ASV op BIPAP- which one?

[Glamdrhel]

The last study confirmed that I need an new machine. I slept with an resmed lumis 150.the machine showed that I used the backup rate 26% of the time. This is above the 15% required for an asv.

Now I need to know what is the difference between an asv and a bipap with backup rate?
I almost got saddled with a restvent ibreeze tech.on paper it looks good and with a very good price.Lucky I decided to test it with an afternoon nap. It sounds like a hairdryer with asthma while working with very poor breath syncing. Needless to say I took it back.close call.

I would like any recommendations as to what machine to get? I was impressed with the resmed machine I slept with,but due to the supplier contracted with my medical I may need to get a resperonics machine.

Any suggestions will be welcome.

[Glamdrhel]

sounds like progress!  looking forward to your next update.  

If you're inclined, I'm also interested in hearing more about your experience with restless legs and testosterone levels, if/how they affect your sleep, if/how they affect or are affected by apnea, how treated, etc.

The testosterone levels doesn’t seem to affect my sleep,it causes more of a general feeling of less energy. The increased testosterone with the injections doesn’t seem to have a big effect right now , but the doctor says I will feel a bigger impact when my sleep gets sorted. As for the restless legs I only have been on the meds for a few days,but I am waking up less feeling the need to move my legs . The meds I am taking is Oxpola

[Sleeprider]

Briefly, a bilevel with backup rate in its simplest form will switch to IPAP pressure on both a spontaneous and timed basis (ST). The ST machines used a fixed pressure and provide the same IPAP/EPAP for each breath. The backup function is timed to switch to IPAP if a spontaneous breath does not occur. It is most appropriate for people with a respiratory insufficiency caused by weakness, obesity and it provides respiratory assistance in the form of pressure support on each breath. iVAPS is a variation of ST that provides intelligent monitoring of the tidal volume or aveolar volume of each breath. It is capable of varying the pressure support to provide Volume Assured Pressure Support (VAPS).

The ASV is used to treat central and complex apnea, hypopnea, flow limitation and periodic breathing. It uses a variable pressure support that changes on a breath by breath basis as needed to maintain the volume and rate of respiration. Variable EPAP pressure (in auto mode) provides airway stabilization and IPAP provides comfort and respiratory support as needed. A common pressure setup would provide an EPAP pressure of 6.0 and an IPAP pressure of 3.0 to 15.0. The lowest PS is used for comfort on each breath while higher pressures are used by the machine when it detects hypopnea or a central apnea, and it causes increased respiration.

Please read the Resmed Titration Guide with particular attention to pages 28 and 34 to learn more about these machines. https://www.resmed.com/us/dam/documents/...er_eng.pdf

[Spy Car]

Glamdrhel, I've only used the ResMed ASV. This machine is an incredibly advanced bit of technology.

If it were me, I would push to overcome supplier issues and get the ResMed ASV.

While I've never used a Respironics device, reading of the disadvantages of that option has disinclined me to wish for something other than my much beloved ResMed device.

Worth a fight IMO.

Bill

[Glamdrhel]

Briefly, a bilevel with backup rate in its simplest form will switch to IPAP pressure on both a spontaneous and timed basis (ST). The ST machines used a fixed pressure and provide the same IPAP/EPAP for each breath. The backup function is timed to switch to IPAP if a spontaneous breath does not occur.  It is most appropriate for people with a respiratory insufficiency caused by weakness, obesity and it provides respiratory assistance in the form of pressure support on each breath.  iVAPS is a variation of ST that provides intelligent monitoring of the tidal volume or aveolar volume of each breath. It is capable of varying the pressure support to provide Volume Assured Pressure Support (VAPS).

