ResMed: Consistent Growth in the Sleep and Respiratory Market

ResMed is a global leader in sleep and respiratory care, best known for its CPAP machines that treat sleep apnea. The company also earns steady, recurring revenue from masks and accessories that patients need to replace regularly, making this a key driver of profits and cash flow. Beyond devices, ResMed is expanding into software, diagnostics, and home sleep testing to help more people get diagnosed and stay on therapy. The big question is: Should this growing healthcare company be part of your portfolio?

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For full disclosure, I should mention that I do not own any shares in ResMed at the time of writing this analysis. If you would like to copy or view my portfolio, you can find instructions on how to do so here. If you want to purchase shares or fractional shares of ResMed, you can do so through eToro. eToro is a highly user-friendly platform that allows you to get started on investing with as little as $50.

The Business

ResMed is a global leader in medical technology focused on sleep and respiratory health. Founded in 1989, the company pioneered continuous positive airway pressure, or CPAP, as the first effective non-invasive treatment for obstructive sleep apnea. Since then, it has grown into one of the world’s largest providers of devices, consumables, and software designed to keep people breathing well and, increasingly, to keep them out of the hospital. Today its products and platforms are used in more than 140 countries by millions of patients, primarily through sleep clinics, hospitals, and homecare providers. The business is organized into two main segments. The Sleep & Respiratory Care segment covers devices such as CPAP, APAP, and bilevel machines, as well as ventilators and masks, which are primarily used to treat sleep apnea, COPD, and other chronic respiratory conditions. This segment is also the company’s largest revenue driver, supported by recurring sales of masks and accessories that need regular replacement and by a steadily growing base of treated patients worldwide. The Residential Care Software segment provides cloud-based platforms that help home medical equipment providers, nursing homes, hospices, and other out-of-hospital care organizations manage workflows, billing, compliance, and patient engagement. ResMed’s competitive moat comes from a combination of product innovation, scale, and digital integration. Its devices are recognized for being compact, quiet, comfortable, and cloud-connected, which fosters strong brand loyalty among physicians and patients. The company was early to integrate cloud connectivity into its ecosystem through platforms like AirView for clinicians and myAir for patients, creating powerful network effects: providers save time through automated monitoring and compliance tracking, while patients benefit from better support and outcomes. A large installed base and global manufacturing reach reinforce these advantages by generating recurring, high-margin consumables revenue and lowering costs through scale. Finally, the expansion into residential-care SaaS and home diagnostics strengthens customer relationships, creates cross-selling opportunities, and diversifies the business beyond hardware. These factors together build high switching costs and a durable position in the global sleep and respiratory health market.

Management

Michael Farrell serves as the CEO of ResMed, a position he has held since 2013 after joining the company in 2000. Over the course of his career at ResMed, he has held a variety of leadership roles across business development, marketing, and general management before ascending to the top position. Prior to ResMed, Michael Farrell gained broad experience across management consulting, biotechnology, chemicals, and metals manufacturing at companies including Arthur D. Little, Sanofi Genzyme, Dow Chemical, and BHP. Since becoming CEO, Michael Farrell has overseen a period of significant growth and transformation. Under his leadership, ResMed’s market capitalization has increased from $6 billion to more than $35 billion, delivering a total shareholder return of over 200%. He has guided the company through a successful expansion of its digital health and software offerings while strengthening its leadership in sleep and respiratory care. His tenure has also been marked by decisive management actions, such as the recent cost-cutting program that included a 5% workforce reduction, a difficult but necessary step to improve operational efficiency and position the company for long-term success. Michael Farrell holds a Bachelor of Engineering with first-class honors from the University of New South Wales, a Master of Science in Chemical Engineering from the Massachusetts Institute of Technology, and a Master of Business Administration from the MIT Sloan School of Management. He also serves on the Board of Directors of ResMed, the Advanced Medical Technology Association, and Zimmer Biomet. As the son of ResMed’s founder, Peter Farrell, he has a deep personal connection to the company’s mission of improving the lives of patients with sleep apnea, COPD, and other chronic conditions. Michael Farrell’s leadership style is characterized by a balance of strategic vision and operational discipline. According to employee reviews on Comparably, he has an approval rating of 85 out of 100, placing him among the top five percent of CEOs at similarly sized companies, a reflection of his accessibility and the strong internal culture he cultivates. At the same time, his willingness to make difficult decisions underscores his focus on long-term value creation. Given his industry expertise, track record of growth, and alignment with the company’s founding vision, I believe Michael Farrell is well-positioned to continue guiding ResMed as it expands its role as a leader in global sleep and respiratory health.

