06-07-2019, 08:46 PM
PR Dreamstation BIPAP ASV vs. ResMed AirCurve 10 ASV
I've had the opportunity to use both the PR DS BIPA ASV and the ResMed AirCurve 10 ASV. I used the DS machine for 4 months, then it broke, while a new one was being processed my home care provider had the ResMed ASV on hand so I used it for two weeks. Then I returned the ResMed when my new DS arrived.
For those of you not interested in the long details that follow, the BOTTOM LINE IS...I think I made a mistake and should have kept the ResMed. It seems quieter at the same pressures, and as others have said seems to adapt to me instead of me having to adapt to the PR DS machine. I think the DS ASV is too aggressive, especially responding to leaks, and tries to do too much, with its Clear Airway Apnea detection algorithm. I'm having much more difficulty re-adjusting to the DS ASV even though the pressures are set to the same values as the ResMed. Its algorithms are definitely different than the ResMed. I may try to get the ResMed back !!
If your interested in the details, first a bit of background on my initial DS machine use.
I started 5 months ago on the PR DS BIPAP ASV, it was supposed to have the same algorithms as the PR ASV machine used in the sleep lab, so I figured I should get it vs. the ResMed. I was first diagnosed with an untreated OSA AHI of 42. After two overnight lab tests, I was diagnosed with Complex Sleep Apnea. My initial Rx pressures were very high (for me), EPAP min 9, max 15, PS min 0, max 15. I struggled mightily for 3 weeks, with little help from either the home care provider or the prescribing doctor. The high pressures (regularly up to 25 or higher) while using a DreamWear ffm woke me and my wife up, mask leaks were very bad and AHIs were high, never under 5 and often over 20.
I have a beard, was snoring badly, am a very light sleeper, roll from side to side during the night, and was recently diagnosed with a deviated septum and enlarged turbinates, all of which can contribute to leakage and my low tolerance for higher noisier pressures.
I decided on my own to switch to a DW nasal cushion. Leaks went down, AHI went down, but the DS BIPAP ASV still spiked to high pressures on even moderate leaks. It seems to aggressively increase flow/pressure when detecting a leak. It also seemed (to me) to leak even more when it tried to compensate for the leak with higher pressure, which lead to more leakage. I still was waking often and sleeping poorly. Finally got my Doc to OK a reduction in pressure, but only to Epap min/max 6/12, and PS min/max to 2/15.
This did not help at all, so I decided to take control of my own settings. I reduced EPAP min/max to 4/6 and Ps min/max to 0/2. I no longer was woken up by noisy pressure spikes, the leakage went down, and initially my AHIs went down. I still was not sleeping real well, often waking up at 2am and having trouble getting back to sleep. Gradually over the next couple weeks, I was sleeping longer with the machine and seeing some sleep quality improvement.
My OSA index has always been much improved from day 1 when using the DS ASV, down from 42 to usually less than one. With the machine I no longer snore. However, I continued to be plagued by moderately high CSAs (which PR DS calls Clear Airway Apneas, CAA), starting at from 5 to 11 per hour and gradually improving at 4 months to between 1 and 4. My recurring Hypopnea index has always been pretty bad, no matter what, it has ranged from 4 to 15 or higher.
Then I switched to the ResMed ASV. Their documentation says they don't report CSAs because they ELIMINATE THEM. I believe the DS ASV really is "guessing" when it reports a CAA.
I had my best sleep since I started therapy the last 7 days of my 14 day period with the ResMed ASV. It had a minimum Ps max of 5, that I was forced to accept, I had been using a Ps Max of 2 with the DS machine. I think I really do need higher pressures, but I don't seem to tolerate pressures above 9 or so. My reasoning for going back to the DS instead of keeping the ResMed was I felt SURELY if I set the DS ASV to the SAME pressure values as the ResMed, I would get the same good quality sleep. WRONG !! The DS machine's algorithm's are significantly different.
So, after 5 months, while my snoring and OSA problems are fully resolved, I still often sleep poorly and have annoyingly high CAAs and Hypopneas. I will say all the software tools the forum offers (which I have used all, including ResScan, Oscar, and Encore Pro 2) are helping. Plus all the help from other users. I will keep slogging along trying to improve. I hope to bring some of my detail reports to a highly recommended sleep doc who supposedly specializes in reading ASV reports. My original pulmonary doc and my home care provider wanted nothing to do with reviewing any of the detail reports with me. Their response was, you just need to get used to the machine for another couple months.
One last note, for anyone else using a PAP machine that has a deviated septum and/or enlarged turbinates. I went to an ENT and he offered a procedure to repair the deviated cartilage and shrink the turbinates. Not real pleasant a surgery, but after a couple weeks of discomfort, supposedly my breathing would be maybe 50% improved or more. He said it would not solve my OSA condition, but would likely allow me to tolerate the PAP machine better with lower pressures needed. I am on the fence about the surgery at this time.
