HELP BUYING AN ASV MACHINE

[Johnny Bravo]

Hi:

I just joined this community cause i'm trying to buy a second hand ASV machine online. Long story short i have severe untreated sleep apnea and it's been very difficult to treat. All paps i've tried haven't worked, neither surgeries (including MMA). Oral appliances either. It's been a struggle with sleep studies, cpap and doctors. I can give more details and show/post my sleep studies if necessary (don't know how here), but essentially what i need is to get an ASV machine and try to rule out central/complex sleep apnea that's been suggested and sometimes diagnosed, but not definitely. After my failed and recent MMA surgery i'm worse than before and my doctors have basically told me there's nothing else they can do for me anymore. I'm in Colombia, South America. I right now use a Respironics Remstar System One bipap auto biflex on bipap mode with pressures 16 inspiratory and 12 expiratory. My AHI is over the 100's and in my last titration i was supposedly treated with a cpap pressure of 12. But if i'm lucky, very occasionally i can sleep a little bit better with my bipap on those settings (16-12, minimum pressure, or expiratory pressure of 12). I surfed the cpap supplier number 2, which is what i can afford and came up with these 2 models of Resmed:10 AirCurve or 9 Vpap Adapt. Should i get the latest newest 10 one cause it's the best Resmed has or should i stay with the 9 that's easier to use and probably will give me less trouble with leaks and pressures, according to what i read here? I don't even wanna think about the different models of Respironics. I'm planning to travel to the US and find a good sleep lab and Doctor to do all this the right way, but meanwhile i need to try and sleep a bit better, as i am very sick from severe untreated sleep apnea, and have been for a long time. Please, anyone, help me if you can, i can barely think to post this thread. Thanks,

Jhon.

[Sleeprider]

Bienvenido! There is not much difference in efficacy (if any), between a S9 VPAP Adapt and Aircurve 10 ASV. You can also consider the Philips BiPAP Auto S/V Advanced (model 960P). I assume you have complex apnea and most of your events on the BiPAP auto are central? It's possible your symptoms are worse on pressure, than using nothing at all. What's clear is that you need help soon and you're on the right track to get it.

Supplier #2 will ship internationally, and their prices are fairly reasonable. Used machines do come up occasionally through other channels, but it's going to be difficult to safely access that from Colombia. Let me know if you have other questions or we can help in any way.

[richb]

Hi Johnny Bravo. Bienvenidos to the Apnea Board. I have Central Apnea and use the Resmed:10 AirCurve ASV machine. It works perfectly to control my Central Apnea. The mask that you choose and get adjusted to will have more to do with controlling leaks. Try installing the sleepyhead software and take a look at your nightly data. You can see if you are having a lot of Central Apnea events. These would include what appears to be Cheyne Stokes Breathing, Periodic Breathing and Central Hypopneas. The ASV machine can help with all of those as well as Obstructive Apnea. I must caution you at the same time. If you have Congestive Heart Failure and your Left Ventricle ejection fraction is less than 45% an ASV machine is not for you. Research has shown that an ASV machine can increase mortality in patients with an ejection fraction below 45%. You need an echo cardiogram to determine your ejection fraction. Talk with your Doctor about this.

Rich

[trish6hundred]

Hi Johnny Bravo,
WELCOME! to the forum.!
I wish you good luck with purchasing an ASV machine.
Hang in there for more responses to your post.

[Johnny Bravo]

Hello all:

Thanks to all for writing and helping. You all are very nice. I feel so welcome in this community (considering i'm so lost and sick and i don't always use cpap so i don't have info to give you).

This is a message i wrote privately to vsheline, an advisory member, which also covers many things i wanna post here, although i might miss some, cause i'm too tired to review all messages you wrote here to add anything else.

The thing i can add that i can remember is if it's a good idea to buy an ASV machine that has the oxygen feature. I read in another thread that this sometimes can be a good therapy when nothing else works.

Vaughn:

Thanks for writing. I'll try to tell you what i thought of talking on the phone

I'm sorry to know about your hearing condition. I hope you get better or are handling that well now.

