Aircurve 10 ASV vs Dreamstation ASV

[Mark Sadler]

[attachment=8635][attachment=8636][attachment=8637]Hi everyone. I have Kaiser in Oregon and they dispence Dreamstation's. Went through the normal procedures. Cpap, Bipap, then ASV. Started using the Dreamstation ASV in April of this year. After fine tuning and many different settings. 6 months later and my AHI average never got better than 8.5.
After reading many posts about the difference between Resmeds and Resperonics, I decided to purchase an Aircurve 10 ASV. The first time I used it I could tell it would be better. It felt more natural breathing and I fell asleep right away. The first night on the Aircurve ASV my AHI was 4.3. It has been as low as 1.5 and I sure feel better. Finially! I have attached a couple charts and would appreciate any input.
I e-mailed my doctor with some sleepyhead charts and he is ordering me a new Aircurve 10 ASV. Said my Dreamstation is still under warranty and will cost me nothing, straight across trade. Thanks again everyone!

[SarcasticDave94]

Glad to hear this. Nothing against the DreamStation units, but I prefer my ResMed ASV. Nice to hear you got what you wanted and that the exchange thing is happening as a nice bonus to you.

[Sleeprider]

Interesting review. It would be even more interesting if you can post a couple charts from the Philips ASV, but you will need Sleepyhead version 1.1.0. I think you nailed the more natural feel for the Aircurve. Everything in your summary statistics and respiration looks about perfect. You do use a relatively high EPAP and PS min and wonder if you can expand on how you arrived at those settings, and what problems were solved by using them. Just trying to learn through your experience.

[Mark Sadler]

Thank you for the replies. My settings originally were much higher set by the dr after a sleep study. They were 14-19 on my BiPAP and he started my ASV out at 11.5-14-6-10 but I couldn’t tolerate the pressure. The high PS was to curb the H’s. I ended up changing things to the current pressure to attain the best AHI on the dreamstation. 
I was surprised that the Aircurve used the same settings with 1/2 or Les AHI. I’m not against trying something new if you have a suggestion. I’m not sure what this machine can do or what pressures I can get away with. It’s been soo much better I hadn’t thought about it yet. 
On the dreamstation I had a lot of central’s and OB’s. Don’t have any on the Aircurve. I guess it’s just that much different. 
Thanks 
Mark

[sheepless]

wow, no offense intended to mark or sleeprider or anyone else but if this is near perfect I clearly need to lower my expectations for my own asv performance. I agree summary statistics look pretty spot on. these are good results and you feel better so again I'm not meaning to disparage that in any way. my reaction is about my results in comparison. I haven't seen that many charts from other asv users so this is an eye opener for me. your charts contain some of the things I've been dissatisfied with: relatively short (fragmented) sessions (not as short or as many as mine), a fair number of flow limitations including plenty of 1.0's (not as many as mine), some residual snores and more ua and h than I've been willing to accept (I've been able to regularly achieve < 1 ahi).

please don't take this as a negative comment on your obviously good results that are better than with your previous machine. that's really excellent. it just hit me like a ton of bricks that even though sleep is still exhausting for me, maybe I should be more positive about my own results.

mark IDK how you can take the pressure. I just lowered my fixed epap from 11 to 9 with min ps at 3.4 because of aerophagia and I'm still getting too much. IDK what your flow limitations used to look like or how they compared to mine but I assume they're better than mine because your min ps is higher. your leaks are fewer than mine, even at higher pressure than me, maybe due to your ffm vs my nasal pillows (with beard I haven't had much luck with ffm's).

okay, now that I've regained my composure (again, relative to me and my results, not to you and yours), bottom line is pretty darn good results and as long as you feel better, you're in business! an unintended consequence of your sharing may be in elevating my attitude toward my results. I should probably thank you for that.

do you know what wakes you at night?

[Sleeprider]

wow, no offense intended to mark or sleeprider or anyone else but if this is near perfect I clearly need to lower my expectations for my own asv performance.  I agree summary statistics look pretty spot on.  these are good results and you feel better so again I'm not meaning to disparage that in any way.  my reaction is about my results in comparison.  I haven't seen that many charts from other asv users so this is an eye opener for me.  your charts contain some of the things I've been dissatisfied with: relatively short (fragmented) sessions (not as short or as many as mine), a fair number of flow limitations including plenty of 1.0's (not as many as mine), some residual snores and more ua and h than I've been willing to accept (I've been able to regularly achieve < 1 ahi).  

please don't take this as a negative comment on your obviously good results that are better than with your previous machine.  that's really excellent.  it just hit me like a ton of bricks that even though sleep is still exhausting for me, maybe I should be more positive about my own results.    

mark IDK how you can take the pressure.  I just lowered my fixed epap from 11 to 9 with min ps at 3.4 because of aerophagia and I'm still getting too much.  IDK what your flow limitations used to look like or how they compared to mine but I assume they're better than mine because your min ps is higher.  your leaks are fewer than mine, even at higher pressure than me, maybe due to your ffm vs my nasal pillows (with beard I haven't had much luck with ffm's).  

okay, now that I've regained my composure (again, relative to me and my results, not to you and yours), bottom line is pretty darn good results and as long as you feel better, you're in business!  an unintended consequence of your sharing may be in elevating my attitude toward my results. I should probably thank you for that.

do you know what wakes you at night?

First, Mark please ignore this comment.

