Benefits of Resmed Vauto over ASV?

[Abletree]

I have been approved for a Resmed Vauto or ASV.   I believe I have little, or no, CSA events (I do have RLS). My chief complaint I have with my AS 10 autoset is aerophagia and difficulty with expiratory pressure. I find myself removing it during the night because of the discomfort - and burping through the day

I am attracted to the idea of the ASV because of rapid response times and capability to handle both osa and the occasional csa, but I have read that the Vauto is more customizable for people who only have osa

Also, I think it might be easier for me to change to the vauto from the asv in case the asv does not work out. It seems like I should get the "top" model while I have the chance


Can someone please tell me what the Vauto can do that the ASV cannot?

[Crimson Nape]

Since I'm unable to directly your question, I am providing the link to the Resmed comparison chart for their devices.

https://resmedwebinars.com/assets/upload...arison.pdf

I hope it may provide some additional insight.
- Red

[SarcasticDave94]

If you don't have pre-dominant Central Apnea, the VAuto is the correct machine. To see if you have need of ASV, your sleep diagnostic PSG study would have that info. I'm puzzled by the either/or machine suggestion you were given. I guess doctors are going with the try any machine and see what works method. Quack.

ASV will have CPAP, ASV, ASV Auto modes, with EPAP and PS pressures. Beyond humidity, heated hose, Ramp, and SmartStart, I think that's it. No way at all to edit breath timing, no Ti Min/Max, no trigger, no cycle. BUT the lesser VAuto does. Another puzzle but on ResMed here.

I'm not certain of VAuto modes, but again it does have the timing settings mentioned.

So again, VAuto is most likely the right choice.

[Gideon]

Please post a full redacted copy of your sleep study. Let us actually see what it says.

Based on what you have relayed, the VAuto, but that is without seeing the data.

For your doctor to even suggest an ASV I'm expecting your sleep study to show mild to moderate central apnea though not necessarily by that name.

If you have had two sleep tests, post both of them.

[Abletree]

So far, this is all of the report info I have. I have requested a more detailed report to come in the mail (I provided the first report below the recent one) The Doc has been concerned that I get very little deep sleep


MOST RECENT STUDY
Impression
1. Obstructive Sleep Apnea G47.33
2. Good response to BiPAP at low to moderate pressures
3. PLMS
Narrative
Overnight polysomnography was performed on this patient for BiPAP titration in the setting of previously diagnosed OSA with poor CPAP tolerance. Quality is felt to be adequate.

Total recording time was 489 minutes. Onset to sleep latency was brief at 6 minutes. Sleep efficiency was reduced at 81 percent. Distribution of sleep stages was notable for relative lack of deep sleep.

The study was performed on room air. Baseline oxygen saturations while awake were acceptable. With sleep onset, the patient again demonstrated OSA that was well controlled on BiPAP at low to moderate pressures.

PRIOR STUDY BELOW on the AS10 autoset

Impression:
This overnight polysomnogram shows mild obstructive sleep apnea with an AHI of 5.4; 14.6 supine and 2.8 non-supine, using the 4% desaturation rule for scoring hypopneas. When the 3% rule is utilized the AHI is 13.1. There was associated oxygen desaturation to 88%.


Narrative:
This polysomnogram was done as part of the work-up for further assessment of excessive daytime sleepiness, for which sleep apnea was considered a possible contributing factor.

This report reflects an epoch by epoch review of the entire raw data recording by the undersigned physician.

Time in bed was 605 mins. The study was started at 9:56 PM and ended at 8:01 AM. Total recorded sleep was 443 mins, resulting in an impaired Sleep Efficiency of 73%.
Sleep latency was normal at 10.5 mins. REM latency was prolonged at 138 mins. Sleep stage distribution showed a decrease in slow-wave sleep at 5%..

Intermittent soft snoring was observed. Sleep disordered breathing was also observed, consisting mainly of obstructive events. Both the 3% and 4% rules for scoring hypopneas were utilized.

The study was done on room air. Mean saturation in sleep: 91-92%. Sleep disordered breathing was occasionally associated with oxygen desaturation, to 88%. There were a couple of readings at 87% but they occurred when there was no definable sleep disordered breathing.

There were no significant cardiac rhythm abnormalities. No EEG abnormalities were noted.

Periodic leg movements were observed during the first part of the night. He had more sleep fragmentation at that time. Leg movement index was 8. Associated arousal index was 2.

Occasional PLMS were seen. No significant EKG or EEG abnormalities were seen.

[Gideon]

I want to see the charts and tables in addition to the narrative.

[Abletree]

I'm waiting for the charts and tables to arrive in the mail

[Geer1]

ASV is for treating central apnea which to my knowledge neither your sleep study or results to date have indicated as an issue. If my memory is correct your autoset is already successful in treating your apnea with AHI usually under 2 and results looking pretty good.

You might think ASV is a better machine but the reality is that it is only usually better for people with central apnea because it is more aggressive and powerful. It literally tries to force people breath in when they don't want to and this usually makes Aerophagia worse and could easily negatively impact your sleep quality since it appears comfort is your main issue not untreated apnea.

ASV is a very one dimensional machine with limited capability to fine tune settings. Your only settings are min/max pressure and min/max PS and max PS always has to be at least 5 cm higher than min PS. The variability in PS is what treats central apnea but it is also what can aggravate aerophagia and with no way to shut it off that machine could be useless to you if it makes your aerophagia worse than it already is.

Vauto is similar to your current machine but has features neither the autoset or ASV has. It has timing controls so you can tweak the pressure waveform shape /timing. It also allows you to use a higher fixed PS which might help with your discomfort of breathing out against pressure but again this might also make aerophagia worse.

More capable machines are not necessarily better when it comes to PAP treatment. More capable machines means more intrusive treatments designed to treat more severe breathing issues. PAP treatment is usually most successful with the most basic machine/settings that treats breathing issue.

[Abletree]

Well, I have not received my detailed sleep report yet, BUT - I am scheduled to pickup my new Vauto tomorrow!   I am very excited I'll be sure to upload some screenshots to see what you think.  If there is good reason to switch to the ASV, I'll deal with that down the road

Thank you - will report back soon