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[split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
RE49: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Understood and thank you for the clarification Tom.  I used this site’s search engine to find the posts concerning children.  It is now my understanding that noninvasive techniques to control sleep apnea should be given priority while the child is still physically growing. The least expensive CPAP machine meets this criteria as well as oral appliances that help shape the throat area like oral appliances do for straightening teeth.  That is why I put the caveat “if the centrals get worse”.  There is no need to spend more money now on an ASV machine or any physical operation that he might outgrow. But it is always good to have clarification.  Our teenage grandson has now gone eight nights without large air leaks since he has transitioned from sleeping on his back to sleeping on his side J  Paul T.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
You may be correct. I didn't do a extensive search but relied on the fact that the study and my assertion came from the Mayo Clinic. I guess my point really was that while it may seem absurd to have to jump through all the hoops, sometimes there are factors that a lay person may not understand. I wouldn't really disagree with what anyone has said. I do think that the doctors that are involved with some of our care could be better educated.
I apologize if I came off as argumentative.

John
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
jm, assuming you were responding to me, no worries. you didn't seem argumentative and you made a valid point. I'm no expert and could be wrong. I presented my understanding without confirming it. my counterpoint was a small distinction for the sake of discussion.
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RE49: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Thank you for your civility and respect for each other.  That is one of the reasons that I choose this forum over other Internet sites.  It is difficult with just the written word to communicate without offending someone by tone or an attempt to make a joke etc.

Dave, I am sharing some mask information with you because you and my wife are using the same two masks for the same reasons and I have noticed your continuing interest in mask equipment.  We received our six month resupply which included new headgear and mask bases.  The new quieter Resmed swivels that attach between the supply hose and the mask were supplied.  So apparently Resmed will eventually supply all their users with the quieter swivel as the users replace their “warn out” items. 
 
We also purchased a $99 Philips Respironics Dreamwear full face mask kit (MPN 1133400) from Amazon because of their liberal return policy.  The kit came with all four mask cushion sizes and the medium size headgear which fit most people.  This mask is not a new design but they are unique because they have the supply line at the top of the users head with the entire full face mask under the nose like the Amara.  So far this mask, like the Amara made by the same company, is not sealing around her mouth while my wife turns from side to side during her sleep.  It has potential as there is less pulling on the mask from the hose because the hose swivels at the top of her head rather than at the mask.  While this mask does allows her to read with her glasses and fall asleep; she still has to switch from it to her Resmed F20 air touch cushion seal for the rest of the sleep period to get a good mask seal.  The only downside I have read is the supply pinches (reduces by one) the flow on whatever side you are sleeping. But the other side receives full flow so this does not seem to be a real issue. Maybe if the supply lines down the side of her face were a little stiffer; it would have sealed better for her.  We are going to pass the kit on to some of our other family members to try before sending it back.   Paul T.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Good info, and thanks for posting it for us to see it. More info is always good to gain. 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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RE51: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Tom, I was not familiar with our youngest (42 years old) sons relatively rare Respiratory Effort Related Arousals (RERA) until you provided the article written by Dr Christian Guilleminault. I learned about a not so familiar Respiratory Disturbance Index (RDI) where the RERA hourly average is added to the Apnea Hyponea Index (AHI) that is more widely used by the sleep apnea community. Treatment is usually approved by health insurers when either index is above 5 events per hour. 
 
This son has completed his first 30 days of a remotely monitored 90 day home trial with a CPAP machine prescribed at 9 with a pressure relief of 2.  We followed your recommendation to increase the pressure relief to 3 for a week. This had a positive effect by reducing his monthly RDI from 6.49 to 6.18 events per hour. Since he reached the pressure relief limit of 3 for a CPAP machine, we loaned him my ASV machine for a weekend to see the effect on his various apneas.  Pressure support can go as high (lower exhale pressure) as 15 with the ASV.  (We had previously loaned him my spare Aircurve 10 Vauto BiPAP which resulted in an AHI of 7.42 over 3 days in Auto mode)
 
We left the ASV set to the default “auto” mode giving the machine full access to its capability.  It eliminated all of our son’s apneas as it has done for both my wife and I.  We are pleased that his body tolerated the machine’s wider swing in pressures throughout the weekend thereby giving him a viable sleep apnea solution. He does feel more rested using the ASV than using the CPAP machine.
 
