[Equipment] ResMed AirCurve 10 VAuto or ST

[halokittie]

I've been using an APAP for a while now, but unable to achieve good sleep or AHI's consistently under 10, so the sleep doctor sent me for a bilevel titration.  i think that, because of the treatment induced central apneas, he has prescribed 25/16 with a backup of 10 (please see attached bilevel sleep study).

He is open to me picking my own machine.  Does that mean I should go with the ResMed ST?  I'm obviously confused.  I was expecting it to just be run-of-the-mill and expected to need the VAuto, but now am not so sure.  

Thanks,
HK

[Gideon]

I see a lot of Centrals in your Feb 19 Sleep Study.  This implies a need for a backup rate.  I think the machine on this basis would be a BiLevel ASV, and based on many members here the preferred one is the ResMed AirCurve 10 ASV.

The AirCurve 10 ASV bilevel machine offers truly personalized therapy for central breathing disorders, such as Cheyne-Stokes respiration (CSR), central sleep apnea (CSA) and associated obstructive events. Featuring the most clinically-studied and proven ASV algorithm, AirCurve 10 ASV is the only adaptive servo-ventilator that targets the patient’s own recent minute ventilation.

[jaswilliams]

I agree with Fred I have used both an ST and an ASV the ASV is the one to go for

[dmeRT]

agree with Fred.  

go with an ASV bipap.  bipap s/t's are a waste of time...imo

[halokittie]

Thanks for your responses.  Unfortunately, it looks like I'm stuck with the ST.  

I had a hard enough time just getting a ResMed.  I had to search out a 50-mile radius of my not-small city to find a DME that would take Medicare assignment for ResMed.  Everyone around here automatically provides Philips Respironics.  One local DME was willing to special order, but wanted me to pay the entire amount up front then file with Medicare for monthly payments.  I can't afford that, so...  The one DME I finally got that was willing to take Medicare assignment was willing to go for the ST, but not the ASV.  

So, I'll give it a try and if it doesn't help the centrals then I guess I'll gird up for another battle.  

I appreciate all your help!
HK

[Sleeprider]

The ASV and ST cost the same. Get the Aircurve 10 ASV which will properly treat your central apnea and hypopnea and provide auto-adjusting EPAP pressure for obstruction. The ST is not intended to treat your problem. Read the information about the machines in the Resmed Titration Protocol. Note especially what conditions the ST is to be prescribed to treat vs the ASV. https://www.resmed.com/us/dam/documents/...er_eng.pdf

Page 28 for ASV which is for treatment of central and complex apnea.
Page 37 for ST which is for treatment of respiratory diseases, hypoventilation, COPD, Neuromuscular/restrictive disorders.

Do not allow the doctor, and especially a DME to pawn off the wrong therapy for your needs. A Philips Dreamstation BiPAP Auto SV is better for you than the Resmed Aircurve 10 ST. As a last resort, get the Philips, but don't get the wrong device.

[ajack]

I'd go back and talk it over with the doctor or the lab tech. who did the sleep study
I think you will find that the standard ASV can't do 25/16. max epap is 15 then add your min PS 9 and you have maxed out the machine and it won't be doing much different to the ST, other than a floating backup rate. You may be better on fixed 10.

ST are used for lung issues and are very good for what they are designed to do. "COPD, NMD, OHS and other respiratory conditions"

This aside, I also think you are jumping the gun with ASV because from your report. It was treatment emergence centrals. bottom of page 6. These normally settle within 12 weeks. They didn't occur till you were at 20/14

The other thing that may be an option is the A/I VAPS, That will auto the minute vent to maintain the required air flow/volume. With my obesity and a wide pressure spread over the night. This one works best for me.

[biyahero]

I see a lot of Centrals in your Feb 19 Sleep Study.  This implies a need for a backup rate.  I think the machine on this basis would be a BiLevel ASV, and based on many members here the preferred one is the ResMed AirCurve 10 ASV.

The AirCurve 10 ASV bilevel machine offers truly personalized therapy for central breathing disorders, such as Cheyne-Stokes respiration (CSR), central sleep apnea (CSA) and associated obstructive events. Featuring the most clinically-studied and proven ASV algorithm, AirCurve 10 ASV is the only adaptive servo-ventilator that targets the patient’s own recent minute ventilation.

