Feature differences in S9 models?

Guest · Post by **Guest** » Sat May 28, 2011 12:39 am

I'm new to this forum but not new to XPAPs. I'm actually here seeking knowledge for my DH as he is the XPAP user in the family. He's had a variety of XPAPs over the past decade, ranging from huge, heavy bricks to the SA AutoSet Vantage, which burned itself out. Not a fan of sleep studies or XPAPs in general, he has been sleeping unprotected for about a year now, so I am happy to see him back in the saddle again, following a sleep study a few weeks ago.

The RT sent out by the DME that his MD's office referred him to came over tonight with the machine someone-other-than-him had determined he should have. Fortunately, she was friendly and flexible as I proceeded to question everything she suggested. She started by giving him a F&P Icon with humidifier, which he nixed because it (1) weighed too much for schlepping through TSA, and (2) had a humidifier, which he's never used nor needed and did not want.

She brought out a few other brands of CPAPs but I showed her that he was previously on an APAP and requested a newer APAP model. She referred to the Rx from his MD, which just specified CPAP but when I held my ground she phoned her manager and got the OK to dispense an APAP, conditioned upon obtaining the MD's consent when the office reopens on Tuesday. She showed him several other brands before eventually pulling out a ResMed S9 Escape Auto, which he immediately gravitated toward due to its light weight and sleek appearance. She kept pushing the humidifier but he insisted he did not want or need one, so she finally removed it and put it away. She told him the data card had to be mailed in a month from now to verify compliance and I asked her whether it would provide him with helpful data (like leakage) or just compliance data. I asked which model had the highest patient satisfaction rating and she said she didn't have that information. I asked which had the lowest decibel level and she said she didn't have that info, nor was she able to tell us what the decibel level was for the S9 (which I easily found online after she left). I found it odd that she said she didn't know these things since she's been a RT for 20 years.

We took the S9 Escape Auto with the assurance that she would check back with him next week and he would have 30 days to decide whether it was working for him, during which time he could elect to get a different XPAP, "no questions asked." She also tried to give him a mask that did not appeal, so we went back and forth on that a while before ending up with an Opus nasal pillows by F&P, again with the 30 day trial stipulation. She gave him a tubing made by Resperonics, which I found odd, but since we'd prevailed on the more major components and DH seemed not to mind, I let it go for now.

I've searched for and read several threads on this fabulous forum that dealt with the S9s, and am encouraged that the consensus is that the S9 is a desirable XPAP. What I did not learn and would still like to know is the difference between the various models available in the S9 product line. On the ResMed site, I found:
S9 Escape (CPAP) - product code 36001
S9 Elite (CPAP) - product code 36003
S9 Escape Auto (APAP) - product code 36002
S9 AutoSet (APAP) - product code 36005
S9 VPAP S - product code 36004
S9 VPAP Auto - product code 36006
S9 VPAP ST - product code 36008
SP VPAP Adapt - product code 36007

I reviewed the specs, but since there was no feature comparison chart, I didn't come away with a clear understanding of the feature and benefit differences. I think DH and I would both like to see him using the best, most comfortable XPAP for him--whatever that may be. I'd really appreciate any specifics you could share as to the relative merits of the various S9 models. His script was written for a pressure of 11, but it just makes sense to me that he should only take a APAP, since his needs may change over time or over the course of the night. If I am mistaken and there is a reason that we should consider limiting our selection to a CPAP, please enlighten me.

It would be wonderful if we could get the best therapy with the quietest possible XPAP. Because of the excessively noisy operation of his previous configuration, we have reluctantly resorted to sleeping in separate rooms. I'd welcome the chance to sleep together again! I personally think the Darth Vader sounds that emanated from his prior components may have been due to repeated leaks throughout the night. Even when I slept with industrial strength earplugs, I could only sleep next to him if I took an Ambien. Having to medicate a bed partner to deal with the shortcomings of the previous system was not good, to say the least. Plus I suspect all that racket meant he was not getting the proper therapy.

We live in a sub-tropical location where the humidity is always very high, and we keep the A/C thermostat set at 73º while sleeping. I would also like to hear comments on the pros/cons of the ResMed ClimateLine heated tube vs. the ResMed Slimline tube, vs traditional tubing like the Resperonics tubing he was given tonight.

Man, many thanks to all of you for developing such a terrific resource, and thank you for considering my questions.

sleepwellmylove · Post by **sleepwellmylove** » Sat May 28, 2011 12:43 am

I am the OP for this thread. I just realized that, unbeknown to me, the computer had logged me out, so my username just posted as Guest. Sorry about that.

Bluecat · Post by **Bluecat** » Sat May 28, 2011 1:02 am

I will let the more seasoned posters here give you a longer answer but my advice is:
Run from the S9 Escape Auto!! It only gives compliance data (hours of use) so it is not useful if you want to follow the effectiveness of XPAP therapy.

