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NEW Failure of a Philps ASV machine
#11
RE: NEW Failure of a Philps ASV machine
When comparing a Respironics AutoSV therapy to ResMed APAP this qualifies as an apple to orange comparison. These are two very different machines, which I'm sure you know. I'm going to bet that since you've had an AutoSV that means a high CA/central apnea count. AND that is almost certainly why you couldn't stand the ResMed APAP. The wrong therapy will tend to do that. Just like square pegs must be hammered through round holes. Tell those idiot docs and/or whoever is controlling your therapy to get with the program. You were scripted an ASV for medical cause, so don't accept less. Run away from any DME that tries to give you a lesser than scripted machine. You can keep running into the Respironics that fails every few years brick wall if that's what you want to do, but I do know the ResMed is a better built machine. AND if you compare Respironics AutoSV to ResMed AirCurve 10 ASV Auto you will notice a good difference in quality build and therapy. Your choice.
Dave

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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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#12
RE: NEW Failure of a Philps ASV machine
Thanks, that makes sense.

My untreated ratings has been 30/30 clear and obstruction...

YET Medicare and Access will NOT order a ASV as I read MUCH less on simple APAP, under 5 AHIs nightly.

The kicker is sleep cycles I do 4/4 night sleeps 4 hours wake to for bathroom break, top up water tank and back to bed for 3 to 4 hours more.

Even with this kind of nights and even with a low AHIs under 5 per night I was crashing with only 2 to 3 hours per day of being able to do any work, and crashing so bad I watched reruns of show I knew as trying to track news shows was frustrating.

I bought a Phillips System One 950 open box with a two year warrantee from Second Wind CPAP and for a few years all was better.

BUT I ran into major problem with these machines, their high failure rates.

They seem to fail seem every two to three years. My first Phillips 950 ASV lasted 1.5 years before doing what I have learned is common “going ape with my breathing” it was replaced with an model 960 which lasted pass its two year warrantee and then it went “Ape”.

By going “ape” I mean sudden unneeded over reactions to nothing, I can be in bed going to sleep but not there yet and the system will suddenly start controlling my breathing rate, over riding my own control and pumping up the pressure when I am still awake and have NO trouble. And it will wake me up a couple of times at night seemly over reacting, again for no reason I can find, there was no report of any problem in the record to cause such a reaction.

At this point I was on Medicare and access so I asked my PCP to replace my bad ASV machine…but they demanded a new sleep study, and the would only provide a APAP machine.

I was showing low AHI numbers so figured THEY were right but I was still crashing nearly every day with only about a couple of hours of being alert….this was very depressing so I looked for help:


I then spent the next two/three years seeing every Doctor I could.


The findings were all the same. They could not find any cause of my crashes. I joking said the Dr.s all said, “ I will live to 125 IF I don’t mind doing it so very tired getting there.”


Then two things turned up. The first was my wife received a Fitbit HR for Christmas.

This device seems to be able to monitor sleep cycles. Not just how long one sleeps but the sleep cycles like Light, REM, and Deep.

A important report of the Fitbit, it CANNOT report any sleep cycle of less than three hours. As I was waken more often that that I was a little hard to get full night’s sleep reports.

I found there are a number of systems to monitor you sleep cycles, I use a system by Resmed called Sleep Score Max, a good system which can give a fairly accurate of all your sleep cycles.


REM and Deep sleep cycles are very important. With low of no REM and Deep sleep cycles you cannot function.


I got a Fitbit HR (For Heart Rate) first and found my replacement simple CPAP Machine was badly reacting and stopping most of my REM and Deep sleep cycles. I matched their time stamps and saw every time I entered REM or Deep sleep the APAP would over react after each event and raise pressure to the point I was aroused and pushed out of either cycle, IT was short changing these sleep cycles.


I dug out my older ASV machine (a much better sleep machine, Adaptive Servo-Ventilation Machines) and did a complete set up. I soon found I have was having a major improvement in my days; my sleep cycles are much better giving me much better days.

NOW HERE COMES THE MAJOR NEWS: IF you getting good numbers from your sleep machine BUT still dead tired all the time THIS MIGHT BE THE REASON:


My research into the subject of sleep cycles turned this up:
This is very much what I have problems with.