I read on another thread that there's such a thing as the complete sleep study or titration and that you can ask for it. Not just the report but the actual detailed graphics and charts. I also asked for this but they didn't give it to me, didn't pay attention. I want to have my actual breathing curves to see if some Doctor can look at them and tell me if i have centra sleep apnea (complex) or not.

Also a read that there's another thing called a back up rate that one of the brands have it (Respironics?) and Resmed doesn't. What's this?

I was hoping we could talk about things like what brand and model of machine to buy, and whether you would help me set the settings of that one.

If i buy your same machine will you please help me set it and use it?

Why buy a machine that has the ASVAuto therapy mode (in addition to the basic ASV therapy mode)? I don't know about this, please explain this to me, how would this help?

Why do you recommend buying the ResMed ResMed S9 VPAP/BIPAP Adapt SV Auto with Heated Humidifier - REF - 36037? Is there a particular reason for this? Is it because you have it and know have been successful with it and know how to use it?

I'm afraid if i buy the AirCurve10, although it seems like a better machine (Resmed's last and best model?), i won't know how to use it, or i will but not set it to the right pressure ranges for me.

On the other hand reading from the thread i posted, i feel like this one, the 10, will give me more track records about the different kind of apneas (obstructive, central) and other events like Cheine Stokes, Shallow Breathing, Central Hypopneas, etc? Or will the 9 give me all this information as well?

I'm so bad at this and have never had a good newer machine that i didn't even know what a Centra Hypopnea was.

Do you know what kind of SD Card does each one of these machines need? How many Gigas or Megas? My old Bipap only works with one that has to be of 2 Gigas and i haven't been able to get it cause they don't make them that small anymore.

I've never been able to keep this apnea track records myself, and i need to do it. I think it's time, but i have to solve this SD card thing, or even better to get this newer better servo maching with a better newer SD Card system. I downloaded SleepHead but don't know how to use it, i've never used it.

Can you post the apnea track records of SleepyHead or other software, the one you recommend using here, on this forum?

As for the AHI records of my machine, i don't have one. I've never done that. That's how bad of a user of cpap i am, how much i don't know. All i know is when i used to go to my last doctor he just took my machine and gave it to his secretary, who took the info out (not via SD Card) and so he knew about my apnea track records but never told me about them, just changed the settings of my machine every time.

What does it mean on your profile where it says Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)?

Do you think it would be a good idea to buy both one machine by Resmed and another one (back up) by Respironics just to try both brands and therapies and see what feels better? Or probably buy the 10 and the 9 by Resmed? It will be more expensive, but it's my life and i know i'll eventually probably have to invest on this with time. But i don't know if for now that will be too much. I don't even know if ASV is for me. This will be a self titration thing.

I've had a lot of trouble and bad luck with doctors here in Colombia, and I now what happened was i had to go through a normal cpap titration procedure cause i asked and that was their protocole. The only way to get a titration on a Servo machine was if i took a normal titration with cpap and they couldn't treat muy apneas with it. Then i would be prescribed with a servo titration with a special sleep technician who was the only one who knows how to do it at that sleep clinic.

I go to a sleep clinic that i have to pay out of pocket with where they kind of listen to me (even with all that trouble) cause the bureaucracy through my enssurance was even worse. I was several months trying to get the sleep study and titration and just couldn't get it.

And it's in general bad and not specialized like that the medicine for sleep apnea in sleep clinics here in Colombia. They don't consider my long difficult history with apnea, i'm just a difficult patient who doesn't wanna use cpap. That's why i wanna go back to the US and take a yet new sleep study if i'm lucky enough to find a good sleep clinic where they take into account my history and give me a detailed, full sleep study (with the graphs and charts) to rule out central sleep apnea and see what's really happening with my breathing (centrals, hypopneas, central hypopneas, complex, cheyne stokes, shallow breathing, etc).

Why do you you doubt they would see something overlooked previously?

Are the latest ASV machines so smart that they give you different kinds of apnea track records that not even a sleep study does? Can a good machine replace a sleep clinic?

