[Equipment] ResMed Autoset CS-A vs. Philips Auto SV Advanced

[MastiffMom]

Can anyone compare these two machines or give me the pro's and con's of each?

During overnight sleep study the tech commented to Hubby that he would likely need a different machine. He was being tested/titrated with a Respironics BiPap. He's already failed with an ResMed S9 Autoset. The only other type of machine I've found is the ASV machines.

He has had problems with the exhale pressure. During the study the EPAP was tolerable at 8 and she maxed the machine out at 15 on IPAP but she was never able to get him stop snoring. He has had over inflated lungs from the AutoSet which was set at the max of 20 to the point that he couldn't exhale all the way. It took about 9 days before his lungs went back to normal. After the study he felt the pressures in his lungs but he was able to exhale fully and the sensation only lasted about a day.

He was also told he has an extremely severe sleep disorder ... whatever that means. Haven't seen Dr. yet since overnight study but want to be armed with as much info as possible when we go. I already know the DSM provider will supply the ResMed unless the Dr. specifies a different brand. So I'm searching for the differences between the machines and the pro's and con's of each. I want to get whichever machine best fits Hubby's problems not the one they get the highest commission on.

Thanks

[archangle]

Those are both ASV machines. They are for central apnea, not for people with trouble exhaling.

It sounds like what he needs is a bilevel machine. ResMed uses the trademark "VPAP" and Philips says "BiPAP," but the regulatory and insurance term is "bilevel."

A bilevel reduces the pressure when you exhale. Some CPAP machines can do this too, but only by about 3 cmH2O of pressure. A bilevel machine can do a larger difference between inhale and exhale. Bilevels can also go to 25 cmH2O or higher in some cases. CPAP's and APAP's can only go to 20.

He may not even need a bilevel. If he can't take the 20 cm pressure from the AutoSet, you should try a lower maximum pressure for a short time, even though it may not completely stop his apnea. Once his lungs and chest muscles adapt to that, bump the pressure up and see if he can handle it. Note this is ONLY for a short time to give him a chance to adapt to the pressure, with the idea to increase the pressure later if needed.

By the way, did he use the maximum EPR setting of 3 when trying to do the AutoSet?

Read the data the SD card records and figure out how his apnea is progressing. The doctors and techs are often too lazy to do the effort to gradually acclimatize the patient to CPAP.

Even if he can't stand a high enough pressure to eliminate his apnea, it may very well reduce it considerably and improve his health considerably. It's probably better to treat his apnea part way, at least to start, rather than have him quit entirely.

Get copies of the test results and find out the AHI numbers.

I don't know why he'd need an ASV, unless he has central apnea, but the PRS1 Auto SV Advanced, the S9 VPAP Adapt, the S9 AutoSet CS, and the AutoSet CS-A are all ASV machines. They have subtle differences. The AutoSet CS-A has an extra part that is a loud alarm to wake you up if you have certain problems like a really long apnea.

BTW, an ASV is not necessarily "better" than a bilevel or CPAP, unless you have the particular problems it treats.

[MastiffMom]

If he can't take the 20 cm pressure from the AutoSet, you should try a lower maximum pressure for a short time, even though it may not completely stop his apnea.

By the way, did he use the maximum EPR setting of 3 when trying to do the AutoSet?

Yes, he was using EPR 3 and they did reduce the pressure to 12. We don't know if the machine was malfunctioning or if the mask was not fitting properly but even at 12 the mask would literally vibrate on his face and he felt like he was drowning in air and couldn't exhale.

Even if he can't stand a high enough pressure to eliminate his apnea, it may very well reduce it considerably and improve his health considerably. It's probably better to treat his apnea part way, at least to start, rather than have him quit entirely.

Agreed wholeheartedly!

The homestudy showed an AHI of 72 and oxygenation of 60%. The data from the AutoSet did show some centrals, of course, we don't know if it was caused by the high pressure or not. Until the results come back from the overnight study we don't know what his problems are other than it was described as "extreme sleep disorder". His overnight study was on a bipap with the exhale pressure at 8 which he could handle but she commented she was never able to get him to stop snoring. Because the tech said he would likely need a different type of machine is why I started looking into the ASV machines. I just want to be armed with information for the doctor's appt.

It is the subtle differences I'm interested in. The DME will push the ResMed but from what I can tell the Philips has more adjustments so it can be fine tuned more. I believe this is true whether it is a bilevel machine or ASV. The first idiot doctor we got stuck with point blank said he didn't know how these machines worked - referring to the AutoSet. I sincerely hope the new doctor we have does know how the different machines work.

[robysue]

He was also told he has an extremely severe sleep disorder ... whatever that means. Haven't seen Dr. yet since overnight study but want to be armed with as much info as possible when we go.

The first thing you and hubby need to do is to get a copy of the sleep study reports for both the diagnostic study and the titration study. You need the full report including the summary graphs. Usually it runs about 3-7 pages per sleep study. You also need to know whether hubby had a full night of diagnostic work followed by a full night of titration or whether the sleep study was a split study where both things happened on the same night.

And you need to know the exact diagnosis (or diagnoses) of hubby's sleep problems. In particular, you need to know whether hubby was diagnosed with severe obstructive sleep apnea or central sleep apnea or complex sleep apnea. And whether or not other sleep problem such as periodic limb movement disorder (PLMD) was diagnosed as well.

Until you know the exact diagnosis, there's no point in speculating on whether hubby needs an ASV machine or a simple bi-level machine.

An ASV machine is much more expensive because it can act as a non-invasive ventilator and in some modes it can trigger inhalations. ASV machines are designed for treating central and complex sleep apnea, but there is no advantage in using an ASV if the problem is plain old severe obstructive sleep apnea. Moreover, ASV machine can be even more difficult to learn to sleep with than ordinary CPAPs, APAPs, and plain bi-level machines.

