[SIPC_Content]It’s been over a year since ResMed’s new range of AirSense CPAP machines was released to the world. This range replaces their highly successful S9 range in a more compact and lighter package. All while adding a few creature comforts that will make using CPAP even easier than before.
Admittedly, the AirSense AutoSet has been my go-to machine for the past year. Not only is it one of the smallest bedside units on the market; it is also one of the quietest and easiest to use. So, I am pretty familiar with what works well, and its shortcomings.
The AirSense AutoSet machine has everything a day-to-day user would want in a CPAP machine. There aren’t any major improvements ResMed could make that I can think of off-hand. If you are looking for a bedside CPAP machine, that can be transported easily if required, it’s hard to look past ResMed’s AirSense AutoSet. If you can afford the hefty price tag. I found the best price and support on the internet for this machine here: CheapCPAPsupplies.com
What’s in the box?
There are a handful of versions in the AirSense range. The one right for you depends what features you need, as well as whether you prefer an AutoSet or fixed-pressure CPAP machine.
The AirSense range comes standard with the Heated Humidifier, however the ClimateLine heated tubing is optional. If it gets cold where you live, get the ClimateLine tubing! The unit I trialed included to ClimateLineAir Heated Tubing. In fact, it’s difficult to find one without the heated tube in Australia.
When we first open the box, we find the Travel Bag. The bag itself has a carry handle and an adjustable shoulder strap. In addition, the bag includes a strap across the back of the bag, allowing it to be slipped over the handle of a suitcase. This makes travelling with it a cinch, especially if you transport the machine as carry-on luggage.
The bags themselves come in two different shades of gray. Most of the machines come with the dark gray carry bag variation which is the standard color. This is what the machine I trialed came with. The AirSense 10 AutoSet for Her CPAP machine comes with a Lighter Gray travel bag.
Opening the bag, you will find the CPAP machine and components secure in the purpose-built CPAP travel bag.
The items in the bag are listed below.
The AirSense AutoSet machine (depending on what model you purchased).
Optional ClimateLineAir™ Heated Tube or Standard Slimline Tubing.
Power Supply and Cord.
SD Card (Installed).
Standard Filter (Installed).
Patient Manuals and user guide user guide, which hopefully you shouldn’t need after you read this review (it’s pretty comprehensive). It does have a few troubleshooting tips as well as the warranty terms and conditions. Basically, the warranty says that I shouldn’t do anything stupid and break the machine, as then it’s not covered by warranty.
A Quick Looksy
ResMed have adopted the the new ‘cylinder and pin’ type DC connector for their AirSense range of machines. This brings them inline with other manufacturers (namely Respironics) in adopting this style adaptor. Let’s hope they stick with this one.
The ClimateLineAir heated tube has undergone a slight design change, adopting a ‘right-angle’ connection angle to the machine. Everything else with the tubing remains pretty much the same.
The humidifier chamber is lighter, of a simpler design, and much easier to use, access and clean than the S9 model.
And finally, the unit itself. Here’s a shot of the front view with the humidifier removed and inserted.
The right side view with the humidifier inserted and removed.
The left hand side view shows where the filter cover (bottom left), SD card slot (top right), and accessories port (bottom right) are accessed.
Finally is the rear view with the hose removed, and then inserted.
Size and Weight Comparison
So how does the AirSense range of machines stack up against it’s competitors? Well, due to the many different shapes and sizes of CPAP machines, it’s a difficult comparison.
To make sure we are comparing ‘horses-with-horses’, I compared the ResMed’s AirSense machine to it’s main competitors. Since it occupies the premium end of the market, it will be compared to the Respironics DreamStation machine, and Fisher and Paykel’s ICON machine.
Here’s how a handful of comparable CPAP machines in the market-place size up today.
Front on, you can see the Fisher and Paykel Icon, the Respironics DreamStation, and the ResMed AirSense.
And since the footprint on the bedside is very important, from the top as well (with the AirSense machine in the centre).
