ResMed AirCurve 10 ST-A vs Aircurve ASV

[modernsportscar]

Quick summary: I have UARS. Crushing EDS, etc. Started BiPAP Last month and symptoms are mildly improved but note close to ‘I can live like this.’ I am on a Dreamstation auto BiPAP and after some research, want to try a new machine rather than trial and error with my current unit.

It appears that the ResMed AirCurve 10 ST-A and Aircurve VSV are mostly commonly recommended. I assumed that the ST-A had a ‘VSV mode’ but can’t confirm that briefly skimming their user’s guide and further, am not sure if I’d even need VSV considering it has iVAPS.

Finally, is there a good argument against buying refurbished?

Thanks in advance for any information.

[Geer1]

Think you are getting models confused, I am not familiar with a "VSV". Maybe you mean ASV?

It is hard to make a recommendation without knowing the issues present in your breathing. UARS does not require an advanced machine like ST-A but I don't know all the effects the EDS could have on your breathing. You don't have much information (sleep study results) or OSCAR data available for us to help you make this decision.

Resmed Vauto is the preferred bilevel as long as backup rate is not required (can't treat central apnea).
Resmed ASV is the preferred bilevel for central apnea.
Resmed ST-A with iVAPS is only required in rare cases where spontaneous breathing effort is insufficient and you require a machine capable of maintaining ventilation.

[Sleeprider]

For an individual experiencing EDS or any respiratory disease or neurological disorder that affects tidal volume, and minute vent, the Aircurve 10 ST-A is far preferable over Adaptive Servo Ventilation (ASV).  This is especially true in the Resmed machine which does not provide settings for respiratory rate and volume. This is substantiated by the Resmed Sleep Lab Titration Guide https://document.resmed.com/en-us/docume...er_eng.pdf which gives criteria for the conditions the machines are intended to treat.  The Resmed Aircurve 10 specifically defends a patient's respiratory volume using pressure support to assist the ventilation volume and rate.  ASV is intended for central and complex apnea, and when used in respiratory disease or hypoventilation can fail to maintain the needed respiratory volume. 

As noted on page 28, the ASV is suitable for:
• Periodic breathing, both normocapnic and hypocapnic 
• Other forms of central and concomitant obstructive events1 (mixed sleep apnea) 
• Complex sleep apnea (CompSA)2

• ASV’s algorithm is not cleared or appropriate for the following patients:
- Chronic and profound hypoventilation
- Moderate to severe COPD
- Restrictive thoracic or neuromuscular disease 

On Page 34, the ST-A is suitable for:
• Neuromuscular disease and restrictive conditions – iVAPS can maintain stable ventilation when respiratory effort fluctuates1
• Obesity hypoventilation – Unlike standard Pressure Support therapy, iVAPS can compensate for changes in respiratory mechanics, such as during nocturnal changes
in the patient’s body position1
• Chronic obstructive pulmonary disease – iVAPS may reduce the risk of hyperinflation associated with increased respiratory rate and can compensate for changes in a patient’s chronic airflow limitation1

While EDS is not specifically discussed in this reference, the neuromuscular disease and restrictive conditions apply. The iVAPS algorithm can help your doctor to target a specific alveolar vent rate and is most appropriate for EDS.

Use the reference to learn more about how each machine works, and feel free to come back and ask any questions. Buying a used or refurbished machine is a great idea, and you will find a couple ST-A models on Dotmed for $1900 to $2000 with 1995 and 40 hours respectively.

[modernsportscar]

I'm very sorry I was too casual with my initialisms--in this case, by 'EDS' I meant 'excessive daytime sleepiness.' My diagnosis is UARS.

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    I'm very sorry I was too casual with my initialisms--in this case, by 'EDS' I meant 'excessive daytime sleepiness.' My diagnosis is UARS.

edit: OSCAR is, however, telling me that I may have a problem with variable breathing (which sounds a lot like periodic breathing).

[Sleeprider]

That makes a pretty big difference. Your needs can be fully met by an Aircurve 10 Vauto and the Airsense 10 Autoset CPAP would be a big improvement over your Philips CPAP. We should take a closer look at your respiratory flow rate examples where you think UARS or flow limitation is occurring. Both ASV and ST-A is overkill.

[modernsportscar]

See attached.

I’m hugely appreciative of any insights. I know Dr Krakow, for example, recommended ASV for optimal UARS treatment. I’m not rich but considering the level of my suffering and it’s effect on my life, money is the least of my concerns. If one machine offers a benefit to my sleep/neurological health, I will pay the $1500 (or whatever) difference.

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Think you are getting models confused, I am not familiar with a "VSV". Maybe you mean ASV?

It is hard to make a recommendation without knowing the issues present in your breathing. UARS does not require an advanced machine like ST-A but I don't know all the effects the EDS could have on your breathing. You don't have much information (sleep study results) or OSCAR data available for us to help you make this decision.

Resmed Vauto is the preferred bilevel as long as backup rate is not required (can't treat central apnea).
Resmed ASV is the preferred bilevel for central apnea.
Resmed ST-A with iVAPS is only required in rare cases where spontaneous breathing effort is insufficient and you require a machine capable of maintaining ventilation.

Yes, I meant ASV. Sorry. Here is a recent night’s sleep with machine/settings info attached.

Also, I currently have a BiPAP.

[Sleeprider]

I'm familiar with the ASV recommendation. Our wiki article on UARS and bilevel is also by Dr. Krakow. I have seen members with UARS that have adapted to ASV very well, and others that had a lot of sleep disruption problems. The use of bilevel is clearly indicated to help overcome inspiratory resistance, but ASV comes in when the pressure support needed for flow limitation triggers central apnea or periodic breathing events. http://www.apneaboard.com/wiki/index.php..._and_BiPAP I have not seen enough of your data nor seen your response to pressure support to know how you would respond. What we know is that your Dreamstation is just about the worst choice for this problem.

[Geer1]

Your data doesn't indicate anything that makes me think ASV would be helpful or necessary. The reason Krakow recommends it for some cases is because it is capable of rapidly responding to obstruction/restriction but that doesn't appear to be your issue (based on couple examples in your other thread).

If anything it looks like different timing controls might help you and that is something the vauto has but ASV does not. Imo the vauto would definitely be your best option.

[modernsportscar]

Thanks for the information.

Is the Dreamstation’s deficiency based on its design, missing features, or something else? It is an AutoBiPAP, for the record. I have been making minor adjustments on minimum EPAP and PS to try to find a result that will produce restorative sleep.

The screenshots I’ve attached show what seem to be significant variable breathing issues—or maybe that’s not abnormal? I obviously don’t know, which is why I’m here. : )

As far as the ASV causing problems, I definitely don’t want to spend thousands of dollars and make the issue worse but it just might be I have to risk that in a trial-and-error approach. 

Ideally, I can use the machine I have but again, I’m more than willing to spend the money to get what I need.

[Sleeprider]

The variable pressure support on the Dreamstation is not targeted to flow limitation. More importantly, you don't have options for trigger and cycle sensitivity (mostly trigger), and the timing for inspiration minimum and maximum. Finally, the Easybreathe™ pressure shaping just works better. You have to look at mask pressure to see it.