The Numbers

The first number we will look into is the return on invested capital, also known as ROIC. We want to see a 10-year history, with all numbers exceeding 10% in each year. ResMed has managed to keep its ROIC at high levels for many years because its business model is both profitable and efficient. The main driver is its mix of devices and consumables. Once a patient starts using a CPAP machine, they need to replace masks and accessories regularly, which generates steady repeat sales without requiring ResMed to spend a lot of extra money to produce or sell them. This creates strong profitability while keeping capital needs relatively low. On top of that, ResMed has built a valuable ecosystem of cloud-connected devices and software that helps doctors and providers manage patients more easily. These digital tools improve patient outcomes and make it harder for providers to switch to competitors, which allows ResMed to maintain pricing power. Its software acquisitions, like Brightree and MatrixCare, have also added high-margin revenue without requiring heavy investment in factories or equipment. In fiscal year 2025, ROIC reached its highest level ever. This happened mainly because demand for sleep apnea devices and masks grew strongly, and ResMed was able to supply the market at a time when competitors faced more constraints. The increase in mask sales, which are more profitable than devices, boosted margins. At the same time, its software business kept growing and contributed to profitability. Looking to the future, ResMed is likely to keep ROIC at a high level compared with most other medical technology companies. Its large base of patients, steady replacement cycle for consumables, and growing software business all support strong returns. However, the record level reached in 2025 may not be sustainable every year. Pricing pressures, changes in reimbursement, and higher costs could bring ROIC down slightly, even if it remains strong overall. In other words, ResMed’s ROIC will probably stay high by industry standards, but it may not go much higher than what was achieved in 2025 unless adoption of sleep apnea therapy accelerates faster than expected.

The next numbers are the book value + dividend. In my old format this was known as the equity growth rate. It was the most important of the four growth rates I used to use in my analyses, which is why I will continue to use it moving forward. As you are used to see the numbers in percentage, I have decided to share both the numbers and the percentage growth year over year. To put it simply, equity is the part of the company that belongs to its shareholders – like the portion of a house you truly own after paying off part of the mortgage. Growing equity over time means the company is becoming more valuable for its owners. So, when we track book value plus dividends, we’re essentially looking at how much value is being built for shareholders year after year. ResMed has been able to increase its equity every year over the past decade mainly because of the way its business generates steady and growing profits. The company sells not just devices but also masks and accessories that patients need to replace regularly. That creates a continuous flow of revenue that tends to rise as more patients are diagnosed and start therapy. On top of that, ResMed has expanded into software for out-of-hospital care, which adds additional profitable revenue streams without requiring heavy investment in factories or equipment. Because the business is consistently profitable and does not need to reinvest massive amounts of capital to grow, earnings accumulate on the balance sheet and flow into equity year after year. Looking ahead, it is very likely that this trend will continue. Sleep apnea remains highly underdiagnosed, so the number of treated patients should keep rising for many years. ResMed’s strong market position, recurring consumables sales, and growing software operations all support stable profitability. While margins may fluctuate somewhat due to pricing pressure or reimbursement changes, the overall business model is resilient. Unless there is a major industry disruption, ResMed should continue increasing its equity in the years to come.