Sleep Stages article from Sistemma CPAP Blog Supplier #33

The Sleep Stages

Every night we cycle through stages of sleep that each have a distinct function in maintaining the health of our bodies and minds. For those with sleep apnea issues, the disruptions to these stages can be harmful whether or not you are awakened by an event. In the long term, what is known as sleep architecture, the rate at which a person cycles through the stages of sleep, is affected in ways that can make it harder to sleep even in the absence of apnea events. Whether you have obstructive, central, or mixed sleep apnea, the breathing changes associated with the disorder can also change the way your brain operates in those hours between evening and early morning, affecting everything from heart rate and blood pressure to memory consolidation and emotional health.

Stage One

Also called NREM1 (Non-REM Stage 1), the transition from being awake to being asleep is a lot more complicated than we previously thought. In a normal sleep cycle, stage one only lasts about five minutes, or just short of 5% of the entire cycle, but it is an important transition because it initiates the sleeping process and carries our waking thoughts into the lulling rhythms of sleep onset. It is the lightest stage of sleep, but also the period when the mind and body begin to relax into auto-pilot.

Though sleep apnea events can occur during the first stage of sleep, they are much more common during the later stages. Recent discoveries have led to a considerable amount of research on the specific phenomenon of REM apneas, a link that may soon advance our understanding of how sleep apnea affects the memory centers in the brain.

Stage Two

The second stage of sleep is the longest period in the cycle, accounting for approximately 50% of each cycle we sleep through. It is at this stage that firings in the brain called spindles begin to occur in fluctuating rates, as well as activity called K complexes. This is when breathing and heart rate settle into slower rhythms and remain there into the third and fourth stages. While stage one is referred to as NREM 1, stage two is actually the first true non-REM stage of complete sleep. The temperature drops, the muscles relax, and everything slows down into long, steady rhythms.

In regard to sleep apnea, the shift in breathing during stage two can be a dangerous moment, and events are increasingly more common with each stage going forward. In particular, the end period of stage two, just before the transition into deep sleep, is when apnea events are most common at this point in the cycle.
[img=838x16]file:///C:\Users\Rich\AppData\Local\Temp\msohtmlclip1\01\clip_image002.jpg[/img]
Normal Sleep Cycle: Wikimedia

Stages Three and Four (Delta Sleep)

Stages three and four are considered by many to be a single stage of deep sleep. This is the most restorative period of the cycle, responsible for many of the recuperative changes that occur in the brain and body when at rest. Almost coma-like in their characteristics, the deep sleep stages can be difficult to wake from. Slow delta waves begin to take over at this point, and will increase in frequency between the third and fourth stages. In healthy sleeping, each of these stages takes up about 20-25% of the cycle. But for those with sleep apnea, the third and fourth stages can be both dangerous and elusive.
Reading descriptions of the third and fourth sleep stages, one would assume that apneas would be a concern at this point. But due to the disruptions caused by abrupt shifts in breathing, sleep apnea patients often fail to sustain their deepest sleep states. This is not simply a problem of sleep quality, but a serious impediment to healing and immunity. Much of the body’s growth and fortifying hormones do their work during these deep stages of sleep, and without those complete minutes of rest, you can wake with fatigue and restlessness, as if you hadn’t slept at all.

REM Sleep

REM, an abbreviation for rapid eye movement, is the final stage in the sleep cycle, lasting about a quarter of a normal sleep cycle’s time. Called Stage R for short, this period is known primarily for the darting of the eyes, a behavior that occurs routinely during dreaming. Brain waves are the most active during this stage, and vivid dreams occur much of the time. Heart and breathing rates can become irregular, and chemicals are released that cause paralysis in our bodies, preventing us from acting out our dreams.

Studies have not only found that apnea events occur at high numbers during REM sleep, but that sleep apnea patients often spend much of their sleep cycle in this stage, leading some researchers to propose that they could be skipping stages like deep sleep entirely and instead alternating between other stages throughout the night. Yet at the same time, research published in January of this year proposes a link between sleep apnea and memory retention. The type of memories that are disrupted in sleep apnea patients are the same types of memories consolidated during REM sleep. The research, led by Dr. Andrew Varga of New York University, has also discovered possible links between sleep apnea and depression, dementia, and Alzheimer’s disease.

