In my situation (described within) which is better: S9 or Aircurve 10?

[erouting]

Hi All,

Sleeprider suggested I get either a Resmed Aircurve 10 ASV or a Resmed S9 VPAP Adapt. I've been trying to figure out which. 

Background: I have a doctor who won't give me my raw test results to prove up his claim that I have central sleep apnea, even after complaints to regulators, threats of legal action and (so far) complaints to politicians. I may or may not have central sleep apnea, but I'm not going back to that doctor. This means another 3 month wait to be seen by someone in the next closest city who takes medicare. 

Some things don't seem to add up about this diagnosis, doesn't rule it out, but would mean that I'm atypical if the diagnosis is correct. I don't take naps. I make a point of not breathing and measuring my O2 the instant I wake up in the AM (I have an o2 monitor mounted over my head so I wake up and have it on in a few seconds) and it's been between 93%-97%, which is odd if I'm being woken up by low oxygen. I don't wake up gasping for air. I'm tired but I have Asthma, Autism, MDD and POTS, all of which can cause exhaustion. The only thing I've found that supports the diagnosis is that I don't breathe as I'm falling asleep. I use a meditative trick to wake up from that state with a pulse oximeter on and there my O2 can fall as low as 73% but once O2 gets below about 88% it rapidly crashes, in a few seconds, to that level, possibly because pulse oximeters lose accuracy at lower readings. But I've also read that not breathing during the transition state from wakefulness to sleep is normal and not, in and of itself, a diagnosable condition. If that's true, I have the word of one doctor (who won't follow state and federal medical records laws) that I have this condition.

For now I'd rather not buy a new Aircurve 10 because 1) I may not have CSA and 2) if I do medicare will buy me one assuming I can find a doctor who isn't terrible to work with. I'm disabled and poor. There are very high hour S9 VPAP Adapts on dotmed. I was thinking of buying two of them (one to use and one for parts, they're really high hour, like 13,000) to get me through the next three months, about the time it will take to get in with another provider. But I want data on what the machine did. Is the data produced by the VPAP Adapt the same or worse than the data produced by the Aircurve 10? Am I right in thinking that the asv records when it helps me breathe so I could then use that data to prove that I do (or don't) have CSA to the next provider? Is one machine more reliable or better than the other?

In my situation what would you do? 

Thank you very much for your time, and to Sleeprider and the other forum members for all their advice, it has really helped me.

[pholynyk]

I think the data produced is nearly the same, but I would have to see if I have any VPAP Adapt files I can compare with the ASV files. It's late here, so I will have to put it off until tomorrow.

[erouting]

Thank you, I'd really appreciate it if you're up to doing that. 

Otherwise I"m inclined to accept your recollection and just go with an older unit. I think they can both be adjusted and have similar settings so as long as the data is close to the same that's all I need.

[Jay51]

erouting, I have an s9 adapt asv I purchased inexpensively from Craigslist.  Great little machine IMO.  A major difference between the s9 adapt and the Aircurve 10 ASV is the EPAP settings.  The s9 only has a single setting for EPAP (only can enter one digit:  6.8, 7.6, 8.0, etc).  It can go from 4 up to probably 15 or so I guess.  The Aircurve 10 has a self titrating EPAP.  You can set the min to the lowest (4) and max to however high it goes (15 or so for example).  

If you get the s9, you will need to experiment to find your sweet spot EPAP.  That is relatively easy.  If your EPAP needs to change during the night for any reason though, it cannot and won't change.  With the Aircurve 10, your EPAP self titrates all night long (goes down when you don't need much pressure; and increases if you need more pressure to keep your airway open.) 

The pressure Support (PS) functions the same on both machines (has a minimum and maximum setting).  Pressure support + EPAP = IPAP.  

You may prefer a single digit setting like the s9 as some people say having a fixed number is easier to sleep with than a flucuating EPAP.  With the Aircurve 10ASV, you can have an EPAP range or set it to a single digit (just set the min and max EPAP as the same number).  

s9 is less expensive.   I do not intend to confuse you, but wanted to let you know this before you made your purchase.  If you have any questions, feel free to ask.