Finally, we will analyze the free cash flow. Free cash flow, in short, refers to the cash that a company generates after covering its operating expenses and capital expenditures. I use levered free cash flow margin because I believe that margins provide a better understanding of the numbers. Free cash flow yield refers to the amount of free cash flow per share that a company is expected to generate in relation to its market value per share. ResMed reached record levels of free cash flow and free cash flow margins in fiscal year 2024 and managed to grow both again in fiscal year 2025 because of a combination of higher profitability and low capital intensity. The company generates a large share of its revenue from masks and accessories, which are high-margin products that require very little reinvestment to keep sales growing. Its software business adds another layer of high-margin revenue without heavy capital needs. At the same time, ResMed has been disciplined with spending on factories, equipment, and working capital, so rising earnings have flowed directly into free cash flow. In fiscal year 2025, free cash flow rose to nearly $1,7 billion, the highest in the company’s history. This was driven by strong demand for sleep and respiratory care devices, growth in recurring consumables, and continued expansion in software. Because the business needs relatively little capital to grow, much of the profit turned into cash, which lifted both the absolute level of free cash flow and the margin. Looking forward, ResMed should continue to generate strong free cash flow thanks to its recurring revenue base and efficient business model. However, margins may not expand endlessly from here, since pricing pressure, reimbursement changes, or higher operating costs could weigh on profitability. That said, the company is structurally set up to produce high free cash flow compared with most medical technology peers, and further growth is likely as the treated patient population expands. ResMed uses its free cash flow in several ways. It reinvests in research and development to keep improving its devices and software, funds sales and marketing to support global expansion, and pursues tuck-in acquisitions to strengthen its technology base and broaden its portfolio. At the same time, it returns significant capital to shareholders. The company has a track record of steadily raising its dividend, with the most recent increase of 13%, and it is also stepping up buyback activity in fiscal year 2026. The free cash flow yield has historically been low, reflecting that ResMed has rarely traded at a discount. However, it is now at its highest level since fiscal year 2016, suggesting that the shares are currently trading at a more attractive valuation than usual. We will revisit valuation later in the analysis.

Debt

Another important aspect to consider is the level of debt. It is crucial to determine whether a business has manageable debt that can be repaid within a three-year period. This can be assessed by calculating the ratio of long-term debt to earnings. After performing the calculation on ResMed, I have determined that the company has a debt-to-earnings ratio of 0,47 years, which is significantly below the limit of three years. Hence, debt is not an issue for ResMed. The company also holds more cash than debt and has access to additional credit if needed, which gives it plenty of flexibility. This means ResMed is in a strong financial position to invest in growth, return capital to shareholders, and pursue acquisitions without putting its balance sheet at risk. Looking ahead, debt is unlikely to become a problem as the business consistently generates enough cash to cover its obligations.

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Risks

Competition is a risk for ResMed because the markets it serves are both global and highly contested. In its core Sleep and Breathing Health segment, the company faces established competitors such as Philips, Fisher & Paykel Healthcare, and others, alongside regional players and new entrants. Many of these rivals compete directly on device performance, mask comfort, pricing, distribution, and customer support. Some competitors are even affiliates of ResMed’s own customers, which makes competing against them more challenging. The competitive environment is further complicated by healthcare industry consolidation, which gives large distributors and providers greater purchasing power to push for lower prices or more favorable terms. In the Residential Care Software business, competition is equally fierce. This market has low barriers to entry, shifting customer needs, and constant technological change. Many potential customers already use in-house systems that they may be reluctant to replace, and new competitors can introduce updated software solutions more quickly. If ResMed fails to keep its software platforms at the leading edge of usability and integration, its offerings could lose relevance. The return of Philips is a particularly important factor in the near term. Philips has been absent from the market for several years due to a major product recall, which gave ResMed an opportunity to capture share. With Philips now working through remediation and preparing to re-enter the market, ResMed could face pricing pressure or more aggressive competition as Philips seeks to win back customers. While ResMed was already competing strongly against Philips before the recall, a revitalized rival could slow its growth or put margins under pressure. Overall, the competitive risks for ResMed come from many directions: traditional device makers, fast-moving software competitors, and the purchasing power of large consolidated healthcare providers.