As for weight, the AirSense range of machines is pretty darn light. The casing itself is made of plastic (which appears to be standard these days), and you really are unlikely to damage it too much unless you make an effort to. In addition, the combining the humidifier into the machine itself sheds much of it’s excess size and weight.
The weight of the machine and water chamber together comes in at 2.75 lbs (1.25kg); or as a total unit packed away neatly in the Travel Bag (except the mask) about 5.25 lbs (2.4 kg).
In comparison, the Respironics DreamStation CPAP machine plus humidifier tips the scales at about 3.16 lbs (1.43 kg).
ResMed’s AirSense machine isn’t rated as the quietest machine on the market (the DeVilbiss IntelliPap has this title). The AirSense machine is still at the lower end of the spectrum when it comes to noise. The AirSense machine’s noise level is stated as 26.6 dBA at 10.0 cmH2O CPAP pressure. This puts it among the quietest CPAP machines on the market.
But this isn’t the be-all and end-all with CPAP noise. As with all machines, the noise you perceive is dependent on a number of things including. These include:
- The frequency of the noise produced by the machine (separate than decibels). Some machines operate at a higher frequency (higher pitch) compared to others, either making them seem quieter or noisier.
- Where the machine sits.
- The mask type, vent, and quality of the mask seal. Some masks cause bone-conduction of sound because of how the air runs through the tubing or where the mask fits on the face.
- Auto machines tend to be quieter versus Fixed pressure machines.
- Changes in noise when the machine increases and decreases the pressure (either via the ramp or expiratory relief).
- Machine upkeep – including filters and humidifier chambers – making sure they are clean and properly assembled.
The screen light
ResMed does not have a function to change the brightness of the screen on this model. Instead, they have included a light sensor that automatically adjusts the light of the LCD screen to the room light. Honestly, it works well and I found it easy to see.
In addition, the machine completely blacks out after a few seconds after the machine is turned on. This might seem like an issue at first, but because the machine can automatically turn on and off during the night, you probably don’t have to go searching for the switch anyway. This means that you won’t be kept up by a constant glowing light during the night; which has been a common complaint among CPAP users.
Putting it together
Honestly, I barely need a section for this, as putting the AirSense machines together is as easy as it is intuitive.
ResMed produced a video which will take you through the steps of setting up the AirSense machine for the first time. This video is below.
If you prefer step-by-step written instructions with pictures, they are below.
Make sure the AirSense device is on a solid, stable, flat surface. Atop your bedside table should be suffice.
Plug the power supply in the back of the machine. It’s just like a laptop power supply, so just line it up, and gently push it in.
Then, while you are looking at the back of the machine, you might as well plug the heated hose in. Simply squeeze the two protruding ‘rubber clips’ in. Line the heated-tube power connection up, and push it in. It might be a little tight at first. Then, simply turn the hose to point it in the direction of your bed. This will help prevent the hose from bending and breaking in the long-term.
To remove the ClimateLineAir heated hose from the machine, grip the rubber protrusions again, squeeze them in, and pull it out. Simply, ey?!?
If you have standard tubing, it will just push straight onto the air outlet.
Connect the mask to the other end of the tubing. The mask should connect firmly to this end, and should require some force to remove it.
The humidifier, I feel, is the simplest out of any humidifier. To fill it up, simply unlatch the right hand side of the chamber and lift the lid. Fill the chamber with water (preferably distilled water) to the water line (or below, not above, definitely not above).
Close the lid by pushing it closed.
The chamber then simply slides into the right hand side of the machine.
To remove the water chamber, grab the top and bottom of the humidifier chamber (thats what the grip stip is for on top of the humidifier). Squeezing slightly pull it straight out.
It’s as simple as it gets with setting up a CPAP machine.
Entering Your Settings.
The AirSense AutoSet machine is ready to use out of the box for most people. The machine should be set in Automatic mode, CPAP pressure between 4 and 20 cmH2O, Automatic ramp and Automatic humidifier settings turned on. If you don’t know what all of these things mean yet, that’s ok. I will explain these through this Setup Guide.
