OSA and CSA. Which of the newest machines is best

[Eurika]

If you are buying your own machine and money was not a consideration, what would be the best machine to get for the treatment of OSA and pressure induced CSA and
Complex SA.

The Aircurve system, which one?

Is there a machine available yet that can provide APAP and AVS in the same unit yet.

So complex apneas as well as regular OSA can be auto titrated.

Interested in what's available now and in the near future.

Looking for the wise ones to enlighten me.

Thanks
D

[PaulaO2]

Unless the Aircurve has some fancy bells and whistles, and because in this scenario I am paying out of pocket, I would stick with the S9 versions. And that would be the VPAP Adapt.
http://www.resmed.com/us/en/consumer/pro...adapt.html

The P-R models confuse the crap out of me with their numbers. And their website is about as useful as Bompa (which ain't saying much).

Oh, wait, you said the wise ones. Sorry I butted in.

[archangle]

Auto CPAP is "best" for OSA. It may even work best if your CSA isn't that bad. APAP's can be set to a limited range of pressures if higher pressure causes central apnea.

ASV is "best" for CSA, but they can be uncomfortable and hard to get used to, especially at first until your brain learns to let the ASV decide when you need to breathe, and you get the settings right.

ASV is much more expensive, so don't think ASV is automatically "right" for everyone, or even for someone with mild CSA.

Auto bilevel/BiPAP/VPAP machines fall in between APAP and ASV in some ways.

ResMed vs. Philips Respironics PRS1 is sort of a tossup at the moment. Each has its pros and cons.

ResMed A10 models are better on paper, and haven't demonstrated a lot of problems yet. However, S9 models have a really good track record, and the A10 machines don't have a lot of obvious or major advantages. I'd call S9 vs. A10 about a tossup as well at the moment.

I don't think any of the ASV machines do "standard" APAP or bilevel modes, although they will do manual CPAP. I'm not 100% sure about this.

[zonk]

Real central sleep apnea (CSA) when the brain does not send proper signals to breath and the airways remain open. Its different from obstructive sleep apnea (OSA) where you cannot breathe because of airways obstruction

There are other causes for CSA such as heart failure and stroke, also sleeping in high altitude and opiate pain relief medication may cause CSA

Pressure induced CSA is different kettle of fish, for some playing with EPR may help and will subside in time, if not ...
Best consult with your sleep physician

S9 AutoSet does not treat CSA as such but increase pressure in response to snoring and flow limitation which both are indication of OSA ... not CSA. During CSA, airways remain open and the S9 can tell the difference ... clever little thing

From http://www.resmed.eu/us/clinicians/about...clinicians
A diagnosis of central sleep apnea (CSA) requires all of the following:
An apnea index > 5
Central apneas/hypopneas > 50% of total apneas/hypopneas
Central apneas or hypopneas occurring at least 5 times per hour
Symptoms of either excessive sleepiness or disrupted sleep

[Eurika]

Thanks guys, and Paula you do yourself an injustice, oh wise one ;-)

The reason for asking is because I do take sleep medication and I don't have access to a sleep doc here, that is unless I want to bankrupt myself!

The APAP has really taken care of the OSA but the CSA is starting to go up and up. At the moment to not an issue at all, but I was hoping that there would be a machine that would basically auto titrate for both OSA and CSA.

The post was initially prompted after a lousy night which made me uber irritable, and I thought I'd got over that as the therapy was making me feel so much better. I know that we should not expect to have great sleep all the time and there are going to be nights that are just plain horrible.

I guess I'm a bit of an OCD perfectionist and am looking to get numbers <1 on a consistent basis.

Thanks guys, I really appreciate being part of the Apnea Board family.

[Peter_C]

My new machine sounds like it fits the bill. You can lock it up tight like a dumb brick CPAP, or open it up like an auto-PAP, or set it like a bi-level, or really open it up like an auto bi-level, and you can turn the ASV off, auto, or 'on' with you setting the backup rate.

regular CPAP - set pressure=check
Auto CPAP - range of pressure=check
BIlevel set EPAP+PS=check
AUTO BIlevel EPAP range+PS=CHECK
Mine also does EPAP range+PS range
ASV off/on/auto - when 'on' is chosen you set the backup rate

The *only* thing I am not impressed with (compared to Resmed) is the water chamber seems smaller, if you run it dry it will lower the temp level (whether you want it to or not), and the temp level does not get as warm as the Resmed units.

As long as all the math stays at 25 or less, you can adjust EPAP and/or Pressure support as much as you like, Resmed limits Pressure support max (can't remember if 6 or?).

[Eurika]

As I've got an AS10 I was hoping to stay with the Resmed 10 range as there are many interchangeable parts.
I'm in no hurry to buy a new unit, I am looking to see what's available and what's likely to become available in the near future.
Zonk you mentioned playing with the EPR might help CSA can you be a wee bit more specific, ie turn it off or increase, I am on the setting of 2 just now.

Thanks for your info Peter, it confirms that the technology is out there.

[Peter_C]

I know nothing about the Resmed 10 series, so I can't speak to it, I just happen to have used a S9 Autoset, and a VPAP Auto 25 (S8 series), read about the VPAP Adapt, and my new machine.

[zonk]

I've used both S9 AutoSet and A10 AutoSet, I happen to prefer the S9 and A10 is somewhere in the cupboard for now
Both machines identical with the exception of A10 AutoSet report % time in CSR

Some people reported by turning off EPR, decrease central events, I've no such experience but I sleep better without EPR .... ymmv

Some info here but don't believe everything you read
http://www.apneaboard.com/forums/Thread-...ring-Sleep

[PaulaO2]

Your goal is to get your AHI to be below 5. To have a goal of getting it to zero is just not practical.

Get used to the machine, the mask, the whole doughnut. Watch your data. Don't fixate on it, just watch it.

Changes you make should be made slowly or at least with patience. Pressure changes should be done the slowest. It takes time for the trends to make themselves known. Humidifier changes are the opposite and vary from day to day.

Set a goal for in several weeks, not for each morning. It doesn't work that way. It can't work that way.

But foremost, chill out. If you must obsess over something, obsess over a sleep diary. Journal every thing you can think of related to your sleep. Type of day, stress levels, anything new, everything old, etc etc etc. It is part of the journey too. When you look at the data, look at the sleep journal. See if you can find any links.