The S9 is a very good series but if you want the APAP and efficacy data you must choose the S9 Autoset.

S9 Escape: CPAP without efficacy data (only hours of use)
S9 Elite: CPAP with efficacy data
S9 Escape Auto: APAP without efficacy data (only hours of use)
S9 Autoset: APAP with efficacy data

The "ignorance" of your RT is either a way to get to foist a brick on you or she really does not know her job (either way, it is not good).

robysue · Post by **robysue** » Sat May 28, 2011 1:45 am

Guest wrote: I've searched for and read several threads on this fabulous forum that dealt with the S9s, and am encouraged that the consensus is that the S9 is a desirable XPAP. What I did not learn and would still like to know is the difference between the various models available in the S9 product line. On the ResMed site, I found:
S9 Escape (CPAP) - product code 36001
S9 Elite (CPAP) - product code 36003
S9 Escape Auto (APAP) - product code 36002
S9 AutoSet (APAP) - product code 36005
S9 VPAP S - product code 36004
S9 VPAP Auto - product code 36006
S9 VPAP ST - product code 36008
SP VPAP Adapt - product code 36007

First, the all the VPAPs are NOT called for in your hubby's situation. He's never been on a bi-level, which is what the VPAP S and the VPAP Auto are. And he certainly doesn't need the VPAP ST or VPAP Adapt models since they are very sophiticated bi-levels that have properties similar to non-invasive ventilators.

Second, there is no good reason to go with a straight CPAP when hubby is used to an APAP.

Third, the major difference between the S9 Auto Escape and the S9 AutoSet is that the AutoSet records full efficacy data and the Auto Escape does not. The full efficacy data does not directly affect the user's comfort, but the leak data which it provides can certainly help in tracking down leak problems. And the detailed breakdown of the AHI data into types of events allows the user to fully determine how well the machine is managing the apnea. Additional useful data can be obtained by downloading the AutoSet's data into ResScan, which can be downloaded for free if you check for posts by a user named Uncle_Bob.

But there are some other differences as well.

The S9 AutoSet is hands down, the best-featured APAP on the market right now. In addition to full efficacy data that is easily accessible from the machine's LCD, it has all of the following:

Resmed's EPR exhale system which makes exhaling against the pressure easier
one of the quietest motors on the market (rated at 24 decibels)
a ramp that allows the user to chose how long the ramp will take to get up to full pressure. (But note, the initial ramp pressure can be changed only through the clinician's menu, so it's important to get the RT to listen about where you want it set to.)
automatic altitude adjustment and ability to be run on international voltages with the appropriate adapter as well as a 12 volt source (like you have in a car) with the appropriate adapter
a smaller 15mm hose as the default hose, but fully compatible with the larger standard hoses if the user prefers them
automatic leak compensation that maintains the appropriate pressure even when there is some (minor to moderate) leaking
Smart On/Off capabilities. If these are turned, the machine will turn itself on as soon as it detects breathing and it will turn itself off when it detects that you've removed the mask. Some people find this a comfort if they are prone to having short power outages since the machine will turn itself back on as soon as the power comes back on. Others find it convenient for when they need to get up at night since it saves looking for the switch.
A mask fit feature that can help make sure the mask is properly adjusted and there are no leaks at the beginning of the night.

The S9 Elite has all these same features---except it is NOT an APAP. It does record full efficacy data though.

The S9 Auto Escape has all these features EXCEPT for the Smart On/Off and mask fit features. And it does not record full efficacy data. It does provide an unbroken down AHI value on the LCD. But the S9 Auto Escape does NOT give you any leak data at all. And unfortunately since you think your hubby may have had problems with leaks in his earlier forays into to hosehead-land, getting a machine that provides leak data is critical.

The S9 Escape has all these features EXCEPT for the Smart On/Off and mask fit features. And it records NO efficacy data at all---not even the AHI. And no leak data. And it's a straight CPAP, not an APAP

It would be wonderful if we could get the best therapy with the quietest possible XPAP. Because of the excessively noisy operation of his previous configuration, we have reluctantly resorted to sleeping in separate rooms. I'd welcome the chance to sleep together again! I personally think the Darth Vader sounds that emanated from his prior components may have been due to repeated leaks throughout the night. Even when I slept with industrial strength earplugs, I could only sleep next to him if I took an Ambien. Having to medicate a bed partner to deal with the shortcomings of the previous system was not good, to say the least. Plus I suspect all that racket meant he was not getting the proper therapy.

The S9's are very quiet---the blower unit itself if virtually silent. However even with a machine as silent as the S9, you may still notice Darth Vader sounds either because of leaks, or just as likely because of conducted noise. And unfortunately earplugs---especially industrial strength ones---magnify conducted noise because they block out all ambient airborne noise.