Obesity drugs present a risk for ResMed, particularly the new class of GLP-1 therapies such as Novo Nordisk’s semaglutide and Eli Lilly’s tirzepatide. These medications are highly effective at helping patients lose weight, and since obesity is one of the leading causes of obstructive sleep apnea, their widespread use could reduce the overall number of patients needing treatment with CPAP devices. Studies indicate that more than three-quarters of obese patients suffer from sleep apnea, and obesity is also strongly linked to conditions such as type 2 diabetes and heart failure that frequently coexist with sleep apnea. If obesity drugs succeed in reducing obesity rates on a large scale, they could shrink the pool of patients developing sleep apnea or at least lower the severity of the condition. ResMed’s own management has acknowledged this risk, estimating that effective obesity therapies could reduce the global number of people with sleep apnea and related breathing disorders from 1,4 billion to 1,2 billion by 2050. That potential decline in prevalence directly threatens the size of ResMed’s long-term addressable market. Clinical evidence has added to these concerns. Trials like SURMOUNT-OSA have shown that substantial weight loss can significantly improve or even resolve sleep apnea in certain patients. If more such results emerge, the market could increasingly view obesity drugs as an alternative to device-based therapy. At the same time, the impact is not straightforward. Not all sleep apnea patients are obese, and not all obese patients will respond to or have access to GLP-1 drugs. In addition, ResMed has presented real-world data suggesting that GLP-1 therapies may actually increase diagnosis and adherence to CPAP in the short term, with patients on these drugs more likely to start therapy and maintain consistent mask resupply. It is possible that by making people more health-conscious and engaged with their overall care, obesity drugs could even drive higher treatment uptake in the near term. The long-term risk, however, is that if GLP-1 drugs or similar treatments become widely used, effective, and affordable, the total prevalence and severity of sleep apnea could fall. In that scenario, demand for CPAP devices and related consumables might slow, limiting ResMed’s growth potential. For now, the ultimate impact remains uncertain and will depend on the pace of adoption, patient adherence, and whether these drugs are approved as direct treatments for sleep apnea itself.

Regulation is a major risk for ResMed, and the experience of Philips shows just how damaging regulatory failures can be. In 2021, Philips was forced to recall millions of CPAP and BiPAP devices due to problems with the sound abatement foam inside the machines. The financial and operational consequences have been enormous: the company has spent billions on settlements and remediation, faced lawsuits and reputational damage, and been placed under a U.S. FDA consent decree that prevents it from selling new devices in the U.S. until a long list of corrective actions is completed. This not only shut Philips out of its most important market but also left an opening for ResMed to capture share. The Philips case underscores how a quality or safety issue can quickly spiral into a full-blown regulatory crisis, with long-lasting effects on sales, reputation, and investor confidence. ResMed has managed to avoid major setbacks like recalls so far, largely because of its strong manufacturing practices and good track record with regulators. But the risks shouldn’t be underestimated. Medical device companies are closely watched by the FDA and other authorities, and any slip in quality, safety, or reporting could lead to recalls, fines, or even sales restrictions. At the same time, the rules themselves are getting tougher. For example, the FDA is updating its quality standards to match international norms and is putting more scrutiny on how products get approved. This means ResMed must keep investing in compliance, and even small changes to a product can require new approvals, slowing down innovation and adding costs. Beyond manufacturing oversight, reimbursement policy is another critical area of regulatory risk. ResMed’s products rely on healthcare systems and insurers covering CPAP therapy, sleep studies, and related diagnostics. Any cutbacks in reimbursement rates, tighter qualification rules for CPAP coverage, or broader healthcare cost-cutting reforms could directly impact demand. For example, U.S. Medicare’s competitive bidding program has historically pressured pricing, and although it is currently paused, it could be revived. Similarly, proposals to change veterans’ disability ratings for sleep apnea could reduce the number of veterans seeking CPAP treatment. Broader healthcare reforms, such as those enacted under the Affordable Care Act or subsequent budget bills, have also introduced new taxes, reimbursement cuts, and coverage changes that ripple across the medical device industry.