The ASV is used to treat central and complex apnea, hypopnea, flow limitation and periodic breathing. It uses a variable pressure support that changes on a breath by breath basis as needed to maintain the volume and rate of respiration.  Variable EPAP pressure (in auto mode) provides airway stabilization and IPAP provides comfort and respiratory support as needed.  A common pressure setup would provide an EPAP pressure of 6.0 and an IPAP pressure of 3.0 to 15.0.  The lowest PS is used for comfort on each breath while higher pressures are used by the machine when it detects hypopnea or a central apnea, and it causes increased respiration.

Please read the Resmed Titration Guide with particular attention to pages 28 and 34 to learn more about these machines.  https://www.resmed.com/us/dam/documents/...er_eng.pdf

Thanks for the link,think I understand the difference a bit better now although I am still not sure which to get.
I will post my latest sleep study after doing some google translation as my study report is in Afrikaans.

Hopefully that will help the smart people here to assist me to choose the right machine.

I just want to thank everybody’s willingness to help. It really is a privilege to have acces to such a great forum

[Glamdrhel]

Herewith the google translated sleep study report. Hope it doesn't read too weird  :

Varied PAP Titration With Volume Support has effectively improved the obstructive sleep apnea and
alveolar hypoventilation, at optimal BiPAP pressures of 20/14 cm H2O (IPAP / EPAP) when the mask showed an optimal seal (19.2 L / min).
During increased leaks (> 25 L / min), the desaturation index was slightly increased, with similar saturation
levels as found with standard PAP (nasal cushions masks therefore not optimal for therapy - See Oxygen
Saturation and Pulse). The inspirational period of 2.36s also shows sub-optimal, and inspirational times of
> 3.5s may therefore have better value at an alveolar ventilation of 6.5 - 11.5 L / min (depending on effective
mask seal).
Home VPAP treatment will thus show greater value for the patient (in terms of standard PAP), provided that a good seal
retained on the mask against the high IPAP / EPAP. Volume support can also be of value,
but only if it is clinically necessary (equipment for it involves much higher costs). Alternative masks must
also being considered st, seeing that the nasal cushion mask will not be optimal for therapy.

Respiration:
During the titration the apnea / hypopnea index (AHI) was within normal limits at 8 / hour.
Only hypopnea was foud and correlate with an increase in the support breaths (backup rate) of 26%, as well as a increase in the
alveolar ventilation from 6.5 L / min to 11.5 L / min (hypoventilation component).
The inspiratory period was 2.36s
(feel very short for the patient -> 3.5s may show greater value), and the Inspiratory / Expiratory
ratio was 1.83: 1 (increased inspiratory breath - fit into hypoventilation component).

Snoring:
No snoring was observed at optimal VPAP pressures.

Oxygen Saturation and Pulse Rate:
The average awake oxygen saturation was 97% with an average oxygen
 saturation during sleep of 95%. The minimum saturation of 88% was measured on single occasions during the
alveolar hypoventilation pattern, and during a good mask seal (<25 L / min with an average of 19.2 L / min),
with a desaturation index of 10 / hour. The average pulse rate was 73 bpm, with a maximum pulse rate of 109
bpm. However, the desaturation index shows higher at 40 / h during high mask leaks (> 25 L / min to 57.6
L / min), and was largely associated with the alveolar hypoventilation component during the periods, the
Minimum saturation during the episodes was 81%. Ivm with previous PAP Titration (previous night) and PSG recordings
the average oxygen saturation shows higher, although the minimum saturation is similar, with a higher
desaturation index (especially during periods of high mask leakages).

VPAP Pressure:
The optimal VPAP pressures for the night's sleep 20/14 cm H2O for IPAP / EPAP, with a 26%
support rhythm at an average alveolar ventilation of 6.5 l / min (provided a good mask seal can be retained).

VPAP Suitability:
The patient shows optimal VPAP suitability and has  slept 7 hours 08 min with the device
for the test period, with his own nasal cushion mask. However, the nasal cushion mask does not show
optimally against the high IPAP / EPAP pressures, and the high leakage contributed to the increased desaturation index.
Alternative masks (nasal mask or full face mask) may therefore be of greater value to the patient on the
device. The inspiratory period also feels very short for the patient (tachypnea), and an inspiratory period of
> 3.5s may also be of better value.

