Sierra

All I can say is that everyone is welcome to their own opinions. I like my AirSense 10 and that is what we plan to buy when my wife's S9 gives out. Would not consider a DreamStation unless I was forced too. A while back the DreamStation's were so cheap that they are hard to resist, but I would spend the extra for a ResMed. The DreamStation 2 still seems to be about 30% cheaper than the AirSense 10, but regardless nothing in stock of either brand where we buy. I hope my wife's S9 is like the energizer bunny and just keeps going and going...

I have not used an ASV and really cannot comment on how the ResMed ASV compares to the Phillips ASV. I have personal experience with a ResMed S9 Auto and AirSense 10 AutoSet. And, have helped numerous people set up adjust their DreamStation APAPs. I have no concerns that the ResMed is ignoring apnea events, and from what I have seen it seems to quite accurately identify them, what type they are, and how long they last. I very occasionally get unidentified events where the machine flags them but does not classify them. It seems to happen when the leak rate is high but not over the leak rate redline. When the leak rate does go over the redline the machine stops reporting all events and when in Auto does not take any pressure action. ResMed claims this is to avoid inappropriate action due to misclassification. Here is an expanded screenshot of a couple of events in succession. The first one lasts about 8 seconds and is not flagged as an event. You can see that after about 4 second the machine starts the pressure pulses to detect the type of apnea it is. Higher amplitude pulses indicate an obstructive event, while lower amplitude indicates CA events. By my eye this one is an obstructive event, but it does not last long enough to get flagged and classified. It has to go over 10 seconds. The second one proceeds the same but lasts longer. Pressure pulse starts at 4 seconds and the total length is about 17 seconds. It gets flagged as a OA event. By my eye the pulse amplitude starts out high but reduces as the event goes on. It in fact may have progressed from an obstructive event to a central during the apnea.

As far as the APAP machines compare I like the ResMed one better because of a few differences:

1. The DreamStation uses what some describe as a "hunt and peck" method of determining what pressure to use. If given a high range between minimum and maximum pressure, it seems to respond more slowly to apnea events but does bring the pressure up. Then when it gets higher it quite quickly starts testing to see if events come back when pressure is lowered. If no immediate events come in, then it keeps pressure down. And when one does it starts this routine all over again. I can immediately distinguish between a DreamStation OSCAR graph and a ResMed graph because on the Dreamstation the pressure will keep going up and down all night long. I don't think that does anything for the quality of sleep and for the frequency of events required to keep bringing the pressure back up again. It essentially ask for them.
2. The ResMed on the other hand brings up pressure in response to an event quicker, and then is slow to reduce the pressure. It does not do this hunt and peck game. Overall I believe that results in fewer events over the night, and a more uniform pressure that is less disturbing to sleep quality. Just my opinion.
3. The ResMed has a nice AutoRamp feature for starting the night out. It does not really ramp the pressure up. It just holds it at a selected pressure comfortable for going to sleep. When it detects you are asleep it ramps the pressure up to minimum.
4. The ResMed allows you to set the EPR (expiry pressure relief) to function full time, or not at all, or only during the ramp period. For some that do not benefit from EPR during sleep, as it may cause the IPAP to be higher, it can be nice to have EPR on during the ramp but off during sleep. The DreamStation does not do that.
5. I believe the EPR is more effective than the FLEX options offered by the DreamStation, as they give you the full selected pressure relief of 1, 2, or 3 cm. FLEX functions to more smooth the transition from IPAP to EPAP and than to provide the full selected pressure relief.
6. The ResMed machine calculates and displays the mask pressure which can be graphed in OSCAR. There is no pressure sensor in the mask, so it has to calculate this value. The DreamStation does not attempt to do that, so all you see is set pressure, not actual pressure. The Mask Pressure lets you see that EPR is working and how quickly the machine is responding to flow demands and how well it actually maintains pressure.
7. ResMed have an AirSense 10 machine that is called the For Her version. It has an extra For Her mode built in for optional use. It raises pressure more quickly in response to flow limitations and holds the pressure longer. It may be more suitable for people with lower levels of apnea. It does not go above 12 cm of pressure. I always suggest that anyone getting an AirSense 10 to get the For Her version. In the new AirSense 11 machine this feature is built into them all. There is no separate For Her version. Not sure if the DreamStation has anything like this.

In any case these are some of the reasons why I recommend a ResMed over a DreamStation for an APAP when I am asked. The DreamStation is still a good machine and I would use one if I had to, but in my opinion it is not as refined a product as the ResMed. And for an ASV things may be totally different. I just have no experience other than reading the Clinical manual for the ResMed model.

