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asv machine without csa
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leiko49 Offline

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Post: #1
asv machine without csa
I was given a new machine by my medical equipment staff today, an aircurve 10 ASV.

Doing some research tonight, I see ASV if for central sleep apnea, which I have never been diagnosed with. I have been diagnosed with OSA.

I see that the way the air is controlled in a ASV machine for csa is quite different for an auto bipap (which is what I thought my physician wanted me to have), which is for OSA.

Is the method of air control that much different in an asv machine, so that it would likely be less effective for me, or even cause some harm? Or is the method of sensitivity on when to lower or increase pressure still likely to be helpful to me?

Wondering if I should return for an auto bipap, such as the respironics system one.

Thoughts?
01-16-2015 10:17 PM
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Sleeprider Online
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Post: #2
RE: asv machine without csa
Wow, you scored some premium machine. It can work as a Bilevel CPAP, but it is an Assisted Servo Ventilator for people with central apnea that do not breath on their on (patient initiated breaths). That machine is capable of delivering timed breaths when the patient stops breathing, and inflate the lungs with servo pressure. A bilevel machine operates on different pressure channels for inhalation and exhalation, but does not have the capability to operate as an autonomous ventilator.

Are you sure you got the ASV? If so, Big dollar item, and sounds like a mistake.

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(This post was last modified: 01-16-2015 10:37 PM by Sleeprider.)
01-16-2015 10:35 PM
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leiko49 Offline

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Post: #3
RE: asv machine without csa
You stated
Are you sure you got the ASV?
says asv on the front, so yes, it is the asv one (there are 4 aircurve 10's, I think).

You stated,
It can work as a Bilevel CPAP
my last machine was an auto bipap, so a bilevel cpap would not be as complex an algorhthm (if it is not also "auto". As I said in my initial post, I may be better off getting a different machine.

I have had sleep apnea since i was a minor, and the machines have helped me sleep through the night, but my AHI has always run high, i get headaches, sleepy at noon (take a nap). Not really sure, as I have gotton better machines over the years, that the more advanced machines as I used them (cpap, bipap, auto bipap), have helped any more than my first cpap. Not sure, in the end, that it makes a difference, whether I use a asv for OSA, or not.

you stated
but it is an Assisted Servo Ventilator for people with central apnea that do not breath on their on (patient initiated breaths). That machine is capable of delivering timed breaths when the patient stops breathing, and inflate the lungs with servo pressure.
not sure what I timed breath is, and what the difference is between the lungs being inflated with servo pressure and the lungs being inflated with cpap pressure. Perhaps a. when the air pressure is increased after an event of breath cessation, the servo times differently when the increase occurs, and b. servo pressure reacts differently than non servo pressure to apneas and hypopneas, than an auto bipap would. c. servo pressure is designed to target csa events, not osa events.

If I have a, b, and c correct, will the servo mess me up even more, since as far as I know, i have osa, not csa, though I am not sure I have faith in the medical professionals I have seen these past three decades?

You stated
A bilevel machine operates on different pressure channels for inhalation and exhalation, but does not have the capability to operate as an autonomous ventilator.
I seems that the terms bilevel and bipap refer to the same thing. So if this machine can be made to function as a bipap, I would however lose the auto bipap function? Also, as stated, not sure what the autonomous ventilator can do for me if I don't have csa...

Thanks for your help!
(This post was last modified: 01-16-2015 11:28 PM by leiko49.)
01-16-2015 11:21 PM
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
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Post: #4
RE: asv machine without csa
Well, if I were you, I'd send an email for a download the clinical manual. Both of these machines are apparently in the library:
ResMed AirCurve 10 ASV
ResMed AirCurve 10 CS PaceWave Adaptive Servo-Ventilator

I have to admit, the features of this machine are a bit foreign to me as I have never aspired to a $5-$6K machine.

Do you have deductibles and co-pay?
What is the invoiced price of this thing? DME prices are usually higher than online prices I'm aware of.

Here is the brief summary description of that machine:
AirCurve 10 ASV: A bilevel device for central breathing disorders such as Cheyne-Stokes respiration, central sleep apnea or obstructive events. Featuring the most clinically studied and proven adaptive servo-ventilation algorithm, the AirCurve 10 ASV is the only adaptive servo-ventilator that targets the patient's own recent minute ventilation. By treating central breathing disorders with auto-adjusting pressure support, and upper airway obstruction with auto-adjusting expiratory positive airway pressure, the device works to rapidly stabilize breathing.

