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Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
#1
Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
Admittedly I find the ease of setup with Resmed ASV, very appealing but quite honestly I miss my Dreamstation BiPAP Auto SV a lot.

First and foremost it is because the DS1 algorithm targets the Tidal Volume better which in my case is important since I can't tolerate high EPAPS (anything higher than 4 keeps me awake which means I only use the Resmed on its ASV mode which fixes the EPAP and since I don't have any obstructive events , the Resmed Auto ASV mode is kinda redundant for me.

As to why I miss my DS1, it is also because I have a lot more control on different therapy parameters including backup rates, where as Resmed does most these calculation by itself as it adapts to my breathing, so an hour into therapy, I don't even know if the machine is on or not , even though it tells me it is doing a great job at keeping my AHI down:-)

So starting tomorrow, Ill be going back to my DS1 ( an since I never use Ozone to clean my machines, I have no cause to worry about the "foam" disintegrating )and I will start posting comparison OSCAR Charts once I finish fine tuning it and start getting a good night asleep.
How about you?
Have you tried two different ASV machines yet ?(there are really only two makes that are widely available commercially).
If so, let us know about your experience.
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#2
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
The Resmed ASV design has a critical omission with the lack of a programmable backup rate.

My sister was diagnosed with severe central apnea at 72 AHI was started on a Resmed ASV that was not effective. She received the wrong machine because the DME was incompetent and did not follow the prescription for the ASV with a programmable backup rate. The DME employee was fired. She received the DS1 bilevel ASV and is getting good results. Her AHI is usually 2 or below. The machine sometimes generates thousands of timed breaths nightly.

I was diagnosed with mixed apnea and was given a DS1 Auto which responded to centrals with a pressure pulse that occasionally triggered a breath but often did not.  When the recall happened, my research and my sister’s experience led me to get a DS1 bilevel ASV which I defoamed.  

I tried the auto backup rate and the results were totally unsatisfactory. With a programmed backup rate my patient triggered breaths vary from zero to 100%, but with the timed breaths, my tidal volume and oxygen saturation stay in a reasonable range. The AHI varies all over the place from 2 to 12. I will put together some OSCAR charts to see if there are any suggestions for improvement or why it varies so much from night to night.
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#3
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
(11-16-2021, 08:53 PM)LindanHotAir Wrote: The Resmed ASV design has a critical omission with the lack of a programmable backup rate.

thank you for that pointed response.That is exactly why I am going back to my Dreamstation ASV.
I don't understand why a ASV algorithm is designed without a backup rate. Resmed only relies on the prior 90 seconds worth of breathing data to deliver breaths to break hypopnea events, without a settable backup rate, BPM or "Rise Time" settings. All these parameters are missing on Resmed ASV and we are to simply "trust" the machine to deliver the goods when needed , based on its own sweet calculations and without allowing the patient/technician any control over it....I find that a little crazy (I am not in medical profession but my company designs industrial robots that rely on "Servo Response" almost entirely, so I have a fair degree of appreciation of how a servo mechanism must work).

I will be posting some comparison charts in a few days to show how Dreamstation ASV handles Hypopnea events, and much more effectively than Resmed.
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#4
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
A machine that depends on the past 90 seconds of patient respiration during a period of extended central apnea, for example, 0% Patient triggered breathing, is going to generate an average respiration rate of zero. That is an example of a very poorly implemented sampled data feed forward system.
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#5
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
(11-16-2021, 11:23 PM)LindanHotAir Wrote: A machine that depends on the past 90 seconds of patient respiration during a period of extended central apnea, for example, 0% Patient triggered breathing, is going to generate an average respiration rate of zero. That is an example of a very poorly implemented sampled data feed forward system.

Could not argue with that Laugh-a-lot
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#6
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
Both of you have a misunderstanding of the ResMed ASV algorithm.

It targets minute vent not respiration rate.

From marketing material for clinicians

Quote:https://www.resmed.com/ap/dam/documents/...520PAP.pdf

MV-target pressure support: physiological therapy to stabilise breathing

PaceWave keeps your patient’s breathing stable and as close to their natural patterns as possible. It prevents under- and over-ventilation by treating apnoeas and hypopnoeas while reducing the risk of hyperpnoeas. It sets a suitable target minute ventilation for your patient: 90% of their most recent minute ventilation based on a three-minute moving average. When the patient’s minute ventilation falls below the target, PaceWave automatically adjusts the inspiratory pressure to provide backup support. As the patient’s breathing stabilises, the pressure is rapidly returned to the minimum required.


There is also a "backup" backup rate of 15 BPM.

So respiration rate is never going to be zero.

From the clinical guide
Quote:https://www.resmed.com.au/hubfs/download...ow-eng.pdf

Backup rate

The AirCurve 10 CS PaceWave device uses breath phase mapping to provide a timed backup rate that is synchronized with the patient’s own breathing. When the patient deviates from the ventilatory target, the CS PaceWave device aims to stabilize the patient by adjusting Pressure Support. If necessary, it will adjust the timed backup rate from one that matches the patient’s own recent rate towards the built-in default 15 BPM backup rate.

Regarding the programmability, that is not agreeable to you. But it works for many people.

http://www.apneaboard.com/forums/Thread-...ronics-ASV

Pick the machine that works for you, given CPAP therapy is so YMMV.
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#7
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
The default backup rate of 15 is a long way from the 9 that is effective for me, or the 11 that my sister uses. Can you explain why 15 was hard coded into the Resmed?
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#8
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
I myself have no reasoning for 15 being chosen as the backup rate, but when my ResMed AirCurve 10 ASV was doing well by staying in sync with me, my backup rate fell in line with my slower 8-12.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
(11-23-2021, 01:13 AM)SarcasticDave94 Wrote: I myself have no reasoning for 15 being chosen as the backup rate, but when my ResMed AirCurve 10 ASV was doing well by staying in sync with me, my backup rate fell in line with my slower 8-12.

How do you know what backup rate Resmed is using? I must be missing something because I can't find the information on my Resmed ASV.
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#10
RE: Going Back To My DS1 BIPAP Auto SV After Trying Resmed AC 10 ASV for 4 Months
My mistake. I had inadvertently pictured respiration rate listed on OSCAR left panel info when I mentioned that.

I'm trying to see if maybe I saw backup rate on the ST-A when I used that recently.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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