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[Equipment] Looking for New Machine
#11
(02-14-2017, 06:39 PM)steve823 Wrote: Thanks to robertbuckley I contacted my DME and asked about what machine they were going to order. They said the 960 and when I asked about it being discontinued. The replacement is the Dreamstation Auto BIPAP. She didn't know what the availability would be do to some restraints by the DME's company, but would check into it and let me know. Apparently one of the features is a built-in modem vs a hang-on-the-back modem on the current model. Different size, shape, color notwithstanding...

Once again, thank you very much for the info.

Once I get the new machine I would like to get the software to view and analyze the data. Any ideas there?

Just to clarify, a Dreamstation Auto BiPap is not
an ASV machine.    You should make sure they are giving you an ASV machine.  At present, despite rumors, there is not currently a Dreamstation ASV.
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#12
(02-14-2017, 03:43 PM)robertbuckley Wrote: I am a current user of the Respironics Bi-PaP Auto SV Advanced (the System One 950 model).  The 960 was an update to that with minimal changes.  Sleeprider has extensive knowledge and understanding of this field and not to be taken lightly.  He has a preference for the ResMed machine and its algorithm/response.  I personally prefer the Respironics.  If finely tuned, and yes it takes some effort, I found it more supportive than the ResMed (granted the one I compared was one that looked like the S-8).  While the Respironics has the ability for more things that can be adjusted, which I like, it really is a matter of personal preference and what works for you.  They are both great machines.  
  NOW - the real reason for inserting myself into this discussion is the following information.  The System One 960 is now officially "discontinued" - though I am sure there are a number of them out there in the supply chain.  I was speaking to Respironics last week and casually asked what was going on and if a Dream version of an auto SV advanced was coming out.  The answer I got, from two different people inside Respironics, was that they had been told that it should be released the end of this month, i.e. February 2017.  Just some info for you.   Good Luck and easy sleeping!

I really appreciate your input as a user of this machine.  It's personal experience and nothing is more valuable.  I have found that in general it is harder to dial people in on these, but Respironics has a very good reputation, particularly in the U.S.  They are manufactured here in my home town, so in a way, I want them to succeed because I sometimes share a beer with the employees and we talk about it.  The design of the algorithm is conservative (old), and in my opinion could use a refresh to work better in auto mode.  No question, that it has the most detailed and flexible settings, and for some it will be the best solution.  I still think there is room for improvement in adapting to the patient without complex manipulation of the settings.  Most doctors just aren't up to it.
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#13
Thank you very much.
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#14
(02-14-2017, 08:36 PM)C0mbe Wrote:
(02-14-2017, 06:39 PM)steve823 Wrote: Thanks to robertbuckley I contacted my DME and asked about what machine they were going to order. They said the 960 and when I asked about it being discontinued. The replacement is the Dreamstation Auto BIPAP. She didn't know what the availability would be do to some restraints by the DME's company, but would check into it and let me know. Apparently one of the features is a built-in modem vs a hang-on-the-back modem on the current model. Different size, shape, color notwithstanding...

Once again, thank you very much for the info.

Once I get the new machine I would like to get the software to view and analyze the data. Any ideas there?

Just to clarify, a Dreamstation Auto BiPap is not
an ASV machine.    You should make sure they are giving you an ASV machine.  At present, despite rumors, there is not currently a Dreamstation ASV.
Is the Bi-PaP Auto SV Advanced an ASV machine? How can you tell? 
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#15
(02-14-2017, 10:03 PM)steve823 Wrote:
(02-14-2017, 08:36 PM)C0mbe Wrote:
(02-14-2017, 06:39 PM)steve823 Wrote: Thanks to robertbuckley I contacted my DME and asked about what machine they were going to order. They said the 960 and when I asked about it being discontinued. The replacement is the Dreamstation Auto BIPAP. She didn't know what the availability would be do to some restraints by the DME's company, but would check into it and let me know. Apparently one of the features is a built-in modem vs a hang-on-the-back modem on the current model. Different size, shape, color notwithstanding...

Once again, thank you very much for the info.

Once I get the new machine I would like to get the software to view and analyze the data. Any ideas there?

Just to clarify, a Dreamstation Auto BiPap is not
an ASV machine.    You should make sure they are giving you an ASV machine.  At present, despite rumors, there is not currently a Dreamstation ASV.
Is the Bi-PaP Auto SV Advanced an ASV machine? How can you tell? 