Regards,
Mark
For those of you not interested in the long details that follow, the BOTTOM LINE IS...I think I made a mistake and should have kept the ResMed. It seems quieter at the same pressures, and as others have said seems to adapt to me instead of me having to adapt to the PR DS machine. I think the DS ASV is too aggressive, especially responding to leaks, and tries to do too much, with its Clear Airway Apnea detection algorithm. I'm having much more difficulty re-adjusting to the DS ASV even though the pressures are set to the same values as the ResMed. Its algorithms are definitely different than the ResMed. I may try to get the ResMed back !!
If your interested in the details, first a bit of background on my initial DS machine use.
I started 5 months ago on the PR DS BIPAP ASV, it was supposed to have the same algorithms as the PR ASV machine used in the sleep lab, so I figured I should get it vs. the ResMed. I was first diagnosed with an untreated OSA AHI of 42. After two overnight lab tests, I was diagnosed with Complex Sleep Apnea. My initial Rx pressures were very high (for me), EPAP min 9, max 15, PS min 0, max 15. I struggled mightily for 3 weeks, with little help from either the home care provider or the prescribing doctor. The high pressures (regularly up to 25 or higher) while using a DreamWear ffm woke me and my wife up, mask leaks were very bad and AHIs were high, never under 5 and often over 20.
I have a beard, was snoring badly, am a very light sleeper, roll from side to side during the night, and was recently diagnosed with a deviated septum and enlarged turbinates, all of which can contribute to leakage and my low tolerance for higher noisier pressures.
I decided on my own to switch to a DW nasal cushion. Leaks went down, AHI went down, but the DS BIPAP ASV still spiked to high pressures on even moderate leaks. It seems to aggressively increase flow/pressure when detecting a leak. It also seemed (to me) to leak even more when it tried to compensate for the leak with higher pressure, which lead to more leakage. I still was waking often and sleeping poorly. Finally got my Doc to OK a reduction in pressure, but only to Epap min/max 6/12, and PS min/max to 2/15.
This did not help at all, so I decided to take control of my own settings. I reduced EPAP min/max to 4/6 and Ps min/max to 0/2. I no longer was woken up by noisy pressure spikes, the leakage went down, and initially my AHIs went down. I still was not sleeping real well, often waking up at 2am and having trouble getting back to sleep. Gradually over the next couple weeks, I was sleeping longer with the machine and seeing some sleep quality improvement.
My OSA index has always been much improved from day 1 when using the DS ASV, down from 42 to usually less than one. With the machine I no longer snore. However, I continued to be plagued by moderately high CSAs (which PR DS calls Clear Airway Apneas, CAA), starting at from 5 to 11 per hour and gradually improving at 4 months to between 1 and 4. My recurring Hypopnea index has always been pretty bad, no matter what, it has ranged from 4 to 15 or higher.
Then I switched to the ResMed ASV. Their documentation says they don't report CSAs because they ELIMINATE THEM. I believe the DS ASV really is "guessing" when it reports a CAA.
I had my best sleep since I started therapy the last 7 days of my 14 day period with the ResMed ASV. It had a minimum Ps max of 5, that I was forced to accept, I had been using a Ps Max of 2 with the DS machine. I think I really do need higher pressures, but I don't seem to tolerate pressures above 9 or so. My reasoning for going back to the DS instead of keeping the ResMed was I felt SURELY if I set the DS ASV to the SAME pressure values as the ResMed, I would get the same good quality sleep. WRONG !! The DS machine's algorithm's are significantly different.
So, after 5 months, while my snoring and OSA problems are fully resolved, I still often sleep poorly and have annoyingly high CAAs and Hypopneas. I will say all the software tools the forum offers (which I have used all, including ResScan, Oscar, and Encore Pro 2) are helping. Plus all the help from other users. I will keep slogging along trying to improve. I hope to bring some of my detail reports to a highly recommended sleep doc who supposedly specializes in reading ASV reports. My original pulmonary doc and my home care provider wanted nothing to do with reviewing any of the detail reports with me. Their response was, you just need to get used to the machine for another couple months.
One last note, for anyone else using a PAP machine that has a deviated septum and/or enlarged turbinates. I went to an ENT and he offered a procedure to repair the deviated cartilage and shrink the turbinates. Not real pleasant a surgery, but after a couple weeks of discomfort, supposedly my breathing would be maybe 50% improved or more. He said it would not solve my OSA condition, but would likely allow me to tolerate the PAP machine better with lower pressures needed. I am on the fence about the surgery at this time.
Regards,
Mark
