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Resmed Aircurve 10 ASV backup rate
#1
I went to the DME today to get an ASV machine. I had asked for the Resmed Aircurve 10 ASV (due to reviews I found saying it was more responsive to centrals vs Dreamstation BiPAP AutoSV) and she began to set it up in AutoASV mode with my prescription and said she couldn't give me this machine because it has no backup rate setting and that max IPAP - max epap was higher (17) than the rate prescribed. The machine only went to 15. So I ended up getting the Dreamstation BiPAP AutoSV
I've always used ResMed machines so I was hesitant to take the Dreamstation.

My question: is there no rate setting on this machine or did she not find it or not do something correctly?

Here is what the prescribed pressures are: 

MAX IPAP - 25
MAX EPAP - 8
PS Min - 8
PS Max - 4
Rate - 15

Thank you in advance.
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#2
The Resmed Aircurve 10 ASV is adjustable in pressure from a minimum of 4.0 to maximum IPAP of 25.0 at increments of 0.2.  Pressure Support is adjustable from zero to 15 cm.  The backup rate is usually adjusted automatically, and most people consider this more comfortable than the mechanical timing of the Auto SV.  The default rate of the Resmed ASV is 15 BPM.  It is clearly able to match your prescription exactly.    From the manual:

ASV mode
In ASV mode, the expiratory positive airway pressure (EPAP) is fixed and can be manually adjusted
to eliminate obstructive events. The Pressure Support (PS) varies between the Min PS and the Max
PS to answer to the patient's need. Mandatory breaths are delivered at the patient’s recent
spontaneous breath rate, ie, the timed backup rate is automatically calculated to match the patient’s
needs and is applied appropriately in the case of an event.
ASVAuto mode
In addition to the functionality of the ASV mode, the device in ASVAuto mode automatically adjusts
the expiratory pressure in order to provide only the amount of pressure (EPAP) required to maintain
upper airway patency. The device analyzes the state of the patient’s upper airway on a
breath-by-breath basis and delivers expiratory pressure within the allowed range (Min EPAP and
Max EPAP) according to the degree of obstruction. EPAP is automatically adjusted depending on
three parameters: inspiratory flow limitation, snore, and obstructive apnea.

Backup rate
The AirCurve 10 ASV 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 ASV 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.
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#3
Thank you Sleeprider. 

What do I need to say to her so that they swap out the machine, that the backup rate is defaulted to 15 and she doesn't do the 25-8 calculation? 

Thanks
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#4
In order to duplicate your prescription, she would set the Resmed to autoASV mode with EPAP min 4, EPAP max 8, PS min 4, PS max 8 and use the default auto backup rate of Resmed which is 15, but auto-adjusts to patient needs. You did not specify an EPAP min, but I assume they are using the default 4 cm.

The better way would be to ask your doctor to revise the prescription to specify a backup of 15 or Auto. You can probably describe the Resmed algorithm from the clinical manual. Think about it, people do not breath at the same rate all the time, including at night. This is one of the key comfort features of the Resmed that it does adapt to your needs rather than a mechanical timer. It gives you the best opportunity to breathe spontaneously when possible.
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#5
As a user of the ResMed AirCurve 10 ASV, I'm in agreement with Sleeprider's assessment. I can edit EPAP Min and Max and the PS Min and Max. IPAP and the Backup rate is handled automatically via the algorithm. Trust me this ASV works well. Not anything against the PR DreamStation, but I'm keeping my ResMed.

Dave B
Coffee
Due to my sarcastic nature, it may not be obvious that I am not a doctor nor do I pretend to be one. My advice is from personal experience. Follow my advice as a choice not as an order. 2 of these  Coffee Coffee per day keep the bad times away.
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#6
Given the prescription rates of max EPAP = 8, and max PS = 8 the max IPAP can only ever get to 16, regardless of which machine you're using. The max IPAP is a required parameter to avoid the combination of max EPAP and max PS giving you an uncomfortably high pressure. It's not intended as a therapeutic value. Your DME has got this wrong.

The Resmed, as far as I know, has no way of setting the backup rate - it's entirely automatic and it works extremely well.

Get the script re-written as:

EPAP min. 4
EPAP max. 8
PS min. 4
PS max 8
IPAP max 16
Backup rate. AUTO

For good measure, have him prescribe the Resmed "dispense as written".
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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#7
There is some info from page 28 about ASV S9, the 10 will be similar.
https://www.resmed.com/us/dam/documents/...lo_eng.pdf
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#8
So, I went back to the DME just to clarify what she said. She said that in order to achieve the Max IPAP of 25 as written on the Rx, the max EPAP would need to be 15 and the doctor would need change the Rx for the Max PS to 10. I will go with what you wrote DeepBreather.

Also, I had tried the Dreamstation at the DME office and on inhalation the air feels too forceful. Is that normal or is a setting too high?

I'm with you @SarcasticDave94, I've used ResMed since 2009 and don't plan on changing.
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#9
With central apnea, the max PS of 8 in your prescription is low. The machine at default settings of PS 4 min and PS 15 max would probably perform better. The prescription is frankly bizzare in the context of modern ASV.
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#10
Quote:She said that in order to achieve the Max IPAP of 25 as written on the Rx...

Yeah, maybe she isn't up to speed on ASV machines. The Max IPAP is a limit, not to be exceeded. It's not a target value.

Quote:Also, I had tried the Dreamstation at the DME office and on inhalation the air feels too forceful. Is that normal or is a setting too high?

It's hard to say, as "too forceful" is a very subjective appraisal. What I can say is that the Resmed adapts much better to your own breathing pattern than the Philips, and consequently feels more "normal". That's my experience YMMV.

I think the best thing to do at the moment is to get hold of the Resmed at whatever settings are agreed on. Then download and install SleepyHead to monitor your results. Post your daily charts here and we'll be able to help you home in on an optimum set of pressures very quickly.
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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