when changing settings, which I would normally do while standing up. But here the Airsense is almost as bad. And Resmed has improved the hose output connection so it doesn't come out the back, but the Dreamstation is still better.

One thing that would make me get the Airsense is if the therapy was better, i.e., the software responded faster or more intelligently so the user's AHI could be better. That would trump most other considerations. But I never noticed a lot of difference between my S9 and my original PRS1, and Mosquitobait said that the software is the same in the Airsense and the Dreamstation as in previous models. It might be interesting if someone has done a serious independent impartial study on effectiveness differences for various machines, but I've never seen such a study.

Re try before you buy: That's a great idea, but not practical for me. If I get the Dreamstation from KP I can return it within 30 days, but there is a $150 'restocking fee.' And to try the Airsense I'd have to order it online.

To follow up on what is happening: I called the KP sleep specialist Friday to let her know that the loaner she gave me was missing part of the power cord, but that I had, in fact, a PRS1, so I had used the card from KP in it and changed the pressure to her settings (8-20cm). She apologized for the power cord snafu. I asked how much data she wanted, e.g., how long I needed to use the PRS1 before bringing her the card back. She said a week would be enough, and that her day for walk-ins in the office would be next Thursday. So I said that I would see her then with the data card containing a week's data and the loaner to return. In the meantime, I now have three days data on the card and, of course, I am checking it daily with Sleepyhead. Lately I have been having severe pain from a pinched nerve, so I frequently have bad nights, but I have two good nights on the card with seven hours of sleep on them. Both nights the machine started at 8 and quickly ramped up to 15, and maxed at 18, and my AHIs were 1.22 and 2.10. When I had told her before that I had set my S9 to 15-20cm the look on her face was that she didn't believe me or that a patient couldn't figure out what settings to use. Hah!

[Spy Car]

Kaiser in Southern California uses ResMed.

At your level of pressure wouldn't a Bi-level be the appropriate choice for your next machine?

Bill

[Sleeprider]

With median pressure over 15, you may find they recommend BiPAP. Not a bad option for you since most people find it is more comfortable. How is your comfort level with the Dreamstation so far?

There is a Resmed Airsense 10 Autoset "elite" for sale on Craigslist in Oregon City. The picture is an Autoset, so that might be a good deal. The Autoset in Portland is overpriced at $500 for a 2-year old machine, but the seller says willing to negotiate. A PRS1 Auto in Salem Keizer for $55 is older, but well-priced. The PRS1 Auto in Bend looks good at $100 but is farther away.

The best deal is a Resmed Aircurve 10 Vauto for $500. I don't know where it is, but comes up in the Portland CL under search term "Resmed" as listing 6490930546.

[JJJ]

With median pressure over 15, you may find they recommend BiPAP. Not a bad option for you since most people find it is more comfortable.  How is your comfort level with the Dreamstation so far?

First, I don't have the Dreamstation yet, I'm using my old PRS1.

Second, thanks a lot to you and to Bill for the comment about bipap. That had not even occurred to me. My comfort level has always been fine with the PRS1 and my deceased S9. Just now I looked again at the Sleepyhead data for the last three days. Last night's data is more typical and it shows median 14.10, 95% 17.60, and max at 18.90. The median on the other two days is even lower. I have data from my old S9, but since it was set to 15-20cm so the median is always at least 15. We'll have to wait and see. Aren't bipaps about twice as much as plain apaps? I shudder to think of what 20% of list price for one is.

[Sleeprider]

BiPAP prices vary, but we have seen them sold for as little as $770 on Amazon, and the retail is actually closer to the $1500 you suggested for the APAP. I think you'd be hard pressed to find them for more than $1800 on any of the suppliers, in face Supplier #1 lists the Dreamstation BiPAP Auto at $1689 +$189-$227 for humidifier, and the Resmed Aircurve 10 Vauto is $1726 all-in. DMEs can mark up prices for extended warranty and patient care, but I don't think Kaiser does that. Since a new Auto CPAP costs about $900, your assumption the Bilevels are about twice that, is pretty accurate.

[JJJ]

Well, with help from others I got the S9 Autoset apart and pulled out the motor. Definitely a lot of stiction, which is what I suspected. Before putting it back together I'm going to put a drop of sewing machine oil on the shaft and let it sit for a while. Not likely to help, but what the heck.

I googled all over for some place that would sell me a motor, but no luck. In case someone else wants to try, the connector on the motor says 0A06 and 113P on one side and 000-0401-30 above a QR code and A101401829 below it on the other side. Google goggles said 'no matches' for the QR code. I am sure this motor existed before Resmed designed the S9 Autoset, so they just specified it in the manufacturing details.

