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[split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
RE44: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Tom, That is a terrific article on Upper Airway Resistance Syndrome (UARS) and Respiratory Effort Related Arousals (RERA).  The author of the article, Dr Christian Guilleminault, turns out to be one of the pioneers of our current understanding of sleep apnea and is still doing research according Wiki.  I appreciate you being aware of these rare conditions and also for keeping my wife and son intact on this string.  One of the things I am trying to show is that sleep apnea can be family related.  

Turns out my wife's mother and father had sleep apnea but it was undiagnosed. Sleep apnea was unknown when my wife was growing up listening to her parents snore and complain about being tired all the time. All four of my wife's brothers and sisters have sleep apnea as do our three sons and at least one of our six grandchildren.  One of our sons and his son (the one with apnea) have also been diagnosed with dyslexia and attention deficit disorder which are now all being related together.  So Apnea Board members should be aware that their apnea could be affecting other members of their family who could benefit from CPAP therapy.  Talking about your sleep apnea with your family could help them discover what is causing them to be tired all the time etc.  Back to your recommendations.

First of all my wife had two central apneas during her sleep study earlier this year.  But the centrals did not occur again as the technician kept increasing the CPAP pressure.  There was one central at CPAP 6 and another at 7 but none at 8 where she was prescribed. No other "x"pap therapy was considered during the sleep study and she was prescribe just a CPAP machine by our pulmonary specialist who owns the sleep lab that we used. 

Now our youngest son has increased his EPR from 2 to 3 (the max allowed by his machine) and his AHI went from 2.96 to 1.7.  So reduced by half but that is comparing a 28 day average to just one night.  We plan to keep this setting for a week and then I will loan him my Aircurve Vauto or my ASV and see what happens in auto mode.  I loaned him my Vauto for two days in August but it seemed to cause centrals (no RERA's) and imply that an ASV will be needed.   Will follow your advice with EPR 3 and leaving CPAP at 9 for now.  Paul T.
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RE45: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Time for an update about me and my Resmed Aircurve 10 ASV since using it for about a month.  Attached are two recent Sleepyhead screenshots.  As is usual, no apneas since using this machine. I feel fortunate that my body tolerates the pressure swings from minimum exhalation of 4 to maximum inhalation of 19 as many members write they would  awaken with such variances.  But the mask pressure usually does not swing more than 6 from each breath inhale to breath exhale even though the maximum throughout the sleep period is larger.  The machine needs the larger adjustment room to combat the different apnea types. 

I find the ASV more comfortable as the pressure is low on exhale and higher on inhale compared to high all the time (even on exhale) with my past CPAP therapy.  The minimum exhale pressure with a CPAP is normally no less than three below the setting (EPR=3) which is usually higher than the minimum mask pressure of 4 that I am experiencing on exhale with the ASV.  My past prescriptions were CPAP = 10 and Bilevel = 11-15 which yielded a much higher exhale pressure than 4 with the ASV.  I do not realize the machine is turned on most of the time while wearing the full face mask because it is not blasting out at high pressure all the time.

Remember I am retired and normally sleep during the day and in short periods averaging about two hours each.  The ASV is allowing longer sleep periods that are more restful than with past CPAP and Bi-level therapy.  I even achieved an eight hour period several days ago!  What I have attached represent my current "normal" of almost four hours per sleep period.   Bottom line is that I love this ASV machine.  Hats off to the programmers and all the research that went into getting this current technology that was not available just forty years ago.  It is providing more normal sleep with pressure very low on exhale and helpfully high on inhale.  Paul T.