Reasons to invest

Favorable trends is a reason to invest in ResMed. The company operates in a vast, underpenetrated market, with more than 2 billion people worldwide suffering from conditions such as sleep apnea, COPD, respiratory insufficiency, and insomnia. Not all of these individuals will require devices, but the scale of the problem highlights the long-term growth opportunity. Today, awareness and diagnosis rates remain low, leaving a wide gap between those who need treatment and those who actually receive it. As this gap narrows, ResMed is well-positioned to capture demand. Several important global trends are driving this opportunity. Consumer technology companies such as Apple, Samsung, and Fitbit are playing a growing role in raising awareness about sleep health. Their wearables can screen for sleep issues, and some are even developing sleep apnea detection features. This creates a new pathway where consumers move from general sleep tracking to medical diagnosis and eventually to treatment with devices like those made by ResMed. ResMed itself is investing heavily in physician education, particularly with primary care doctors who are often the first to see patients with sleep-related issues. Through its continuing medical education programs, thousands of doctors have been trained on the benefits of CPAP and other frontline treatments, and surveys suggest that many plan to change their clinical practices as a result. This is critical, as it helps build a steady flow of new patients into the diagnosis and treatment funnel. Finally, ResMed benefits from a global footprint across more than 140 countries. The company is present in many underpenetrated regions where awareness and diagnosis are still very low, meaning the runway for growth remains long. Taken together, rising consumer awareness, physician education, and ResMed’s geographic reach provide strong tailwinds that should continue to support growth for many years.

ResMed’s mask and accessories business is a reason to invest in the company because it provides a steady, recurring stream of revenue that supports both growth and profitability. Unlike device sales, which are one-off purchases, masks and accessories need to be replaced regularly as parts like cushions, frames, and headgear wear out. This creates a dependable flow of repeat business that continues for as long as patients remain on therapy. As ResMed sells more devices, the base of patients needing replacement supplies expands, reinforcing this recurring cycle. This segment is also highly profitable. Mask and accessories sales carry higher margins than devices, which helps explain why ResMed has consistently achieved strong ROIC, built equity every year, and generated record levels of free cash flow. In other words, this business is not only growing but also fueling the company’s financial strength. Growth in this area has been impressive. In the most recent periods, masks and accessories have grown at double-digit rates, supported by the launch of new products such as the AirFit F40. Innovations like these improve comfort and usability for patients, helping ResMed maintain premium pricing without relying on discounts, which keeps margins strong. Another important factor is ResMed’s focus on patient adherence. Through resupply programs and digital platforms like myAir and Brightree, ResMed makes it easier for patients to reorder parts and stay on therapy. These tools use data and even AI to predict when patients are at risk of dropping off treatment, allowing providers to reach out and keep them engaged. Better adherence leads to healthier patients, lower costs for payers, and higher long-term resupply volumes for ResMed. Finally, there is still significant room to grow internationally. In many parts of Europe, Asia, and other underpenetrated regions, access to resupply programs is limited. As ResMed expands its reach and adapts its consumer-focused model to these markets, the recurring nature of this business will become an even larger contributor to growth.

Acquisitions are a reason to invest in ResMed because they strengthen the company’s long-term strategy and help it capture more patients across the entire sleep health journey. Instead of chasing large, risky deals, ResMed focuses on “tuck-in” acquisitions, smaller, targeted purchases that fill gaps in its portfolio and support its 2030 strategy. Recent deals illustrate this approach. The acquisition of Somnoware gave ResMed advanced software tools for sleep and pulmonary physicians, making it easier to manage patients and streamline workflows. Ectosense added the NightOwl, a fingertip-sized, wearable home sleep apnea test that improves convenience and expands access to diagnosis. Most recently, VirtuOx, a leading provider of home sleep testing, was brought into the group to reduce diagnostic delays and help patients move from symptoms to treatment faster. These acquisitions are important because diagnosis has long been a bottleneck in sleep apnea care. Sleep labs are often full, and patients face long wait times. By expanding home testing and integrating software, ResMed is building an ecosystem that accelerates diagnosis, keeps more patients on the path to therapy, and ultimately drives demand for its core devices and masks. The strategy also makes financial sense. These businesses may be small individually, but together they create a portfolio that improves patient flow, enhances recurring revenue streams, and supports international expansion. Over time, they can generate attractive returns by feeding more patients into ResMed’s therapy funnel, which then drives higher adoption of CPAP devices, masks, and resupply programs. In short, acquisitions allow ResMed to expand beyond being just a device maker into a more integrated healthcare player, covering diagnostics, software, and patient management. This strengthens its competitive moat, reduces dependence on any one product line, and positions the company to capture more of the massive underdiagnosed sleep apnea market worldwide.

