ASV op BIPAP- which one?

[Glamdrhel]

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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.

hi
I only got the summary from the vpap study that I posted earlier. Wil try tomorrow to see if I can get the details out of the sleep lab.
 i am attaching the results of the previous study. It is also in afrikaans, but you should be able to figure it out using google translate. I will have a go later.

[jaswilliams]

Glamdrhel

Can you post a sleepyhead daily report from your existing machine ? So we can see what’s happening there ?

[Spy Car]

$15,000 USD?

Say what!!!???

Could you fly to the US and carry one home from a place like [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List?pid=31#pid31]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]

Wheww. Quite a typo.

I may have misunderstood your condition, I thought you had central/mixed apneas. 

I'd follow Sleepriders advice.

Good luck finding the right machine.

Bill

[jaswilliams]

I am not sure your numbers are bad enough to justify the expense of purchasing your own asv, unless the graphs posted in this thread are non typical.


But the ASV will be the more comfortable machine to use rather than an ST

[Sleeprider]

Glamdrol, I was overly influenced by the bias in  your most recent sleep study.  It was clearly directed toward maintenance of tidal volume/aveolar volume and failed to show what we saw earlier in this thread.  First, we started with the fact you have central apnea with no respiratory effort based on polysomnograpy.



About 1/3 of the apnea is obstructive with the remaining amounts being mixed or central.


The only Sleepyhead chart we have suggests a mixed apnea problem in the mild range, and a respiration rate of 16 BPM which contradicts the concerns of the most recent study of a long inspiratory time or tidal volume seem mis-placed given a PS of 2 in this case.  This chart does suggest an EPAP minimum pressure of 8 to 10 may be appropriate, so your most recent titration suggesting 14 cm seems to be excessive.


I would dearly like to see more CPAP data from Sleepyhead in this thread, but the everything we saw pointed to ASV rather than ST. If you are not aware of a restrictive or neurological cause for hypoventilation, then I think your most recent study was biased and you should pursue ASV therapy.  We can make ASV work similarly to ST, but we can't make an ST machine do what ASV does.  Based on past results and unless a pathological reason exists for ST, I recommend you get the ASV machine.  If you must pull the trigger on the basis of available information, I recommend the Pacewave CS/ASV rather than a ST machine. Not very surprising that my friend Spy Car had this right from the beginning.

[Glamdrhel]

Hi
Please see attached a few sample sleepyhead reports.

Sleeprider,
thanks for your detailed explanation.
There is no exsiting condition for a restrictive or neurological cause for hypoventilation.

I am myself leaning towards an asv.

regards
Wouter

[Sleeprider]

Thanks for the extra charts. Not a lot of central activity there, but if you're going for a bilevel with backup, I like CS Pacewave / ASV in ASV auto mode at EPAP min 8.0, EPAP max 12.0, PS min 3.0, PS max 15.0. Feel free to run through the protocol starting with lower EPAP pressure, but I think you may end up here.

[Glamdrhel]

Thanks

Just waiting for quotes from diffrent suppliers.

[Glamdrhel]

Ok
Got the quotes

the cs pacewave goes for about $3500
and the lumnis 150 for about $2100
These prices seem reasonable .

Both local suppliers are recommending that I get the lumnis 150.

Both prices are less than I expected.

Now the question is: Do I listen to the suppliers and get the lumnis 150 and will it be enough to cover my treatment or do I bite the bullet and get the pacewave cs?
My medical will cover the same amout of about $600 regardless of what machine I get.

I am willing to go for any one of those two machines.

Thanks

[Sleeprider]

Based on a presumption of backup rate for central or complex apnea, and the ability to maintain bilevel pressure support, the Pacewave is more appropriate. With the Lumis you will get the same pressure support on every breath whether you need it or not. The Pacewave will maintain your respiration rate and volume with automatic pressure adjustments.