Here is what Resmed says: http://www.resmed.com/epn/products/s9_vp...c=patients

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(This post was last modified: 01-16-2015 11:55 PM by Sleeprider.)
01-16-2015 11:48 PM
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justMongo Offline

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Post: #5
RE: asv machine without csa
ASV has 3 pressures. A normal IPAP setting and a normal EPAP setting. Since CA is a clear airway apnea, when the ASV detects a clear airway apnea, it pushes a pressure above IPAP to inflate the lungs. It ventilates the patient similar to what mouth to mouth does in CPR. (I believe CPR protocol now only calls for chest compression?) And it does this in a timed manner.

Bilevel is a generic term for a machine with a different IPAP and EPAP pressure. BiPAP is proprietary to, I believe Phillips-Respironics.
VPAP is ResMed's name for it. There are BiLevel Auto machines -- as my VPAP Auto in my profile is one.

Whether or not the aircurve 10 ASV can run as a VPAP Auto is TBD. One would need the clinician manual.

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01-17-2015 12:02 AM
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leiko49 Offline

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Post: #6
RE: asv machine without csa
sometimes I wonder how much of the description is bs marketing jargon vs scientific description. For example, from your quote it states that the servo "targets the patient's own recent minute ventilation. By treating central breathing disorders with auto-adjusting pressure support, and upper airway obstruction with auto-adjusting expiratory positive airway pressure, the device works to rapidly stabilize breathing.'

From what I understand, an auto bipap also "targets recent ventilation" that would trigger pressure increases on the inhalation, and same on exhalation. I think that auto bipap also treats breathing disorders with auto adjusting inhalation and expiratory pressure to rapidly stabilize breathing.

The key difference is perhaps in what is not said (and which may be proprietary), regarding the timing and degree of pressure increases, and the sensitivity of the triggers. Not sure the manual will help me understand this, hence my query here, because the science is not something I am knowledgeable of.

I suppose I can just submit myself to be a guinea pig on this, but then it is an expensive machine (not as expensive as a similar Repironics for ASV System One DS960HS) which I read you can set up as an auto bilevel.

http://www.mednamics.com/resmed-aircurve...ubing.html

the non asv aircurves sell for slightly less!
01-17-2015 12:23 AM
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leiko49 Offline

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Post: #7
RE: asv machine without csa
just mongo,
not sure what you mean by "3 pressures". Do you mean the three are
1. normal IPAP setting (higher pressure, like 15)
2. normal EPAP setting (lower pressure, like 6)
3. the pressure the ASV machine sets when it detects clear airway apnea.


Whether I guessed your meaning correctly or not, your description of the "general idea" of mouth to mouth, I would guess that I should probably switch back to a non ASV machine, since no has ever said to me I have central sleep apnea.

What are your thoughts on this? (assuming it can't be set as an auto bilevel)

(01-17-2015 12:02 AM)justMongo Wrote:  ASV has 3 pressures. A normal IPAP setting and a normal EPAP setting. Since CA is a clear airway apnea, when the ASV detects a clear airway apnea, it pushes a pressure above IPAP to inflate the lungs. It ventilates the patient similar to what mouth to mouth does in CPR. (I believe CPR protocol now only calls for chest compression?) And it does this in a timed manner.

Bilevel is a generic term for a machine with a different IPAP and EPAP pressure. BiPAP is proprietary to, I believe Phillips-Respironics.
VPAP is ResMed's name for it. There are BiLevel Auto machines -- as my VPAP Auto in my profile is one.

Whether or not the aircurve 10 ASV can run as a VPAP Auto is TBD. One would need the clinician manual.
(This post was last modified: 01-17-2015 12:41 AM by leiko49.)
01-17-2015 12:35 AM
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vsheline Offline

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Post: #8
RE: asv machine without csa
(01-16-2015 10:17 PM)leiko49 Wrote:  Is the method of air control that much different in an asv machine, so that it would likely be less effective for me, or even cause some harm? Or is the method of sensitivity on when to lower or increase pressure still likely to be helpful to me?

