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S9 ASV or Aircurve ASV?
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magictrkaz Offline

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Post: #1
S9 ASV or Aircurve ASV?
I currently have S9 Auto, which I have had for a few years. I recently had another sleep study done and I was found to have complex apnea, where my central apneas increased significantly when CPAP was used. I just had another sleep study to see if the ASV would fix this, and was told by the techs I had excellent results with almost no events. My question is that I see the Aircurve 10 ASV has recently come out and should I request my doctor prescribe this or stay with the tried and true S9 ASV? I would think it would be beneficial to get the new one since likely support for the S9 will go away eventually, but I have seen some issues with the humidifier and pressures being off. I was wondering what all your thoughts are and if you would elect to get the Aircurve 10 or stick with the S9?

Thank you for your time!
12-15-2014 09:56 AM
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3porpoise Offline

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Machine: S9 VPAP Adapt ASV
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Post: #2
RE: S9 ASV or Aircurve ASV?
Hi magictrkaz,
I opted for the S9 ASV. I debated , but decided the S9 was working for me and maybe let the kinks, if there were any get worked out of the A10. I like the detailed data and wasn't really sure what upgraded software entailed .
Not sure I've read of anyone with the Aircurve ASV.
I'm sure you can't go wrong whatever you decide.
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12-15-2014 06:41 PM
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archangle Offline
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Machine: ResMed S9 AutoSet
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Post: #3
RE: S9 ASV or Aircurve ASV?
It's a bit of a toss up in my opinion.

Sometimes new products have various kinds of problems until they get the kinks worked out. The S9 has a great track record.

Unlike the transition from S8 to S9, there aren't a lot of major improvements between S9 and A10.

On the other hand, the A10 is the newer model with all the advantages of that. The AirSense models have been out for a few months with no obvious major problems yet. I presume the AirCurve machines have a lot in common with the AirSense. In fact, I wouldn't be surprised if the AirCurve machines are the same except for the software.

One thing to consider is "does it make sense to wait until after the start of the year to get the new machine for insurance purposes?"

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12-15-2014 07:13 PM
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magictrkaz Offline

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Post: #4
RE: S9 ASV or Aircurve ASV?
I spoke to my doctor and she said the ASV reduced my obstructive and central apneas to 0. She said she is ordering the ASV right away. I asked her about the new one and she said they will probably give me the latest and greatest. I called the new DME who she sent it to and likes better than Apria who I have used in the past, and the lady had not heard of the Aircurve 10, but was going to follow up.

Archangle, as to your point about insurance, my insurance should cover it 100% regardless of end of year or beginning of the new year. Is there a reason in your opinion why I should wait until the new year or purchase it in this year? I didn't have issues with the S9, I just hate to get a new machine that no longer has parts to support it in a few years because they are trying to switch everyone to the 10 (but maybe this will get me a new machine in a few years)... I do like the reviews that have said it is quieter as my wife will appreciate this. I also like the function that turns off the flow when you get up and unplug the mask. I don't like the fact that it is connected via cellular and that I have some old climatelines I won't be able to reuse.

I agree that it may have bugs, such as the discolored water tub, but appreciate the new tub design. I just am not sure one way or the other.

Thanks again!
12-15-2014 07:28 PM
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vsheline Online

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Post: #5
RE: S9 ASV or Aircurve ASV?
(12-15-2014 07:28 PM)magictrkaz Wrote:  I didn't have issues with the S9, I just hate to get a new machine that no longer has parts to support it in a few years because they are trying to switch everyone to the 10 (but maybe this will get me a new machine in a few years)...

Hi magictrkaz, welcome to the forum!

If I were looking to buy a new ASV unit, I would try searching the internet to see if I could find comments from several patients or researchers who have used (or monitored patients who have used) both an S9 ASV and the new A10 ASV. But, because the AirCurve 10 ASV is so new, I doubt that any comparisons like that exist yet.

As of now, personally, I would probably go with the new A10 unit.

Regarding, "I would think it would be beneficial to get the new one since likely support for the S9 will go away eventually, but I have seen some issues with the humidifier and pressures being off."

On the A10 Series, I do not believe the therapy pressure is "off" in the sense of being inaccurate; instead, my assumption is the A10 units may be more sensitive to Flow Limitation (causing the machine to raise the pressure faster and higher), perhaps because new sensors may have been used which are more sensitive, or perhaps because of improved calibration or something like that. ResMed has said that the Enhanced AutoSet Algorithm itself (introduced in the S9 AutoSet) has not been changed in the standard A10 AutoSet model.