Ajack ... just to clarify what you have said... is the "AirCurve 10 ASV" you refer to just another name for the AirCurve 10 VAuto?
My sleep Doctor wanted me to have a AirCurve 10 VAuto to replace my AirSense 10 AutoSense since my pressure is always maxing out at 19.8 or 19.9 every night.

The VA through a 3rd party Medical Device Supplier issued me an AirCurve 10 ST, and repeatedly told me when I mentioned that my Doctor wanted me to have a AirCurve 10 VAuto (so the maximum pressure would not be limited to 20), that the 
AirCurve 10 ST was just another name for the AirCurve 10 VAuto.  Once I determined after they had given it to me that it is NOT the same machine, I brought up the issue of returning it, and then said I could as long as I don't use it, so I am not using it.  However they continue to insist that it is better, more high end, and more expensive than the AirCurve 10 VAuto, and also features a "backup rate" (whatever that is).

I personally feel that they just had an ST in stock and the VA told them they should expedite my machine since it is a long time since it was ordered, and the supplier further claims that my VA Doctor ordered it (based on my Sleep Doctor's Prescription) by Reference Number 37307.  I don't believe that, but if somehow they were ordering by Reference Number
so you know the correct Reference Number for an AirCurve 10 VAuto so I could ask them to correct the order?

Be that as it may about the claims it is a more advanced machine by the supplier, the specification chart I found at ResMed indicates that the differences are that the ST model has additional modes of "S" and "T" (whatever they are) that the AirCurve 10 VAuto does not have, and the ST model also lacks the Auto mode that is present on the AirCurve 10 VAuto, which I think would be more helpful to me than the S and ST modes.

My Doctor is unavailable until April 9, so I am trying to understand these machine differences as my "homework" while she is unavailable.

It sounds like to me that the AirCurve 10 VAuto is what I need rather than the AirCurve 10 ST that I was issued.

[Sleeprider]

The Aircurve 10 Vauto, ST and ASV are all distinctly different machines with different therapy missions. This titration guide from Resmed describes each machine and its intended uses https://www.resmed.com/us/dam/documents/...er_eng.pdf

The ASV is a bilevel with a backup rate, meaning it will switch to IPAP when you fail to take a breath or your breathing is too shallow. It automatically adjusts EPAP pressure to prevent obstructive apnea, and provides pressure support as needed, as much as needed to keep you breathing in the event of central apnea. This is the machine for complex apnea.

The ST is a bilevel with a backup rate, but has fixed EPAP and IPAP pressures. The EPAP must be set at a level that keeps the airway open, and the IPAP is set to make breathing easier for people that suffer from neuromuscular respiratory insufficiency, obesity hypoventilation and COPD. This is a machine for respiratory disease or restriction to make it possible to get a full breath with less effort.

The ST-A is a bilevel with backup rate that has automatic adjusting EPAP and Pressure support. It targets maintaining respiratory volume and rate. This is the machine the ST wanted to be, and can function to treat pulmonary restriction as well as central apnea. This is the machine that can maintain a consistently high minimum pressure support, and add more pressure support as needed to maintain tidal volume, or aveolar volume.

The Vauto is a bilevel machine with no backup rate. It is used to treat obstructive sleep apnea, hypopnea and upper airway resistance. In the event of apnea, it does not switch to IPAP until the user spontaneously breathes. This is a more comfortable alternative to CPAP, but is not a treatment for central apnea.

[Gideon]

We see this happen a lot.  This is from the Wiki article Prescription - CPAP - APAP - BIPAP

CPAP choice to treat OSA, CA, obstructive or pulmonary restriction
The Auto CPAP such as the AirSense 10 AutoSet is typically the initial machine of choice for treatment of obstructive apnea and hypopnea
Just to clarify The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between the three to treat a single condition.
They should be chosen to treat the specific condition that the user has,

• To treat obstructive apnea and minor hypopnea and for most initial treatments a standard Auto CPAP such as AirSense AutoSet (or for her) is appropriate.
  
  
• To treat obstructive apnea and hypopnea, and a standard Auto CPAP is insufficient the treatment of choice is the Aircurve 10 Vauto (has higher pressure and greater Pressure Support (PS) (similar to EPR) available
  
  
• To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV
  
  
• To treat obstructive or pulmonary restriction including hypoventilation, would be the Aircurve 10 ST