And what is conducted noise? It's noise that gets into your head through your skull and into the middle and inner ear through the bone, and thus it bypasses those industrial strength earplugs. And where is the conducted noise coming from? Well, if you hubby's hose is touching the bed and bedcovers and your pillow, then all the noise the machine makes PLUS an amplification of his own breathing is likely being conducted through the hose and into the bed, the bedcovers, and your pillow. And if it is being conducted through something that touches the back of your skull, the noise gets into your head that way.

So if you find yourself listening to Darth Vader again and the problem is not leaks, the first thing to do is to move the hose far away from your side of the bed. If you are really sensitive to it, you may need to make sure you and your pillow are not touching hubby either. And put the machine below the level of your mattress if possible. A hose cover might also help dampen some of the noise. And a white noise machine or a nature sounds machine running at a very low (almost inaudible) volume may be enough to mask the conducted noise and let you get to sleep without the Ambien.

But since you also think that part of the Darth Vader problem may have been caused by leaks, you will need a machine that provides you with quality leak data. And that means you need the S9 AutoSET instead of the S9 Auto Escape that you accepted. It may be very difficult to get the DME to exchange the current Auto Escape for the AutoSet that provides the leak data. Best of luck on negotiating that exchange.

We live in a sub-tropical location where the humidity is always very high, and we keep the A/C thermostat set at 73º while sleeping. I would also like to hear comments on the pros/cons of the ResMed ClimateLine heated tube vs. the ResMed Slimline tube, vs traditional tubing like the Resperonics tubing he was given tonight.

The Slimline tube is just an extra flexible tube with a smaller diameter. It's a 15mm hose instead of the standard 22mm. I'm a tiny person and I personally prefer the 15mm hoses (Resprionics also makes a 15mm hose now). There are folks here who have found that the Slimline seems to be prone to tearing near the cuffs at the end of the hose. However the speculation is that this is because of the location of the air outlet in the integrated humidifier.

Without the integrated humidifier, the ClimateLine hose will not work. If hubby doesn't like humidified air anyway, he most likely would hate the ClimateLine: It's purpose is to allow the humidifier to provide very warm and very humid air while minimizing the chances of condensation problems in the hose and mask, which are very uncomfortable to deal with. The ClimateLine is really loved by folks whose noses crave warm moist air but who inhabit cold (as in 60--65º) bedrooms in the winter time. It too has a reputation here of being on the fragile side for a hose---much more fragile than just the Slimline hose.

sleepwellmylove · Post by **sleepwellmylove** » Sat May 28, 2011 8:59 am

Many thanks to @bluecat and @robysue. You've provided me with excellent information on the S9 series -- exactly the type of info I was seeking from the RT. If you're ever considering a career change, you would make a great RT. If his RT will cooperate in exchanging the S9 Escape Auto for a S9 AutoSet, it sounds like we will be all set.

We do travel internationally, and once toasted the fuses in an earlier generation CPAP brick while in Europe. We'd only used an adapter when what we should have used was a transformer to convert the voltage from 220 to 110. Thanks to a very savvy hotel concierge in Beaune, we were able to replace the fuse and start anew. Having this feature built into the XPAP is a valuable feature.

msradar65 · Post by **msradar65** » Sat May 28, 2011 12:37 pm

Let me add you can use the climite line hose and humidifier and not put any water in it. And turn the humidifier to off. That is how I used mine this spring. i am back on set to 70 degrees...and mine is using very little water.

sleepwellmylove · Post by **sleepwellmylove** » Sat May 28, 2011 5:01 pm

msradar65 wrote:Let me add you can use the climite line hose and humidifier and not put any water in it. And turn the humidifier to off. That is how I used mine this spring. i am back on set to 70 degrees...and mine is using very little water.

Really? I didn't know that. If the humidifier is dry, do you notice a different between sleeping with it and without it?

chunkyfrog · Post by **chunkyfrog** » Sat May 28, 2011 5:18 pm

Hmmm. When my humidifier went dry, the smell was unpleasant.
I guess we want to make sure the humidifier is off.

msradar65 · Post by **msradar65** » Sat May 28, 2011 5:57 pm

sleepwellmylove wrote:
msradar65 wrote:Let me add you can use the climite line hose and humidifier and not put any water in it. And turn the humidifier to off. That is how I used mine this spring. i am back on set to 70 degrees...and mine is using very little water.
Really? I didn't know that. If the humidifier is dry, do you notice a different between sleeping with it and without it?

I don't notice any difference. When the humidifier is on and starts heating it has an orange light. When the humidifier is off the light is blue.