I am not sure how widespread are the issues with the A10 humidifier which some users have reported. I've heard that using the washable tub may improve things, but I'm not sure. On balance, I don't see this as widespread enough or serious enough to be a reason to avoid the A10 series. And at some point a slightly redesigned tub or a software upgrade may address the issue.

As you probably know, and unlike with the A10 series, the S9 series cannot receive software upgrades in the field, over the air. Nor, for example, can a DME provider install software updates on the S9 series. In that regard (software updates), there has never been support for the S9 series, other than the ability to return a malfunctioning unit for hardware repair/replacement if the unit is still under warrantee.

Both the S9 and A10 have only a two year warrantee. So your concern about the future availability of repair parts is a significant one for repairs which may be needed after the two year warrantee is over.

At some point ResMed may simply decline to repair S9 units (no matter how much you may be willing to pay), if replacement parts are no longer available. This will not be an issue during the two year warrantee period because ResMed has the option to simply replace the S9 unit with the equivalent A10 unit.

If you call up ResMed Customer Service and ask whether there is any guarantee that repair parts will be available for at least 5 yrs for all S9 models (which are continuing to be sold as new), it is my guess is the answer would be "No, we recommend purchasing the AirCurve 10 model."

My own S9 VPAP Adapt unit is an early model, manufactured earlier than November 2012, which includes the "ASV" treatment mode but not the new "ASVauto" treatment mode. On my S9 VPAP Adapt model, EPAP (the pressure during exhalation) is fixed (manually adjustable). S9 VPAP Adapt units manufactured more recently include the ASVauto therapy mode which (in addition to quickly adjusting Pressure Support to counteract obstructive and central apneas and hypopneas which are in progress, which the earlier "ASV" therapy mode does also) adjusts EPAP slowly in the background, like the AutoSet units do, to raise EPAP to avoid obstructive events. By the way, Pressure Support is merely the name for the amount by which the pressure is boosted during IPAP (the pressure during inhalation). EPAP + Pressure Support = IPAP

Anyway, if the S9 series had allowed software downloads (like the A10 series will allow), perhaps my machine could have been automatically updated to include the new ASVauto therapy mode when it came out. In any case, I think the ability of the A10 series to receive software downloads over the air may prove helpful in future.

You do have the Clinician set-up manual for your present machine, right?

If your present machine reports these numbers, what numbers does the machine report for the 95% (95 percentile) pressure, Max pressure, Obstructive Apnea Index (OAI), Central Apnea Index (CAI), Hypopnea Index (HI) and total Apnea Hypopnea Index (AHI)? (If your present model is the S9 Escape Auto, it does not detect whether the apneas are obstructive or central in type and reports very little data, unfortunately, much unlike the S9 AutoSet.)

I think you will need to download ResScan to view the data on the new unit, whether it is an S9 or an A10. It will be important to see the detailed data to see what is going on, so as to be able to fine tune your therapy and address any problems which arise, such as aerophagia (air swallowing) and excessive leak and other issues caused by higher pressures, which are common with ASV therapy. (Also, it would be a good idea to use ResScan now, to view the data from your present machine.)

New ASV models automatically adjust EPAP (the pressure during exhalation) to provide about the same EPAP pressure as an APAP machine (like your present S9 Auto) will provide in order to treat/prevent obstructive apneas and Flow Limitation and Snore. Additionally, ASV machines will automatically vary "Pressure Support" such that IPAP (the pressure during inhalation) will usually automatically vary up to perhaps 10 cm H2O higher in pressure than the EPAP pressure in order to do for us all the work of breathing when we are in the middle of a central event.

Thus, with ASV treatment the IPAP pressure can get a whole lot higher than on the standard APAP machines, and the higher pressures can require tighter mask straps and use of a Full Face Mask (above 20 cm H2O of pressure, if using a nasal mask type, air tends to blow right past the lips, even if the jaw is closed) and use of mask liners to stop leaking (or at least to quiet it down and make it untroublesome).