Sheepless, the difference between therapy with an AHI at 1.5 split into 3 sessions and the one you recently posted with AHI of 0.0 split into 13 sessions is open to debate in terms of what is better.  ASV is one of the hardest therapies to optimize and direct comparison of results between individuals is not really the objective or useful.  There are ASV users that can use a low EPAP of 4 to 5 and PS max as low as 8 and they get zero AHI and sleep continuously.  Others struggle to stay below 5 AHI and often more, but it usually is better than CPAP, BPAP or non-treatment.  Learning what changes or settings improved a particular problem for a person may or may not be applicable to another ASV user, but this forum probably offers ASV users the rare opportunity to compare notes with other users of ASV.  You and Mark probably have different issues and experiences that brought you to ASV.  Respecting those differences and supporting each other's efforts to make the therapy as good as it can be is probably more useful than trying to directly compare.  But if comparison is what you want, then this is what you're putting up as needing to lower  your expectations?

[Mark Sadler]

So, after an in house sleep test that said I had an AHI of 56, I was given a dreamstation cpap. My AHI went down into the 20s, which made me feel good, a little. Then a trip to the sleep lab. When I got my bipap, my AHI went down to the high teens. that made me feel a little better. When I got the ASV my AHI average was 8.5. that made me feel real good mentally. Now, with my new machine, its 2.5 average and I feel good compared to all the other times. So its really just relative to how You feel.
The Dr. sent me home with preasure that was hard to keep in the mask. The preasure doesn't bother me, its the mask Farts that wake me. Any way using sleepy head I could see where I could lower things because the machine kept going there. So I pretty much just followed the machine until it leveled out. On all the machines i've had, I don't do well on anything below 10 on EPAP which gives me 15 on IPAP starting out. Any lower and I start to struggel for air.
My doctor told me he would be happy with an AHI under 12 for me!
My DME said he would be happy with an AHI of 8!
I wasn't happy with eather one of those.
And no offence taken 

[Mark Sadler]

And I think what wakes me up is arthritis pain. Most every joint hurts if I think about it. Ibuprofen, 800 mg every 4 hours. I used to be on an opiate contract for the pain but enough joints froze up, I get by with the ibuprofen alone now.
At least 2 Ps per night.

[sheepless]

sleeprider, I'm not entirely sure what you are getting at but here's my attempt to clarify. if I'm misunderstanding you or vice versa, please let me know.

btw, there was more than one chart and those had higher ahi than 1.5 and some of his segments were in the 2.5 hour range. mark's ahi's were all under 5 and as you point out his statistics are near perfect or to use my words, spot on.

and yes, the chart you show is what I meant. could be we may be thinking with semantic differences however viz lower vs higher expectations?

first, I tried hard to be clear it is not my intent to be unsupportive of or disrespectful of mark, you or anyone. quite the contrary. it was not my intent to disparage mark's progress by any means. it was not my intent for mark to compare his progress with mine. my intent was not to compare my progress with his so much as to with what near perfect looks like. when I said 'wow' I was not being sarcastic but genuinely sincere. I had a bit of a revelation.

if anyone read it any other way then I seriously miscommunicated. I know direct comparisons aren't always apples to apples but we do it all the time just with comparing ahi's (and pressures and plenty of other measures). I know there will be differences because people are different but some measure of comparison is part of what measurements are for. a way to simplify and communicate more complicated things. all these metrics are aggregations of facts, avgs, medians, percentiles, etc. and are therefore less than accurate by definition. their purpose is largely a means to compare. near as I can tell, ahi's and other metrics vary from mfgr to mfgr and certainly between say pap and psg's. that means we can't make direct comparisons with assurance and all we really have is our relative experiences to share and compare. metrics are one way to do that (with caveats).

as I said, mark's statistics are great. what I was focused on are some of the things I see in his charts that continue to bother me about my pap experience. if it wasn't clear, I was trying to say that my ahi in that chart is terrific, so despite continuing to be disappointed that I'm still exhausted maybe I should take greater satisfaction than I have been to the extent I've successfully reduced flagged events. maybe I should be happier my statistics are near perfect, to repeat your term, just like mark's. maybe I should lower my expectations with respect to what I expect hope wish this machine will do for me. or put in the inverse, maybe I should raise my assessment of my progress.

I am sorry if I failed to make myself understood. it was kind of a revelation to discover what others' describe as success because I was defining it differently and maybe unrealistically.

if I'm not understanding you correctly (and vice versa) please let me know.

mark, I apologize for the diversion from your case.

[Sleeprider]

So, after an in house sleep test that said I had an AHI of 56, I was given a dreamstation cpap. My AHI went down into the 20s, which made me feel good, a little. Then a trip to the sleep lab. When I got my bipap, my AHI went down to the high teens. that made me feel a little better. When I got the ASV my AHI average was 8.5. that made me feel real good mentally. Now, with my new machine, its 2.5 average and I feel good compared to all the other times. So its really just relative to how You feel.
The Dr. sent me home with preasure that was hard to keep in the mask. The preasure doesn't bother me, its the mask Farts that wake me. Any way using sleepy head I could see where I could lower things because the machine kept going there. So I pretty much just followed the machine until it leveled out. On all the machines i've had, I don't do well on anything below 10 on EPAP which gives me 15 on IPAP starting out. Any lower and I start to struggel for air.
My doctor told me he would be happy with an AHI under 12 for me!
My DME said he would be happy with an AHI of 8!
I wasn't happy with eather one of those.
And no offence taken 

The number of people that use ASV is fairly low, and the numbers that have direct comparison of both Philips and Resmed versions is even lower.  I appreciate the feedback, and as someone who has never used either machine, but coaches many users in obtaining and adapting to ASV your points are consistent with what I have been saying for several years.  In addition, I frequently attempt to lower overall pressure both in bilevel and ASV when someone has the discomfort and results you experienced.  That approach has really paid dividends in therapy results and sleep quality where it works.  I'm impressed with your ability to accomplish that on your own.  Too many people are issued these machines, then don't understand how and why they work, and are afraid to touch the settings.  You clearly don't fall into that category.