What is the best machine today for both COPD and Sleep Apnea?

[BrainFog]

        I am in the process of buying a new machine. I wanted to ask the community what your personal opinion might be in regards to the best machine on the market today for the treatment of a person who has both COPD and Sleep Apnea before I buy a new and very expensive machine.
 
I was diagnosed about January 2017 with both COPD and Sleep Apnea. (This condition is sometimes called the Overlap Syndrome or the Deadly Duo). I have been using a DreamStation Pro CPAP machine set at a fixed pressure of 14 (cmH2O) and 4 liters per minute of oxygen which is fed into an oxygen port connected to an unheated hose from the CPAP machine to my mask. This treatment has been effective, but I am hoping to find a better treatment solution. I am not looking specifically for any comfort type features, but not opposed to any of the comfort features. I want to find a machine that will give me the most effective treatment and maybe extend my life.

I have spent many hours researching and trying to find the best machine and treatment options for me. It seems the newer machines are much more high-tech and have more setting options. The more current machines have advanced considerably compared to the DreamStation machine I started with in 2017. However, it seems the higher end machines in the 2020 market have become much more controversial within the medical community. 

I am leaning towards buying a ResMed AirCurve 10 ST-A. Some say the ResMed ST-A is the minimum machine I should buy.

I am also considering the ResMed S10 AirCurve AVS. I have read the AVS type machines are not recommended for people with COPD. However, others say: this machine is excellent for central apnea (which I do not have) and should only be used if your COPD disease hasn't progressed to GOLD 2 standard or worse. 

I spoke with a licensed respiratory therapist. She was also undecided and was as confused as I am if the AirCurve 10 ST-A or if the S10 AirCurve AVS would be the best machine for me because she said each person's results vary. Both of the above machines cost over $3,000.00.

Others have recommended the ResMed Stellar 100 or 150 and the Astral 100 or 150. (The Astral 150 is supposed to have more flexible setups, but costs about $15,000.00). Others have recommended a NIV type machine which I am just starting to read and learn about.

I also need to consider if the newer OSCAR software will be compatible with my new machine. It important for me to be able to track my results so I can stay motivated and make changes as needed. I have found none of the manufacturers of the machines offer much in their reporting software capabilities and nothing I have ever been able to find even compares to newer OCSAR or the older Sleepyhead reports.

My biggest concern is my breathing will probably get worse in the future. COPD is a progressive disease, there is no cure for COPD, and COPD continually gets worse until you die. Most of the medical profession say 40% to 70% of people die within 5 years of being diagnosed with COPD. However, there are some people that have lived with COPD for over 20 years and are still running in 5K marathons. So, I am thinking of having a machine with lots of flexibility is going to be an important feature for me now and in the future.

Any ideas, recommendations, or comments will be greatly appreciated.
 
Thank you for your time reading this and helping me find a machine,
BrainFog
 
 
PS. I have attached a sleep study Dated 8-23-20. This study was done with only room air and without any CPAP or oxygen assistance. With CPAP and 4 liters of oxygen per minute, I am usually able to get my AHI to be about 2 to 3 per hour and I can usually keep my oxygen level above 88% about 80% of my sleep time. I usually do not need oxygen during the day.  

[SarcasticDave94]

This is what I stated in a PM that was requested be sent to you in answer to the question at hand. After the quote I'll clarify or edit the answer that reflects what I've seen in the sleep study pages you've posted.

"First off, I have had that same ASV from ResMed you're looking at. For central apnea it's excellent. If you mix in COPD then it can work if your disease hasn't progressed to GOLD 2 or worse. Remember COPD is rated on the GOLD standard of 1-4 with 4 as the worst. Going by worst case scenarios, if you've got respiratory Overlap, as in apnea and COPD, the ResMed ST-A is the remaining good choice if you're staying in the CPAP family of machines. However if your COPD symptoms have progressed much, you may need an NIV ventilator.

Here's the progression of machines from least to biggest for COPD: ST I'd rule this as a no-go, it's old style straight 2 pressure with backup rate. At a minimum it's the ResMed ST-A. Next is in between called a ResMed Stellar 100 or 150, 150 is more flexible, then the big one Astral 100 or 150, again 150 has more flexible setups.

If you go ASV the ResMed 10 ASV is missing timing controls which I believe is necessary for COPD treatment. Remember "O" is obstructive which means your inhale to exhale times are not the same as normal breathers.