A simple bilevel or auto bilevel machine (the Resmed S9 VPAP S and VPAP Auto OR the PR System One BiPAP Pro or BiPAP Auto) are often prescribed for people with ordinary OSA (even severe OSA) who are having problems adjusting to a CPAP or APAP because of discomfort induced by the pressure. These machines can provide substantial help with the "can't exhale fully" problem you describe since the difference between IPAP (pressure on inhalation) and EPAP (pressure on exhalation) can be set as much as 8cm (or more) apart. For people who have real discomfort on CPAP or APAP, the switch to bilevel can dramatically increase comfort and feel much more normal to breathe with.

[archangle]

I still see no indication of needing ASV. Bilevel is probably what's needed to help with exhale.

We don't know if the machine was malfunctioning or if the mask was not fitting properly but even at 12 the mask would literally vibrate on his face and he felt like he was drowning in air and couldn't exhale.

The machines almost never malfunction like that. People talk about them "running away," but that's usually a case of an APAP that decides to run away to the programmed maximum pressure, not blowing more than it thinks it is. Look at the pressure displayed on the display and see what the SD card data shows.

The mask vibrating on his face sounds like just a badly fitted mask. You need to try adjusting the straps tighter or looser. The mask is designed to work like a hovercraft in some ways. The "skirt" needs to inflate and seal his face. You might need a better fitting mask.

Why did you end up with a Full Face Mask (FFM)? That's usually a bad first choice unless you have a problem with mouth leaks or can't breathe through the nose.

Drowning in air is probably just panic. Try wearing it during the day while watching TV or reading. Consciously inhale and exhale and feel the air coming in and going out.

Was he ever able to sleep with the AutoSet? What pressure and what AHI?

I'd suggest you get them to turn down the max pressure on the AutoSet to something he can stand, and see what the AHI is. Then slowly increase the pressure as needed and as he can stand it. Concentrate on getting him to be able to sleep with the machine, then work on getting his AHI down by slowly increasing the pressure.

Don't worry too much about snoring to start with. While he's snoring, he's breathing. Snoring does have its problems, but it's mostly important because it indicates you're on the edge of having an apnea.

I use 16 cmH2O minimum on my AutoSet and I sometimes have to lift up the edge of my mask to convince myself it's still blowing. You ought to be able to adjust.

[jbema]

I was wondering if anyone could provide an answer to the question:

ResMed Autoset CS-A vs. Philips Auto SV Advanced?

I have both idiopathic CSA and Complex OSA. My CSA is exacerbated by the Resmed S9 and therefore is of no help to me. I am wondering if an auto adaptive machine may make my life more bearable. Currently I am using an oral mandibular device which helps reduce my OSA but does nothing for my CSA. Thank you.

[archangle]

I was wondering if anyone could provide an answer to the question:

ResMed Autoset CS-A vs. Philips Auto SV Advanced?

They're both basically ASV machines.

The obvious difference is that the CS-A has the little extra segment between the blower and the humidifier. That segment is a loud alarm that goes off under some conditions. I'm not sure exactly what conditions, but I suspect that stopping breathing is one of them. I think it's a "wake you up or alert the nurse" type of alarm.

There's a ResMed S9 AutoSet CS that doesn't have the extra loud alarm. It may or may not have an alarm of some sort. There's an S9 VPAP Adapt that's very similar to the AutoSet CS. AutoSet CS vs. VPAP Adapt may just be a label change for different countries, but I'm not sure.

I have both idiopathic CSA and Complex OSA. My CSA is exacerbated by the Resmed S9 and therefore is of no help to me. I am wondering if an auto adaptive machine may make my life more bearable. Currently I am using an oral mandibular device which helps reduce my OSA but does nothing for my CSA. Thank you.

Sometimes you can tame the AutoSet by limiting the maximum and minimum pressure and find a happy medium that helps OSA and doesn't exacerbate CSA. What's your pressure settings, AHI, CAI, etc.?

[jbema]

Thank you for your quick reply.

[vsheline]

He has had over inflated lungs from the AutoSet which was set at the max of 20 to the point that he couldn't exhale all the way. It took about 9 days before his lungs went back to normal. After the study he felt the pressures in his lungs but he was able to exhale fully and the sensation only lasted about a day.

Hi MastiffMom,

I think you will need to communicate this again and again, loud and clear, to all his doctors. They must make VERY SURE that "spontaneous pneumothorax" (air in the chest cavity) is not being caused or made worse by CPAP therapy. "Spontaneous Pneumothorax" can be very serious and can lead to death.

A tendency toward spontaneous pneumothorax is a reason for limiting the Max Pressure setting to a pressure which is much lower than normally allowed for most CPAP patients.

In fact, I think CPAP treatment may need to be interrupted or discontinued if he is having symptoms of air in the chest cavity.

If he is not using CPAP therapy, I suggest your hubby may need to sleep partially upright in a recliner chair to help avoid obstructive apneas (which are usually highly positional, much worse when sleeping flat on the back in the supine position) .

Take care,
-- Vaughn

[vsheline]

We don't know if the machine was malfunctioning or if the mask was not fitting properly but even at 12 the mask would literally vibrate on his face and he felt like he was drowning in air and couldn't exhale.

Hi MastiffMom,

1. The mask vibrating might be solved by using a different size mask or different style mask, or by using a mask liner, which is sort of a cloth gasket which goes between the mask and the face, to eliminate vibration/flapping and to help seal leaks.

2. His feeling like he was drowning and couldn't breath may have been caused by weak breathing muscles which would gain strength as he adapts to breathing under pressure, but may also have been much more serious, if it was caused by spontaneous pneumothorax.

Take care,
-- Vaughn