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Arik - Therapy Thread
Should I look for an ASV machine?
           

Hi, 
I have to replace my old, faithful S9 machine. I’m considering a ResMed ASV machine for the following reasons:
My S9 reported AHI scores are really low (last 6 months average is 0.68, divided as follows: OA 0.21, CA 0.31 H 0.16). Last week I had a full night PSG test that scored as follows: AIH 13, Mixed Apneas 0.4, and Unclear Hypopneas 12.6. Although I think they messed up the results, still there were a lot of Hypopneas there. CPAP machines are known to miss Hypopneas and RERAs.
Additionally, my breath pattern at night goes disruptive very often. My S9 is ignoring this.
What I’m looking for is a machine that will bring my AHI close to zero, treat my (missed) Hypopneas and RERAs and improve my breath pattern if possible.
Would an ASV machine come up to my expectations? (Disregard the price issue).
Thanks,
Attached are:
Screenshot A – Typical night report with all the settings.
(I’m using constant pressure after endless tries for better overall results).
Screenshot B – An example of disruptive breath pattern.
Screenshot C – another example that demonstrates what happened when I removed my mighty cervical collar at about 1 o’clock….
 
 
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RE: Should I look for an ASV machine?
Unless you're dealing with a lot of Central Apnea, the ASV would not be the best answer for a new machine. I would suggest the ResMed AirCurve 10 VAuto as your best bet. Alternate is same as you have but the 10 series. However with the VAuto, you'll have full bilevel power to work with.

The test results you mention didn't say anything about centrals, so further confirmation ASV would not be your best answer.

That third chart has several centrals in it, most people do have some. I'm not certain even this amount would justify ASV. The Central Apnea issue for ASV is where you have even more than this, the whole night, most every night, except when the CA decide randomly to disappear.

You likely understand that getting zero events isn't as good of a goal as it may seem. Low events as presented here and good comfort is a much better target. Attempting zero events will reduce comfort in pursuit of the last fraction of events not caught already.

I don't recall your other thread info, things like why straight pressure, CPAP fixed 9, is being used. Regardless it's working well for you.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Should I look for an ASV machine?
I agree with the Vauto as a more versatile and effective machine. There is nothing in your charts or description that would suggest ASV could be helpful. ASV might smooth out the periodic breathing, but it would not touch the clusters of OA which are positional obstruction.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Should I look for an ASV machine?
Hi,
Thanks a lot for the detailed answers. I spend a lot of time learning the differences between the Vauto and ASV machines. In my opinion, as I can handle even EPR of 1 cm H2O, there is no advantage of the Vauto machine over the AirSence 10/11. Please let me know if I missed something.
I would like to explain why I seek AIH close to zero; My PSG test found out a very short deep sleep phase (about 6%) which is not uncommon at my age. Even this short period can be terminated by a random arousal or Apnea/Hypopnea event. So it is crucial that I try to eliminate these events as far as possible.
In summary, I need a machine that will fight both central and obstructive events of all types, this way reduce the number of arousals. Please let me know what you think.
Thanks,
Arie
 
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Inspiration Expiration Ratio
Hi,

Usually, my Inspiration/Expiration Ratio, using my old S9 is about 0.7 (longer expiration time). I’m evaluation a PRISMA 20A as a potential replacement and realized that the ratio was changed to about 2 (longer inspiration time). Is it a machine error, as proposed in VIKI, or the PRISMA “forced” a change in my breathing pattern? I do feel weird breathing with the PRISMA.
Thanks,
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RE: Inspiration Expiration Ratio
(07-17-2024, 01:01 AM)Arik Wrote: I’m evaluation a PRISMA 20A as a potential replacement and realized that the ratio was changed to about 2 (longer inspiration time). Is it a machine error,... 
The best way to assess it is to look at the flow pattern in OSCAR to ensure that the reported number is correct. For instance, the expiration flow often crosses the zero line before the end of the full expiration, and it's mistakenly counted as the end of expiration, leading to bloated ratios like your example. Much depends also on the software which is different in different devices.
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RE: Arik - Therapy Thread
Arik  -  29 of your threads are related to your therapy.  For this reason, I have merged them.  This provides the reader a history of your past settings and results.  Having the ability to see past attempts and their results will help to form better recommendations.  Please use this thread for all your therapy related posts. I have changed the thread title to, "Arik - Therapy Thread" to be more inclusive.
- Red
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Arik - Therapy Thread
Great idea!
Thanks,
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