I prefer ResMed and these are the ones I've found. BTW Non US has Lumis. This is typically equal to ST-A.

More info, I'll be glad to help more."

What I saw in your sleep study is you've no CA or central apnea, so the ASV is out. You're dealing with the respiratory overlap in the sense you have COPD/Obstructive Apnea. You need a machine that has timing controls for breathing in my experience, but not one that is geared towards Central Apnea treatment so that's why the ASV is ruled out.

The ResMed ST-A makes sense in several ways. It is smarter than an ST for one. ST-A has ResMed's version of AVAPS called iVAPS or intelligent VAPS. It should have all the pressure and timing settings you should need.

If your COPD is a moderate or severe case, you may need something more like an NIV ventilator. Maybe that is the Stellar 100 or 150, but definite on the Astral 100 and 150, all are ResMed products as well. Stellar are a step above CPAP and a step below the Astral NIV/ventilator.

PS my own COPD diagnosis was about 4 years ago, supposedly caught early by constant complaints by me on trouble breathing. I take 2 daily long term inhalers; currently these are Spiriva Respimat and Breo Ellipta. I have Ventolin rescue inhaler and a new nebulizer with what my DME calls duo-neb or Ipratropium Bromide.

[SarcasticDave94]

The ST-A is fully supported by OSCAR as seen here

"Here's the answer in PM but it'll be out in the public thread too. The ResMed ST-A is fully supported on current OSCAR.

From the OSCAR support page
"Resmed Machines
Fully Supported by Oscar
The following machines have been tested and are supported by OSCAR v1.1.0

Resmed Airsense 10 and Aircurve 10

Airsense 10 Elite
Airsense 10 Autoset
Airsense 10 AutoSet for Her
Aircurve 10 S (Lumis 100 VPAP S)
Aircurve 10 ST (Lumis 150 VPAP ST)
Aircurve 10 ST-A (Lumis 150 VPAP ST-A)
Aircurve 10 VAuto
Aircurve 10 ASV (PaceWave CS)" "

Americas get the ResMed ST-A and other markets like Europe etc get Lumis as I understand it. They are the same just a name change.

[Sleeprider]

Brainfog, if you have not read through the Resmed Sleep Lab Clinical Titration Protocol document https://www.resmed.com/us/dam/documents/...er_eng.pdf That is definitely mandatory reading. You are of a completely inappropriate CPAP machine at this point and I would consider the Vauto as the minimum level of bilevel that should give you decent results. At least with that, we get bilevel pressure with time of inspiration controls and trigger/cycle sensitivity settings. Moving up gets you into the respiratory assist devices that have backup rates and can target ventilation rates. For your purposes the ASV is intended for central and complex apnea and the problem is that it uses a 90 second lookback at your average minute vent and respiratory rate. as a result it can gradually reduce the target as your spontaneous respiration changes. You can't set the minute vent target. So the ST-A is more appropriate machine in that you can set the alveolar vent rate and maintain a minimum respiration rate if needed.

We know nothing of your current health and therapy results except that you say you have overlap syndrome. SarcasticDave has been pursuing this for quite a while, and developed a pretty deep knowledge of treating it. That said, he recently was instructed by his doctor to significantly drop his EPAP min and use settings closer to default on the ASV, and to my eye, it looks pretty good. Your needs are not going to be known to us without a lot more background and perhaps the usual trial and error of using alternate therapy strategies and observing the results. I hate to admit it, but much of sleep "science" is this trial and error experiment, and it may be hard to predict your needs with the limited information available.

[SarcasticDave94]

What Sleeprider said makes a lot of sense. And I agree there is a lot more info needed to give anything close to a definitive answer. All the info I've provided is only going to be applicable in a generic sense only. As is, we both have COPD, but we're very likely at differing levels of advancement and had or have now various other medical treatments. Given that you use oxygen, it is definite we are at different levels of medical need.

Unfortunate only some info I mentioned may actually apply, or maybe none of it applies. It may be best to revisit the doc or RT that is helping you. We can do all the research that's available, but there are times when we do get good medical suggestions from the doctors. Since I do not know your full medical history, calling any one of these the right machine isn't going to be possible. The answers I gave above are truthfully only generalized. Having had it pointed out that there's lots of medical info missing, my answer to what the best machine for you is will not be something I can determine.