So our next step is to try to get the remotely monitored home testing switched from a CPAP directly to an ASV machine without having to go through a BiPAP and at least 6 of the 12 steps that you outlined.  We are going to start with our general practitioner as our pulmonary specialist owns the local sleep lab and has a vested interest in doing as many sleep studies as possible by going through all 12 steps.  The attached is what I am providing for our general practitioner in the hope of getting our son better therapy more quickly with less expense.   The big downside is his health insurance is through California's Medicaid bureaucracy and they usually require at least the first 9 steps. I will let you know how our next Monay doctor appointment goes. Paul T.


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.pdf   Aaron ASV 90 D.pdf (Size: 73.29 KB / Downloads: 10)
.pdf   Aaron CPAP B.pdf (Size: 193.77 KB / Downloads: 10)
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
The ASV detail looks like he needs a minimum EPAP at 5.0, but otherwise impressive. I think you may meet your match with MediCal in terms of getting approval for ASV without a diagnosis of some kind of thorasic disorder or diagnosis of central apnea. This looks like a go-fund-me project if you really determine it is desirable. While it is important to resolve a serious RDI issue, the bureaucrats are not going to have that in their approval checklist and will look at his efficacy for AHI with CPAP. As far as I know, ASV does not even have RDI as a FDA approved use. I honestly doubt they will even move to simple BPAP. Just offering you an honest opinion so you don't spin your wheels to the point of digging in.

The results and anecdotal evidence are impressive, interesting and innovative. You might even consider writing Dr Christian Guilleminault and asking his opinion of this application. So few people have access to ASV, even for critical need to resolve central and complex apnea, I think this one has a long way to go.
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RE52: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Sleeprider, Thank you once again for sharing your expertise.  We snail mailed our son’s complete sleep apnea history to Dr Guilleminault explaining that an ASV machine had eliminated our son’s RERA’s while operating in Auto mode.  We offered the history for information (at your request) to aid Dr Guilleminault’s ongoing sleep apnea research.
 
Our General Practitioner agrees with you that the relief our son is getting from the CPAP machine is all our son’s health insurance will cover.  (See Attached CPAP 2).So we are continuing with the 90 day “try before you buy home CPAP monitoring”. The objective is now to get his health insurance to pay for future consumable supplies. We can switch to a more therapeutic machine after the insurance company stops monitoring compliance at the end of the 90 days.  The attached ASV90 K is what we wanted to provide to the insurance company (as it is the correct diagnosis) but it can now be used to further this board’s knowledge base. Note also attachment CPAP 11 which tabulates the wide variance in daily CPAP therapy results any one of which could result in a questionable six hour sleep lab recommendation.
 
Remember when I reported that our son tried my VAuto for three days with a resulting AHI of 7.42?  Well the machine was operating with severe restrictions because I forgot to reset it to the default settings L.  Dr Guilleminault’s article wrote that EPRs usually range between 4 and 12 to eliminate RERAs.  We tried the VAuto again with the default settings (EPR=4) and it eliminated the RERA’s.  Attached are the resulting VAuto Sleephead screenshots (BPAP 1 and 2). We can adjust the VAuto settings if we want to further lower the AHI. (Your EPR adjustment advice was in the correct direction but could not be achieved for our son because the maximum CPAP EPR setting is 3.)  So we now have a family use for my spare VAuto machine and our teenage grandson has been successfully using my wife’s spare CPAP Autoset For Her.  To ere is human; to forgive divine.  Paul T.


Attached Files Thumbnail(s)
           

.pdf   Aaron ASV 90 K.pdf (Size: 77.28 KB / Downloads: 6)
.pdf   Aaron CPAP 11.pdf (Size: 193.67 KB / Downloads: 4)
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
The way we use the term in bilevel (Aircurve) is pressure support. It gets confusing because the only difference is we add pressure support to EPAP in bilevel to get IPAP, but subtract EPR from CPAP pressure (IPAP) to get EPAP with the Airsense. One other difference is that the Aircurve 10 Vauto does not record RERA, so it's possible they were eliminated, but we don't really know. I think a good surrogate for RERA is the flow limitation graph.
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RE53: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Sleeprider, Just when a novice like myself thinks I am beginning to understand the intricacies of sleep apnea therapy, you have to confuse me with more details!  But thank you for continuing my education. Can I assume the ASV machine does not log RERA’s either because its computer program effectively eliminates them?
 
OK, so attached are the two VAuto graphs with the flow limitation chart depicted.  I noticed on the CPAP machine graph that the flow limitation was usually above 25% when a RERA occurred. The CPAP flow limitation was above 25% for about half the sleep period.  Does the fact that there is little flow limitation above 25% on the attached VAuto graphs mean that we can assume we have eliminated the RERAs with the VAuto?  What can you tell from the attached VAuto flow limitation charts?  Are there more VAuto adjustments we can make to ensure the RERA’s have been eliminated?


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