[ShaunBlake]

Well, with help from others I got the S9 Autoset apart and pulled out the motor.
...

What help did you get? Did it include manuals? I'd love to try to repair my S9 Escape but can't get it open, and can't find a repair manual.

Thinking about KP not "carrying" ResMed I fear somebody has been misleading you. KP doesn't do their own fulfillment here, they use a DME supplier to do so, and that's how others I've "talked" to have reported (south; southeast; northeast; midwest; and Spy Car and someone else in CA (LaLa, actually) said they prescribed ResMed. As has been commented on many times, what does the doctor or the DME care which brand; their margin is the same. Oh well, it seems you really like the DS, so that's going to be the most satisfying device for you as long as it does the job.

[JJJ]

ShaunBlake wrote:
What help did you get? Did it include manuals? I'd love to try to repair my S9 Escape but can't get it open, and can't find a repair manual.

Thinking about KP not "carrying" ResMed I fear somebody has been misleading you. KP doesn't do their own fulfillment here, they use a DME supplier to do so, and that's how others I've "talked" to have reported (south; southeast; northeast; midwest; and Spy Car and someone else in CA (LaLa, actually) said they prescribed ResMed. As has been commented on many times, what does the doctor or the DME care which brand; their margin is the same. Oh well, it seems you really like the DS, so that's going to be the most satisfying device for you as long as it does the job.

Re taking the S9 Autoset apart: Once a month a local Linux users group has a meeting to help with problems, and from previous experience several of the regulars are magicians at taking things apart, which I am not. Not only that, but one of my helpers is an electronics engineer who designs devices for a living. Just looking at the printed circuit board he pointed to various chips and told me what their function was, like "See these three wires and these three chips? The wires feed power to the motor and the chips control the motor speed."

Re manuals: Don't we have the manual for the S9 Escape on Apnea Board? I didn't look, but I'd be surprised if we don't, and usually the manuals here are the clinician manuals that explain how to change settings.

Re KP and machines: Thanks for your observation. The 'sleep specialist' told me 'All we use are Respironics," where I took the 'we' to mean 'all of KP.' I did so because, as anyone who has KP knows, the adjective that best describes KP is 'cheap,'* which led my mind to jump to the conclusion that they had made a (probably very favorable) deal with Respironics because their  numbers would give them massive bargaining power. KP does that with everything - I have had to go over my PCP's head to get certain more expensive medications which I knew were what I needed. Thanks to your post I now know that I might be able to get the Resmed, although there's still the issue of them not being able to look at the data. I have been to their sleep centers three times previously, each time bringing the data card from my S9 Autoset, and each time the sleep specialist I talked to declined to look at the data.

Knowing that I might be able to get KP to provide the Resmed makes some difference in my decision, as that was one advantage of the Dreamstation. Neither machine pleases me 100%

*I do not mean to imply that there is anything wrong with working hard to control costs; in fact I applaud KP for their efforts.

[ShaunBlake]

PM'd you re: link.

sheesh! Been four-zero years, how the time flies! I was in a TRS 80 club that was like that. In fact, one of our members was Dennis Hayes, who eventually "invented" the digital modem, marketed the Hayes modem, to gain immense wealth. I can imagine the awe and pleasure having a friend explain that circuitry to you -- particularly so regarding that troublesome motor. How sweet!

Manual? What manual? The DME Tech/Rep who brought me the machine (in '12) didn't include one -- but it was only a compliance verification machine -- it had seen a *lot* of use, and I was supposed to get a newer and much better machine... but he really screwed me over and I finally gave up on getting service out of them. I've downloaded a user manual and clinician's manual, and seen a couple of articles on taking S9 devices apart but mine is just a bit different, and I'm not able to get into the guts as shown in those articles' pics. Would dearly love to get my hands on a repair manual, but can't find a hint that such a thing exists.

Re: don't take your data card -- they probably don't have a machine (or the software) to properly read your card. Though you would think that though the arrangement might be different, the data would be the same, right? The only difference in the data would be the frequency of sampling... unless Phillips has invented sensors that they won't license to others. I don't like developing low opinions of others, especially second-handed, but I'm having trouble maintaining respect for your sleep medicine staff. Y'know, Atlanta is pretty hilly, and there's a "mountain" (in fact 3) nearby... why don't you come down here? My RRT/RCP is a wizard (seems as smart as Sleeprider)

and my doctor reminds me of Mr Rogers; an incredibly nice person. (And since you like KP so much...