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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Not everone can be promised results like this, but for you ASVauto nailed it! As you know I keep track of these long-term journeys from regular or auto-CPAP therapy to ASV and refer the relevant people to them. Your questions, difficulties and success will help many others on the forum that hope to follow the path you blazed. Your doctor must surely be amazed, even if he suppresses it. You have to wonder if he might be more willing to prescribe ASV in the future.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Congrats on the success. Hope it continues to go well. Keep us posted. Coffee
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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RE46: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Tom, I think the health insurance industry has a lot to do with how our pulmonary specialist prescribes the various types of apnea machines.  There is a hierarchy of price and capability with the CPAP machines being the least expensive and capable then on to the bilevel machines and finally the most expensive and capable ASV machines.  Since the insurance industry is for profit, their primary interest is making money now.  There is little interest in preventative medicine and saving money in the long run unless somebody takes the time to convince them otherwise.  The health insurance industry requires sleep study tests before they will cover any expenses for machines and there is a tendency to start with the least expensive.  Our pulmonary specialist understands this tendency and has established his own sleep study side business.  He makes the most money by first slowly prescribing the least expensive machine followed by future sleep studies to justify bilevel and then finally ASV machines.  At least that is what happened to me.

With the knowledge gained from this forum, I was able to short circuit this tendency by providing our pulmonary specialist my wife's Sleepyhead charts showing cluster central apneas while using her newly prescribed CPAP machine. He is now willing to do an ASV sleep study for her skipping over his normal practice of going to a bilevel machine next.  Both my and my wife's initial sleep studies showed central apneas indicating with high probability the final need for ASV machines.  But for the few hours of time required to do a sleep study, our pulmonary specialist was able to show that a bilevel for me could eliminate my central apneas; so that is what he prescribed a year ago.  He could have gone directly from CPAP to ASV for me, but he choose not to do so and I suffered for that decision.

If the insurance industry wanted to save money, they would consult with doctors concerning sleep study results.  Our health insurance partially paid for both a bilevel machine and then an ASV machine for me within a years time.  They could have skipped the bilevel if they saw my central apneas during the initial sleep study and gone directly to an ASV machine after consulting with my pulmonary specialist.  This is just one example of waste within our convoluted USA healthcare system.  Since all machines have a CPAP mode, I believe an analysis would show prescribing ASV machines for anybody presenting central apneas during an initial sleep study (and ejection fraction greater than 45%) would save the healthcare system money in the long run and be more beneficial to the patient.  Just my opinion. 
 Paul T.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Paul, and even more diabolical aspect of the machine level is that the inside of an ASV is essentially the same as the CPAP with the only difference being the mainboard and firmware. I'm not even sure if there is a difference in the chip-sets, but the blowers are the same. The real cost of producing an ASV is the sunk cost in software and research. These must be very profitable machines for the manufacturer, and probably all subsequent levels of the supply chain, wholesale, distribution and retail.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I completely agree that our (USA) healthcare system could be improved. I am not sure that your example is representative of the average sleep apnea sufferer. Users of this website most likely have some skills or aptitudes that allow a more direct approach to the diagnosis. Whether for-profit or not for profit, either system is looking for cost efficiencies. To provide a $3000 machine to everyone, when user compliance is in the 30%-50% range, instead of doing sleep studies isn't going to save all that much (I have no proof). The sleep studies also catch some odd situations that require more care than sleep apnea. I do believe they also moving to "at home sleep studies" that reduce diagnoses cost and unnecessary expensive sleep lab studies .


Respectfully,

John
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I wonder what would happen if some IT guy hacked into a CPAP and converted it to an ASV... Thinking-about

And NO I cannot do that BTW, but I think my former co-worker that made the office printer alert the staff to it being low on mayo probably could give it a shot.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I think the firmware to make the machine ASV is on a different chip-set that would be nearly impossible and certainly illegal to "hack".
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
(09-20-2018, 01:56 PM)Sleeprider Wrote: I think the firmware to make the machine ASV is on a different chip-set that would be nearly impossible and certainly illegal to "hack".

Likely true on the legal aspect, and I was not seriously suggesting it.

Sorry for topic drift to all.

It does look like we have another great success on ASV use here. Personally, I like hearing about patients successes by getting whatever machine it takes to get better. I don't like the bean counter mentality with some involved in the process. As Paul/waldo1945 mentioned, if the insurance wanted to cut some waste out, why not permit some like myself the ability to skip BPAP when ASV for treating centrals was indicated on the PSG for BPAP?
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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