“For the first time we’ve shown that sleep apnea, an increasingly common medical condition, might negatively impact formation of certain memories, even when the apnea is limited to REM sleep,” said Dr. Varga. What this means for the sleep apnea community is that the fragmented sleeping patterns caused by apnea events can have a direct effect on mental health. As Dr. Varga describes it, untreated sleep apnea is the real issue because the long-term consequences can even more difficult to treat than the apnea.

Future Research

It should probably be pointed out that studies cited in this article relied upon untreated sleep apnea patients as research subjects. Use of CPAP (Continuous Positive Airway Pressure) and other sleep apnea treatments can potentially limit sleep disruptions caused by the disorder. But it is important to understand the direct effect of apnea on the natural stages of sleep. Researchers will continue to look into the links between apnea, memory, and how the disruption of the sleep cycle contributes to comorbidity and other health concerns over time. The more we know about the harmful aspects of the disorder, the easier it will be to treat effectively in the long term.

References
Journal of Neuroscience – http://www.jneurosci.org/content/34/44/14571.short
National Center for Biotechnology Information (NCBI) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2893208/
———. – https://www.ncbi.nlm.nih.gov/pubmed/23366967
Nationalgeographic.com – https://www.nationalgeographic.com/magaz...-of-sleep/
NYU Langone – https://nyulangone.org/press-releases/in...day-events
Psychcentral.com – https://psychcentral.com/news/2014/10/31...76798.html
———. – https://psychcentral.com/news/2019/02/04...pcycle.comhttps://www.sleepcycle.com/sleep-apnea/s...-big-deal/
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#13
RE: NEW Failure of a Philps ASV machine
Then you tell them some form of what you showed here. They should understand something like "Despite the good therapy numbers, I do not feel well rested. My sleep is still being disrupted frequently every night in spite of the PAP machine and mostly good treatment numbers and results. I have X Y or Z happening that causes arousals or disturbances." BTW if you had 30 CA and 30 OA that is a qualifier for ASV. Show them that test result. Tell them you would like to TREAT the CA not AVOID. To treat the CA needs an ASV. You can sometimes avoid it with any other machine. Make them listen. Don't be mean or hateful, but boldly tell them that anything other than an ASV or tests to prove ASV need will not be accepted.
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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#14
RE: NEW Failure of a Philps ASV machine
I spent most of Tuesday 8/18/2020 researching nearly every aspect of my Sleep Apnea problem.
 
I was able to talk with a good number of people about machines, treatment, and how the Doctors and insurance companies take care of sleep apneas.
 
This was two repair services, a reseller of these machines, a Phillips rep. and a Sleep Doctors medical nurse.
 
By trial and error testing and living with two types of sleep machines sense 2013 I have found I NEED a good ASV machine to get a GOOD night’s sleep that is both with low ratings of sleep apneas AND good full correct sleep cycles containing good deep sleep, and good REM sleep.
 
Sadly currently the Doctors and insurance companies have some hard to qualify rules for the type of sleep machine THEY will supply. They only will consider control of the Sleep apneas and NOT the kind of sleep.
 
A simple machine does not respond correctly to my sleep apnea and will report good treatment for my apneas BUT it will over react to my apneas and cut off my deep and REM sleep leaving me wasted most of the days.
 
An ASV machine is much more sensitive to my apneas and does not disturb my sleep cycles allowing me to get good quality sleep not just low apneas.
 
I am running into a fair amount of trouble getting the ASV machines. Here is what I have learned:
 
A) There is almost no way I can prove to any insurance I need this machine. The rules are stacked too high for me to show a need for an ASV machine. They also have another rule: ONCE I submitted to a sleep study in a clinic I am no longer able or allowed a home study. So I cannot do it in my own bed which should give more real readings.
B) ALL high end CPAP machine have a three to four year life span. Thus insurance will fight to use the cheapest possible unit. An ASV Machine costs around $4000.00. (OUCH)
C) My current systems an older 950 is NO longer allowed to be rebuilt as Phillips will no long supply parts!! My current 960 System is still supported but not for long!!
D) There are none better systems than Phillips or Resmed.
E) I was told the new Dreamstations ASV machines are having very low mother board failures BUT will lose their Fans every two to three years, and most likely will need to be replaced by a tech so they can be calibrated to the mother board, if so then I cannot DYI.
F) I have found a company that come HIGHLY rated by many. I am glad I found them. And they are NOT under the thumb of Phillips etc. I now have two repair companies to repair my machines.
G) The best plan I have been able to come up with is the get a newer Dreamstation ASV by any means possible, then have it tested and rebuilt as needed. This will allow me to keep a good running machine for hopefully the next 10 years. At that point I will need to upgrade to the newest machines.
H) Once I get a good Dreamstation ASV, I will keep on fighting to get a second one because of the down time for Fan replacements. Meanwhile I will have my older model 960 machine rebuilt so I have a backup system.
 
