Chronic Insomnia

[mawaw1992]

I had noticed on the forum that most people think the Resmed is more effective than the Dreamstation. I do not use a DME and always purchase my cpap equipment online. Price is no issue. I am not familiar with the Resmed 10 series. What is the difference between the Airsense 10 Autoset and the Aircurve 10 VAuto? Which one do you think would help me the most with my problem? Also, what would be the best way to go about selling my Dreamstation that only has a few hours on it? 

Thanks,
Mark

[Sleeprider]

If price is not ans issue, then the Resmed Aircurve 10 Vauto is by far the best device for treating obstructive sleep apnea and related sleep disorders. The Airsense 10 Autoset is an excellent auto CPAP. Compared to the Dreamstation, it provides a more proactive response that prevents events rather than responds to them. The exhale pressure relief is a true bilevel pressure limited to 3-cm, and it therefore has a real therapeutic option for treating flow limitation and hypopnea. Moving up to the Aircurve 10 Vauto gets unlimited pressure support (difference between inhale and exhale) with the same responsive auto-pressure algorithm. It also has controls for time of inspiration (Ti min, Ti max) and sensitivity settings for the IPAP trigger and EPAP cycle. You may never need those features but they are there if you do. Most people moving from the Airsense 10 to Vauto comment on a smoother feel to the pressure transitions. Anyway you look at it, these are a significant upgrade to your Dreamstation. I'll look forward to reading your reaction to the difference. There really is no way to describe what you need to experience to believe.

[mawaw1992]

I definitely want to switch to one of the Resmed's you mentioned and will probably switch my wife to a Resmed. She is having a lot of Hypopneas that her Dreamstation doesn't seem to help her much with. Is there some where other than Craigslist or ebay that I could sell both of our Dreamstation's. I have only used mine a couple of months. 

Thanks,
Mark

[mawaw1992]

I was looking at purchasing the Resmed Aircurve 10 VAuto but noticed a company that has a Certified Refurbished Resmed AirCurve 10 ASV for just a little more than what the 10 VAuto would cost me. Would this be a viable option for me?

Thanks,
Mark

[Sleeprider]

There is discussion of using ASV for severe upper airway resistance based on its ability to maintain tidal volume using adaptive pressure support on a breath-by-breath basis. This off-label use is not widely accepted, however would be particularly useful for individuals with a tendency for central apnea in the presence of pressure support. In most cases it is overkill, and can actually be a source of disrupted sleep. For most people, the Vauto is extremely effective in reducing or eliminating flow limitation from airway resistance and providing pressure support behind inspiratory effort. The effect is that therapy becomes more or less constant compared to ASV, which is less disruptive for those that don't need a backup function. Your wife had some centrals, but we would really need to look closer to see what the cause of these actually are. I suspect it is sleep disruption and flow limitations with respiratory arousals. At this point we have only looked at a single chart from Dec 7. The bottom line is, Vauto is an easily accepted and recognized therapy for the kinds of issues we see in your wife's chart, however ASV would be nearly universally rejected as an extreme and unacceptable therapy for this application and without a physician's oversight and supervision as well as appropriate cardiac screening.

Private sale of CPAP machines is limited due to pressure from manufacturers on outlets like Amazon and Ebay to prohibit ads on those sites. We see a few on Ebay that usually get taken down pretty quickly. The main legitimate channel is through resellers like Supplier #2 and the ads you see in nearly every Craigslist offering cash for machines. This is where the supply of used machines with warranty or "certified" come from. Obviously, they buy low and sell high. I would try listing privately on Craigslist, Offer-up or Facebook Marketplace, the latter being a fairly safe channel without the scammers. Be sure you own the machines and are not required to demonstrate compliance to your insurance or are bound by a lease agreement. If this machine was supplied by a DME through insurance, it may not be yours to sell, and you should discuss your intolerance of CPAP and desire to upgrade to bilevel with them and your doctor. It is not really a significant change in prescription that requires more studies. This is also the basis for upgrading from Philips Auto CPAP to Resmed Autoset. They are equivalent machines with very unequal capability. Holding onto the machines for a while will not depreciate them and may be a safer option until you KNOW you own them.

[mawaw1992]

As far as the Dreamstations my wife and I use they are ours. I do not use insurance and always purchase my machines through online retailers. As far as the Refurbished AirCurve ASV, I was looking at it for me and not my wife. I will be getting her the AirSense 10 Autoset (For Her model) to hopefully help her problem. When you looked at my charts I thought you mentioned that I maybe had a serious problem with flow limitation causing arousal's that was apparently waking me up through the night. Last night it looked like I had an event (dreamstation showed a RERA) that apparently woke me up.  I just thought running across this refurbished ASV for a little more than a AirCurve VAuto might be something that would better help my problem. You know a lot more about this than I do and I look to people like you for help because I do not seem to get it from my doctor. If you think the AirCurve 10 VAuto is all I need I will go with it.   

Thanks,
Mark

[Sleeprider]

I lost track of what you're doing for yourself and your wife, and I don't recall the chart of your flow limitations you mention here. It is almost a given that if you were using a Dreamstation at the time, the event looked pretty awful, and the way Flex works, makes it even worse. ASV just does not leap to mind as the way to address flow limitations and RERA, and in the few cases where it has been tried, there was mixed success.

We had a thread on this topic not long ago, and I think Bonjour and I actually see eye to eye on preferring the Vauto as a primary solution http://www.apneaboard.com/forums/Thread-...RS-Therapy There is very little available to guide on on using ASV for therapy in upper airway restriction, and we really only look to ASV when the pressure support needed for therapy causes central apnea. We have had highly repeatable success in coaching members to use a Vauto to get results they didn't think possible. There is just no compelling reason to move up to ASV with all the potential complications that come with that therapy.

[mawaw1992]

Thanks that is what I needed to know. I am going to go ahead and order the Airsense 10 Autoset (For Her model) for my wife and the AirCurve 10 VAuto for me. Once I receive them and we have had a few nights of sleep with them I will probably show charts to see what settings may need to be changed. 

Thanks again for the help,
Mark

[mawaw1992]

[attachment=28956][attachment=28957]While I am waiting to get my new Resmed machine I decided to try something to see if it made a difference. The first chart is 2 nights ago where I switched back to CPAP at the pressure I have been using for years which is 12. At this pressure I was able to keep my AHI under 1.0 most of the time until my sleep problem started back in June. The second chart is from last night which I bumped the pressure up to 13 just to see if it made a difference. I am still new to Oscar and really don't know how to read the charts but to me it looks like the Snore rate went up at the pressure of 12 and even higher at 13. Is this correct? And on both of these nights I woke at around 4:00 for some reason. On auto pap my pressure would normally run from 10.2 to 10.5 and seemed like the Snore rate was not as high. On the last 2 nights I have made sure my chin strap was tight and I used Somnifix over my mouth.  I do not see how I could snore. If someone would take a look at these charts and see what you think. Also, how did my flow rate change switching from Auto Pap to Cpap?

Thanks,
Mark

[mawaw1992]

[attachment=28958][attachment=28959]Here are charts from the last 2 nights around the 4:00 time when I woke up both nights to see the effect on my Flow Rate.

Thanks,
Mark