I don't need my health insurance to cover an ASV machine. As i said i'm doing all this on my own and out of pocket cause i haven't gotten any answer or treatment from doctors. That's why i go to a private sleep clinic where i don't need a prescription to get a sleep study and just ask for it and pay. I'm getting the ASV machine to try to self titrate and help myself.

I don't use the mask liners cause we don't have them here in Colombia, though i know i could buy them online. I do have leak issues with the Simplus, although it's been a good mask (the only one i can stand). What website do you buy these from?

I'm sorry for this long message.I hope you can give me answers to all my questions. Thank you for you time.

Thank you,

John.

[jerrydaw]

hi

I am a recent new user of the ResMes 10 ASV machine. I love it and have been using it for about 5 weeks. I prefer the ResMed to the Phillips as I detect a smoothness between the inhale and exhale that it not there with the Phillips. I started all this in January of this year, with a ResMed AirCurve 10 Auto. That was subsequently replaces with The AirCurve 10 VAuto. Finally, after all others did not work, it was replaced with the ASV machine. I am now averaging less than 1 event per hour.

There are not a lot of settings on the ASV machine. I have mine set in the ASVAuto mode. That takes care of all the centrals via the titration action. Other settings are minPS 4, max PS 15. Min EPAP 7, max EPAP 15. I use a 0 minute rampup time. The reason is that when I get up in the night to go to the bathroom, I shut the machine off and when I get back in bed and turn in back on, I do not want a rampup time to fall back to sleep. This is personal preference.

Shop around on the internet and you can find ASV machines for discounted prices. I should however caution you that most want a doctor's prescription before shipping the machine.

The ASV therapy is truly wonderful, and is a god sent blessing for us with centrals.

[vsheline]

Hi. Since Johnny posted his questions to me, I'll go ahead and post my lastest responses.

Take care, all.

Hi John,

The S9 ASV and A10 ASV use the same software algorithms and therefore will behave the same to your apneas. I think treatment with one won't be better than treatment with the other.

Your 750 series machine is a little older than the 760 series machines and does not support a heated tube. But in as far as data is concerned, they both offer a terrific amount of data.

I think probably would be better to wait until you've seen the data your machine can show you, before you buy another machine. An ASV machine is not best for everyone, but if it would be best for you the data in the 750 machine will tell us.

The data in the 750 will also show whether it is adjusted correctly for you, and if it isn't, how to improve the settings for you. If you sometimes feel choked on it, the data will help us see why, and how to improve the settings for you.

If the data shows lots of central apneas, an ASV might help a great deal. But if you are having all obstructive apneas then an ASV might not help. So be patient and wait for the SD card to come.

Take care,
---Vaughn

Vaughn:

Thanks for writing. I'll try to tell you what i thought of talking on the phone

I'm sorry to know about your hearing condition. I hope you get better or are handling that well now.
>> I'm doing okay. In a couple years I may look into cochlear implants. I'm already using the most powerful hearing aids available.

I read on another thread that there's such a thing as the complete sleep study or titration and that you can ask for it. Not just the report but the actual detailed graphics and charts. I also asked for this but they didn't give it to me, didn't pay attention. I want to have my actual breathing curves to see if some Doctor can look at them and tell me if i have centra sleep apnea (complex) or not.
>> I can help you find SD cards which will work in your present machine, and then you can see whether you have central apneas happening very often. (Nearly everyone gets at least a few per night, usually short, like 20 seconds.)

Also I read that there's another thing called a back up rate that one of the brands have it (Respironics?) and Resmed doesn't. What's this?
>> Both ResMed and Respironics ASV machines have an automatic backup respiration rate (breath rate), which is the speed at which the machine breathes for us when we are having a central apnea and are not breathing on our own. There is no need to set this manually, but if one wants to, only the Respironics lets us set it to a fixed, unchanging rate to use if we stop breathing on our own.

I was hoping we could talk about things like what brand and model of machine to buy, and whether you would help me set the settings of that one.

If i buy your same machine will you please help me set it and use it?
>> Don't buy the REF 36007. The 36037 is newer and better.

