How concerned should I be about the length of these Centrals?

[Sleeprider]

Both machines are designed to target the respiratory rate and tidal volume. The algorithm is different due to patents, but results are similar. Resmed is much more automated, while the Philips requires more manual adjustments, but what I Told you about EasyBreath is accurate. You Are Used to Resmed, and the Philips does not come close for comfort.

The Philips allows manually setting BPM from 4-30, Ti between 0.5 and 3.0, and has BiFlex or rise time. All if this is handled automatically by Resmed, and the only setting that might affect tidal volume is Ti (time of inspiration). So far, that has not been a factor for you. She is trying to pull a fast one.

[LookingForward]

With all this information I would honestly try to seek out a MD/neuromuscular specialist. It's quite possible that you need a machine purely for mechanical reasons - to rest your muscles, not to treat OSA. Sleep studies are often not helpful because muscle weakness can be misinterpreted as OSA events when you don't take a breath because you physically cannot, not because of complex sleep apnea.

I have gone to several neuromuscular specialists. I was originally diagnosed at the Cleveland Clinic though genetic blood testing. More recently I've gone to the head Neurologist for the Muscular Dystrophy Foundation in Cleveland. They make it very plain that there is absolutely nothing that can to help with MD. There are not medications, diets or any amount of exercise that will either slow down or stop the progress. They said I'm on my own to figure out the best work-arounds to help myself. What works for one with MD, often doesn't work for the next person. They also tell me there is nothing new on the horizon either. At the end of the appointment, they generally charge a high fee just to tell me not to come back for a year. They do look for peripheral diseases that often come at some point because of the MD, but my primary care doctor can do the same. So I don't see the purpose of going back to neuromuscular.

What kind of a machine rests the muscles, an ST-A? Or are you talking about a ventilator?

Your knowledge in using a BiLevel machine with lung issues shows. I very much appreciate all of your insight.

[LookingForward]

Both machines are designed to target the respiratory rate and tidal volume.  The algorithm is different due to patents, but results are similar. Resmed is much more automated, while the Philips requires more manual adjustments, butmwhat Imtold you about EasyBreath is zccureate.  You Are Used to Resmed, and the Philips does not come close for comfort.   She is trying to pull a fast one.

Thanks so much SleepRider. I was with my two year old grand daughter when she called and didn't realize until later that she likely totally lied to me because she didn't want me requesting a machine. I figured when I go to pick up the new one, I'll ask for a copy of the prescription and ask her to show me the "special" setting that she was talking about. The look on her face will be interesting.

What do you think about the Tidal Volume from last night? That was much lower than the other nights.

[LookingForward]

Do you understand?  You do not need to make this change, but I'm trying to explain the respiration impacts of higher vs lower EPAP, and telling you the CA you had, was the result of too much PS.

Yes, I understand. I realize through all the knowledge on this board and for my specific threads, the CA is directly related to the high pressure setting and the PS 6. 

I very much appreciate your knowledge and all of your help. You specifically take the time to help so many people on this forum. Myself included. I learn just as much from the knowledge on everyone's threads. I would be lost without the valuable input these boards provide.

I feel more confident switching over to the new machine soon knowing that there is valuable help available here and I won't need to rely on trying to get my doctor to respond. 

If ASV machines weren't so costly, I would have bought one myself and no longer include the doctor, DME or insurance. Then I would have turned to this forum to help me find the right settings.

[Sleeprider]

I edited my previous post, so see the clarification. Your tidal volume has been 380 to 400. It is affected mainly by minimum pressure support, and we cut that back on your current machine due to your centrals. You originally had PS 6.0 with pressure at 18/12. Your Vt was 460 with PS 6.0.

With ASV, you will again set EPAP min to prevent any obstruction. I think that will be lower than your current 9.0 cm. PS min can be set to 6.0 for tidal volume, and EPAP max will be 10-15 as needed for centrals. You Will no longer have CA regardless of the pressure support used. Get your settings, and then you will know if the Dreamstation is being selected for valid reasons.

[SarcasticDave94]

As an ASV user, A FWIW: I cannot speak to experience in Respironics ASV usage, never had one, but I know Sleeprider is correct on the Respironics does have more MANUAL settings than that of a ResMed 10 series ASV like mine. That alone does not make the Respironics better (or worse). It just means you have a need to set more things with the Respironics vs the ResMed.

I have either 3 or 4 pressure settings, dependant on my MODE choice. My ASV modes are as follows: CPAP, ASV, and ASV Auto. I run ASV Auto. Obvious, but if you're getting an ASV, let's just scratch off choosing CPAP mode. When you get the ASV, assuming ResMed is given, as the patient that benefits from the therapy, please choose to run it in ASV Auto.

THE difference between modes ASV and ASV Auto is ONE setting modification that I know of. It is this: ASV pressure settings are EPAP and then a Pressure Support (PS) range of Min and Max. ASV Auto has exactly the same PS range, but it modifies EPAP to become a Min and Max range too. Results are better because there is a range where you set the minimum EPAP, which BTW is the lowest the machine will supply. Example is if you set EPAP Min to be 6, then 6 is what you feel when you first turn the machine on.

Look at my sidebar please...this is an example and I am not suggesting you duplicate these settings for your own therapy...I start at 9.8 EPAP, it then ranges to 13 as the Max EPAP. My PS range is 3-12. There are the numbers I plugged in to fill 4 pressure settings. Next setting to run? There are no more. Everything else is automatically selected via the ResMed algorithm that tracks my prior few minutes of breathing pattern; it considers that as what my breathing should be like, and it moves the pressure settings accordingly to be as close as what I just breathed like. Then, if there is an obstruction OR a central event, it adjusts accordingly. It just has those numbers to work on as boundaries of the low and high extremes that it won't cross.