Now, it should be said from the outset that these settings alter the treatment pressures that the CPAP machine delivers to you. Usually these will set for you by your CPAP provider, according to your prescribed settings. However, you may need to setup the CPAP machine for yourself, which is why I have provided these instructions.
Video showing how to change CPAP settings
Jason, aka ‘The Lanky Lefty’ from freecpapadvice.com has produced a very useful video describing how to access the clinical menu and how to change the settings within it. This video is below.
For those of you who prefer a text and picture tutorial, it is contained below.
Accessing the Clinical Menu
To setup your machine you need to access the clinical menu.
To access the clinical menu, simply press and hold the ‘Home’ and ‘Dial’ button together for atleast 3 seconds. The menu changes to clinical menu.
From the clinical menu, you have two options, but we are mainly interested in changing the settings, so make sure ‘Settings’ is highlighted on the screen and press the dial.
The Settings menu looks like this.
Adjusting any of the settings is done by the following steps:
- Turn the dial until you highlight the setting you want to change
- Press the dial.
- Turn the dial until the desired setting is reached.
- Then press the dial again to save the setting.
For example, to change the ‘Essentials’ settings of your CPAP machine:
- Turn the dial until the ‘Essentials’ option is highlighted
- Press the dial.
- Scroll clockwise (to increase) or anti-clockwise (to decrease) until the desired pressure is showing.
- Press the dial again to save the setting.
There are many settings you can change, but since we are focusing on ResMed’s AirSense AutoSet machine, we will focus on the settings available on this particular device.
Changing the Treatment Pressure Settings
First of all, with the AirSense CPAP machines, you have the option to choose either AutoSet or CPAP mode. Basically, AutoSet mode constantly monitors your breathing, and the subtle changes in your respiratory flow. If it detects narrowing of your airways the machine responds by increasing the CPAP pressure. The way in which ResMed devices do this will be covered in another section. CPAP mode operates at a particular pressure as set by you (only if you know what you are doing) or your CPAP provider.
The next one (or two settings) depends on what ‘Mode’ the machine is set on.
If the machine is in AutoSet mode, you will see Min Pressure and Max Pressure. These settings are the minimum and maximum pressures that the AutoSet machine can cycle through to treat your sleep apnea. If you set the maximum pressure too low it might result in ineffective treatment of your sleep apnea.
The pressure’s can be set in 0.2cm H2O increments.
If the machine is set on CPAP mode, you will see the Set Pressure setting. This is the therapy pressure that the machine will stay at through the night. Usually, it is based upon the setting given to you from the sleep specialist. Once again, changing the pressure may affect the quality of your therapy, and I advise against it unless you are sure of what your pressures are meant to be, and you consult with your point of contact for sleep therapy.
The next setting that can be changed is the Mask setting. Due to the slight differences in the ways that different types of masks vent the air, these settings subtly change the pressure settings of the machine. To be honest, having the incorrect mask setting here is unlikely to greatly change the efficacy of the therapy, but having the correct mask setting may make therapy more comfortable and tolerable.
Comfort Settings – Ramp time and Start Pressure
You can also change a number of the comfort settings from the clinical menu. The comfort settings are standard across the ResMed range, and are available no matter what version of the AirSense CPAP machines you have.
Firstly, you can set the Ramp Time. This is the length of time between turning the machine on, and the machine reaching the full treatment pressure.The treatment pressure means either:
- the Set Pressure in the CPAP AirSense machine
- the Min Pressure in AutoSet machines.
The ramp time can be set to Auto (suitable for most people), or between 5 and 45 mins depending on your preference. Setting the ramp to means the machine only starts to ramp the pressure up when it detects you fall asleep. It does this by detecting the subtle changes in your respiration at sleep onset, and works well for most people. It also helps for those night-to-night changes in sleep onset where either
- You can’t get to sleep, so the pressure doesn’t increase too soon or;
- You go to sleep after your head hits the pillow, so you don’t have apneas whilst the machine is still ramping up.
The Start Pressure determines the pressure that the machine first starts at when you first put the mask on. Largely, this is up to the CPAP user them-self, and you should put it at the pressure that you are most comfortable with. It can be set in increments of 0.2 cmH2O between the minimum pressure of 4 up to the Set Pressure (or Min Pressure).