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Valuation

Now it is time to calculate the share price. I perform three different calculations that I learned at a Phil Town seminar. If you want to make the calculations yourself for this or other stocks, you can do so through the tools page on my website, where you have access to all three calculators for free.

The first is called the Margin of Safety price, which is calculated based on earnings per share (EPS), estimated future EPS growth, and estimated future price-to-earnings ratio (P/E). The minimum acceptable rate of return is 15%. I chose to use an EPS of 9,51, which is from fiscal year 2025. I have selected a projected future EPS growth rate of 10%. Finbox expects EPS to grow by 10% in the next five years. Additionally, I have chosen a projected future P/E ratio of 20, which is twice the growth rate. This decision is based on the fact that ResMed has historically had a higher P/E ratio. Lastly, our minimum acceptable rate of return is already set at 15%. Doing the calculations, we come up with the sticker price (some call it fair value or intrinsic value) of $121,94. We want to have a margin of safety of 50%, so we will divide it by 2. This means that we want to buy ResMed at a price of $60,97 (or lower, obviously) if we use the Margin of Safety price.

The second calculation is called the Ten Cap price. The rate of return that an owner of a company (or stock) receives on the purchase price of the company is essentially its return on investment. The return should be at least 10% annually, and I calculate it as follows: The operating cash flow last year was 1.752 and capital expenditures were 90. I attempted to review their annual report to determine the percentage of capital expenditures allocated to maintenance. I couldn't find it, but as a rule of thumb, you can expect that 70% of the capital expenditures will be allocated for maintenance purposes. This means that we will use 63 in our calculations. The tax provision was 277. We have 146,4 outstanding shares. Hence, the calculation will be as follows: (1.752 – 63 + 277) / 146,4 x 10 = $134,29 in Ten Cap price.

The final calculation is called the Payback Time price. It is a calculation based on the free cash flow per share. With ResMed's Free Cash Flow Per Share at $9,51 and a growth rate of 10%, if you want to recoup your investment in 8 years, the Payback Time price is $142,78.

Conclusion

I believe ResMed is an intriguing company with strong management that has built its moat through product innovation, scale, and digital integration. It has consistently delivered a high return on invested capital and reached record free cash flow and margins in fiscal year 2025. The company does face risks. Competition is intense, with global and regional rivals challenging it on price, quality, and distribution, while healthcare consolidation gives buyers more leverage, and the return of Philips after its recall could intensify pressure and slow growth. Obesity drugs such as semaglutide and tirzepatide are another risk, as their effectiveness in reducing obesity could lower the prevalence of sleep apnea and shrink long-term demand for CPAP devices, even though in the near term they may drive more patients into diagnosis and treatment. Regulation is also a key risk, as strict oversight means even small safety or quality lapses could lead to recalls, fines, or sales restrictions, and evolving standards or reimbursement changes could add costs, slow innovation, or reduce demand. On the positive side, favorable global trends support long-term growth, with rising awareness of sleep health through consumer wearables, increased physician education, and a vast underdiagnosed population steadily expanding the pool of patients entering the treatment funnel. ResMed’s global presence in over 140 countries positions it well to capture this opportunity. Its masks and accessories segment adds another reason to invest, as it provides recurring, high-margin revenue that strengthens cash flow, with innovations and adherence programs ensuring consistent demand for replacements as more patients begin therapy. Acquisitions further support the investment case, as ResMed strategically expands into diagnostics, software, and patient management, reducing bottlenecks in care and reinforcing its ecosystem in ways that ultimately drive demand for its core devices and consumables. Taken together, I believe ResMed is a strong company with durable growth drivers, and buying shares at the Payback Time price of $142 could be a compelling long-term investment.

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