Best to your success.

[LookingForward]

I had one big success today. I got ahold my physician's secretary and asked her if I could get a copy of the ASV Sleep Study and the Prescription for the machine. She had it ready for pickup in 30 minutes. 

This is the wording on the prescription that was sent to Lincare:

Please send to Lincare (PRIORITY/URGENT SETUP PLEASE)
PT having significant central apneas per download of BiPap (18/12 cm H2O) data, pt underwent PSG titration study 10/24/2018 with report showing: myotonic dystrophy, mild-moderate OSA, and treatment emergent central apneas with bilevel 18/12.

This AVAPS titration study showed adequate control of OSA and CSA with AVAPS using a Respironics unit with the following settings: EPAP 12cm H2O, IPAP min 17 cm H2O, IPAP max 25 cm H2O, Vtital 470cc, Ti nsp 1.5 seconds, rate 12 bpm. A small Simplus interface was used.

I assume that both the ResMed AirCurve ASV and the Respironics can do those settings, correct? 

Any input at this point about the final results?

What does Ti nsp 1.5 mean?

Does rate 12 bpm refer to the backup rate?

Was my study done only on the AVS mode and not ASV Auto?

[LookingForward]

As an ASV user, A FWIW: I cannot speak to experience in Respironics ASV usage, never had one, but I know Sleeprider is correct on the Respironics does have more MANUAL settings than that of a ResMed 10 series ASV like mine. That alone does not make the Respironics better (or worse). It just means you have a need to set more things with the Respironics vs the ResMed.

I have either 3 or 4 pressure settings, dependant on my MODE choice. My ASV modes are as follows: CPAP, ASV, and ASV Auto. I run ASV Auto. Obvious, but if you're getting an ASV, let's just scratch off choosing CPAP mode. When you get the ASV, assuming ResMed is given, as the patient that benefits from the therapy, please choose to run it in ASV Auto.

THE difference between modes ASV and ASV Auto is ONE setting modification that I know of. It is this: ASV pressure settings are EPAP and then a Pressure Support (PS) range of Min and Max. ASV Auto has exactly the same PS range, but it modifies EPAP to become a Min and Max range too. Results are better because there is a range where you set the minimum EPAP, which BTW is the lowest the machine will supply. Example is if you set EPAP Min to be 6, then 6 is what you feel when you first turn the machine on.

Look at my sidebar please...this is an example and I am not suggesting you duplicate these settings for your own therapy...I start at 9.8 EPAP, it then ranges to 13 as the Max EPAP. My PS range is 3-12. There are the numbers I plugged in to fill 4 pressure settings. Next setting to run? There are no more. Everything else is automatically selected via the ResMed algorithm that tracks my prior few minutes of breathing pattern; it considers that as what my breathing should be like, and it moves the pressure settings accordingly to be as close as what I just breathed like. Then, if there is an obstruction OR a central event, it adjusts accordingly. It just has those numbers to work on as boundaries of the low and high extremes that it won't cross.

Best to your success.

Thanks so much for the explanation of your machine, Dave. You show that your machine asks for PS minimum and maximum set in Auto mode. My sleep study shows EPAP the IPAP minimum and maximum with a backup rate.

Does my results show IPAP min and max instead of PS because a Respironic machine was used during the study? 

Do you use a BackUp Rate? Is that a separate setting on the AirCurve?

[jaswilliams]

There is no backup rate in the Resmed machines as the ASV uses the breathing rate of the last rolling 3 minutes and maintains the breaths at that.


Jason

[Sleeprider]

I had one big success today. I got ahold my physician's secretary and asked her if I could get a copy of the ASV Sleep Study and the Prescription for the machine. She had it ready for pickup in 30 minutes. 

This is the wording on the prescription that was sent to Lincare:

Please send to Lincare (PRIORITY/URGENT SETUP PLEASE)
PT having significant central apneas per download of BiPap (18/12 cm H2O) data, pt underwent PSG titration study 10/24/2018 with report showing: myotonic dystrophy, mild-moderate OSA, and treatment emergent central apneas with bilevel 18/12.

This AVAPS titration study showed adequate control of OSA and CSA with AVAPS using a Respironics unit with the following settings: EPAP 12cm H2O, IPAP min 17 cm H2O, IPAP max 25 cm H2O, Vtital 470cc, Ti nsp 1.5 seconds, rate 12 bpm. A small Simplus interface was used.

I assume that both the ResMed AirCurve ASV and the Respironics can do those settings, correct? 

Any input at this point about the final results?

What does Ti nsp 1.5 mean?

Does rate 12 bpm refer to the backup rate?

Was my study done only on the AVS mode and not ASV Auto?

They are in the process of prescribing an Assured Volume Positive Pressure (AVAPS) with base pressure of 17/12 and backup rate of 12 breaths per minute.  The prescription allows an IPAP to 25, which would mean iVAPS (automatic pressure support).  This is the same as PS min 5 and PS max 13 cm in ASV, but the machine is a variant of ST (spontaneous/timed).   The machines are either the Resmed VPAP ST-A with iVAPS, or Philips BiPAP AVAPS.  Philips does produce this machine in a Dreamstation series, but there is no Sleepyhead support at this time.  The Resmed ST-A is just like the other Aircurve 10 variations for VPAP, ASV, and ST.  Compare the links below

Get the Resmed.  https://www.resmed.com/us/en/healthcare-...0-sta.html
Here is the Philips https://www.usa.philips.com/healthcare/p...ventilator