[Equipment] Resmed Aircurve 10 ASV vs Aircurve 10 VAuto?

[bilbofett]

Hi everyone.
Long version: I have mild OSA (mouthbreather/small nose/Joker chin) possibly CSA, or mixed. Leaning towards mixed.
My insurance ran out when I was terminated by my job, but I still have COBRA which I won't be able to pay anymore soon. I need to think about my best options that I have right now, as far as deductibles/copay, etc.
I can't do another sleep test, and I'm a little concerned my sleep doctor was a little lazy and may not have properly diagnosed my condition. There's been a few signs/rumors of passive negligence.
From what I've been reading, its very possible I have mixed, OSA and CSA.
I have the opportunity to get either the Resmed Aircurve 10 VAuto or the Aircurve 10 ASV. I don't see too many reviews of Adaptive Servo Ventilation machines here... seems like only a minority has them, and the machines are wickedly expensive (why?)
Will the ASV (or any Adaptive Servo Ventilation) work for OSA in addition to CSA?
Here's my gamble/risk: I get the ASV, and hope it covers OSA/CSA/Mixed.
If it does, I'm in good hands and can relax.
If it does not, I may be better off getting the VAuto.

Short version: Will ASV also cover OSA/mixed, or does it do CSA only? It seems a person w/ mixed or even OSA would be covered by an ASV machine, but a person with CSA will not be covered by a BiPAP/VPAP machine?

P.S. I think I remember reading something rather concerning earlier, where, if you do NOT have CSA, but begin treatment as if you did, your brain will automatically adapt, get trained, and almost "give" you the condition, when you didn't really have it before. I'm concerned about that too Ie., your body should be telling itself to take breaths, not an artificial 3rd party, if the only issue is just "obstruction", and not brain damage. I don't want to do any permanent damage by getting the wrong machine and training myself to do something I shouldn't.

Your ideas/tips/knowledge is GREATLY appreciated, please

[PaytonA]

bilbofett,

The ASV machine will handle both OAs and CAs and can be set so that it acts pretty much like a straight bipap or like a bipap auto or like an ASV. You can even set it to operate in CPAP mode.

i have never heard of the syndrome where the mind causes CAs just because the machine is correcting for them. There might be something to that but I am not aware of it and if you set the ASV to operate like a bipap auto it I do not think it would cause it anyway.

Best Regards,

PaytonA

[DeepBreathing]

The ASV machine will handle both OAs and CAs and can be set so that it acts pretty much like a straight bipap or like a bipap auto or like an ASV. You can even set it to operate in CPAP mode.

I'm not sure that's completely correct, Payton. The Aircurve 10 ASV is like the S9 VPAP Adapt, which has three modes - CPAP, ASV and ASVAuto. In both ASV and ASVAuto there's no way to turn off the backup rate, so it will always act as an adaptive ventilator. You can't make it work like a simple bilevel. It will work like a simple CPAP, but not like an Autoset.

Getting back to the original question - yes, the ASV treats both obstructive and central apnea (and Cheyne-Stokes respiration), but is an expensive option if you don't need those capabilities. There is another thread on the board where somebody is using the VPAP Adapt (ASV) to treat straight obstructive apnea and getting very low AHIs.

Thanks to bilbofett for the links to these devices.

[bilbofett]

Guys, thank you very much for your help!
Since an ASV (Adaptive Servo Ventilation) does OSA too, I think I'll be fine.
FYI when I used the term "mixed" I guess I meant "Complex Sleep Apnea" where treatment via CPAP or BiPAP for OSA newly introduces CSA, that didn't exist before treatment.
It seems like the "Philips Respironics AutoSV Advanced" is what I'm really looking for.

"ASV is a form of bilevel ventilation or "BiPAP". The difference is that ASV varies IPAP and/or EPAP to adjust ventilation as needed by the patient. With traditional BiPAP the pressures are set and don't vary. With ResMed's ASV the EPAP is fixed and the IPAP varies depending on the respiratory rate and air flow, measured continuously. Respironics currently has two machines: AutoSV and Advanced AutoSV. With regular AutoSV the EPAP is fixed and the IPAP varies. With Advanced AutoSV both EPAP and IPAP can vary."

I find that incredibly interesting.

An ASV that dynamically adjusts IPAP but *NOT* EPAP seems like an Oxymoron, to me.
I had a Respironics a long time back, and wasn't very comfortable with it. I liked the Resmed alot more. But this seems like the way to go.
I think the backup rate can be disabled too, unlike the Resmed ASV.

Any further thoughts or questions to help are very much appreciated!

[trish6hundred]

Hi bilbofett,
WELCOME! to the forum.!
Good luck to you on your machine decision and much success to you with your CPAP therapy.
Hang in there for more responses to your post.

[vsheline]

It seems like the "Philips Respironics AutoSV Advanced" is what I'm really looking for.

