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[CPAP] I want to buy a bi-level or AVS machine and am in need of advice.
#1
I want to buy a bi-level or AVS machine and am in need of advice.
I'm a 76 year old man who had a sleep study done a year ago, but held off purchasing until now because of covid. I have had life long asthma, but would believe it is mild COPD based on this standard. 

Stage 1 -- Mild -- FEV-1 ≥80%: You may have no symptoms. You might be short of breath when walking fast on level ground or climbing a slight hill.

I can climb a fairly steep hill for 45 minutes without stopping. I post this because there is a caution about using AVS with moderate or severe COPD. 
My family physician wrote the prescription for a CPAP at 7 cm rather than not be in agreement with the sleep study. I'm not sure if can post my sleep study on the board. On the test I had 3 apneas, two were obstructive and one central. I was very happy to come across this website!




Thanks
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#2
RE: I want to buy a bi-level or AVS machine and am in need of advice.
Welcome to Apnea Board,

Sure you can post your sleep study. Black out your personal data for your own privacy protection. COPD concerns are maybe warranted. Depending on which doc I ask, I have stage 1 COPD or Asthma.

The ResMed AutoSet may be OK for you, but better is the VAuto a BPAP. It's got some timing controls that you'll find necessary due to COPD. The ASV may not be best however. It's best to combat Central Apnea, which you don't have in abundance according to your post. Best of the bunch may be the ST-A from ResMed. It's design is for respiratory disease patients.
Dave

OSCAR
Standard OSCAR Chart Order
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: I want to buy a bi-level or AVS machine and am in need of advice.
I agree with Dave, and recommend the Resmed Aircurve 10 Vauto for several good reasons. First, it is the best auto-bilevel device on the market with a responsive auto-adjusting pressure that comfortably transitions between inhale and exhale positive pressure (IPAP/EPAP) thanks to Easybreathe™. The Vauto includes controls for minimum and maximum time of inspiration (IPAP) which can make a big difference in preserving expiratory time with COPD, and it has adjustable trigger (IPAP) sensitivity and cycle (EPAP) sensitivity. These features simply put it in a different class than any other bilevel without backup rate.

I believe you were considering "AVS" or more commonly ASV (adaptive servo ventilation). This type of respiratory assist device is intended for use with individuals that have central or complex apnea, and has a backup rate that works to cause a breath when spontaneous inspiratory effort is not present. Without some evidence of central apnea, I would not suggest this as appropriate. The Vauto has a CPAP mode and can be setup as your doctor specified, but more importantly, it has full data capability so you can self-titrate and optimize the therapy. A titration test at a sleep clinic is rarely an optimal setup because it just doesn't consider the effects of flow lmitation and other respiratory issues that are not considered as events. It really doesn't even consider sub-optimal oxygen saturation. You should request that your doctor revise the prescription to an auto-bilevel positive air pressure device HCPCS code E0470 for Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) as maintained by CMS falls under Oxygen Delivery Systems and Related. This prescription can be justified in consideration of your history of COPD and obstructive sleep apnea. You were apparently titrated to a fixed pressure of 7.0, and a good bilevel pressure would be EPAP min 6.0, IPAP maximum 14.0 with PS 4.0. The pressure support will make breathing easier, improve ventilation and prevent obstructive events. The detailed data available from the Resmed Vauto will allow for full optimization of all goals and a higher level of comfort than is possible with CPAP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
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RE: I want to buy a bi-level or AVS machine and am in need of advice.
Thank you SarcasticDave 94 and Sleeprider!    like

Wow!  I'm going to say you two have to be among the top people in the country in regard to knowledge of sleep apnea and the underlying health issues that go with it. I will contact my physician of 30 years Monday. He's a really good doctor. Very excited to shop for a Resmed Aircurve 10 Vauto and start getting some good sleep!

Thanks
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#5
RE: I want to buy a bi-level or AVS machine and am in need of advice.
Very good to hear you expect to make progress soon. Best wishes you succeed. Keep us updated on your status.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: I want to buy a bi-level or AVS machine and am in need of advice.
(05-08-2021, 04:40 PM)mid range Wrote: Thank you SarcasticDave 94 and Sleeprider!    like

Wow!  I'm going to say you two have to be among the top people in the country in regard to knowledge of sleep apnea and the underlying health issues that go with it. I will contact my physician of 30 years Monday. He's a really good doctor. Very excited to shop for a Resmed Aircurve 10 Vauto and start getting some good sleep!