Ok Hope that is readable. I tried correcting mistakes but my english usage is only for self defense

2nd question:
As i have a beard I am only considering nasal masks as fullface masks tend to cause to many leaks with me.
According to their specs the following two mask will work, any opinions on them:


ResmedAirFit N10 Compact Nasal Mask 
Resmed Swift FX Nano

Thanks

[Glamdrhel]

These are the 2 machines I considering getiing:

Resmed Lumis 150 VPAP ST with a climateline pipe

ResmedAircurve 10 CS PaceWave with a climateline pipe

I can only buy once as both these machines are very expensive.
I really,really must get the right machine the first time as my copayment will be around 15000 usd.

Any thoughts?

[Spy Car]

$15,000 USD?

Say what!!!???

Could you fly to the US and carry one home from a place like Supplier #2? (where you could get one closer to $2500 new and less gently used). Or get one shipped in?


You want a ResmedAircurve 10 CS PaceWave with a climateline pipe. It is the same model we use here as the AirCurve 10 ASV Auto.

Great machine. Those prices are insane. Full DMR retail here is around $5,000.

Bill

[Sleeprider]

First, with regard to cost, please consider Supplier #2 on our supplier list. They can sell new "open box" and lightly used machines, and frequently have ST and ASV machines at under $3000. This company provides reasonable cost international shipping and will service your machine and provide warranty services.

Your sleep study is focused on hypoventilation and aveolar volume, which may make the Lumis 150 ST or Resmed Aircurve 10 VPAP ST the machine of choice. Nothing in your study cites a problem with central apnea, so we would not choose the CS Pacewave or Aircurve 10 ASV in this case. If you want to post the chart that shows the titration pressure with events, sleep position, sleep stage, SpO2 and other details, I can probably figure out better what is going on with regard to the hypopnea and AHI reported at 8. The study seems concerned with a relatively high mask leak rate and its effect on oxygenation. The titration recommendation is 20 IPAP and 14 EPAP (PS 6.0) and the backup rate was used 26% of the time. If that backup rate is due to central apnea then the CS Pacewave/ASV is the proper answer, but the study summary does not give us that information.

The real question of appropriate machine is what happened during the times the machine backup rate was triggered. Did you experience proper full breaths, in which case the ST is the correct machine; or did use of the backup rate result in hypopnea or apnea, in which case the CS Pacewave/ASV would be a better choice. The reason is that the backup rate on the ST only provides an increase of 6-cm at these settings, while an ASV could provide much higher pressure support as needed up to 15 cm. ASV can also vary the EPAP pressure so you might be able to use a pressure range for EPAP, instead of a fixed pressure of 14. It would be useful to know why and EPAP of 14 was selected, and whether you require that EPAP to prevent obstructive apnea or if a range of say 10 to 14 in auto mode (CS Pacewave/ASV) could do better. You seem to do well with a pressure support of 6.0, but the summary of your study leaves a lot of questions unanswered.

The summary of the sleep test does not provide the details that would be really helpful in assisting you with this decision. If you can make images of the test results, perhaps we can work around the Afrikkans language issues together. Finally, the study points to "hypoventilation" issues. Please let me know if you are aware of a reason for hypoventilation such as COPD, asthema, obesity, neuromuscular issue etc. These conditions clearly take us to the ST option.

[Glamdrhel]

$15,000 USD?

Say what!!!???

Could you fly to the US and carry one home from a place like Supplier #2? (where you could get one closer to $2500 new and less gently used). Or get one shipped in?


You want a ResmedAircurve 10 CS PaceWave with a climateline pipe. It is the same model we use here as the AirCurve 10 ASV Auto.

Great machine. Those prices are insane. Full DMR retail here is around $5,000.

Bill

Oops ,typo there . Comes from clicking to quick in Google. Real payin is around $4000.
Almost gave myself a heart attack [url=http://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum][/url]