[Equipment] Can I use Aircurve 10 ASV (PaceWave CS) instead of an Aircurve 10 Vauto ?

[Gillyweed]

Hello everyone.

I need help about knowing whether a machine could be right for me or not. I have severe OSA (31 ahi). I need to buy a BIPAP machine because I have expiratory pressure intolerance with CPAP even with EPR on (due to my Empty Nose Syndrome, I have trouble expiring). 

I'm looking on the second hand market in my country and somehow can get a Resmed Aircurve 10 CS Pacewave easier and cheaper than a Resmed Aircurve 10 Vauto...

However the CS Pacewave seems marketed towards also taking care of central sleep apnea events (which I do not have on my sleep study, and because CPAP made completely unable to fall asleep for days I did not even get to the point of knowing if CPAP causes central events in my case. However empty nose syndrome causes all kinds of weird respiratory problems so perhaps an ASV could be good for me anyway).

The Aircurve 10 Vauto is marketed as a simpler autoset bipap. 

Sorry because my account is new I cannot post links to the models, but if you type "support resmed" + the name of the machine on google you should find more info about them.

My question is : Can I use the CS Pacewave instead of the Vauto version without problems? Is it just a better, more functional model, or could the central apnea functions actually be detrimental for my case? In such case, can I deactivate the central sleep anea functions or settings in the machine for it to act like a regular bipap autoset?

I need to close the deal on that secondhand machine soon - I've looked around the internet but couldn't find extensive information on that. Thanks for your input. Sorry I'm not very knowledgeable. My apnea is so bad right now I'm barely functional.

[Jay51]

2 big major differences between the VAuto and ASV.  1.  The maximum pressure support on the VAuto (difference between EPAP and IPAP) is 5 I think?  The ASV can be much larger (at least 13 or 15 and maybe more). 

2.  The VAuto will wait for you to initiate inhaling (and it has a sensitivity trigger for this also with settings - low, medium, high, very high, etc.).  The ASV uses a dynamic back up breathing rate based on your natural 3 minute respiration rate and tidal volume.  So if you breathe at say, 15 respirations per minute, then the ASV would trigger Pressure Support every 4 seconds or so (15 x 4 = 60seconds).  This is why it is so effective in preventing Central Apneas.  But, it will trigger a breath even if you don't breathe, and can take time to get used to in both falling asleep and staying asleep in my experience.  

Hopefully this is clear.  If not please post further questions.  Which one seems like it would fit you better with your, "Empty Nose Syndrome?"

[Gillyweed]

2 big major differences between the VAuto and ASV.  1.  The maximum pressure support on the VAuto (difference between EPAP and IPAP) is 5 I think?  The ASV can be much larger (at least 13 or 15 and maybe more). 

2.  The VAuto will wait for you to initiate inhaling (and it has a sensitivity trigger for this also with settings - low, medium, high, very high, etc.).  The ASV uses a dynamic back up breathing rate based on your natural 3 minute respiration rate and tidal volume.  So if you breathe at say, 15 respirations per minute, then the ASV would trigger Pressure Support every 4 seconds or so (15 x 4 = 60seconds).  This is why it is so effective in preventing Central Apneas.  But, it will trigger a breath even if you don't breathe, and can take time to get used to in both falling asleep and staying asleep in my experience.  

Hopefully this is clear.  If not please post further questions.  Which one seems like it would fit you better with your, "Empty Nose Syndrome?"

Thanks a lot for all this information. If I understand this correctly, the Vauto and ASV have different ways of controlling how inhaling is initiated. Do you know if the feature for the dynamic breathing rate of the ASV can be turned off, so that it acts like a Vauto, just in case it does not suit me?

About which one would fit me more, I'm not sure to be honest with you. Empty nose makes it so I have to breathe harder than normal during the day, and also have trouble expiring well. There is a compensatory tendency towards hyperventilation (small in my case) yet there is also a disruption of the normal naso-pulmonary reflexes (so breathing becomes more conscious and less "automatic" so to speak). It's been linked to central apnea events in studies and seen in other patients. However, my sleep study did not show central apnea (0.2 per hour). When using CPAP I would wake up very soon after falling asleep, as if I was not breathing, and this was increasingly the case as the pressure progressively ramped up or was manually set higher. The more it ramped up the more difficult it felt to expire.

