Should I switch to Bi-PAP and is it worth it for me?

[SarcasticDave94]

Wouldn't these 9 series be similar to my 10 series ResMed ASV? Excepting for physical design that is. I'm thinking the Auto variant should be closest to mine which should have ASV, ASV Auto, and CPAP modes and similar pressure range settings dependent on those modes. I do think these ASV units will be without a straight BPAP mode like jaswilliams mentioned.

[Sleeprider]

Wouldn't these 9 series be similar to my 10 series ResMed ASV? Excepting for physical design that is. I'm thinking the Auto variant should be closest to mine which should have ASV, ASV Auto, and CPAP modes and similar pressure range settings dependent on those modes. I do think these ASV units will be without a straight BPAP mode like jaswilliams mentioned.

The older VPAP Adapt did not have the auto adjusting EPAP pressure function and a few other important features.  While the newer Adapt Auto SV is similar to the Aircurve 10 ASV, the older one is actually an older technology.  It certainly worked for some people, but is not the current approach to ASV where the machine adjusts pressure for obstructive events while providing adaptive pressure support for hypopnea, CA and periodic breathing.

[DeepBreathing]

The S9 VPAP Adapt comes in two varieties:

The older version does not have AutoASV mode - the EPAP is fixed and will not vary during the night. The model code (USA) is 36007.
The newer version has ASVAuto - the EPAP will adjust itself as required through the night. Model 36037 (USA)

Both versions deliver ASV and CPAP (fixed pressure) modes. There is no ability to turn the backup rate off.

If it's a choice between the two S9 models, then definitely pay the extra and get the newer version with ASVAuto. It will most likely be more comfortable and will better treat obstructive events. If its a choice between an S9 and an Aircurve 10 ASV, my preference would be to go for the A10, as it will be newer (less time for internal circuits to degrade) and has a smaller footprint. However (AFAIK) the algorithms have not changed between the later S9 and the A10.

[pr560]

What if you set a low backup rate like 1. Wouldn't it effectively be just a Bi-PAP?

[DeepBreathing]

What if you set a low backup rate like 1. Wouldn't it effectively be just a Bi-PAP?

You can't do that with a Resmed ASV machine. The backup rate and a whole host of other settings are controlled by software with no provision for user adjustment. The Philips Respironics ASV does have manual adjustments. However the Resmed ASV is an ASV - that's what it's designed for and that's what you have to use it for.

[Sleeprider]

DS560, with regard to backup rate, you don't seem to have a problem with a slow breathing rate, quite the opposite. The ASV learns your natural breathing rate and bases its backup on that. The adaptive pressure support uses the last 90 seconds of average minute vent as a target ventilation rate. Between these two functions, the Resmed ASV will maintain a natural rate and volume for you. I have no doubt it will remove the double inspiration peaks and result in a higher tidal volume.

[pr560]

I've been looking at the data a bit more. I notice that I register quite a number of CA in the 1.5 hours before I get out of bed which is the sleeping in period.

Because I am usually unable to straight up wake up due to poor sleep, I have a period between 6:30 and 8:00 where I drift in and out of semi-sleep trying to squeeze some rest. It's not really restful sleep, in fact I kinda feel worse after having it rather than if I woke up before.

This week, from Sunday to today I woke up around the 6:30 mar instead of sleeping in. I had 5 CAs for each of those day except yesterday night when I had 8. That is lower than the previous average of 14-15.

Anyways, does such a level of CAs warrant an ASV? Would a bi-level resolve the issue of the low tidal volume and high breathing rate?

Thanks for the suggestions guys. I just want to be sure before I go ahead and plan on the purchase.

[holden4th]

It's quite probable that this 60-90 minuteperiod, when you are semi awake, results in the machine showing what we call Sleep Wake Junk (SWJ). To put it simply, your machine is programmed to detect and respond to real sleep breathing patterns and it does this by recognising the way you are breathing. When we are awake (or semi awake) our breathing patterns are different and the machine can and does flag these as events which are false positives.

If you have no other significant CA events during the rest of the night then you can ignore what you are seeing close to getting up. Posting your OSCAR results can let the experts have a good look at what's happening but I suspect that you are not having CAs.

[pr560]

I think I've found out what is giving the high respiration rate in Oscar. It seems there is some sort of double-counting. In the below graph, if we take a 1 minute period and count the number of breaths, they come to around 15.5, but the respiration rate is reported as 30.


   

I believe the double-counting is due to this small peak after expiration which I think is counted as a whole breath since it is above 0. Is that small peak normal? Does my breathing flow rate look normal as a whole?

   

I think that that the double-counting is a known issue for Philips Respironics System One APAPs.

In all other cases, a spike in respiration rate seems to be due to that double-counting as far as I can tell.

My biggest issue though is still to do with the Tidal Volume and Minute Ventilation. A minute vent of between 4.8 - 5.5 seems a tad low. When it goes to about 5.5 it is padded by the higher 'fake' respiration rates due to the double-counting. So I would figure that the real MV is about 4.8 - 5.1.

Tidal Volume - which some days goes down to 260 and generally is an average of 300 - seems low too.

I have had this apnea thing for many years without knowing so I can understand why my body is kinda used to just drawing very little air.

I get the feeling that an ASV would do very well for me. But would a Bi-PAP like the ResMed S10 AirCurve VPAP Auto VAuto do it for my case?

I get the feeling like an increase in TV and subsequently Minute Vent might bring an increase in Centrals(I get about 5 a night) as well so having then an ASV would be the absolute right call.

I'd appreciate you guy's thoughts on my post.

[Mark Douglas]

For what it's worth I bought a highly capable low time not cheap Bi-pap on the theory a smart machine can be dumbed down if desirable but a lesser machine cannot not be smartened up. Paid a little more to lessen risk.  Personally I find the bi-pap mode very comfortable and the occasional central doesn't seem to be an issue.

AHI averages 0.4 over 4-1/2 yrs.

I spent a little more upfront but avoided the possibility of a forced upgrade later. I have not regretted that decision.

Cannot thank enough the people on this board who got me to this place!