Yes, I believe it is - but I am less familiar with that machine. I know the auto BiPap is not an ASV because it was one of my options and I am not on ASV.
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#16
The BiPAP Auto SV Advanced is an ASV capable machine, however it has several modes which are not ASV, including BiPAP-S and CPAP.
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#17
Thanks guys. I wish I could just stick to the ResMed, but I don't think these folks I deal with want me to have that. I think it has to do with "their" familiarity and not my preference. But I don't get the feeling the people prescribing and/or selling these things really know that much about them.
This whole thing reminds me of the time, 1967 that I bought a 1966 Ford Bronco. Went into the parts counter at the Ford dealership that sold me the Bronco and asked for a wheel-hub socket. Their question to me was, "what's a Bronco?"

Getting old can be hard on the frustration level.  Dont-know
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#18
This article explains some of the history of ASV and the BiPAP Auto SV Advanced. http://www.lakesidepress.com/CPAP/ASV.htm Note this is based on older machines, but the the basic information is unchanged. Resmed invented and patented ASV, and the method of tracking a patient's respiratory rate, volume and airflow. The reason your doctors know more about Philip Respironics has more to do with medical sales representatives than the technology. What really needs to happen is a head to head study of efficacy, and we don't have that; however there are considerably more studies and data based on the Resmed technology than Philips. This really should be the basis of a professional decision rather than a salesman. Any doctor or professional conceding they are more familiar or comfortable with one machine than another is simply betraying their overall lack of familiarity with the technology and its history and development. This is the reason, Philips gives away its devices for titration clinical use, so they get the order for the consumer device.

The bottom line to me is that the Resmed builds it's algorithm around the patient's baseline respiratory pattern, while Respironics uses an engineering approach to correct breathing patterns, an this explains much of the commentary that "Resmed feels more natural".

Quote:The basic difference between the two devices is the way the patient's breathing is tracked so that IPAP and/or EPAP can be adjusted. Per ResMed's fact sheet, the algorithm for ResMed's VPAP Adapt SV (now Aircurve 10 ASV):

"uses three factors to achieve synchronization between pressure support and the patient's breathing.
1. The patient's own recent average respiratory rate, including the ratio of inspiration to expiration and the length of any expiratory pause.
2. The instantaneous direction, magnitude, and rate of change of the patient's airflow, which are measured at a series of set points during each breath.
3. A backup respiratory rate of 15 breaths per minute."

In other words, the algorithm is proprietary and unique to ResMed. To highlight this point, below is a quote about the ResMed algorithm from Brown LK. Whither adaptive servo-ventilation? Current Opinion in Pulmonary Medicine 2010;16:527-29:

"The [ResMed] VPAP Adapt SV relies on a complicated estimate of recent average ventilation using mask pressure and total airflow to obtain target minute ventilation and determines respiratory phase using an estimate of intantateous respiratory airflow (and may also utilize 'fuzzy' catergories of resipratory phase). Furthermore, a host of internal constants and parameters govern the microprocessor's decisions with respect to pressure changes and cycling times, none of which are user-adjustable or explicitly stated."

Read the article. There are lots more out there.
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#19
WOW! So much information. Thank you so much for taking the time to explain all this to me.

My DME (NORCO) and my new PA. (not DR.) wants me to have the Respironics. My previous DR. who set me up with the ResMed after multiple sleep studies prescribed the current VPAP Adapt SV.

How do I convince those folks to let me upgrade to the AirCurve 10 ASV?
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#20
I don't know other than asking them to prescribe a machine type with settings, and leave the choice of brand to you. Settings will include least EPAP, or EPAP min and EPAP max, minimum PS and maximum PS, and may include an backup rate although auto is probably best. Either machine can be setup with this, and brand is not important.

I apologize for the rant, but it's intellectually lazy to tell someone to choose a machine based on their "familiarity". Tell them it's an opportunity to learn something new. Who can't like that? Alternatively, you can always use a general prescription to obtain the equipment a a DME that will dispense Resmed. Check with your insurer who is in-network, then call around. What's the deal with sole-sourcing? Shop around. If you end up with the Philips, it's a good machine, and you will adapt and finally be treated. I just think with the Resmed, the machine will adapt and you'll be well treated.

Why not start a thread on the forum and ask members using VPAP Adapt/ ASV or Auto SV Advanced for their experience and opinion? Useful to everyone.
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