going from cpap to bipap

[ckingzzzs]

Well after 6 months of therapy with the CPAP and input from wonderful individuals on this board, a recent visit with my sleep doctor has resulted in him replacing my cpap machine with a bipap machine. Apparently, the cpap machine was not doing the trick for me. After trying different masks, and narrowing pressure ranges I still found myself with AHI's of 8-10, and centrals of 6-9. He has suggested that I try the bipap machine for at least 3 months. I was just getting to know the airsense 10 machine now I have to start all over with another machine.

Does anyone have any comments or opinions regarding the resmed bipap machine??? anything I should be aware of.

[Gru.]

Does anyone have any comments or opinions regarding the resmed bipap machine??? anything I should be aware of.

I found the bipap way more comfortable than cpap with the relief pressure on exhalation. Only thing I've found that is sometimes bothersome is the mask will sometimes pulse with the pressure going from exhalation to inhalation. Not a problem with nasal pillows and small nasal masks. Hope this helps a little.

[Sleeprider]

ckingzzzs, be aware that you are currently in an insurance mandated progression, that first tried CPAP/APAP, and will now try the next level, BiPAP to resolve your AHI that is predominately central or complex in nature. Bilevel will be more comfortable for you, and it may help, but it's unlikely to resolve the problem because it still relies on your spontaneous initiation of a breath. If you continue to see high levels of central apnea, you should shortcut your doctor's recommendation of a 3-month trial, and get to the ASV therapy you probably need.

Best of luck, and hope it works for you. Don't hesitate to ask questions, or to question your doctor if you fail to see positive results from bilevel alone. BiPAP is a trademark of Respironics, and VPAP is the term used for bilevel at Resmed. You will get either an Aircurve 10 Vauto or the 10S version which is not auto adjusting. You will probably end up with the Aircurve 10 ASV unless you for some reason respond to bilevel. Also, with an AHI less than 15, insurance may not allow the ASV level since it is about twice as expensive as VAuto.

[ckingzzzs]

ckingzzzs, be aware that you are currently in an insurance mandated progression, that first tried CPAP/APAP, and will now try the next level, BiPAP to resolve your AHI that is predominately central or complex in nature. Bilevel will be more comfortable for you, and it may help, but it's unlikely to resolve the problem because it still relies on your spontaneous initiation of a breath. If you continue to see high levels of central apnea, you should shortcut your doctor's recommendation of a 3-month trial, and get to the ASV therapy you probably need.

Best of luck, and hope it works for you. Don't hesitate to ask questions, or to question your doctor if you fail to see positive results from bilevel alone. BiPAP is a trademark of Respironics, and VPAP is the term used for bilevel at Resmed. You will get either an Aircurve 10 Vauto or the 10S version which is not auto adjusting. You will probably end up with the Aircurve 10 ASV unless you for some reason respond to bilevel. Also, with an AHI less than 15, insurance may not allow the ASV level since it is about twice as expensive as VAuto.

sleeprider, thanks for your input I greatly appreciate it and your time. My doctor and I did discuss ASV as a possible resort, but he indicated mortality rate issues using ASV, and the fact that it is a very difficult device to get use to. Do you know what and how ASV works because I have a very limited amount of info and knowledge as to how ASV works. You are correct in that it appears I am having issues with central sleep apnea. Though I am really not sure I wish to pursue ASV as my centrals are 5-7.

[justMongo]

In simple terms, the ASV keeps track of your respiration. It realizes when a breath is missing and provides pressure to inflate the lungs much in the same manner as mouth-to-mouth. I would say they are a little trickier to set up (titrate); but they are smart machines.

As for mortality, your doctor may be referring to this article:
http://www.resmed.com/us/en/consumer/new...erapy.html

excerpt:
"San Diego, Calif. – May 13, 2015 – ResMed (NYSE: RMD) today announced that SERVE-HF, a multinational, multicenter, randomized controlled Phase IV trial did not meet its primary endpoint. SERVE-HF was designed to assess whether the treatment of moderate to severe predominant central sleep apnea with Adaptive Servo-Ventilation (ASV) therapy could reduce mortality and morbidity in patients with symptomatic chronic heart failure in addition to optimized medical care.

