[Equipment] Which ASV machine to choose dilemna

[dangood_47]

Hoping I can get some input on which ASV unit to purchase. I have bolded some key questions below.

I have read some of the product reviews on this portal and comments from some users but am still wondering as to whether to go the resmed aircurve S10 ASV route or the Respironics route vis-a-vis the dreamstation Auto SV or Auto advanced auto Sv DS960.

Some background, I live in ontario canada and there is no extended health care funding either through private insurance(i have) or the public system at this time for ASV machines so this is going to be a self-funded venture so budget is a bit of a concern.  However this is a priority as my health has been suffering with my only funded alternative - the respironics A40 using the Bipap St mode. i did try this unit in AVAPS mode but was a failure.  My numbers have been erratic with this unit and AHI has more recently been spiking into teens and my clinical symptoms show this - fragmented sleep, feeling dragged, sleepy and low energy.

I have complex central sleep apnea and episodic insomnia. Unfortunately ASV units are not commonly prescribed currently in Ontario - a political health(risk related to the associated cardiac issues that have been identified) and funding issue is my read. I actually went to 2 prominent medical supply vendors who specialize in sleep apnea and one said they hadn't sold one in 2 years and the other couldn't remember when the last one. Why is this relevant- I do not have good sources of information on ASV units nor is my physician up on them as she doesn't have many patients using them, hence I'm looking to this forum for some advice, direction and information. I have a prescription however but is pretty minimal in its content something that took about 2 years to get and had a sleep study specifically for ASV assessment.

A question related to the above, what is key information  should be in the prescription for an ASV unit and does it differ between the respironics versus the resmed units considering their initial set up?

Also my respiration is slower than most (14-15 bpm) or at least that is what I have been told by respiratory techs and my respirologist and I use meditation and progressive relaxation to deal with insomnia- even slower breathing and I found on a both my A40 and a my previous resmed VPAP III device that it forced breaths that were not matched to my breathing rate that had me fighting with the machine- made doing my slowed breathing in meditation prior to going to sleep highly challenging.

Is there a difference between the three units in relation to matching or keeping cadence with ones breathing patterns and is there any difference in how dynamically they adjust to ones respiration rate?

Over the 10 years I have used both resmed and respironics CPAP and Bipap machines, including the dreamstation Auto bipap pro- not a good choice for me but at least I am familiar with it as a bipap device- it was quiet, worked well as a bipap but it lacked a backup rate which made it an inappropriate choice for my condition but I was at least introduced to it's features and interface and there were many things I liked about it- quiet, light for travel, detachable humidifier and 12 volt capability versus 24 volt for resmed.

Upon purchasing the dreamstation i also purchased an external 12 volt lithium battery pack for international travel(often on unstable power grids) and back country camping along with power inverter/solar panel so I have some auxilary 12 V components that would be compatible with the Dream station ASV or the DS 960 Advanced which has me leaning towards it.

Am I correct in assuming that my very expensive 12 volt battery would be incompatible with the resmed device or is their an adaptor of some kind?

However  I have noted in reading through this forum that there seems to be a preference by some for the Aircurve S10, due to its seemingly better capability to manage central apnea, easier setup and perhaps has higher patient compliance/efficacy rates as a result??

As mentioned I'm looking for direction, advice and information. I have read in this forum commentary that suggests that the Respironics earlier models had more settings and sounded more complicated to set up while the Resmed was more straightforward- please correct me if this is an incorrect perception of mine.

I wondered if that is the case with the dreamstation version of the ASV unit?

I also wondered if the new dreamstation and the Aircurve ASV units can also function in Bipap St modes - I am inquiring about this as should for some reason the ASV not work out for me I thought it prudent to have a "fall back " position.

I'd be interested in hearing from others on their experience with the Dreamstation, Aircurve and the Respironics advanced auto Sv  units in terms of pros and cons etc.

Hope this isn't too tall a request.

Thanks in advance

[Gideon]

OK, 1 question answered.
I have the ResMed Aircurve VAuto. Same power supply as the ASV
Search for this. ResMed DC Converter 24V 90W For AirStart™ 10, AirSense™ 10, and AirCurve™ 10 Machines. I used it with both a 12 volt deep cycle battery connected with Alligator clips, and with a lithium Ion Battery. Works great.
The connector to the ResMed Device is Proprietary (power on center pin or something like that) and the machine will not work with a "generic" connector.