Comfort Settings – EPR
The next setting that can be changed is EPR. EPR basically stands for Expiratory Pressure Relief and when it’s turned on, it results in a drop in the treatment pressure on exhalation. This reduces the effort to expire. Most CPAP brands have their own version of this feature (i.e. Respironics A-Flex and C-Flex). It definitely makes treatment more bearable (and increases the likelihood of compliance to therapy) for many who find it difficult to expire against the increased pressure.
The EPR can be turned on or off, depending on your preference. I’ve found that many long-term CPAP users do not find this feature useful, and instead prefer a constant CPAP pressure.
Furthermore, the EPR can be on either Full Time or during the Ramp Only. The options are self explanatory, and most people do not require the EPR to be active outside the Ramp period (when they are awake). This is especially true if the Auto Ramp is activated, as the machine should only ramp up the pressure when you have fallen asleep. It is up to you what you find most comfortable.
In addition, the EPR has three settings, which control how much the pressure drops when you exhale. Once again, this is largely a personal thing. There are three settings available, 1, 2, or 3. These settings correspond to the corresponding cmH2O pressure drop during exhalation. I like the EPR set to 2. Generally, I recommend that people start on an EPR of 1. If you are still finding it hard to push the breath out, increase it. Just find the setting you prefer. The maximum drop in pressure available is 3 cmH2O.
Climate Control Settings – Introduction
The final three Comfort settings available to change here are related to the humidifier and heated hose.
If the water tub is used and the ClimateLineAir heated tubing is connected, you will be able to choose between Manual or Auto climate control settings. The Auto setting automatically adjusts the humidifier and ClimateLineAir tubing to work in unison. This will be sufficient for most people, and will give close to the best humidity level for the climate.
However, sometimes you require more control over the humidifier settings. Either you find the Auto humidifier too warm, or you find that you are getting condensation in the tubing. This is where the Manual mode is useful. In Manual mode, you can adjust the Tube Temp and Humidity Level separately.
Climate Control Settings – Tube Temperature and Humidity Levels
The Tube Temp setting does as the name implies, it changes the temperature of the Heated Tubing on the AirSense machine. The temperature can be changed in 1 degree increments between 60 and 80 degrees Fahrenheit (16 – 30 degrees Celsius). According to the ResMed manual, the set temperature refers to the minimum temperature delivered by the heated air tubing. This setting is not available if you are using the standard SlimLine tubing. Increasing the temperature increases the temperature of air that is delivered, and decreasing it has the opposite effect. Careful not to decrease the temperature too much (especially in cold weather) as this may cause condensation in the tube or mask (which is a rather unpleasant experience).
The Humidity Level has 9 levels; Off, and on between 1 and 8, with 8 being the warmest. Increasing the Humidity Level effectively increases the temperature of the heater plate, hence increasing the temperature of the humidifier chamber and water within. It increases the amount of moisture added to the air. Basically, if you are getting a dry mouth and/or nose, increase this setting.
Miscellaneous Settings: Tube Type, AB Filter, and Oximeter
There are a few other settings that can be changed depending on how your CPAP machine is setup.
The Tube setting allows you to tell the machine whether SlimLine tubing (15mm) or Standard tubing is connected to the AirSense machine. Due to the different calibers of tubing, this allows the AirSense machine to slightly alter it’s pressure and flow settings and measurement s to accommodate for the different diameter CPAP tubing. If you have the ClimateLineAir tubing connected to the AirSense machine, it will detect as much and the Tube setting will reflect it accordingly.
If you install an AB filter (antibacterial filter) in your AirSense machine, it asks you to notify the machine. I’m not sure why this is exactly, or how it changes the operation of the machine if it isn’t done. I’ve got inquiries at ResMed trying to work this one out.
Another option, ‘view oximeter’, will show up if a compatible oximeter is connected to the AirSense machine. While an oximeter is connected the AirSense is able to record your pulse oximetry, which can be useful for clinicians making sure that CPAP (or APAP) is sufficient in treating your sleep disordered breathing.
