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I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
#1
I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
After 9 months of resmed 10 apap and problems with centrals, I used a resmed asv and generally had less than 1.0 AHI, now with a new dreamstation asv I’m seeing 3+, mostly hypopneas.
 
   
 
Resmed settings = ASVAuto, Min EPAP = 4, Max EPAP=15, Min IPAP=8, Max IPAP=35, PS Min=4, PS Max=20

when I try to replicate these settings on the DS, the hypopneas linger.

here's an example of a great resmed asv night, zoomed in on one of the few hypopneas, and showing how the pressure responded.

   

my thoughts:

The DS is turning the central apneas into central hypopneas, but not enough pressure or not fast enough to eliminate completely.
The DS is marking hypopneas that the resmed would not.  

I think the epap min is fine, no obstructive apneas.  I’m trying different settings.  I’m up to PS Min=6, and still having hypopneas.  

Any thoughts on anything to try next? Just keep bumping up PS min?  it’s already starting to feel like too much.  I tried moving the rise time from 3 to 2, but it didn't seem to change anything.   

thanks!


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#2
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
Typical comparison. How did you end up with Dreamstation? Can you switch back to Resmed? Your results speak for themselves and your doctor could prescribe a dispense as written order. It's obvious that the Philips machine does not develop the pressure support in the time needed to manage CA and H events. It may be noteworthy that your EPAP is set 4 cm higher on the Philips, and you also have PS min 6.0 rather than 4.0. I suspect this is in response to mitigating the hypopnea events, and I would have done the same thing, however, what were your results with lower EPAP min? Events are very high on the Philips for SV and your median tidal volume has increased showing the machine is likely pushing your respiration a bit hard with the PS min.

What are we looking at on the overview chart? There are three distinct sets of results with January 23-March 5 looking pretty good compared to the other data sets.
Sleeprider
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#3
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
>How did you end up with Dreamstation? Can you switch back to Resmed? 

My sleep doc didn't think an asv would help, so bought a used one :-).  Then, on a follow-up, after months of saying it wouldn't be worth it, my sleep doc says I should get one now!   needed another sleep study.  Of course the DME only supplies respironics asvs, and claims they are sooooo much better than resmed!   

My used resmed has got  a lot of hours on it, and need to have a prescription in hand, because finding used ones was hard! 

>It may be noteworthy that your EPAP is set 4 cm higher on the Philips, and you also have PS min 6.0 rather than 4.0. I suspect this is in response to mitigating the hypopnea events, and I would have done the same thing, however, what were your results with lower EPAP min?

Correct.  I had set the resmed myself.   they worked great so I never had to adjust them.

My original settings on the DS was Min EPAP = 6, Max EPAP=20, Min IPAP=6, Max IPAP=25, PS Min=0, PS Max=19. I ran that for a week before I messed with any settings.  I originally thought the hypopneas were obstructive in nature....now I don't think so (but could be wrong :-).  

I thought the PS min=0 was weird...but when I moved it to ps min = 4 to match the resmed . the ahi was over 8 that night.   Then I backed off, and bumped it up slowly each night.  

here's a night with original settings.   

   


 
> What are we looking at on the overview chart? There are three distinct sets of results with January 23-March 5 looking pretty good compared to the other data sets.

that' s  the Resmed ASV.  I wanted to show the results of the resmed 10 apap, then I switched to the resmed asv on Jan 23rd, then the insurance purchased respironics asv since March 6th.

ugh, I hate battling with doctor/insurance/dme!  I was really hoping the ds would be able to perform as well
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#4
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
If you look at buying one out of pocket look at Supplier #2. They are on the suppliers list at the top of the site.

They sell used machines (all brands) I have purchased 2 ResMed VAUTO from them used. One had less than 1moth use the other one less than 1week. They come with a year warranty.

Great company - I called and they told me the hours on the machine I was going to buy. Quick shipments and nothing I could say negative about them or the machines.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
Your DME has an exclusive marketing agreement with Philips. You need to change because they never will. You should have checked that going in. My best advise is to advise the DME this machine has not worked out and you want to return it. Have your doctor write the prescription for the Resmed Aircurve 10 ASV. There is no reason that incentives paid to your supplier should limit your choice and effective care. That machine is still nearly new. Return it now or live with it for the next five years. You have your Resmed as backup until you can source a DME without an exclusive agreement with Philips.

Where do you live? I see ASV fairly often on the used market and they are very reasonable. I use the SearchTempest search engine, and while you have to call and verify run hours and condition, I am seeing:
ResMed Aircurve 10 sleep apnea machine - $350, Perrysville, Ohio
Resmed AirCurve 10 ASV - $150 Temple, TX
RESMED S9 VPAP ADAPT WITH ASV - $400 Castle Rock, CO
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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#6
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
The DME sold you a bill of not so goods. Respironics is definitely different, mostly not as good as the ResMed ASV. As mentioned, they likely have a contract to sell Respironics for a discount to them, not you. If product A costs more for the DME to buy than product B, but they get insurance reimbursement that's equal for both brands, they'll scam their way to sell you brand B. It's all about profit and nothing to do with caring about your needs.
Dave

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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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#7
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
I agree with the above, Return the PR ASV. Then source a ResMed.
Your story is not an uncommon one.
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#8
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
Check with other DME's near you that's in-network with your insurance. Quiz them on issuing ResMed machines. If they say no, keep shopping.
Dave

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Standard OSCAR Chart Order
Mask Primer
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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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#9
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
I messaged my doc about switching out from the dreamstation asv to a resmed, and the answer was

"the change to the prescription to Resmed is approved. I contacted the DME and they aren't able to exchange it because they would lose $2000 in doing so"

what? oh, ok, I'll have less than ideal sleep for the next five years, wouldn't want to inconvenience you!! Doesn't that sound like a fat lie from the dme?

I can buy a new resmed asv for about that!

I've request to speak further to the doc's office for guidance. I've never had to return a unit...isn't that pretty common?? I got it less than a month ago

again, thanks for all the advice, I appreciate it!
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#10
RE: I can’t eliminate hypopneas on dreamstation ASV compared to Resmed ASV
My guess is the supplier still has that exclusive marketing agreement and can't get a Resmed. So you need a new supplier. You should be able to return and then it is their problem. You may want to discuss with your insurance first since that is where the money is.
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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