New to all of this… confused which machine to get

[cmarshall234]

Hello all, 

Finally bit the bullet and got a sleep study done through an at home test. Results came today and it seems worst case scenario. Dr is recommending a Bipap machine. I’m confused about which to get. 

I’m looking at the Resmed AirCurve, and I was told by the “coach” I called that I should get the VAuto, but I’m reading that now that might not be for me since I have some central apnea? 

Forgive me if I’m missing details or doing something wrong… new to all of this and just want to get started in the right direction asap.

[Deborah K.]

If I am reading their report correctly they want you to have a titration study.  If so, ask them to test you on a ResMed ASV machine as well as the ResMed Bilevel machine.  That will make it clear which machine you need.

Good Luck!  

[cmarshall234]

Thanks for your reply. I was hoping to just jump straight into getting a machine. My sleep is so bad, it’s affecting my quality of life and my partner’s as well. 

I’m also doing this all without going through insurance, so there are some budgetary constraints.

[Sleeprider]

Request a split titration study based on spontaneous bilevel and ASV. If you want to jump into therapy, request a prescription for the Resmed Aircurve 10 or 11 ASV. Most people do well with the default ASVauto mode at EPAP min 5.0, EPAP max 15.0 PS min 3.0, PS max 15.0. It will certainly work, and we can help you to optimize settings, but it's very unlikely insurance will reimburse for ASV without a proof you failed to have efficacy with CPAP/spontaneous BiPAP.

[cmarshall234]

Request a split titration study based on spontaneous bilevel and ASV.  If you want to jump into therapy, request a prescription for the Resmed Aircurve 10 or 11 ASV. Most people do well with the default ASVauto mode at EPAP min 5.0, EPAP max 15.0 PS min 3.0, PS max 15.0.  It will certainly work, and we can help you to optimize settings, but it's very unlikely insurance will reimburse for ASV without a proof you failed to have efficacy with CPAP/spontaneous BiPAP.

Thank you so much! So you wouldn’t recommend the VAuto to get started with?

[SarcasticDave94]

With the diagnosis including Central Apnea, there's a few things to recognize. Most doctors that order sleep studies have this aversion to recognize Central Apnea as an issue needing treated, or some form of failing to offer treatment for the CA.

This diagnosis indicates a few things: you have some Central Apnea needing treated, they were enough for the doctor to diagnose, this doctor seems to recognize they're a problem.

I've used the word treat a few times already. Regular CPAP, bilevel without backup breath rate like the VAuto or higher devices like ST, cannot treat Central Apnea. They can, in various levels of success, avoid some CA but never treat them. This is the difference with an ASV, it specifically treats CA and everything else Apnea too.

ASV is not for everyone though, so it's not suggested for all Apnea patients.

The normal insurance path is fail CPAP, fail VAuto, likely forced to fail ST, then success with ASV.

Info from a guy that has used an ASV 2 years successfully until COPD got a bit worse.

Best answer when you get an ASV is get a ResMed AirCurve 10 ASV.

[Sleeprider]

Everything Dave said. The Vauto provides the benefits of CPAP therapy and throws in pressure support that can help with flow limitation, RERA and hypopnea related to obstruction. The device relies on spontaneous breathing, which means it is not generally useful for CA. What we can't know, is whether it will work for you to resolve CA events. Insurance generally requires that patients start on CPAP and demonstrate they don't tolerate it or can't achieve efficacy with it. We have a lot of members that have used the Vauto and overcome mild to moderate CA events using that device. The Vauto has controls that increase the trigger sensitivity, to make it "trigger" IPAP with very low levels of spontaneous airflow. This is often enough stimulation to cause the user to take a normal spontaneous breath when they might otherwise have a central apnea or hypopnea event with a normal or medium trigger level. We have done this to help hundreds of individuals with mild/moderate or therapy onset CA successfully use the Vauto. If you want to take the risk that it may not relieve the central component of your sleep disordered breathing, we can help you to optimize it. There are also some tools like "Enhanced Expiatory Rebreathing Space" (EERS) that can increase CO2 and stimulate breathing volume and rate. Not bragging, but we're way ahead of the game most sleep specialists play. So we can probably significantly improve or resolve your problems with a Vauto, but you have to go into it knowing the Vauto is not intended to treat central apnea. All that said, it is very likely you will be required to trial a CPAP or bilevel before being approved for ASV, and in that case, the Vauto is by far your best choice.

[Deborah K.]

If you are not going to use insurance, you need to wait for the results of the titration study.  Otherwise, you might end up buying the wrong machine.

[cmarshall234]

Everything Dave said. The Vauto provides the benefits of CPAP therapy and throws in pressure support that can help with flow limitation, RERA and hypopnea related to obstruction. The device relies on spontaneous breathing, which means it is not generally useful for CA.  What we can't know, is whether it will work for you to resolve CA events.   Insurance generally requires that patients start on CPAP and demonstrate they don't tolerate it or can't achieve efficacy with it.  We have a lot of members that have used the Vauto and overcome mild to moderate CA events using that device. The Vauto has controls that increase the trigger sensitivity, to make it "trigger" IPAP with very low levels of spontaneous airflow.   This is often enough stimulation to cause the user to take a normal spontaneous breath when they might otherwise have a central apnea or hypopnea event with a normal or medium trigger level.  We have done this to help hundreds of individuals with mild/moderate or therapy onset CA successfully use the Vauto.  If you want to take the risk that it may not relieve the central component of your sleep disordered breathing, we can help you to optimize it.  There are also some tools like "Enhanced Expiatory Rebreathing Space" (EERS) that can increase CO2 and stimulate breathing volume and rate.  Not bragging, but we're way ahead of the game most sleep specialists play.  So we can probably significantly improve or resolve your problems with a Vauto, but you have to go into it knowing the Vauto is not intended to treat central apnea.  All that said, it is very likely you will be required to trial a CPAP or bilevel before being approved for ASV, and in that case, the Vauto is by far your best choice.

Thank you so much… this is very valuable information. I’m really excited and grateful for this board and recognize that (like you said) I’m probably getting better recommendations here than from a single sleep specialist. 

I have the fortunate opportunity to acquire an AirCurve 10 VAuto for next to nothing, and since I’m not going though insurance, I’d like to jump on it. 

Thank you so much to everybody who responded and guided this newbie this far. Very thankful that a community like this exists and looking forward to getting more knowledge and advice. 

Side note… where do I go from here once I get up and running? I assume uploading my machine’s statistics (OSCAR, etc) and seeing what everyone thinks?

[Sleeprider]

Get the machine, erase all data in the settings. Configure for the correct mask (full-face) and start with these settings:
Mode: Vauto
EPAP min: 5.0
EPAP max 10.0
PS: 3.0
Trigger Sensitivity: Very-High
(default Ti-min 0.30, Timax 2.0, cycle: medium).

Sleep as best you can and post a chart. We will go from there.