The study did not show a statistically significant difference between patients randomized to ASV therapy and those in the control group in the primary endpoint of time to all-cause mortality or unplanned hospitalization for worsening heart failure (based on a hazard ratio HR = 1.136, 95 percent confidence interval [95% CI] = (0.974, 1.325), p-value = 0.104). The results from SERVE-HF are preliminary and will be submitted for future publication after further analysis.

A preliminary analysis of the data identified a statistically significant 2.5 percent absolute increased risk of cardiovascular mortality for those patients in the trial who received ASV therapy per year compared to those in the control group. In the study, the cardiovascular mortality rate in the ASV group was 10 percent per year compared to 7.5 percent per year in the control group. There were no issues associated with the performance of the ASV therapy device in the trial."
Fair use, educational non-profit. 17 USC 107

[Sleeprider]

I know of a number of members that use ASV, including some with no central apnea problems...they just like it. There was a recent study by Resmed that indicated an increased mortality rate for severe chronic heart failure patients with ASV. Here is a link to the the study, and the most updated study conclusions and ongoing research status: STUDY Ongoing Research

The take-away is that while a specific population with severe CHF displayed a possible (and unexpected) adverse affect, this conclusion would not be applicable outside of that cohort of CHF patients. Adaptive Servo Ventilators serve as non invasive, positive pressure bilevel devices with an added algorithm that analyzes a patient's respiratory rate and volume, and can respond on a breath by breath basis, when needed, to provide additional inspiratory pressure to induce a breath. They have gotten so good with the auto algorithm that it is actually pretty easy to provide a machine to a person, and it will reliably provide good and comfortable therapy with the default settings. I have personally seen very severe complex apnea resolved with ASV, and have also seen people with mild occurrence of centrals and OA have near-zero AHI using these machines. About 15% of the population using CPAP would benefit from ASV. So it may not be as unusual as some think.

[justMongo]

^ What he said.

[brianwood619]

I was switched to BiPap and it was the best thing that's happened to me since I've been on therapy. So much more comfortable, and my AHI consistently stays under 1 each night. You may find it easier to adapt to BiPap than cpap. Good luck

[vsheline]

Study results: http://www.resmed.com/us/dam/documents/s...ux-hcp.pdf

The devices used in the SERVE-HF trial used fixed EPAP, ResMed's older "ASV" therapy mode rather than their newer "ASV Auto" mode, but ResMed believes that automatic EPAP may also increase cardiovascular risk in patients with symptomatic chronic heart failure with reduced ejection fraction (LVEF<45%).

Although the small increase in risk (10% versus 7.5%) might have been a statistical fluke, the study was large enough (1,325 patients) that it is most likely correct.

But even the small increase in risk does not apply to us if we do not have symptomatic Chronic Heart Failure with Left Ventricular Ejection Fraction 45% or worse.

[vsheline]

I have personally seen very severe complex apnea resolved with ASV, and have also seen people with mild occurrence of centrals and OA have near-zero AHI using these machines. About 15% of the population using CPAP would benefit from ASV. So it may not be as unusual as some think.

Before switching to an ASV machine I used a standard bilevel Auto, the S9 VPAP Auto. Although I much preferred the easiness of breathing with Pressure Support set to 4 or 5 (and the higher PS also beneficially boosted my SpO2), I found that PS higher than about 0.6 increased the number of Cental Apneas I would get. (Having a few short CA events, though, is no cause for concern.)

I no longer take my backup machine with me when traveling; instead I take my ASV with me, because I feel significantly better on ASV than when on APAP or standard bilevel. Every few months I'll have really huge Leak or while asleep will roll over onto my back, and will have some apneas or hypopneas. Other than that, week after week my AHI is always zero. And I can use all the Pressure Support I like.

When my present ResMed ASV machine wears out I will probably replace it with one from Phillips Respironics, because they are far more adjustable, far less one-size-fits-most. Unlike Philips Respironics ASV models, ResMed ASV models cannot be set up to work like an APAP or like a standard bilevel.

Also, in fixed-pressure CPAP therapy mode (their only non-ASV therapy mode) ResMed ASV machines cannot even distinguish between central apneas versus obstructive apneas. On an expensive machine specifically designed for patients with central apnea issues. Simply shameless.