[Equipment] What ASV machine has the most user settings/range?

[SanFranSnorer]

My doctor has decided that I am a candidate for an ASV machine.

By nature I am an analytical tweeker/engineer. So naturally, someone else doing set-and-forget is not my style.

I want to upload my SD card and see what’s going on. To that end, I would also like to have the option to get into
the machine’s inner workings and see/tweek the settings (with input from my respiratory technician - of course).

I’ve looked at the ResMed and Philips units and am leaning toward the Philips. But before I commit to either, I’d like to
see what other options there are.  I’m new to the wonderful world of sleep apnea (or at least new to dealing with it) —
and don’t have a lot of time to personally see/evaluate what other units are available.

Your comments/recommendations will be appreciated.  Also input on the various units algorithms.

Thanks,
SFS

[SarcasticDave94]

SanFranSnorer,

Hi and welcome to the Apnea Board. Me personally, I would consider staying with either ResMed or Respironics. I have the ResMed AirCurve 10 ASV. It may not have as many adjustments as the Respironics, but IMO it does a great job of tackling my mixed apneas. I see reports that it responds faster to events, and I can somewhat believe it. Why only somewhat? Because I've not tried the PR ASV. My non-treated AHI would be around 72; I typically get about an AHI of 1 now.

The Respironics algorithm tends to be a bit slower to respond, and feels less natural, from what I hear. It will need to be set much closer to the patient's pressure needs to be effective.

FWIW running my ASV in ASV Auto, I have 4 pressure settings: EPAP Min/Max and Pressure Support Min/Max. Their algorithm modifies those range settings to add up to the IPAP range.

[Sleeprider]

Put simply, there are more settings on a Philips BiPAP Auto SV Advanced, including adjustment to the breath rate per minute (BPM). The software to access efficacy is much more difficult and lower resolution that the Resmed Aircurve 10 ASV. The biggest advantage of the Philips machine is the ability to set BPM to a low level that allows for spontaneous breathing to be maximized.

Resmed allows a full range of settings and gives you access to the timing of inspiration pressure as well as sensitivity for trigger and cycle. It may be less to play with but most users report a more natural and comfortable experience and their results show consistently fewer AHI events.

ASV is no picnic to get accustomed to. You will have your hands full just learning to tolerate the therapy for the first month. Tweaking settings can become counter-productive to the main task which is to use the ASV to resolve complex or central apnea, and learn to live with the pressure variations that are inherent in the technology. Expect to experience some discomfort for about a month while this process runs its course. Once you have "arrived" the results can be life-changing and very positive. So keep your eye on the prize, but not so much the settings.

We are currently working to bring #Sleepyhead software to work with the Philips BiPAP Auto SV, but so far, we only have a beta that must be built from code. I think in the next few months a new release will be availble that has full function and inatalltion as exists for the Aircurve 10 ASV.

[DeepBreathing]

Sleeprider, I think your second paragraph above is in error (or mistyped). Perhaps this is what you meant:

The Philips allows a full range of settings and gives you access to the timing of inspiration pressure as well as sensitivity for trigger and cycle. Resmed may give you less to play with but most users report a more natural and comfortable experience and their results show consistently fewer AHI events.

[Sleeprider]

Thanks DB! Poorly written at best. With your S9 Adapt (ASV), you might have some thoughts on this as well.

[Spy Car]

Forgive me if I have this wrong, but I thought the knock on the Philips Respironics (aside from the incompatibility with Sleepyhead that's being addressed currently) was that the timing of breaths (while adjustable) was fixed once it was set vs a more sophisticated breath-timing algorithm with the ResMed. Is my understanding correct (or mistaken) in that regard?

I positively love my ResMed ASV. It is no exaggeration to say it has been life-changing in helping my quality of life and quality of sleep. I think I'm still in recovery from a long period of sleep-debt, but what a difference!

Bill

[Sleeprider]

Spy Car, the Pace Wave algorithm on the Resmed adapts to the user's natural respiratory rate over the past 30 minutes as I recall. So it feels natural compared to the timed intrusion of the Respironics. The Resmed does target a respiration rate of 15 BPM while the Philips can be manually set at much lower rates. All I know is that the results I have seen would strongly endorse the Resmed from a comfort and effectiveness standpoint. You are much more experienced with this than I am.

[Spy Car]

Spy Car, the Pace Wave algorithm on the Resmed adapts to the user's natural respiratory rate over the past 30 minutes as I recall.  So it feels natural compared to the timed intrusion of the Respironics.  The Resmed does target a respiration rate of 15 BPM while the Philips can be manually set at much lower rates.  All I know is that the results I have seen would strongly endorse the Resmed from a comfort and effectiveness standpoint.  You are much more experienced with this than I am.

I guess this is what I'm asking. ResMed's algorithm paces the respiratory rate in an adaptive fashion. For this reason, it feels very natural to this user.

There was for me--which seems typical of ResMed ASV users--an initial period when there could be struggles over who was taking "the lead" in setting the breath rate--me or the machine--and in my case this was especially noticeable just at the transition to sleep.

I do not know if I adapted to the machine, or if it "learned" my breathing patterns or both, but that struggle is virtually gone and I feel very in sync with the machine. It has been very comfortable for me to use and I'm very thankful for the good results (and for your good advice getting me optimized!).

There is a "trick" that Dave and I have both used, he has dubbed it the "blowback method," to reset the ResMed ASV to follow the human lead and to reduce unnecessary pressure, which involves exhaling hard into the mask if and when the ASV starts getting too forceful and/or ahead of the user. I rarely need to perform this trick anymore, but did so frequently early on.

You know far more about these devices than I do, but as a ResMed ASV user, I love the comfort and effectiveness of this device. It would be difficult to pry it away from me.

Bill

[jaswilliams]

The Resmed to Quote with an initial target of 15 breaths per minute


Sets a suitable target minute ventilation for your patient: 90% of their most recent minute ventilation based on a three-minute moving average. When the patient’s minute ventilation falls below the target, PaceWave automatically adjusts the inspiratory pressure to provide backup support. As the patient’s breathing stabilises, the pressure is rapidly returned to the minimum required.

[SarcasticDave94]

"...

I do not know if I adapted to the machine, or if it "learned" my breathing patterns or both, but that struggle is virtually gone and I feel very in sync with the machine. It has been very comfortable for me to use and I'm very thankful for the good results (and for your good advice getting me optimized!).

There is a "trick" that Dave and I have both used, he has dubbed it the "blowback method," to reset the ResMed ASV to follow the human lead and to reduce unnecessary pressure, which involves exhaling hard into the mask if and when the ASV starts getting too forceful and/or ahead of the user. I rarely need to perform this trick anymore, but did so frequently early on.

..."

Bill

Well described. And it does work to train the machine IMO.



PS My episodes of training the ASV are over, possibly by around month 3 I rarely encounter needing to blowback.