Comparable Machines

[cjmstable]

I'm trying to get a Resmed machine to replace my recalled Dreamstation bi-pap asv. I think the Resmed equivalent is an aircurve 10 bi-level asv. Doctor's office wrote prescription for aircurve 10 ST. Although doctor is great, his office is TERRIBLE. Doctor told me there's only one model of Resmed bipap when I asked for specifics of what to get. When I search there's a lot of options on a bi-level aircurve 10 such as: S, ST, ST-A, VPAP, asv and others.

I spoke with a representative who said that not all bi-levels push a breath. I have central sleep apnea and stop breathing 40% of the time. He said that the ST didn't push a breath and to get nothing but the asv. I don't know who's speaking the truth and if the doctor meant to write an ST or the office messed it up. I'm trying to get back in touch but that office is terrible about responding. I fear I may be already too late and can't afford to wait days or weeks for their reply. [When my husband shifted off of Apria, the doctor's office failed to send the sleep study to the new provider even after 4 requests and over 3 weeks time!] 

Can you help me to know which aircurve 10 bi-level models push a breath and if an asv isn't available, is it worth waiting for it or am I better off buying a lesser model? [I'm super ill and can't afford to go without a machine.] Which lesser model is the next closest?

Any thoughts will be greatly appreciate.

cjm

[OpalRose]

It sounds like you need an ASV machine (Adaptive servo ventilator)

I would go with an AirCurve 10 ASV. I don't know much about the others. Hopefully someone else will chime in and advise.

http://www.apneaboard.com/wiki/index.php...V_machines

[Gideon]

Most BiLevels work by "chasing symptoms" and adjusting Pressure.

the ASV and ONLY the ASV works by monitoring volume and maintaining volume, for ResMed this is Minute Vent.  It is VERY effictive.

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  

So. . . . , which of the conditions that the ST is designed to treat do you have?  

ASV and ASVAuto are modes in the same machine, which of those conditions do you have?

DO NOTE  that both the ST and the ASV have the same billing code.

[SarcasticDave94]

Oh no! ResMed ST is NOT an ASV. ResMed AirCurve 10 ASV is their offering of the similar Respironics SV Auto.

I implore you, DO NOT accept the ST.

Yes correct on HCPCS code is identical for ST & ASV, E0471. Still you don't want to touch ST with 5 ten foot poles.

[cjmstable]

Gideon:

I appreciate your reply. I have central apnea, with some obstructive, and Dr. thinks likely complex. My condition isn't the standard stuff likely that will ever be listed on the Resmed sheet and it's complicated because the medication is greatly contributing to my breathing issues but I can't get off of it.

This is a bit beyond the depth of my understanding. I've read your list but to really understand the implications of it in my circumstance requires a depth of knowledge that I lack. It sounds like using ST for central, mixed, or complex apnea isn't a wise shift [as Dave just implored]. It looks like ST treats OSA not central, mixed, or complex. Which makes me think the rep was right, ST doesn't push a breath. That leads me to conclude that I should stay with the ASV and maybe consider an ASV auto.

Is that a reasonable conclusion or is my thinking faulty here? [I think Dave supports that conclusion.]

Thanks for everyone's help.

cjm

[SarcasticDave94]

Request this specific machine:

ResMed AirCurve 10 ASV.

Ask the doctor to write that name exactly and request as well Dispense As Written. DAW prevents substitutes by the DME.

PS that is an ASV Auto as an option in the mode selection.

[Gideon]

Almost, ST pushes a breath, EVERY BREATH, and the same amount of push for every breath, which is often not enough to get you to breath. Both EPAP and IPAP are fixed here similar to a CPAP but the difference between inhale and exhale is typically 5 or 6

The ASV and ASVAuto are different in that the ASVAuto is like an auto BiLevel to manage and Obstructive events you have in addition to the ASV mode
ASV mode has a starting Pressure (Min EPAP) and a Variable Pressure Support which is applied on the same breath it detects an issue with only apply enough PS to maintain your breathing volume. PS is variable typically between 3 and 15, thus a lot more capable to "push a breath". A MUCH better choice for you.

[cjmstable]

Thanks Dave!

[SarcasticDave94]

Let us know if we can help further and post with you get the ASV. Well help in setup. By we I mean members of Apnea Board, not just me specifically. But I've used it till I had to graduate to a higher type still in progress.

ASV Auto is easy to setup really.
Well, unless you're Dr. Dolittle the common sleep medicine doc.

[cjmstable]

I think we have consensus. Get the ASV.

You've greatly helped me to have a better understanding of these models and I LOVE Dave's suggestion to write the prescription dispense as written.

Thanks all!

cjm

I will definitely return if I need your help again