Take care,
-- 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.
(This post was last modified: 12-15-2014 10:09 PM by vsheline.)
12-15-2014 09:03 PM
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magictrkaz Offline

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Post: #6
RE: S9 ASV or Aircurve ASV?
Vaughn,
I appreciate your thorough response. You stated many things I was thinking. I haven't found any reviews of the 10 ASV, but have found generally positive reviews of the AirSense 10. I guess more people are going to comment if they have issues than positives with not very many in use thus far, and that is what I have seen with the pressure and humidifier issues that I previously spoke of. The main reason I went back to the sleep doctor and why she ordered the study is that I started having issues my breathing using the standard CPAP. My subsequent study showed that when CPAP was engaged, my obstructive apneas were minimized, but my central apneas went significantly up. Thus, the next sleep study tested the ASV machine and I got the results and it shows 0 centrals and obstructive events.

I did have good results with the S9 VPAP Adapt, so I hope that I would have similar results with the 10 ASV. I did notice higher pressures and use a FFM, but I did have to tighten it significantly to prevent leaks. I previously had a nasal mask, but would leak through my mouth and the FFM seems to work well, albeit it is a medium and hits just below my bottom lip and is a bit uncomfortable after a full night with it on.

I do like that the 10 has the ability for over the air updates, if they use it for that. One concern was that they kept th algorithm the same, as my doctor said she only wanted the ResMed because their algorithm is the best, but when I emailed ResMed they stated they couldn't confirm the algorithm was the same since it is proprietary. This sounds like the guy didn't know because I am not asking for the algorithm, just if it is the same...
12-16-2014 10:07 AM
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Crimson Nape Offline

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Post: #7
RE: S9 ASV or Aircurve ASV?
I thought I saw something about the "AS10 for Her" having a different algorithm than the S9's and all the other AS10's. Somebody help me out here and collaborate or correct what I said.

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12-16-2014 10:23 AM
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magictrkaz Offline

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Post: #8
RE: S9 ASV or Aircurve ASV?
(12-16-2014 10:23 AM)sgearhart Wrote:  I thought I saw something about the "AS10 for Her" having a different algorithm than the S9's and all the other AS10's. Somebody help me out here and collaborate or correct what I said.

From ResMed's website: The AirSense 10 AutoSet for Her is based on ResMed’s AutoSet algorithm. It responds to female-specific characteristics of sleep apnea and is tailored to meet the special needs of women.

The ResMed AirSense 10 AutoSet for Her APAP machine features the first algorithm designed to treat mild to moderate obstructive sleep apnea in females.
12-16-2014 10:34 AM
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vsheline Online

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Posts: 1,908
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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Post: #9
RE: S9 ASV or Aircurve ASV?
(12-16-2014 10:34 AM)magictrkaz Wrote:  
(12-16-2014 10:23 AM)sgearhart Wrote:  I thought I saw something about the "AS10 for Her" having a different algorithm than the S9's and all the other AS10's. Somebody help me out here and collaborate or correct what I said.

From ResMed's website: The AirSense 10 AutoSet for Her is based on ResMed’s AutoSet algorithm. It responds to female-specific characteristics of sleep apnea and is tailored to meet the special needs of women.

The ResMed AirSense 10 AutoSet for Her APAP machine features the first algorithm designed to treat mild to moderate obstructive sleep apnea in females.

The A10 AutoSet For Her is 3 machines in one. Has standard fixed-pressure CPAP therapy mode, standard Enhanced AutoSet therapy mode (reportedly unchanged from the S9 Enhanced AutoSet therapy mode), plus the new AutoSet For Her therapy mode which raises the pressure less aggressively and automatically corrects for when the Min Pressure setting has been set too low.

Unfortunately, the standard A10 AutoSet does not have the option of using the new AutoSet For Her therapy mode. I view this as a major mess-up by ResMed, and I recommed to both men and women that the A10 For Her model is preferred over the standard A10 AutoSet model, because many men (maybe most men) may prefer the new AutoSet For Her algorithm, so why buy the machine which is less capable?

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.
(This post was last modified: 12-16-2014 12:13 PM by vsheline.)
12-16-2014 12:00 PM
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magictrkaz Offline

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Post: #10
RE: S9 ASV or Aircurve ASV?
Thank you Vaughn. I am assuming the ASV wouldn't be different for him and her since there is only one, but will it act more like a for his since it won't have the gentler modes as seen in the for her?
12-16-2014 06:57 PM
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