[Equipment] AirCurve 10 ASV vs DreamStation ASV treatment of centrals ?

[mmannari99]

These two ASV manufacturers treat central apneas differently. I'm wondering why.

The ResMed machine documentation claims to "solve" all instances of central apneas and so does not report them.
The PR machine tries to identify a central by sending a test pressure pulse to determine if the airway is "clear" or "obstructed". If the test comes back as clear, they report a Clear Airway Apnea or CAA.

My home care provider, who I generally don't believe as he has not been real accurate, says that even though the PR ASV reports a CAA event, he says they still "solved" it by providing the ASV backup pressure. This makes no sense to me. Why would a CAA be included in a residual AHI report if they took care of it?

I'm currently try to readjust to a replaced PR DS ASV and it has been showing a moderate number of CAAs, last night my CAI or Central Apnea Index was 4.3 (according to Oscar). 

I'd appreciate anybody's thoughts on this topic.

[Sleeprider]

In the case of Resmed, FOT (forced oscillation technique) is used to differentiate the type of apnea. Philips uses a pulse. There is really no time in ASV therapy to make the machine response dependent on the pulse or FOT test, so Resmed just leaves it out and counts a UA (unidentified apnea) ancm od applies up to the full PS setting. If a breath does not occur, even with 15 cm of pressure support, it is most likely obstructive, and the Resmed ASV increases EPAP pressure in ASVauto mode.

To be honest, we're still trying to figure out what the Dreamstation Auto SV does. To say the least, Philips does not publicize it's approach to therapy. It would be great to see some charts including the events, flow rate, mask pressure, and anything else you think is relevant.

[mmannari99]

To: Sleeprider:


I love this website, thanks much for responding. I am happy to include data & charts for you to look at.
My apologies for repeating some background info on me from a previous Software Forum post, but it may be relevant here.

I responded to my wife's complaints about my snoring and "appear to stop breathing then gasp awake" events late last year.
1st overnight sleep test, at home, diagnosed me with untreated severe OSA, AHI of 41.6, 373 OSAs, 9 Hypopneas, no centrals.
2nd overnight sleep test, at a lab, CPAP 5-6, then BIPAP 4/8 diagnosed me as also having Complex Sleep Apnea, AHI 23.4, 72 centrals, 2 mixed, 1 OSA, 6 Hypopneas. Slept hardly at all during entire test.
3rd overnight sleep test, at a lab, BIPAP ASV at final pressures of EPAP 9/15, PS 0/15, MAXP 30, BIFLEX 3, RATE Auto, AHI was 0.6, 0 centrals, 0 mixed, 0 OSAs, 1 Hypopnea, 0 RERA. Again slept hardly at all, only 5 minutes REM sleep, 95 minutes total sleep out of just less than 8 hours of testing.

Started on PR DS BIPAP ASV 4 months ago, with ffm, leaked badly, woke me up from high pressures, only 1 time in 1st 3 weeks did AHI drop below 5.0 (4.8), AHI averaged 11 for those 3 weeks, OSA/CAA/Hypopnea indexes averaged 0.6/6.0/4.7. 

Got no help from doc or home care provider so I changed masks to Dreamwear nasal cushion. Less leaks right away. AHI averaged under 4.0 for next 2 weeks. Still getting woke up often (me & wife), sleeping very poorly from frequent high pressure spikes, up to 27. So, on my own I dropped the pressures to EPAP 4/6, PS 0/2, MAXP 8. Started sleeping longer and somewhat better, at least for the first half of the night. AHI remained under 5.0 for next 4 weeks. OSA index was usually 0.5 or less, but continued to frequently get moderate numbers of CAAs (index average 1.2 to 3.9) and large numbers of Hypopneas (index average 3.0 to 8.6).