[SarcasticDave94]

Posting now so I'll find this on PC. I have ResMed AirCurve 10 ASV, so I for myself would choose ResMed. Nothing wrong with Respironics, but ResMed's algorithm IS faster to respond when it needs to adjust. This isn't just an IMO, but I'm thinking others believe this about ResMed and the ASV algorithm as well.

Be right back to try to answer bolded questions...

OK back from the commercial break........

A question related to the above, what is key information  should be in the prescription for an ASV unit and does it differ between the respironics versus the resmed units considering their initial set up?

A) I am not certain of the PR machines and what settings they have, but I can say my ResMed AirCurve 10 ASV has 4 pressure settings. As follows, they are EPAP min and max, and Pressure Support min and max. IPAP is determined by adding EPAP to PS and it is not directly adjustable as are EPAP and PS. (this does not include hose settings, humidifier settings, etc.)

B) Script requirements: It must say somewhere ASV, it may say BiPAP ASV. It needs to state at least 2 of the following I think; EPAP, IPAP, PS. It could say humidifier and/or heated hose specified, maybe mask preference, FFM, pillows, etc. brand, model, or patient preference. On my script, it states estimated length_______99 years (AKA lifetime), Diagnosis ICD-10; mine is under "Other" Central Apnea G47.31. There has to be a "Therapy Ordered" section filled indicating device therapy required. Mine got by with Code E0470 Auto Adjust Bi-Level: IPAP settings X cmH20, Min EPAP X setting, PS setting X to X and alternate PS settings X to X

For my ASV, the report from the PSG stated it was an overnight study specifically for ASV only.

Is there a difference between the three units in relation to matching or keeping cadence with ones breathing patterns and is there any difference in how dynamically they adjust to ones respiration rate?

IMO, yes. I know my ASV is quite fast to respond to the breath-by-breath adjustment requirements. As for the PR machines, having not used them, I can't comment on them.

Am I correct in assuming that my very expensive 12 volt battery would be incompatible with the resmed device or is their an adaptor of some kind?

Correct-ish. ResMed is 24V with proprietary connection. See SleepRider's answer below for more/better details...

I also wondered if the new dreamstation and the Aircurve ASV units can also function in Bipap St modes - I am inquiring about this as should for some reason the ASV not work out for me I thought it prudent to have a "fall back " position.

No ST mode is available on my AirCurve 10 ASV. I have ASVAuto, ASV, and CPAP.

[Sleeprider]

Get the Resmed Aircurve 10 ASV. By far the superior machine in terms of patient results here on the forum.

Key information for the prescription: Mode (ASVauto), EPAP min, EPAP max, PS min, PS max. Alternatively, "patient to auto titrate on ASVauto."

Resmed uses Pacewave, Respironics uses backup timing...no comparison. Get the Resmed.

Your 12-volt battery will work with any Resmed 24-volt machine with the "Resmed 37297 Air10 DC-DC Converter" that up-converts 12 to 24 volts It is all DC voltage so pretty efficient, and much better than an inverter. About $70 to $80.

You have replies from several forum users of the Resmed Aircurve 10 ASV units. Simply put, the Respironics unit does not provide the data, or therapy equivalence.

[Spy Car]

@dangood_47

I'm not sure of their shipping policy to Canada, but if I wasn't approved for ASV through my insurance (as was, and am on night 3 tonight with a ResMed Aircurve 10 ASV) I was considering purchasing one myself and I spoke with Supplier #2 who had a number of reasonably priced ResMed ASV machines (including gently used ones).

I can't compare the Respironics model. Pretty happy with the ResMed and still in the dialing in phase.

Bill

[CTcentrals]

I share some similarities related to Dx, BPM, meditation, and PMR. I started with a Respironics bipap auto sv advanced that I used for years and this last June purchased a slightly used Resmed Aircurve S10 ASV from Supplier #2 (see Supplier List at top of page). 

The Respironics always seemed to force my breathing differently than my norm, especially when I used a full face mask. It also seemed to be slower to respond to pressure needs and was more forceful when it did change.  I used the ramp feature to allow me to regulate my breathing before I went to sleep and then the machine kicked in its rhythm to which I adapted.

