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New sleep study
#1
I recently had a new sleep study. I have had diagnosed sleep apnea for 17 years now.I am on my fourth machine. My old S9 needed repairs and I felt that I could benefit from a new machine and sleep study and the Doc agreed. She wouldn't give me a R/x for a new machine because she said that I may need a bilevel machine and wanted to wait until after the study. Well the sleep study suggests a bilevel machine and an increase in pressure. I currently use sleepy head and since downloading it and adjusting my machine over the past 5-6 months I have lowered my AHI from a worst case night of 115 which only happened once, to an average night of about 25-35 AHI and not very compliant to an average AHI of either slightly above or below 5AHI. When I saw my sleep Doc she suggested I try melatonin as I have a difficult time getting to bed on time. Well I have been taking the melatonin varying from 1-3 mg an hour or two before bed and the unexpected benefit is that it dropped my AHI in half to an average of 2.5.
Anyway my reason for posting is that I want to make sure I get the right bilevel machine. During my sleep study I slept very poorly, probably 2 hours of fragmented sleep if that. When I was semi sleeping awake I instantly knew when they kicked in the bilevel and I was struggling with it adjusting to the rhythm and pressure. The new R/x is recommending a pressure of 16-21 and 3-6 for the bilevel and auto set.. I may not have the wording exact as it was mentioned to me over the phone when I asked.. I am going in on Tuesday for a new machine, a rental.
Any thoughts about what I need to ask or what I should know or be aware of would be very appreciated. From my research so far which is not a lot it seems that the Resmed Aircurve 10 ASV seems to be a potential machine. At the sleep lab I dont know the model but it was a Respironics machine. I have heard that some people struggle with one brand and that the other is easier to comply with..

Thanking everyone in advance

Steve
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#2
I doubt you'll get an ASV. (Expensive and intended for Central and mixed apnea.)
I would try to get a bilevel auto.
For ResMed that would be the AirCurve™ 10 VAuto

PR makes a comparable machine.
They are a slightly different twist on the same animal.

For reasons that are very minor, I happen to prefer ResMed; there are people who prefer PR machines who feel strongly about it.
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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#3
Thank you for such a quick response,
The reason the Doc was holding back on giving me a new cpap was because on my last sleep study 5 years ago I had a higher amount of central apnea events than she would like and the bilevel is supposed to address central apnea better she told me. What is the difference between the bilevel auto and the ASV?

Thanks in advance justmongo

Steve
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#4
(12-23-2015, 07:55 PM)sleepyOttawaSteve Wrote: What is the difference between the bilevel auto and the ASV?

Bilevel auto is much like any auto adjusting machine. But, the pressure split between IPAP and EPAP pressures can be greater than on an Autoset; plus the split is constant. The VPAP S9 and S10 VAuto can exceed 20 cm-H2O pressure. (Upper limit is 25)

ASV tracks your breathing pattern and can adjust on a breath by breath basis; performing an inflation of the lung (much like mouth-to-mouth) to ventilate a person when a missed breath is detected.
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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#5
G'day sleepyOttawaSteve, welcome to Apnea Board.

If you have a high percentage of central apneas you might well end up with an ASV. However these are very expensive (here in Oz they're about twice the cost of an ordinary bilevel) so the insurance company will want you to try out a more conventional (cheaper) machine first.

Quote:What is the difference between the bilevel auto and the ASV?

A bilevel is a more sophisticated form of CPAP. The main difference is that the inhale (IPAP) and exhale (EPAP) pressures can be set separately. This is important at high pressures as it allows a much more comfortable exhalation. Some of the better models have a range of settings (trigger, cycle etc) which try to smooth out the inhale / exhale transition and respond better to your breathing. ASV stands for adaptive servo-ventilator and will force you to breathe if you stop. (As you may know - and putting it extremely simplistically - central apneas occur when the brain fails to send the "breathe now" signal to the lungs). The ASV responds by varying the IPAP on a breath-by-breath basis and will respond instantly if you pause.

I have the Resmed S9 VPAP Adapt, which is the predecessor to the current S10 AirCurve ASV. I did try the equivalent Respironics machine for a month but could never get on with it. Other people have had the opposite experience, so if you end up with an ASV don't be afraid to ask for a trial on both machines and see which suits you best.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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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#6
(12-23-2015, 07:32 PM)sleepyOttawaSteve Wrote: I have heard that some people struggle with one brand and that the other is easier to comply with..

True, but it depends on the individual so there's no "right" brand. I noticed a huge difference switching from ResMed to Philips Respironics (but to be fair, my ResMed was an S8). Some people have the opposite experience, doing better with a ResMed.
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#7
Thank you to everyone for your comments and suggestions Smile
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#8
Hi sleepyOttawaSteve,
WELCOME! to the forum.!
I wish you much success at your next sleep study and also as you continue your CPAP therapy.
trish6hundred
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#9
I use a ResMed AirCurve 10 VAuto with pressure ranges similar to what you describe. During an in-home BiPAP trial, I was using an Respironics DS760. I liked both of them, could easily adapt to either one. I chose the ResMed, honestly, because I like the form-factor better - it's a bit more compact. I'm actually planning on picking up a Respironics machine as a backup so I'll have both available.

I did find that after a month or so of acclimatization, I was able to tweak a couple settings that made the machine even more comfortable - after the first few breaths, I barely even notice that the machine is there anymore.
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#10
(12-23-2015, 07:32 PM)sleepyOttawaSteve Wrote: Anyway my reason for posting is that I want to make sure I get the right bilevel machine... I am going in on Tuesday for a new machine, a rental.
Any thoughts about what I need to ask or what I should know or be aware of would be very appreciated. From my research so far which is not a lot it seems that the Resmed Aircurve 10 ASV seems to be a potential machine. At the sleep lab I dont know the model but it was a Respironics machine. I have heard that some people struggle with one brand and that the other is easier to comply with.

Hi sleepyOttawaSteve,

A standard bilevel Auto is the best machine for simple Obstructive Sleep Apnea when uncomplicated by an excessive amount of Central Apnea. However, for those who have a tendency to get Central Apneas, standard bilevel therapy or standard Auto bilevel therapy usually tends to make central apneas worse.

ASV bilevel machines are more expensive, and ASV bilevel therapy is usually more difficult to get used to (inhale pressures range higher, and the machine sometimes seems to have a mind of its own), but it is well worth the effort if an excessive amount of Central Apneas are an issue.

When I was using a bilevel Auto machine I would occasionally still wake up slightly headachy and unfocused, having had more than 5 CA per hour. My ASV machine has solved that problem and is definitely my friend.

For ASV, I think usually (but not always, because it depends on insurance requirements) a separate ASV Titration is required to show that ASV therapy is able to successfully treat your central apnea component.

Take care and good luck,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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