What is the ‘Essentials’ Setting on ResMed’s AirSense Devices?
The Essentials option appears a little ambiguous to the casual observer. Admittedly, it took me some time to get my head around what turning it off and on would do. Effectively, with the Essentials option turned to ‘On’, only the most basic information will be available to you on the home screen (i.e. Mask Leak, Hours Usage, and Humidity). By turning this setting to Plus, you can see how well your therapy is treating your sleep apnea in greater detail. You will now be able to view your AHI for example on the user-accessible Sleep Report screen.
The next feature, I have always liked about the ResMed machines. They includes reminders to change your mask, water tub, tube and filter. No more guessing how long since you have changed the filter in your machine. Too many times have I seen machines brought in to my clinic which are putrid; as the person continually ‘forgot’ (or is too lazy) to change the filter, hose, mask or humidifier chamber. These automatically resetting reminders go a long way in helping reduce these incidences.
General and Admin Settings
The last lot of settings are the general admin (or configuration) settings for the machine. Here you can set the language, date (NOTE: The date is DD MM YYYY, i.e. how it should be written. 😀 :D), time, as well as the pressure (cmH2O vs hPa) and temperature (oF vs. oC) units of measurement to be used. From this menu, you can also erase the data, reset back to the default settings, as well as view detailed information about your AirSense machine.
I found the AirSense machine extremely easy to use. In fact, it is probably the easiest CPAP machine to use available on the market.
If the SmartStart is turned on (as recommended), all you have to do is:
- Put the mask on
- Start breathing into the mask. The machine is constantly in standby mode, and can detect when you start breathing into the system.
Alternatively, press the Start/Stop button on top of the AirSense machine.
Unlike some other machines, the AirSense machine will start at the programmed Ramp pressure (you don’t have to press the Ramp Button).
When the machine starts, you will see the Sleep Report screen on the LCD screen. The current operating pressure is displayed front and center in green. The surrounding circle will ‘spin’ whilst the machine is in ramp mode, and will fill completely when the full treatment pressure is reached. Additionally, you can easily view the Pressure settings (above the current pressure), Ramp settings (bottom left) and Humidifier settings (bottom right) on this window.
The LCD screen will go black after a short period of time. You can press either the dial or the home button to relight it.
To stop therapy, remove the mask and therapy will stop within a few seconds. Once again, the ‘breath detect’ sensors will identify when you are no longer wearing the mask.
Alternatively, press the Start/Stop button on top of the AirSense machine.
The Sleep Report
The automatically-generated sleep report is a neat little feature that ResMed have optimized from the S9 machines. The Sleep Report pops up after you turn the AirSense machine off each morning, giving a nice little summary of your nights sleep. The amount of detail it shows depends on whether the Essentials option in the clinical menu is turned to On or Plus (Plus gives a more detailed report).
If the Essentials option is turned on, you will see the Usage Hours, Mask Seal, and Humidifier displayed. This gives you an indication of the number of hours the machine was used for during the last session. N.b. If you got up for a midnight snack, like I often do, it may only show the number of hours for the second session of the night. A frowny face next to the Mask Seal item indicates that your mask needs adjusting (you can have a read of our Nasal Pillow, Nasal or Full Face mask fitting guides). A frowny face next to the Humidifier item indicates a fault with the humidifier. It may need troubleshooting.
If the Essentials option is set to Plus, you will have much more data at your disposal. The machine will display the AHI for the last day. In addition, you can view the: Days Used, Days 4hrs+, Avg. Usage, Used Hrs, Pressure, Leak, AHI, Total AI, and Central AI for the time period you select on the Period option (1 Day, 1 Week, 1 Month, 3 Months, 6 Months, or 1 Year).
ResMed uses the software program ResScan to download and view the AirSense machine data.
Needless to say, it is good. It provides very detailed reports.
Furthermore, you can also download your machines data onto the freely-available SleepyHead software. It is compatible with most major CPAP companies and (I believe) has been updated for the AirSense range of machines. Sleepyhead can be downloaded from here.