The OP indicated this in a second post.

"My titration study showed virtually no central apneas."

It looks like it is treatment emergent central apnea, and an ASV would not have been indicated as a result of the lab titration. However, one may be needed at some point, if other changes cannot bring it into control. At one point I was convinced I needed an ASV, but that has not turned out to be the case. The right settings in a simple CPAP fixed pressure mode has worked for me.

Here is an example of the trouble I was in back in 2018 in Auto mode of my machine with EPR (like pressure support) at 3cm.

And here is my report from last night. This in fixed pressure CPAP mode with EPR at 2 cm. It is not always this good, but I do now average 0.83 for AHI over quite a long time.

"It looks like the OSAs are very minimal, but the central apneas are now very high (30-60 AHI). My titration study showed virtually no central apneas."

It looks like you may have treatment emergent central apnea. This is when the pressure used to reduce obstructive sleep apnea causes an increased number of central events. I had something similar happen to me. In some cases this type of central apnea can go away after 6-8 weeks or so. In my case it did not go away. I have made some changes to limit the pressure the machine uses and have been able to average about 0.8 for AHI, but it still goes much higher on certain nights when central events happen.

If you could post a full screenshot of the Daily Report it would be helpful to see where you are at. The events bar, pressure graphs, and flow graphs are the most important and should be at the top From what you have posted it looks like you may be getting into Cheyne Stokes respiration (CSR) or if you have a DreamStation machine they call it periodic breathing (PB). A starting point to look at is to determine when central events are occurring. Then you can see if higher pressure is related to when they occur. If that is the case then you look for opportunities to reduce the pressure. In my case I believe my machine (ResMed AirSense 10) was seeing Hypopnea events and responding with increased pressure. Hypopnea can be central in nature or obstructive. If they are central then increasing pressure is not the correct response for the machine. I addressed that by limiting the pressure it could automatically go to.

Do you know why they selected a BiPAP machine? It may not be the best solution for you. I have an Auto machine but I now run it in simple CPAP mode with a fixed pressure, and do not allow the machine to automatically increase pressure. I set that fixed pressure based on what I saw when it was in Auto mode and then with just trial and error to see how low I could reduce the pressure before obstructive events started to occur.

In any case if you post a full screen it would help a lot to understand what is going on in your particular case. Where you are now with those regular CA events running up your AHI is not a good place to be.

I don't like buying the distilled water in the wasteful 4 liter plastic containers. Instead I have a couple of 5 gallon water jugs that I fill with Reverse Osmosis water from a local store. Saves me trips to the store, some money, and all those plastic jugs going to recycle, or whatever they do with that stuff. Depending on how often I clean the humidifier I can find some slight residue. When we go on vacation for a couple of weeks we just use tap water, and I have no concerns about that. The humidifier acts like a mini distillation unit, so the minerals stay behind in the reservoir. It takes a bit longer to clean up when we get back, but vinegar does the job. Pure vinegar is also a good disinfectant when used full strength. I would never consider using one of those So-Clean ozone units. Ozone is very aggressive and it is not surprising it would attack foam in a CPAP. I am surprised that Phillips has not sued So-Clean for the damage to their machines and the recall costs they had to pay.

This is the history of ResMed as I know it. Colin Sullivan started out by using parts from a vacuum cleaner and I recall a dog for the first subject. Tests in people were done by gluing the mask to the face of the subject. Sounds gruesome compared to what we have today. I also recall that ResMed and Respironics came close to amalgamating at one point, but it did not happen. Have not read the full article for a while now, so forget most of it. Seems like they spend most of their time suing each other over patent rights.

ResMed Origins

I clean my machine with pure vinegar, then Dawn dishwash soap, and then a thorough rinse with tap water, followed by a final rinse of demin water. I do not have this issue of white stuff blowing out. Vinegar dissolves any minerals which may build up in the water reservoir.

The truth will be in the flow rate graph when you expand it to reveal the detail. Either the breaths will be there or they will not. The machine is simply reporting flow rate on a second by second basis.

This is what I found in the ResMed ASV clinical manual:

"Backup rate The AirCurve 10 ASV device uses breath phase mapping to provide a timed backup rate that is synchronized with the patient’s own breathing. When the patient deviates from the ventilatory target, the ASV device aims to stabilize the patient by adjusting Pressure Support. If necessary, it will adjust the timed backup rate from one that matches the patient’s own recent rate towards the built-in default 15 BPM backup rate."