Why buy a machine that has the ASVAuto therapy mode (in addition to the basic ASV therapy mode)? I don't know about this, please explain this to me, how would this help?
>> ASVAuto mode will automatically adjust both EPAP (the exhale pressure) and PS (Pressure Support, the amount the pressure is boosted while we are inhaling). Basic ASV mode only automatically adjusts PS. It is helpful to know where the machine's treatment algorithm would set the pressures.

Why do you recommend buying the ResMed ResMed S9 VPAP/BIPAP Adapt SV Auto with Heated Humidifier - REF - 36037? Is there a particular reason for this? Is it because you have it and know have been successful with it and know how to use it?
>> You mentioned Secondwind, and used REF 36037 machines are presently available from Secondwind for a reasonable price. (I copied and pasted the description from Secondwind, of a "gently" used machine.)

I'm afraid if i buy the AirCurve10, although it seems like a better machine (Resmed's last and best model?), i won't know how to use it, or i will but not set it to the right pressure ranges for me.
>> Both the S9 and A10 work the same. No significant difference. The treatment algorithms were not changed between S9 Adapt and A10 ASV. I wouldn't say the A10 is better today, except you would likely be able to get an A10 repaired if it breaks down in a few years, but maybe not if it was an S9.

On the other hand reading from the thread i posted, i feel like this one, the 10, will give me more track records about the different kind of apneas (obstructive, central) and other events like Cheine Stokes, Shallow Breathing, Central Hypopneas, etc? Or will the 9 give me all this information as well?
>> Both S9 and A10 give this info, if you use the free SleepyHead software to read the SD card.
>> This is most important: your present machine can also give you all the same info, so you must get a 2GB full size (original standard size) SD card to put in your present machine, which is a very excellent and relatively new model machine.

I'm so bad at this and have never had a good newer machine that i didn't even know what a Centra Hypopnea was.
>> Hypopneas can be obstructive or central in type/cause.
>> Your present PRS1 BiPAP Auto machine can record waveforms showing every breath you take all night, and will flag/mark most (almost all) of the central apneas which are happening. So you don't need a special sleep study to find out if you are getting an excessive number of central apneas (more than 3 or 4 central apneas per hour of sleep).

Do you know what kind of SD Card does each one of these machines need? How many Gigas or Megas? My old Bipap only works with one that has to be of 2 Gigas and i haven't been able to get it cause they don't make them that small anymore.
>> They still make them that small. The newer machines can use the old 2GB and also higher capacities, but 2GB is large enough to use on the A10 series.

I've never been able to keep this apnea track records myself, and i need to do it. I think it's time, but i have to solve this SD card thing, or even better to get this newer better servo maching with a better newer SD Card system. I downloaded SleepHead but don't know how to use it, i've never used it.
>> After you get an SD card to put in your machine, there is a very good introductory beginner's guide to SleepyHead available on Apnea Board.

Can you post the apnea track records of SleepyHead or other software, the one you recommend using here, on this forum?
>> I recommend using SH with your present machine, and either SH or ResScan if you get a ResMed machine.

As for the AHI records of my machine, i don't have one. I've never done that. That's how bad of a user of cpap i am, how much i don't know. All i know is when i used to go to my last doctor he just took my machine and gave it to his secretary, who took the info out (not via SD Card) and so he knew about my apnea track records but never told me about them, just changed the settings of my machine every time.
>> It is easy to get the data off the SD card and into Sleepyhead software, which will plot the data for you/us to see.

What does it mean on your profile where it says Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)?
>> It means there are 3 models of S9 ASV machines, and I only recommend the later two, which I think are about equal.

Do you think it would be a good idea to buy both one machine by Resmed and another one (back up) by Respironics just to try both brands and therapies and see what feels better? Or probably buy the 10 and the 9 by Resmed? It will be more expensive, but it's my life and i know i'll eventually probably have to invest on this with time. But i don't know if for now that will be too much. I don't even know if ASV is for me. This will be a self titration thing.
>> Self titration is especially easy with ResMed ASV. I suggest getting only one, to start. If you like it, I suggest a second of same type, as a backup.