Wondering if I should return for an auto bipap, such as the respironics system one.

Hi leiko49, welcome to Apnea Board.

I use the initial version of the S9 ASV machine. I suggest you go ahead and try the machine. A likely problem, however, is that the medical equipment provider may have left the machine on its default settings (wide open), which would likely be unnecessarily uncomfortable or worse.

I suggest you should get a copy of the prescribed equipment and therapy settings from the doctor.

The new ASV machines like the AirCurve 10 ASV and the BiPAP autoSV Advanced are Auto machines, by which I mean these do slowly auto-titrate EPAP to minimize obstructive events, much like the ResMed AutoSet or the AirCurve 10 VAuto or the PRS1 BiPAP Auto. EPAP slowly auto-adjusts itself within a range, to prevent Snore and Flow Limitation and reduce the likelihood of obstructive events.

Where the ASV machines differ from the AirCurve 10 Auto and the PRS1 BiPAP Auto is neither of those standard bi-level Auto machines will do anything to end an apnea or hypopnea which is in progress.

In contrast, when an apnea or hypopnea begins (of any type, obstructive or central) an ASV machine will immediately counteract both obstructive or central events, by starting to automatically cycle between IPAP and EPAP, to keep us breathing at our recent natural respiration rate.

Also unlike the AirCurve 10 Auto and the PRS1 BiPAP Auto, an ASV machine will immediately increase Pressure Support (PS, the pressure difference between IPAP versus EPAP), if necessary, to keep us breathing at least 90% as much air as we were breathing recently, before the obstructive apnea or obstructive hypopnea or central apnea or central hypopnea began. The AirCurve 10 Auto uses manually adjusted PS. The PRS1 BiPAP Auto does slowly adjust PS within a range, but its PS adjustments are not made faster than about 1 cm H2O per minute.

The AirCurve 10 Auto and the PRS1 BiPAP Auto machines (and also the standard auto-titrating CPAP machines like the
AutoSet or REMSTAR Auto) will do nothing to end an apnea or hypopnea which is currently in progress. After the apnea or hypopnea has ended, these machines may adjust the pressure higher in order to help avoid future apneas.

(01-16-2015 11:21 PM)leiko49 Wrote:  You stated,
It can work as a Bilevel CPAP
my last machine was an auto bipap, so a bilevel cpap would not be as complex an algorhthm (if it is not also "auto". As I said in my initial post, I may be better off getting a different machine.

"CPAP" is sometimes used as a general term for all types of Continuous Positive Airway Pressure therapies and can refer to fixed-pressure CPAP or auto-adjusting APAP or bi-level or auto-adjusting bi-level or ASV therapy modes.

Quote:I have had sleep apnea since i was a minor, and the machines have helped me sleep through the night, but my AHI has always run high, i get headaches, sleepy at noon (take a nap). Not really sure, as I have gotton better machines over the years, that the more advanced machines as I used them (cpap, bipap, auto bipap), have helped any more than my first cpap. Not sure, in the end, that it makes a difference, whether I use a asv for OSA, or not.

Maybe you would benefit from ASV therapy, but it does usually take a few weeks to get used to ASV therapy mode. It feels different, but we can get used to it and it may help to end your headaches and tiredness, after you get used to ASV therapy and can sleep with it. I would suggest watching TV or reading while using ASV therapy, so you can get used to the different feeling, before you try to sleep using the machine.

Also, at least for a few days, you may want to adjust your pressure settings to be close to the settings which are used on your old machine, to help you get used to the new therapy mode.

Quote:you stated
but it is an Assisted Servo Ventilator for people with central apnea that do not breath on their on (patient initiated breaths). That machine is capable of delivering timed breaths when the patient stops breathing, and inflate the lungs with servo pressure.
not sure what I timed breath is, and what the difference is between the lungs being inflated with servo pressure and the lungs being inflated with cpap pressure. Perhaps a. when the air pressure is increased after an event of breath cessation, the servo times differently when the increase occurs, and b. servo pressure reacts differently than non servo pressure to apneas and hypopneas, than an auto bipap would. c. servo pressure is designed to target csa events, not osa events.

