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ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
#1
ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I know from reading the clinical manuals that the VAuto machine in not intended to treat mixed or central apnea, only obstructive apnea and hypopnea. However, BiPAP is often recommended for first line central apnea treatment when APAP fails. From those having experience with these machines how effective has the VAuto configuration been in reducing central apnea? I assume that the ASV model which was designed to treat centrals and has the capability to measure and correct on a breath to breath basis does work very well. I see that the VAuto has the following features in addition to the AirSense 10 APAP models. Are they actually effective in helping to reduce centrals?

25 cm maximum pressure - higher than the 20 of the AirSense models, but pressure can create centrals. Helpful or harmful?

Pressure Support - 10 cm max compared to the 3 cm max with EPR in the AirSense models. Does this actually assist/force enough breathing to reduce centrals?

Easy-Breathe - In S mode. Hype or actual benefit?

Backup Rate - In S mode a manual fixed backup of 10 BPM rate can be set - useful for centrals?

Ti Control - Allows fine tuning of the minimum and maximum window available for inhalation. Is this helpful with centrals in forcing breathing?

Trigger/Cycle - Again seems to allow fine tuning of the flow rate at which pressure switches from IPAP to EPAP, and the reverse. Helpful to force breathing?

Rise Time Control - In S mode only it determines how fast the pressure switches from IPAP to EPAP and back. Of help?

I guess the basic question is if one cannot achieve the recommended <5 AHI due to centrals, and is in the 5-10 range, are the VAuto features likely to be enough to get back under 5 AHI, or does one need to bite the bullet and get the ASV model? All thoughts appreciated...
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#2
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Generally speaking, a bilevel without backup rate results in a worsening of central and complex apnea results, forcing the use of BPAP with a backup rate (i.e. ASV). Almost invariably, members that present with complex apnea or predominately central apnea on the forum, do best with relatively low fixed pressure with no Flex or EPR. When these individuals are challenged with varying pressures and especially with EPR, the central apnea and hypopnea go through the roof.

We have become accustomed to this absurd irony being a part of the process of approving adaptive servo ventilation, and it is a consequence of Medicare approval guidelines that specifically require a patient to not tolerate CPAP, and the next promotion is to Bilevel which generally worsens results. It is only until these people move to bilevel with a backup IPAP rate that they begin to show improvement. Keep in mind the current Medicare approval guidelines were developed before modern auto ASV machines were available. They are the epitome of ignorance. No knowledgeable physician would actually use these standards, but the amazing thing is most practicing physicians follow those guidelines and sacrifice their patients's health and comfort to follow them.
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#3
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
(04-17-2018, 05:20 PM)Sleeprider Wrote: Generally speaking, a bilevel without backup rate results in a worsening of central and complex apnea results

OK. I see there is a AirCurve S model and the S is also offered as a setup option in the VAuto. It seems to have the capability to use a manual fixed 10 BPS backup rate. Are you saying that would be helpful in treating centrals?
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#4
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I have no experience with the VAuto, but I had to do the dance to go from CPAP to BiPAP (DreamstationAuto BiPAP) to ResMed AirCurve 10 ASV. BiPAP was terrible for me. I literally got worse every night I used it. Sick, tired, headaches because I used the BiPAP.

Sorry I can't add experiences for VAuto, but this is an interesting conversation.

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Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

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#5
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
(04-17-2018, 05:27 PM)Ron AKA Wrote:
(04-17-2018, 05:20 PM)Sleeprider Wrote: Generally speaking, a bilevel without backup rate results in a worsening of central and complex apnea results

OK. I see there is a AirCurve S model and the S is also offered as a setup option in the VAuto. It seems to have the capability to use a manual fixed 10 BPS backup rate. Are you saying that would be helpful in treating centrals?

When I refer to the term "backup rate" I mean a bilevel device that is programmed to trigger IPAP on a timed basis (that is the old fashioned way for breaths per minute), or using an algorithm like the Resmed Pacewave.  It is a different billing code under Medicare.  Bilevel is E0470, and includes the fixed pressure bilevel (S) as well as Auto bilevel devices.  The devices with backup rate are code E0471, and this is what is required to treat central and complex apnea.  The bilevel function in a E0470 device requires "spontaneous respiratory effort" to trigger IPAP. The E0471 will trigger during an apena without the patient effort.  The pressure support in a E0471 unit is usually 8 to 12 cm above EPAP which will normally cause a breath to occur if the airway is open.  The E0470 is typically using a PS of 4 to 6 cm and is mainly for comfort or to improve ventilation. It cannot trigger a breath during apnea.