Both the Philips Respironics System One BiPAP autoSV Advanced and the ResMed AirCurve 10 ASV machines treat obstructive and central apneas and hypopneas. Both EPAP self-adjusts automatically (slowly, to avoid obstructive events) and IPAP self-adjusts automatically (very quickly, to treat central events). Another way of saying the same thing is that EPAP slowly self-adjusts and, independently, Pressure Support (the difference between EPAP and IPAP) very quickly self-adjusts.

The PRS1 BiPAP autoSV Advanced (would recommend getting the Heated Tube version) is extremely adjustable. In addition to ASV therapy mode, it can be adjusted to act like an APAP or like a standard (fixed EPAP and fixed Pressure Support) BiPAP or similar to an Auto BiPAP. Would be essential to study the set-up manual (Clinician Guide) so the the various settings will be adjusted for max comfort. (The set-up manual is available by email request from Apnea Board - see important threads section at top of the forum.) Some find the very quick adjustments between Min PS and Max PS feel annoying and have great trouble falling asleep, especially patients who are totally new to PAP therapy, but at least in the PRS1 ASV unit the Min PS and Max PS can be adjusted close together or even to the same value. Adjusting Min PS and Max PS close together defeats the ability of ASV therapy to treat central events (which is the main purpose of having an ASV machine) but adjusting Min PS to the same value as Max PS allows the PRS1 model to act like an APAP or standard BiPAP machine if desired, and after the new patient has become accustomed to APAP or standard BiPAP therapy the Max PS can be adjusted higher than Min PS so that central apneas and central hypopneas may be treated.

The ResMed ASV units are always in an ASV therapy mode (unless set to very basic fixed-pressure CPAP therapy mode). Both EPAP (slowly) and IPAP (very quickly) can automatically adjust if in ASVAuto mode, similar to the PRS1 model. Some find the very quick adjustments between Min PS and Max PS feel annoying and have trouble falling asleep. Unlike the PRS1 ASV machine, on the ResMed ASV machine the Max PS must be set at least 5 cmH2O higher than Min PS, and this is why the ResMed ASV machine is unable to be adjusted to act like an APAP or an Auto BiPAP.

I consider the AirCurve 10 ASV to be a "one size, fits most" type of ASV machine, with relatively few adjustable (or misadjustable) settings. Some have found the PRS1 ASV machine less comfortable than the smooth way the ResMed model transitions between EPAP and IPAP, even after the various PRS1 settings for how the pressure transitions between EPAP and IPAP have been adjusted for best patient comfort. I think some may prefer how ResMed ASV therapy feels, and I think others may prefer how PRS1 ASV therapy feels.

If you get an unusually noisy machine (CPAP machines are occasionally damaged by vibration during shipment in ways which make the machines run loudly) ask for a replacement.

Good luck and take care,
--- Vaughn

[DeepBreathing]

"ASV is a form of bilevel ventilation or "BiPAP". The difference is that ASV varies IPAP and/or EPAP to adjust ventilation as needed by the patient. With traditional BiPAP the pressures are set and don't vary. With ResMed's ASV the EPAP is fixed and the IPAP varies depending on the respiratory rate and air flow, measured continuously. Respironics currently has two machines: AutoSV and Advanced AutoSV. With regular AutoSV the EPAP is fixed and the IPAP varies. With Advanced AutoSV both EPAP and IPAP can vary."

I find that incredibly interesting.

An ASV that dynamically adjusts IPAP but *NOT* EPAP seems like an Oxymoron, to me.

I think that's very old information you're quoting there. As Vaughan said, both EPAP and IPAP adjust as necessary in ASVAuto mode. Resmed does have an ASV (non-auto) in which the EPAP is fixed, but I don't know why you'd use that. Possibly for the same reason some docs prescribe straight CPAP and not autoset.

[PaytonA]

The ASV machine will handle both OAs and CAs and can be set so that it acts pretty much like a straight bipap or like a bipap auto or like an ASV. You can even set it to operate in CPAP mode.

I'm not sure that's completely correct, Payton. The Aircurve 10 ASV is like the S9 VPAP Adapt, which has three modes - CPAP, ASV and ASVAuto. In both ASV and ASVAuto there's no way to turn off the backup rate, so it will always act as an adaptive ventilator. You can't make it work like a simple bilevel. It will work like a simple CPAP, but not like an Autoset.

Getting back to the original question - yes, the ASV treats both obstructive and central apnea (and Cheyne-Stokes respiration), but is an expensive option if you don't need those capabilities. There is another thread on the board where somebody is using the VPAP Adapt (ASV) to treat straight obstructive apnea and getting very low AHIs.

Thanks to bilbofett for the links to these devices.

Actually I had thought that by setting the min and max PS in a certain way, one could make the ASV emulate other machines like the autoset or BiPAP. I had not taken into consideration the adjustment limitations of those two settings on the Resmed ASV. My bad.

Best Regards,

PaytonA

[DeepBreathing]

I think that with judicious adjustments it could be like an APAP with EPR turned on all the time. But the "feel" of an ASV is quite different from an APAP.