I've had a lot of trouble and bad luck with doctors here in Colombia, and I now what happened was i had to go through a normal cpap titration procedure cause i asked and that was their protocole. The only way to get a titration on a Servo machine was if i took a normal titration with cpap and they couldn't treat muy apneas with it. Then i would be prescribed with a servo titration with a special sleep technician who was the only one who knows how to do it at that sleep clinic.

I go to a sleep clinic that i have to pay out of pocket with where they kind of listen to me (even with all that trouble) cause the bureaucracy through my enssurance was even worse. I was several months trying to get the sleep study and titration and just couldn't get it.

And it's in general bad and not specialized like that the medicine for sleep apnea in sleep clinics here in Colombia. They don't consider my long difficult history with apnea, i'm just a difficult patient who doesn't wanna use cpap. That's why i wanna go back to the US and take a yet new sleep study if i'm lucky enough to find a good sleep clinic where they take into account my history and give me a detailed, full sleep study (with the graphs and charts) to rule out central sleep apnea and see what's really happening with my breathing (centrals, hypopneas, central hypopneas, complex, cheyne stokes, shallow breathing, etc).
>> Your present machine has central apnea detection. It can tell you whether you have mixed (central plus obstructive) sleep apnea.

Why do you you doubt they would see something overlooked previously?
>> Usually sleep apnea is only problem.
>> Before getting another sleep study or titration, it is impotent for you to look at the data which can be gotten from your present (very excellent) machine, using an SD card.

Are the latest ASV machines so smart that they give you different kinds of apnea track records that not even a sleep study does? Can a good machine replace a sleep clinic?
>> A sleep study is just one night. If sleep apnea is the main problem, a few weeks of data from a auto-titrating machine will usually be better than an overnight lab titration.

I don't need my health insurance to cover an ASV machine. As i said i'm doing all this on my own and out of pocket cause i haven't gotten any answer or treatment from doctors. That's why i go to a private sleep clinic where i don't need a prescription to get a sleep study and just ask for it and pay. I'm getting the ASV machine to try to self titrate and help myself.
>> First, important to look at the data your machine can show you/us.

I don't use the mask liners cause we don't have them here in Colombia, though i know i could buy them online. I do have leak issues with the Simplus, although it's been a good mask (the only one i can stand). What website do you buy these from?
>> RemZzzs. A "30-day supply" lasts me nearly a year.

I'm sorry for this long message.I hope you can give me answers to all my questions. Thank you for you time.

Thank you,

John.

[Johnny Bravo]

Hi:

So i finally bought the ASV machine from second wind cpap yesterday and today i got this mail from them:

Re: Notification of payment received
MR
Mark Seager RRT

We either need a copy of a prescription, or what we call a Physician Authorization Form (PAF), which is attached to this email. Many physician's will be happy to fill out the PAF, especially if you are currently a CPAP user, and are simply looking for a replacement or second machine. We get these PAF's returned to us on a regular basis. You can fax this documentation to 507-412-8249 or attached a copy to this email.

If you have any further questions, please let me know.

Mark Seager, Owner

I replied to his mail telling him that i don't have either a prescription, nor a current doctor now. He hasn't replied. I don't know what else to do at this point. What's gonna happen? Can he give me my money back?

Thanks,

John.

[Sleeprider]

I'm sure you can find a physician in Colombia that would listen to your symptoms and write you a prescription, or complete the form. Secondwind is a U.S. Durable Medical Equipment (DME) provider, and under U.S. law needs to have a physician's approval in order to dispense the equipment. This is true, even if the recipient is not subject to U.S. FDA regulations.

[vsheline]

Hi Johnny,

Tried to send you a PM but apparently you may need to delete some old ones before you can receive more.

Don't worry that you won't get your money back. If Secondwind decides they cannot ship, they will reverse the charges. But if you want them to ship the machine, go ahead and ask a doctor to sign the authorization for you to help you buy the upgraded CPAP machine.

Doesn't need to be a sleep specialist or anything; any helpful doctor or dentist can fill out the authorization for you if you ask them.

By the way, has your SD card arrived yet? What I really suggest is looking at the data on your present machine before buying another.

Be patient and don't give up.

Take care,
--- Vaughn