If I have a, b, and c correct, will the servo mess me up even more, since as far as I know, i have osa, not csa, though I am not sure I have faith in the medical professionals I have seen these past three decades?

An ASV machine reacts the same way to both obstructive and central apneas. It immediately starts cycling between EPAP and IPAP, and it increases Pressure Support as much as necessary in an attempt to immediately end the apnea or hypopnea.

I think the word "servo" may simply refer to controlling or varying the pressure level, which all bi-level and ASV machines do.

(01-17-2015 12:23 AM)leiko49 Wrote:  sometimes I wonder how much of the description is bs marketing jargon vs scientific description. For example, from your quote it states that the servo "targets the patient's own recent minute ventilation. By treating central breathing disorders with auto-adjusting pressure support, and upper airway obstruction with auto-adjusting expiratory positive airway pressure, the device works to rapidly stabilize breathing.'

From what I understand, an auto bipap also "targets recent ventilation" that would trigger pressure increases on the inhalation, and same on exhalation. I think that auto bipap also treats breathing disorders with auto adjusting inhalation and expiratory pressure to rapidly stabilize breathing.

No, AirCurve 10 Auto and the PRS1 BiPAP Auto machines do not target recent ventilation. Instead, the Auto bi-level machines analyze the Flow (which is the rate of airflow entering and exiting our lungs) for signs of apnea and hypopnea and Flow Limitation (partial obstruction) and snore, and these machines try to adjust EPAP by the minimum amount necessary to make future obstructive events less likely.

The A10 ASV adjusts Pressure Support as much as needed in an attempt to maintain 90% of our recent natural Minute Ventilation (which is the total amount of air breathed during one minute, which is the Tidal Volume in Liters per breath, times the Respiration rate in breaths per minute).

Quote:I suppose I can just submit myself to be a guinea pig on this, but then it is an expensive machine (not as expensive as a similar Respironics for ASV System One DS960HS) which I read you can set up as an auto bilevel.

Well, the BiPAP autoSV Advanced DS960 is definitely more adjustable (and mis-adjustable) compared to the ResMed ASV machines. There are fewer settings which can be adjusted on the ResMed ASV machines because more things are automatic. But neither one can be configured into a therapy mode which is exactly like the ResMed AirCurve 10 Auto or the PRS1 BiPAP Auto.

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: 01-18-2015 02:23 PM by vsheline.)
01-17-2015 06:31 AM
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leiko49 Offline

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Post: #9
RE: asv machine without csa
Thanks vsheline much for your helpful information.

You stated

In contrast, when an apnea or hypopnea begins (of any type, obstructive or central) an ASV machine will immediately counteract both obstructive or central events, by starting to automatically cycle between IPAP and EPAP, to keep us breathing at our recent natural respiration rate.

You make it sound like the asv machine would in fact help osa better than a non asv machine, though the marketing states asv for csa. Still not sure what is true.

So far as my sleep goes, first night with machine, woke up with migraine, feel worse than usual.

I'm inclined to return for non asv machine, though your description is compelling. I did order the instruction manual, and will check the settings. As great as the machine is, if it was wide open, it may have sent two much air too fast down the pipe (from the old simple cpap days, trying a higher than recommended pressure caused similar headaches). Though as you said, maybe need to get used to a different approach to air pressures. As well, I will try to analyze the data from last night with some software (if I can figure that out).

Thanks again.
01-17-2015 06:57 AM
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archangle Offline
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Post: #10
RE: asv machine without csa
Find out what you're being billed. If you're paying a percent copay, you're probably paying a lot more than necessary. ASV machines cost a LOT more.

Per this page http://www.resmed.com/us/en/consumer/pro...-asv.html, the AirCurve 10 ASV only does CPAP and ASV modes, not Auto CPAP or S or T mode bilevel. i.e. it can't be made to work like a normal bilevel or APAP.

If you don't actually need ASV, I suspect the ASV machine is going to "beat you up" because it will try to decide when you need to breathe if it sees something it doesn't like. You'll occasionally feel it bumping up the pressure to make you breathe when you're not read and this may be uncomfortable.

I suspect you should ask your doctor if he wanted you to have an ASV machine. Sounds a bit like a dumb DME, or maybe one doing something sneaky.

Get the free SleepyHead software here.
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01-17-2015 07:16 AM
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