Best ASV machine to buy?

[ppk8]

Hi All,

I have been using CPAP machine for a yr now and have not had major improvements as I tend to have pressure induced central events with higher pressure settings. Although my sleep test reported no central events and only OSA.

As such, the Dr has suggested using ASV as the next step. It is a big cost and I wanted to ask here what is the best machine to buy? I am leaning towards the Redmed Aircurve 10 ASV but wanted to ask around here first.

Also, in terms of pressure settings, the Dr suggested between 8-14. But there seem to be other settings on it as well? Any recommendations for them?


Thank you very much!
Ppk8

[DeepBreathing]

G'day ppk8.

Basically the choice comes down to Resmed or Philips, though there may be other less-known models around. The general consensus seems to be that the Resmed is better than the Philips for most patients. My own experience (some years ago) is that the Philips tends to force you to breathe at its rate, while the Resmed conforms to your rate. The Philips has many more settings to optimise therapy (or to get wrong!) and the Resmed does much more with software.

Regarding pressures, you're right - it's a lot more complicated than just setting the minimum and maximum. There are three sets of pressure to be aware of:

EPAP - expiratory positive airway pressure - the pressure applied when you're breathing out. You can set EPAP max and min.

IPAP - inspiratory positive airway pressure - the pressure applied as you breathe in.

PS - pressure support - the additional pressure applied on top of EPAP to get the desired IPAP. (EPAP + PS = IPAP) You can set max and min PS.

You can read about the titration protocols to determine your ideal pressures here:

Resmed: https://www.resmed.com/us/dam/documents/...er_eng.pdf

Philips: http://incenter.medical.philips.com/docl...%3D9792335

[SarcasticDave94]

G'day ppk8.

Basically the choice comes down to Resmed or Philips, though there may be other less-known models around. The general consensus seems to be that the Resmed is better than the Philips for most patients. My own experience (some years ago) is that the Philips tends to force you to breathe at its rate, while the Resmed conforms to your rate. The Philips has many more settings to optimise therapy (or to get wrong!) and the Resmed does much more with software.

Regarding pressures, you're right - it's a lot more complicated than just setting the minimum and maximum. There are three sets of pressure to be aware of:

EPAP - expiratory positive airway pressure - the pressure applied when you're breathing out. You can set EPAP max and min.

IPAP - inspiratory positive airway pressure - the pressure applied as you breathe in.

PS - pressure support - the additional pressure applied on top of EPAP to get the desired IPAP.  (EPAP + PS = IPAP)  You can set max and min PS.

You can read about the titration protocols to determine your ideal pressures here:

Resmed:  https://www.resmed.com/us/dam/documents/...er_eng.pdf

Philips: http://incenter.medical.philips.com/docl...%3D9792335

Agreed, the ResMed ASV is better IMO. Note that I never tried the Respironics ASV, but I'm basing this as an opinion from other users' comments on the Respironics, that it seems a bit less natural and somewhat more difficult to get used to the therapy it supplies. ResMed ASV is the unit I chose. I feel like I adapted to my ResMed ASV very quickly, despite all the things the ASV does while in therapy.

You're also correct on the settings and descriptions. One addition is that to get EPAP Min and Max, the ASV needs to be operating in ASV Auto. If it's on ASV it reduces the EPAP setting to a one setting EPAP. Both sets of EPAP and PS are user adjustable, IPAP is algorithm controlled.

[Sleeprider]

I have never used ASV but have coached many users in optimizing, adjusting and adapting to their machines. It has been consistently easier to obtain optimized results on a Resmed Aircurve 10 ASV than the Philips BiPAP Auto SV.  One of the main advantages of Resmed is that is is supported by Sleepyhead software which makes viewing the results, and effects of setting changes much easier to understand.  Here is the simple titration protocol recommended for the Resmed ASV

[ppk8]

Hi All,

Thank you for your responses. At the moment, I currently use 8-14 on a CPAP. My thinking is, since IPAP is the pressure I inhale, this should match the pressure of the CPAP. In other words, IPAP range should be 8-14 and hence EPAP set at 5-11 and pressure support at 3-10? Does this make logical sense?

Ppk8

[Sleeprider]

That's a good start. My suggestion would be EPAP range of 5-11 and PS range of 2 to 12. The EPAP needs to only keep your airway patent to prevent obstructive apnea. The PS will counter any hypopnea, central apnea and periodic breathing. The suggested guideline for PS for starting out is 3-15 and that's something to consider. Most people find 12-cm is sufficient to cause a breath during CA events, and you may find that 10 is sufficient for you, but for starting out, I would just allow 12 or even 15 cm and then analyze the results. Keeping the PS max lower can prevent the machine from over-reacting and this has improved comfort for some. PS min on the other hand is the minimum pressure support for each breath. I suggested 2.0 but the machine will over-ride with higher PS if it is needed. The PS min should be mostly a comfort setting and the machine uses it's logic to increase PS above that as needed. A higher PS min may help with hypopnea, but since you have CPAP induced central apnea, keeping the minimum PS lower may reduce the number of events the machine needs to deal with, and keep pressures lower overall.

[ppk8]

Hi SleepRider,

Thank you very much for your reply. 

Since I do have some hypopneas at my fixed pressure 8 on CPAP, perhaps then is it better to set pressure support minimum to 3 and max to 12? I know its a small change to the min PS but just want to get the initial settings right. My pressure-induced central events tend to come at higher pressure levels so ideally i set a minimum pressure that reduces the hypopneas.

Look forward to hearing from you.
Regards,
Ppk8