[SarcasticDave94]

No, the ASV will track and pace breath rate with no option to turn this off. It'll have a basic CPAP mode as well, but that's a step down from VAuto.

[Gillyweed]

No, the ASV will track and pace breath rate with no option to turn this off. It'll have a basic CPAP mode as well, but that's a step down from VAuto.

Thanks. By basic "CPAP mode" you mean it will not have different IPAP and EPAP like a BIPAP? Or that it will not have an autoset feature like Vauto hence the "step down"?

What do you think is best for expiratory pressure intolerance ?

[Gillyweed]

2 big major differences between the VAuto and ASV.  1.  The maximum pressure support on the VAuto (difference between EPAP and IPAP) is 5 I think?  The ASV can be much larger (at least 13 or 15 and maybe more). 

Sorry for double posting but I finally found the clinical guides ( ) for the two models and those are the figures I'm getting :

Aircurve 10 CS Pacewave :

• EPAP is 4 to 15 H2O (can be fixed in ASV mode or set to a maximum in ASVauto mode)
  
• Min pressure support is 0 to 6
  
• Max pressure support  is 5 to 20
  

Aircurve 10 Vauto :

• Min EPAP is 2 to 25 while in S-mode (bipap)
  
• There does not seem to be min/max pressure support in S-mode, you just set the IPAP
  
• Min EPAP is 4 to 25 while in VAuto mode
  
• Pressure support is 0-10 in Vauto mode
  

I guess if I really wanted to try having the EPAP as low as possible, the Vauto in S mode would be my best bet. However it's true that if I want to use an auto function, the CS Pacewave is able to have higher pressure support (20) compared to (10) for the Vauto.

But I'm not sure what EPAP I need or can tolerate, and 2 might not be sufficiently high to maintain airway patency anyway  I guess my Airsense 10 CPAP felt OK while ramping up from 4 H2O at first which was the minimal pressure. Dunno if lower would be better. I don't know if need an auto mode either... Decisions decisions 

[SarcasticDave94]

When I say ASV has a CPAP mode that's static, it's not going to adjust, period. You set a single pressure and that's the only thing you're getting. Example ASV in CPAP mode set to 10, you'll get 10 all night. It will not edit pressure for anything overnight.

ASV has 3 operation modes.
CPAP, single pressure
ASV, single EPAP, PS Min-Max
ASV Auto, EPAP Min-Max, PS Min-Max

Both ASV modes have IPAP range as well that's the sum of EPAP and PS, IPAP is not manually edited but by edits to EPAP and PS.

ASV has no setting that is close to VAuto, due to the backup breath rate that's automatically on in both ASV and ASV Auto modes. And it cannot be switched off. Timing controls that are on VAuto cannot be adjusted on the ASV.

[tcinoz]

2 big major differences between the VAuto and ASV.  1.  The maximum pressure support on the VAuto (difference between EPAP and IPAP) is 5 I think?  The ASV can be much larger (at least 13 or 15 and maybe more). 

2.  The VAuto will wait for you to initiate inhaling (and it has a sensitivity trigger for this also with settings - low, medium, high, very high, etc.).  The ASV uses a dynamic back up breathing rate based on your natural 3 minute respiration rate and tidal volume.  So if you breathe at say, 15 respirations per minute, then the ASV would trigger Pressure Support every 4 seconds or so (15 x 4 = 60seconds).  This is why it is so effective in preventing Central Apneas.  But, it will trigger a breath even if you don't breathe, and can take time to get used to in both falling asleep and staying asleep in my experience.  

Hopefully this is clear.  If not please post further questions.  Which one seems like it would fit you better with your, "Empty Nose Syndrome?"

Brilliant. That's the clearest description yet that I've read of the difference between the two machines - a decision I myself have been grappling with.