[Sleeprider]

The S9 VPAP Adapt came in two flavors. One was a fixed pressure ASV as described by Jay51, but later models had Auto ASV. Both are adaptive servo ventilators that provide breath by breath correction of periodic breathing and central apnea. I do not know what refinements are available in the Aircurve 10 ASV, but the machines are functionally the same. The ASV model is #36007 and the Auto ASV is #36037. The 36007 has ASV mode, and the 36037 has ASV and ASVauto modes. Other than the capability to set a range for EPAP, the machines have the same therapy algorithms. Either would be capable of treating central or complex apnea, however the EPAP pressure would need to be manually titrated in ASV mode, high enough to stent the airway and prevent obstructive apnea. Given your intention to determine whether ASV is an appropriate or effective therapeutic device for your issues, either one would answer that question. There is a significant price difference between the 36007 and 36037, with the latter approaching the price of an Aircurve 10 ASV which is the most expensive of these ASV capable machines.

A point of clarification. I have not suggested you need ASV, but I did point you the direction to obtain one if you feel the need to try it. We have not actually seen any diagnostic data or CPAP data or any other evidence that you actually have central sleep apnea or periodic (CSR) breathing, and your original post indicated daytime desaturations while away that are not sleep disordered breathing at all. Just so we are straight, I am an enabler of your desire to try this, but not not making a personal or medical recommendation.

[Gideon]

Do note that the Air curve ASV does not show Central Apneas in the data. It does do an excellent job of treating them. So much so That AHI often approaches zero. To my knowledge the same is true of the older machines.
You obviously have other threads I have not sought out but without data our hands are somewhat tied.

The typical toad to get an ASV is long and difficult often with acquiring and failing at several different machines, CPAP, BiLevel without Backup, BiLevel With Backup, then finally succeeding with a inlab Titration study on ASV to prove efficacy, that it works. These CPAPs and BiLevels do log and show centrals.

[erouting]

Sorry for the delay in following up, my POTS has been acting up these last few days and I couldn't think. I'm very grateful for the information all of you have taken the time to share and I felt bad not being able to reply before now. 

@Jay51 - Thank you very much for the write up. This is really helpful. I think I'll go with an S9 for now.
 
@Sleeprider - As always, I really appreciate the information. Sorry for any confusion I caused. I thought that the background I had provided would make it clear that you weren't telling me to do anything, just sharing your knowledge. I regret that I gave that impression. I just wanted to give you credit for sharing your knowledge. And you're correct, we absolutely don't know anything about what I have given the questionable conduct of the sleep medicine provider to date. 

My doctor ordered an overnight O2 test, the reasoning being that it's a pretty simple way to confirm desaturation without having to deal with the sleep medicine clinic. Apparently there's another sleep medicine clinic in town. I called them. They expressed extreme confusion that anyone with CSA would be fitted with a CPAP during a sleep study and assured me that, if the O2 test supported the idea that I was having desaturation, any sleep studies they ran would be with bipap and then with ASV. Obviously I'll be insisting on an ASV because I refuse to undergo the torture others have described on bipap for no good reason. If not I'll play in my own sandbox. 

@Gideon - That's very good to know, thank you for telling me. 

It's also very odd. Why wouldn't they record that data? Is there some design logic there that escapes me? Or is it just an assumption that anyone on an ASV is mostly central and only obstructive is logged with any pressure change in the absence of an OSA log indicating a central event? Did resmed do that to stop people like me from proving up the need for an ASV without buying a CPAP and BIPAP first? 

I had another thread, but it was started over a week ago and had been dormant for a while. I thought that was long enough to justify starting a new thread. I'm sorry if that was not the case. I did read the rules but I may have misunderstood their intent.

[erouting]

Rather than starting a new thread...

Got my doctor to order an overnight O2 test. The device I was given was an Virtuox VPOD ultra. I'd like to pull the .spo2 files but can't figure out how.

OSCAR, SPO2 Assistant and Smart Assistant all see the device as a 50I, all of them can list the sessions on the device but they fail when I try to download any of those sessions. Device also doesn't show up as an external drive on either Windows or Linux. OSCAR remains responsive when I try to download a session and just displays "waiting for the device to start the upload process" forever. The other two programs freeze up and then state that the device isn't responsive. 

Does anyone know a way to pull this data?

Thank you for your time.