The Resmed seems to be much quicker to respond to pressure change needs and smoother in its pressure changing. I don't use the ramp with it and I can do some diaphragmatic breathing at first if I want, to which it adapts reasonably well. If it gets too far off rhythm to start, I can blow it out (full face mask) and it slows down and starts over.  I don't do that very often.

Depending on your needs and practice, you may also want to consider a sensory-based meditation to start or a long mantra rather than focusing on breathing. 

My most recent prescription included:
BiPap Auto SV Prescription
Indication: ICD-10-CM G47.31, Severe CSA/Neuromuscular Disease
Duration: 99 months
Prognosis: Good
Max Pressure: 30
EPAP min: 5
EPAP max: 15
PS min: 0
PS max: 15
Rate Auto

Ramp
Heated Humidity
Mask to Comfort
CPAP Supplies
Chin Strap

[DeepBreathing]

Just following on from the responses above, my breathing rate is substantially slower that yours - about 10 bpm - and I found the Philips VERY hard to get on with. Note this was the superseded model (as is my Resmed) but I don't believe the algorithms have changed significantly on either machine. I simply could not get comfortable with the Philips - it was always trying to force my breathing, while the Resmed was much happier to comply with my needs. Note that the Philips does have a number of adjustable parameters which could conceivably have overcome the problem but at the time I was not aware of that (and neither apparently was my doctor or therapist). The Resmed makes a lot of adjustments on the fly, using its Pacewave algorithm. It works extremely well in my experience.

[dangood_47]

Thanks for the tip spycar, re: buying gently used, when I consider the warranty the one supplier is offering on gently used equipment it seems reasonable but their price on the new ones is also pretty good in comparison to what i'd pay here. I live close to border so was going to have it shipped to my US Kinex mailbox and pick it up in us and then bring back with me. Many suppliers will not ship to canada where as for others it's no problem, part of this is the manufacturer directs the supplier in the US that they are not to ship to canadians, but instead it has to go through the Canadian disributer, or so I have been told.  Sure hope the powers at be don't kill NAFTA cause if we ever go back to what it was like to bring things across the border pre-NAFTA it will be a real pain. 

Curiously there is a huge price (30-40% ) difference between US and canadian suppliers of these units even when taking difference in cdn dollar and taxes, perhaps the reason why us distributes are sometimes directed they can't sell to a Canadian customer. i've yet to find a retailer here in canada that sells used units and it would be nice to be able to trial or rent one of these units before you purchase to "test" drive the product.

[dangood_47]

Thanks very much for all of your responses, they have all been very informative and are helpful in my decision making. Regarding my respiration rate, the rate I originally stated was incorrect, I thing a feature of what happens when my apnea gets real bad- my cognition suffers. My real rate is more like 10-11 breaths per minute. Curiously the respironics A40 unit I have was very problematic for me in getting it to synch with my usual breath rate and it has taken a lot of tweaking to stop it from fighting me. Had to max out on its rise time setting and lengthen the inspiration time setting way beyond what the res tech initially set it despite me telling I was a slower breather.I had a similar problem with the dream station bipap auto and the only way  I could get it to synch with me was to use its  manual bipap mode so it seems to be common with respironics products perhaps??

It's encouraging to hear that the resmeds algorithm and technology is so responsive and it sounds like it will synch better with both my respiration rate but also better control my apnea, especially considering it's episodic nature. So just want to thank you all for your input on this, I'll update this on my own experience once I have made my purchase and tried the machine out for a bit.  No doubt there will be a ASV learning curve and a few bumps along the road but i'm optimistic that an ASV unit will make a big difference in treating my central apneas.
Thanks, sleep well!
Dan

[Spy Car]

I'd never counted my breaths-per-minute, so I picked a section at random from last night's ASV charts and it was 8 bpm. And I've been feeling the ASV is "pushing" my rate.

I'm still "negotiating" with the new machine over breathing rates. Much of the time we fall into sync (and the feeling is delicious). Sometimes the machine gets aggresive and ahead, and I've had to over breathe it or adapt to it.

Still figuring out this dance myself.

Bill