My PR DS then broke, had to use a ResMed AirCurve 10 ASV for 2 weeks, still using the DW nasal cushion. Could not duplicate my exact low pressures cuz ResMed limited the minimum Ps to 5.0. So I set the machine to EPAP 4/4, PS 0/5, MAXP 9, AUTOASV. By the second week I was sleeping GREAT, OSA index still less than 0.5, Centrals at 0, still large # of Hypopneas (average was over 4.0). My leak rate, as reported by the ResMed Air app, was excellent, as low as 1.2 L/m, averaging 8.1 the last 7 days with this machine after I found a way to get the nasal cushion to fit moe snugly to my nostrils.

When my PR DS replacement was available (just last week), I debated keeping the ResMed, but did not and swapped them. Not sure if that wa a mistake or not. Struggled for most of this 1st week back with the DS, with the same settings as ResMed it seemed way too noisy and the pressures felt much higher. My AHI for this last week (6 of 7 days on PR DS) was 12.1, OSA/CAA/Hypopnea indexes 1.6, 0.6, 8.6. I cannot get the leak rate below 20 L/m with this machine and the same DW nasal cushion mask.

I continue to fool with the pressures, last 2 nights was set at EPAP 4/4.5, PS 0/3.5, MAXP 8. Last night was 1st night of semi-decent sleep with the replaced PR DS.

My main continuing problems are 1) sleep well for first 3-5 hours, then poorly for rest of night, 2) continuing high # of Hypopneas, 3) occasionally moderately high CAAs, 4) on poor nights my Periodic Breathing percentage jumps way up, sometimes over 20%, 5) high leak rates. My OSA and snoring problems have been solved.

Couple more probably relevant things about me relative to my sleep apnea.....
I have a beard, am a very light sleeper, have always had a tendency to wake up in middle of night with an "active brain" (am a retired systems engineer who loves to research stuff), was recently diagnosed with a deviated nasal septum and enlarged turbinates, and generally roll from side to side frequently during the night.

I've attached the following 3 charts:
Oscar Daily Report for last night (June 8 evening to June 9 morning)
Encore Pro 2 Details Report for June 2 -June 8 (with just 1 day of details for last night June 8)
Encore Pro 2 Waveform Report for last night, June 8

Many thanks for your time spent reviewing.
Mark


  EncorePro 2 Detail-Mannarino-Jun-9-2019.pdf (Size: 676.97 KB / Downloads: 31)

P.S. Am having trouble attaching files....says Oscar and Wafeform file "types" limit its 1024 KB ?

[mmannari99]

Will try to attach two files for review that I was unable to previously attach.....Nope, won't attach.

I previously deleted all past attachments so my allocation is currently less than 700 KB out of the 20 MB allowed.
The two PDF files Im trying to attach are 1.8 MB and 2.7 MB.

Apparently the size limit on any one file is 1 MB, is that right ?

[Sleeprider]

I'm glad to try to help optimize therapy, but you already found what worked. Maybe ask for the Resmed based on the excellent results and better comfort. I can understand the supplier not wanting to play musical machines, but your doctor could help you with this argument. Your settings were extremely unusual for ASV, with EPAP 4-4, PS 0-5, maximum pressure at 9.0. With EPAP set to a fixed range, you don't need the ASVauto mode, and the pressure support is not high enough to trigger a breath. If you're not getting apnea with those settings, then I would say your complex apnea may be resolved with CPAP at a low pressure. Your machine has a CPAP mode, and you might want to try using it at 4.0 and see what happens.

[mmannari99]

Thanks for the suggestions. 

[mmannari99]

My bad  I did not read the instructions for attaching files.

Im going to post an Oscar Daily report in another thread and ask about high Hypopneas.

[jaswilliams]

Just a note on DS leaks, the Dream station includes intentional leak in its figures so a leak of 20l/m is not a leak, just normal mask venting, Large leak does not occur on the Phillips until leak is in excess of 60-70 l/m based on your pressure and mask type


20 l/m is great

[mmannari99]

Thanks for the info