DreamStation BiPAP AVAPS Noninvasive ventilator question?

[Fastlane]

Hi All, I suffer from Hypoventilation Syndrome and have been prescribed an AVAPS or IVAPS bi-level device.  

I have a question about the Philips Resperonics DreamStation BIPAP AVAPS functionality:


Does anyone know if the Dreamstation AVAPS machine provides an Auto EPAP feature? 


If so, can anyone here differentiate the way a  Dreamstation AVAPS triggers adjustments in EPAP, IPAP and/or PS verses the algorithms used in a Dreamstation AutoSV?


Thank You!

[Sleeprider]

I'm pretty sure the Resmed Aircurve 10 ST-A has the iAVAPS algorithm that has adaptive pressure support and variable EPAP. I'm not aware of these features being available on Philips machines at this time.

[Fastlane]

IThanks Sleeprider. 

The Resmed Aircurve 10 ST-A does indeed have their iVaps functionality, but it does NOT had Resmed's "autoepap" feature. 


The only ResMed machines I have seen with autoEPAP are their ventilators: Astral 150 and Stellar 150.  Both of those are overkill for my situation. 

The only other ResMed machine that currently comes with autoEPAP is the ResMed Lumis 150 ST, which is still not available to consumers in the United States, ? despite having been "officially announced" in April 2015. ☹️


Last year I was able to do a month long trial with a Phillips Resperonics Dreamstation Auto BIPAP.   The Dreamstation Auto Bipap does automatically and independently adjust EPAP and IPAP based on separate algorithms, but it limits the PS to 8...  ?

It was an improvement over the ResMed Aircurve 10 Vauto, which does not allow for a variable PS as AVAPS and IVaps machines do...


However, the Dreamstation Auto BIPAP limits its PS to a max PS of 8 or less and I generally require a higher PS. 

So neither of those Auto Bipap machines have been able to control my frequent nocturnal oxygen desaturations during sleep.  


I have also done a trial with the Resmed Aircurve 10 ST-A in iVaps mode, and while it is a minor improvement over the previously mentioned Auto Bilevel machines, it still falls short of maintaining adequate nighttime oxygen levels for me while I sleep, because my airway needs a variable EPAP to maintain airway patency.


My diagnosis is an E0471 and my doctor and I feel that I need AVAPS or IVAPS with Auto adjusting EPAP and IPAP...


So, back to my original question, does the newly released Dreamstation AVAPS machine provide an automatically adjusting EPAP, IPAP and PS simultaneously?

I'm hoping that it's essentially a Dreamstation VAuto without the 8 PS limitation... ?



And in case you're thinking that an ASV machine would work for me, my doctor doesn't think it's appropriate, and I don't really have Central Apneas to qualify for an E0472 diagnostic code.  


My issues are caused by obstructive apnea and hypoventilation syndrome, so my insurance has approved an E0471 device, now I just need to find one that can keep my airway open with auto EPAP and provide backup NIV when I hypoventilate. 



Thank you!   Any guidance or suggestions are welcome, here or through PM!


Best Regards!

[Sleeprider]

Fastlane, why are you not prescribed the Resmed Aircurve 10 ASV which has the auto EPAP, variable pressure support and is intended for complex apnea and centrals? In general, most people I'm aware of have had great success and comfort on the ASV which can provide minimum pressure support to deal with restrictive pulmonary conditions, as well as breath by breath PS increases to deal with any central apnea.

[Fastlane]

Fastlane, why are you not prescribed the Resmed Aircurve 10 ASV which has the auto EPAP, variable pressure support and is intended for complex apnea and centrals?  In general, most people I'm aware of have had great success and comfort on the ASV which can provide minimum pressure support to deal with restrictive pulmonary conditions, as well as breath by breath PS increases to deal with any central apnea.

Hi Sleeprider. 

I cannot be prescribed an ASV machine because I do not meet the criteria of Central Apnea's to have it covered by my insurance company. 

And some have argued that an ASV is detrimental to those with Hypoventilation Syndrome.  

I believe that's why AVAPS and IVAPS exist. 


For those who are in my same situation, I have been able to confirm that the Dreamstation BIPAP AVAPS does NOT have an autoEPAP feature. 


However, My doctor had prescribed a Dreamstation BIPAP AVAPS machine for me because he believes it will be benificial for me, given that the max pressure of 30 will allow him to give me a higher Pressure Support.

[ajack]

I think it is more the issue of insurance and need. I don't need an ASV and the basic fixed pressure ST without ivaps, suits me fine. Though I could be treated with the different machines, from what I have now up to an AVS.

The ASV will do most all that other machines do. The contraindications that I know of so far, are for CHD with left ventrical dysfunction, it seems the cheyne stokes pattern is protective to that group and you don't want to 'fix' it.
Thanks for bringing up Hypoventilation Syndrome, at face value I would have thought it would be ideal, if not overkill. I'll read up on what the issues are for my understanding. It is an evolving science with home ventilation.
In their titration guide, they overlap between both st and asv
http://incenter.medical.philips.com/docl...%3d9792335

[Matt00926]

The Respironics Trilogy 100, ResMed Stellar 150 and ResMed Astral 150 will support VAPS with auto-EPAP. I don't like how AVAPS-AE works on the Trilogy; the forced oscillations to test for airway patency are very disruptive.

[SarcasticDave94]

FWIW!

On my script for the ASV I have has E0470 checked off, the third listing for E0470 that allows the doctor to input Max IPAP, Min EPAP, PS and then it also has Alternate settings of: PS setting range of Min and Max.

My script order form also has 2 other entries of choice for E0470, choice 1 is Bilevel or BiPAP with doctor assigned values for IPAP and EPAP, and choice 2 is for BiLevel Auto adjust machines.

Also of note under code Diagnosis ICD-10: Other is checked and for me Central Apnea and Code G47.31 which is CSA.

Note that this is on DME Apria's sleep therapy order form, and that the E0470 is the highest this form goes.

Why do I bring it up? I think there are ways to obtain various level of machines under the various E codes and ICD-10 codes that with supporting documentation will get insurance approval. I for one am a personal witness of my own approval, another FWIW.

[mhehe]

According to the resmed web site E0471 is a Bilevel device with a backup and Apria will provide you with an AirCurve 10 ASV  (with AutoEPAP) that you want! I was prescribed E0471 and got the AutoASV machine.

[mhehe]

The ASV machine has a much higher PS capability as well. I have seen prescribed PSmax = 15 cm!