It is no wonder the sleep apnea treatment has a 50% failure rate of people dropping out, I can only wonder how many are caused by the cheapest machine treatment possible without checking for sleep cycles are causing people whom use these systems and still have bad days so it seems to not work to give up on them??
 
I found that they will only test and treat about 60 to 70% of the problem. The Doctors and Insurance are only allowed to treat the apneas, not how well your sleep.
 
I am finding health insurance has a few BIG holes in what and how they will take care of you.
 
This is one of them.
 
Sometimes you’re forced to take care of yourself.
 
I hope all of this will help someone.
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#15
RE: NEW Failure of a Philps ASV machine
Of course you know a new ASV machine can be purchased at about half the price you quoted, so while the machines are relatively expensive, a full attended PSG sleep study is actually more costly. The difficulty that insurance imposes to obtain coverage for any machine, and especially more advanced machines is by design. It does not save money, so the remaining motive is to make it so uncomfortable and frustrating that you just go away or self-pay. It works, and as you note, there is a high failure rate in PAP therapy and much of it is due to imposing the lowest possible machine onto all patients regardless of their needs. The insurance companies, doctors and suppliers never explain the rules of the game, but a few lucky individuals are motivated enough to learn how to "beat the system" or more likely get around it.

The more control insurance or government has over doctors, suppliers and patient rights, the less likely it is you will receive timely and professionally appropriate treatment. If you look at our members from around the world, those of us in the U.S. are truly bless with relatively good care, low prices and availability of the therapies we need. These machines cost considerably more in the U.K., Europe, Middle East, Asia, Africa and Australia, if you can even source one or find a medical professional that is even aware of them.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: NEW Failure of a Philps ASV machine
On Supplier #2 the cost of S10 AirCurve ASV NEW 2149 Used 1319. There used machines are all under 2,000 hours but I got a VALTO with only 250 hours. I would call and ask for a machine with XXX hours or less. They have great customer assistance.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#17
RE: NEW Failure of a Philps ASV machine
OMG it is so outrageous over seas, and I have keep hearing how much better it is over there!!! Guess that is NOT true.

As you can read I had some deep talks with a bunch of people. I am by the rules up an creek not only with out a paddle I got no boat either.

And yes a open box Dreamststion ASV can be bought fore $2200.00 for a used one and $2800.00 for a open box. Still breaks the bank.

The Doctors have tried and I have tried and THE ONLY thing that will get the insurance Medicare and/or access to give me a ASV is for me to nearly die in a sleep study WITH a CPAP system running....which is impossible.

The sleep cycles is NOT even to be considered by any means.

So self help is my only course.


Rich
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#18
RE: NEW Failure of a Philps ASV machine
I can tell you that I did get a fully funded ASV and now that it's not meeting my needs, I'm doing battle again to get my NIV/Vent. I will win too. The nurse at the new pulmonary facility stated more or less exactly what I've been saying in my own Overlap thread.

Anyway, to the topic, yes I believe you can win getting a new ASV if you want to do battle, and IF you have the medical evidence. As I said earlier if you can prove the 30 CA to 30 OA test, they should honor it. Unless they want to be jerks like normal. If you have the cash, go for one at Supplier #2 and save yourself the headache and ulcer. But in all seriousness, I would not get another Respironics that you have said will fail in about 3 years.
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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#19
RE: NEW Failure of a Philps ASV machine
My understanding is the DreamStation system do not have the failure problem the old System Ones did, the two repair shops have not even seen one and they have been out for 5 years. They can ware out Fans.

And I did NOT get along with a ResMed APAP system.

I also am told that all other brands are not all that much better in service.

I also think a lot of people do not have the same sleep cycle problem as I do or do not even know of it.

I do see a number of threads with the subject of: "I am doing everything I can, my Dr. saids we are doing it right, BUT I am still tired all the time", or such and I am trying to help spread the word.

And I also think a lot of people are not really able to tell when their system is acting up.

Rich
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