The major machine types in E0471 are the ST (Spontaneous/Timed), ASV (Adaptive Servo Ventilators). Some of the ST machines also include intelligent volume assured Pressure Support (IVAPS) which can target alveolar volume and is used for patients with COPD or obesity hypoventilation. The gold standard for central and complex apnea currently is the Auto ASV, however many doctors have not caught up with the technology and will prescribe ST. The difference is that ASV can use variable EPAP to treat obstructive apnea, and also use a variable pressure support from zero to 15 cm to allow spontaneous respiration when the patient is breathing, or to induce respiration when central apnea is present. The pressure support is variable to the extent that it can produce the amount of pressure as needed, when needed to overcome apnea, hypopnea and periodic breathing issues.
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#6
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I am using the Resmed AirCurve 10 ASV right now and am very satisfied with it having used it for 45 days or so. My average AHI is of the order of 0.5 and occasionally I get 0. I was on the 10 Vauto and in the Vauto mode was never able to get less than 10 for my centrals. However, it is a fine machine and I was determined to make it work. Each case is different but I looked at it analytically and with the information gleaned from this forum I was able to get my centrals under control. I was able to get an AHI of 2.9 and consistently under 5.0. I can share with you the tricks that I used. The Vauto machine has a lot of parameters that can be controlled. The secret is to use it in fixed Bipap mode and since you need to force a breath when experiencing a central set the sensitivity to ultra sensitive. In addition do a fixed EPAP and IPAP titration to get the numbers to knock out your OSAs and HAs respectively.
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#7
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
(04-17-2018, 10:03 PM)mhehe Wrote: I am using the Resmed AirCurve 10 ASV right now and am very satisfied with it having used it for 45 days or so. My average AHI is of the order of 0.5 and occasionally I get 0. I was on the 10 Vauto and in the Vauto mode was never able to get less than 10 for my centrals. However, it is a fine machine and I was determined to make it work. Each case is different but I looked at it analytically and with the information gleaned from this forum I was able to get my centrals under control. I was able to get an AHI of 2.9 and consistently under 5.0. I can share with you the tricks that I used. The Vauto machine has a lot of parameters that can be controlled. The secret is to use it in fixed Bipap mode and since you need to force a breath when experiencing a central set the sensitivity to ultra sensitive. In addition do a fixed EPAP and IPAP titration to get the numbers to knock out your OSAs and HAs respectively.

Yes, I would be interested to know what tricks you used. What mode did you operate it in? S? How much pressure support? Not necessary to dig up the exact settings but which features helped?
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#8
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I did 5 nights as a trial using a ResMed VAuto Bi-level to treat what were my barely-out-of-range mixed apneas on a ResMed AirSence 10 AutoSet.

My AHIs soared on the Bi-level. Worse was the awful way I felt. For me, it was five nights of pure torture. I endured the experience but hated every moment.

In contrast, the ASV has been very welcome.

Bill
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#9
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Attached is a session using the 10 vauto. Note the ahi is 2.92 that can be acceptable. There is only 1 episode of osa and few csa. Remaining are hi that I could live with as my SpO2 did not go below 90%. My priorities were to kill osa, minimize csa then deal with hi but with the proviso that my tidal volume was within range. The trick was to go into S mode with the EPAP value I found to kill osa and IPAP to deal with hi AND set the trigger level to ultra sensitive to try to force a breath. My breathing rate median is usually 15-16 bpm and so the 2 ms time interval was fine for a nominal 15 bpm and as you can see my tidal volume is right.
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#10
RE: ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Hypopnea remains just a bit high. I think you should continue in S mode and consider raising PS by small increments, perhaps 0.2 cm, and see if you can drive that down without increasing CA. I agree you have eliminated OA effectively. You are at 19.6/15.2 (PS 4.4) so you may have already done this. I have to say it is a great improvement over what we saw early in your forum posts.
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