Cleaning the AirSense Machine – Introuction
Before cleaning the AirSense device, you need to pull it apart. Cleaning it regularly will prevent it from getting ‘smelly’ and will help keep those nasty germs away.
A two minute guide to cleaning the AirSense 10 machine is below.
ResMed recommends that you clean the AirSense device once a week, and I actually agree with them. I’ve seen other sites recommending that you clean the device every day because it will harbor bugs and germs and all other sorts of nasties. Honestly, if you are really that concerned, go ahead, but it’s very unlikely that you are going to get sick from your CPAP machine if you clean it once a week, and you are otherwise healthy. These same people replace the air filter once a week. Also unnecessary.
If your immune system is compromised, it may be worthwhile to clean it more often; or even disinfect it regularly. Otherwise once a week is fine.
How do I Clean the AirSense 10 Machine?
My procedure is as follows:
- Disconnect the tubing (heated or standard) from the machine and mask end and remove the humidifier chamber.
- Tip any excess water out of the water chamber (and hose (if there is any condensed in there) into the sink.A white residue is sometimes left in the humidifier chamber. This usually only occurs when you use tap water (distilled water shouldn’t do this) and is just an admixture of the impurities in the water as the pure water evaporates away during the humidification process. To remove it, just add one part white vinegar to 10 parts hot water. Let it soak for a while (30 minutes should suffice) and then wash it out.
- In warm soapy water, wash the humidifier chamber and hose. I use a mild dish washing detergent. Do not wash in a dishwasher! Make sure you pull the humidifier apart fully (remove the seal and lid) to clean it.
- Rinse both the chamber and the hose out with tap water, and air dry away from direct sunlight and/or heat. Drying these items in sunlight or near heat will make them wear out quicker.
- Give the machine itself a quick dust with a dry cloth.
- Checking the humidifier chamber for any cracks, or if the plastic has clouded (a sign of wear).
The main problem area is where the metal base joins to the plastic. In addition, check the removable seal.
The Air Filter.
ResMed recommends replacing the air filter once every six months. This largely depends where you live, where your machine lives, and how dusty it gets.
Some people in dusty parts of Australia (I’m sure it’s similar in the US) need to replace the filter every month.
Usually, I recommend replacing it every 3 to 4 months at a minimum.
Replacing it is easy. Open the air filter cover, remove the old one, replace it with a new one.
Do not wash the AirSense filters. They are not reusable, and will fall apart over time. You don’t want to be breathing in those fibers.
ResMed was one of the first manufacturers to implement an integrated heated tube to their CPAP machines with the S9 (Fisher and Paykel were another early adopter). Needless to say, they have pretty much got it down to a fine art now.
Most people will be able to use the Auto setting on the climate control with no worries. In Auto mode, the tube temperature is pre-set at 80 degrees Fahrenheit (27 degrees Celsius) and the temperature of the water chamber is adjusted automatically (based upon the ambient temperature) to produce 85% humidity levels.
Whilst in Auto mode, you (the CPAP user) can adjust the temperature of the heated tube to what is comfortable for you and the machine will make the necessary adjustments to the humidifier chamber settings.
Very important, and often overlooked. ResMed offers and 2 year warranty on their machines. In Australia, they offer an extra year if you join SleepVantage, or up to 5 years of cover which can be purchased seperately.
I’m not sure if they have a similar program in the USA. Perhaps someone could let me know?
Spare Parts and Consumables
As with most machines, there are a few things that you can replaced if heaven forbid they become worn out or break.
In addition, if you happen to break the filter cover on the AirSense machine, you can easily replace it. Product 19729 (charcoal) and 19768 (light grey) are the item numbers to look for.
Same goes for the power supply (or if you want to have a spare power supply for ease of travelling). They have been known to fail in the past, sometimes due to power surges. The AirSense Power Supply is available on Amazon and is item number 37344.
Wow, these take a long time to put together, there is more to come
I just wanted to get something out there.
Any thoughts on what else should be covered?
Please leave a comment below.