Thanks

Your doctor is the best shot at getting what you need.  The sleep medicine arena is full of charlatans and frauds that care about nothing more than making fees by signing off on sleep reports.  All that matters is that you have been diagnosed with apnea, and need the most appropriate therapy to negotiate your suite of health issues.  Don't expect a sleep doctor to figure that out. Your doctor is the best bet by far.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: I want to buy a bi-level or AVS machine and am in need of advice.
Standard medical practice is to only step up to bilevel or ASV if you fail CPAP/APAP, I doubt your doctor will consider either without first trying CPAP.

At only 3 apnea it doesnt appear that you have issues with apnea. Were there lots of hypopneas or oxygen desaturations on study? Why did doctor even prescribe CPAP?

If you do skip the first step and jumpt straight to one of these other machines pllease know there is absolutely no reason to think an ASV would be needed and if not needed it could be more detrimental to sleep quality then helpful. With bilevel you can at least dial it back to act as a CPAP, you cant do that with ASV so that is definitely the wrong machine for you at this time.
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#8
RE: I want to buy a bi-level or AVS machine and am in need of advice.
The person who administered the test told me that reason for a cpap recommendation was the oxygen desaturation.
                           From the study which was done in February 2020.
SpO2 minimum % = 88. SpO2 range = 88 - 95. Percent sleep time > 89% = 99.7.
Hypopneas
NREM = 43  Obstructive = 43 Mean Duration = 10
REM =     0
Apnea index           = 1.2
Hypopnea Index =    17.7
A + H index NREM = 18.9
A + H index REM   =      0
RDI                        = 18.9
Sleep Time Mins   =   146

From my viewpoint the test was unsatisfactory. The bed/mattress was so hard I had to turn continuously and had no REM stats at any time. Sleep time while using the CPAP was 62 minutes. I had 2 hypopneas during this time on CPAP.
My concern is that I had not been experiencing the COPD cough for 50 years until shortly before the sleep study. I'm not sure I see any advantage of a CPAP over the Aircurve 10 VAuto. I understand I might be missing something.
Four days ago, my wife, who has a brain injury, was experiencing steady snorting using her cpap when I came to bed. I woke her and she cleared her sinuses and seemed to do alright following that. The next night her cpap was make a moaning noise. She had only started to use sleep pillows recently. We visited an 84 year friend over the weekend and my wife told her about her experience. Our friend, who has copd, insisted that my wife accept her cpap, which had hit its 5 year limit on Medicare. My wife is eligible for a cpap with medicare advantage. Her sleep study showed her to be borderline for needing a cpap. She is stubborn. She has gone back and forth with using the cpap, but is always hoping to get away from it. She does admit that the cpap has been a help with her depression and it is great for the sleep interruptions she had previously. We are arguing now about a sleep study and new cpap for her. Her last one was purchased used 5 years or more ago from Goodwill . She gets a kick out of not spending money. We are in need of nothing and probably would be better off with less.
Since the friend's machine is a  Aircurve 10 VAuto with humidifier, I plan to buy a hose and mask and use that, at least temporarily. Hopefully my wife will upgrade her cpap soon. Fortunately I can sleep (some) through a lot.
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#9
RE: I want to buy a bi-level or AVS machine and am in need of advice.
OK when you set it up, let us know and we'll get you started on it ASAP with decent setup pressure. Consider getting the free report tool OSCAR to visually track your therapy on the VAuto.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: I want to buy a bi-level or AVS machine and am in need of advice.
Your SPO2 isn't bad, maybe slightly on low side for average (although not stated) but your minimum stayed good and almost all night was above 89% which is good. Your hypopnea index is probably the main reason for CPAP recommendation and it might raise your average SPO2 slightly.

You are right that the Autoset doesn't have an advantage over Vauto functionally. The advantage of autoset over vauto is practically and it is due to insurance coverage and dealing with doctors. The only way you qualify for a Vauto/bilevel on medicare/insurance is if you first fail CPAP/APAP, insurance is not willing to pay the increased costs for a machine that you do not need and most people don't need a bilevel. If you are going to be using someone else's machine or buying a used machine out of pocket anyways then that is different and getting a vauto would be a good choice.

The key if getting a Vauto is to start at CPAP/APAP like settings and work your way up, don't start higher thinking it is better. Ideal PAP treatment is about finding the minimal settings that treat your breathing issues. If you use too high of a pressure or too high of pressure support etc it will negatively impact your sleep quality in a number of ways (aerophagia, treatment emergent central apneas to name a couple).

Since you are able to use a friends machine you will be able to test the settings and confirm if an autoset would be good enough for you. Then if/when buying your own machine you wouldn't need to spend as much.

Edit: Since you only have hypopneas all you probably need/a starting point would be EPAP of 4 cm and PS of 3 cm (min pressure of 7 cm and EPR of 3 cm if using an autoset).
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