I have used mine in passover mode, no heat...and for a few days with no water at all. I didn't notice the difference because we had a ton of rain and it was very humid and damp.

Normally I use mine set at around 70 degrees on climite line. I had to turn the humnidifier/climite line back on about a week ago because I was getting rain out in my Swift LT for her nose barrel. Even though I have a pad-a-cheek barrel cover.

SleepyHound · Post by **SleepyHound** » Sat May 28, 2011 8:09 pm

This is my first adventure with CPAP, and I'm three weeks into my S9 Elite. I'm sensitive to noise since I've been a very light-sleeper (I found out it's because I didn't sleep well due to my OSA...now I sleep like a brick!). The overall operation of the S9 is very quiet. The noise I hear is with the EPR which was set at 3. And I can hear the water in the humidifier "bubbling" when I take a deep breath. But overall, it's way better sounding than my husband's snoring so I've been able to live with it (he's in denial of the need for sleep study). I also sleep with the ceiling fan on, so I usually try to focus on that white noise.

sleepwellmylove · Post by **sleepwellmylove** » Sun May 29, 2011 4:38 pm

SleepyHound wrote:The overall operation of the S9 is very quiet. The noise I hear is with the EPR which was set at 3.

I don't mean to get off topic here, but is EPR the same setting as pressure, or something entirely different? Right now his pressure is set at 11. If EPR is a separate setting, I need to find out what his is set to (because whatever it is seems to be working well for now, and we would want to preserve that setting if his settings were inadvertently wiped out).

Pugsy · Post by **Pugsy** » Sun May 29, 2011 4:51 pm

sleepwellmylove wrote:I don't mean to get off topic here, but is EPR the same setting as pressure, or something entirely different? Right now his pressure is set at 11. If EPR is a separate setting, I need to find out what his is set to (because whatever it is seems to be working well for now, and we would want to preserve that setting if his settings were inadvertently wiped out)

EPR is separate setting. It is exhale relief. Pressure on exhale is reduced by the EPR setting. EPR 1 is 1 cm reduction, EPR 2 is 2 cm reduction and EPR 3 is the highest choice and give 3 cm reduction in pressure upon exhale. This is a comfort setting and individual preference dictates the choice. It can even be turned of if someone doesn't need it or want it.

Example if someone uses cpap pressure of 10 cm upon exhale the pressure is reduced to 7 cm if the EPR is at 3.

billbolton · Post by **billbolton** » Sun May 29, 2011 6:38 pm

SleepyHound wrote:And I can hear the water in the humidifier "bubbling" when I take a deep breath

You may have over-filled the humidifier then........

Cheers,

Bill

Slinky · Post by **Slinky** » Sun May 29, 2011 7:03 pm

Or - it could have been condensation in the hose not reaching the mask.

When I first started using PAP I had been on 02 for sleep and had a room temperature humidifier on the 02 concentrator. When being set up on PAP w/02 supplementation "no one" noticed the humidifier bottle on the 02 concentrator. An adapter was put on the PAP's integrated humidifier, the 02 tubing from the 02 concentrator attached and I was off an running.

Part way thru the night I heard this "bubbling" but didn't fully wake to check it out. Next night same thing, bubbling sounds coming from the hose. It was probably a couple of nights before I noticed the condensation in the 02 tubing AND in my PAP hose. Once I took the humidifier bottle off the 02 concentrator I didn't have any more "bubbling" sounds.

I've never had problems w/"rain out" w/my PAP (other than those couple of nights) but obviously "rain out" in our PAP hose could cause that bubbling sound.

sleepwellmylove · Post by **sleepwellmylove** » Wed Jun 01, 2011 9:22 am

Pugsy wrote:
sleepwellmylove wrote:I don't mean to get off topic here, but is EPR the same setting as pressure, or something entirely different? Right now his pressure is set at 11. If EPR is a separate setting, I need to find out what his is set to (because whatever it is seems to be working well for now, and we would want to preserve that setting if his settings were inadvertently wiped out)
EPR is separate setting. It is exhale relief. Pressure on exhale is reduced by the EPR setting. EPR 1 is 1 cm reduction, EPR 2 is 2 cm reduction and EPR 3 is the highest choice and give 3 cm reduction in pressure upon exhale. This is a comfort setting and individual preference dictates the choice. It can even be turned of if someone doesn't need it or want it.

Example if someone uses cpap pressure of 10 cm upon exhale the pressure is reduced to 7 cm if the EPR is at 3.

Got it. Thanks, Pugsy!

Is there a way we can determine the current EPR setting without having to contact the RT? I seem to recall a thread that dealt with a special menu on the S9 XPAP, available only to the RT--unless you know how to access it. Right now he has a S9 Escape Auto, but we plan to swap it for the AutoSet.

Feature differences in S9 models?

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