Consider the prior answers by me a generalized information sharing post. I don't mind sharing what I've gleaned, but again it will be only sharing of info. I will not be suggesting what machine is best for you. Best wishes you and your medical team determines what machine is best, as you need one better suited than the one you're on now.

[SarcasticDave94]

Copy/paste from my PM. It is verbatim minus the original greeting line.

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I'll respond here but how about we take this to the public side so we'd get more input and others can learn too. This can be a new post under your therapy thread or you may create a new thread. OK?

Even so I'll answer here in PM and then I'll answer in public via copy & paste. The reason for this is for learning. Nothing wrong with a PM as this to catch our attention. Just not to be abused and not saying you were. Below is the PM and public answer.

I've also got Complex Apnea and COPD. Currently my script is for E0471 the with backup rate due to CA. I'm in the process of getting a video call tomorrow from my new Pulmonary doctor because I need a new therapy device. I've been advised in the past by two of my RTs and a nurse that I'll need NIV running AVAPS. So given that you said you're not going to be able to get NIV, the ResMed ST-A runs AVAPS mode, in ResMed speak it's iVAPS. The COPD machine I'm thinking may be OK, as I recall it is a 9 series which mainly means different form factor, and if that's all they let you have based on medical evidences, that may be fine. I actually don't know much about that model.

However, despite all that, it all really depends on your case. I'm a person that doesn't like or accept easily second best answers or therapy. I am pushing to get my NIV, in part because medical professionals say I need it. Also my medical data says it the right choice. Third I don't like some other person choosing a lesser machine than my need requires. So I'm saying I'm pushing to get the best and it's still a ResMed.

Here's the bottom line. How bad off are you with COPD? You need to get pen and paper and write down your issues, symptoms, complaints, and basically without saying it direct, why you need something to treat your issue. Shoot for the best there is for your need. Maybe that COPD model is a great choice. So is ST-A. NO to ST though, it's a dumb box of square wave rocks. Pick YOUR goal and push like mad.

---

I'm adding this bit. Despite my knowledge of machines, my info is speculation and the fact that your health circumstance is different than my own, the answer to which machine is best still needs determined by in-depth consideration to your overall health and therapy needs.

Hope this helps.

[Sleeprider]

I received a PM from Brainfog, and informed him advice cannot be provided by PM and we will only answer these questions on the forum.

I wanted to thank you again for your ideas and help in the past. It was a long process to get a new BPAP machine approved through my insurance company. Long story short, my insurance would not approve me for the ResMed 10ST, 10STA, or any of the NIV type machines. However, I was approved for a Bilevel machine without a backup rate under Medicare billing code E0470. 

ResMed offers 3 different machines under this billing code. (There may be more than the ones I have found)
1.      Aircurve 10 VAuto
2.      Aircurve 10 S
3.      VPAP COPD

ResMed “claims” the VPAP COPD is the “only machine” approved by the FDA for the treatment of both sleep apnea and COPD. I don’t know if this claim is true or not and there is very little info, customer reviews, or medical studies about the ResMed VPAP COPD machine on the internet. I also don’t trust my DME supplier to tell me what machine is best for me and I don’t believe my pomologist is up to date on the entire ResMed product line.

The ResMed VPAP COPD machine is still today an older series 9 machine and has been sold since about 2011. It’s also my understanding the ResMed VPAP COPD machine has not been updated to the 10 series machines like the Aircurve 10 VAuto, and the Aircurve 10 S. Most of the people who only have sleep apnea (I have both sleep apnea and COPD) say the ResMed series 10 machines have been upgraded with newer and better algorithms and reporting capacities compared to the older ResMed series 9 machines.

I wanted to ask what you think might be the best machine for me between the Aircurve 10 VAuto and the older ResMed VPAP COPD machine?

Any of your ideas, suggestions, or comments will be greatly appreciated to help me decide which machine I should use to maximize my sleep apnea and COPD therapy.
 
Thank you very much,


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Let's start this off with the fact an insurance company is driving the therapy you need, instead of a physician. I can't imagine anything more inappropriate or unethical.  The question is, what is your doctor's prescription, and why isn't he taking the lead in appealing your needs?

Getting back to a choice between the Aircurve 10 Vauto, VPAP S and the S9 VPAP COPD, we are working from incomplete information to answer this.  I know you currently have a Dreamstation CPAP.  In order to assess the best choice, I really need to see some detail charts, including the respiratory statistics on the left column  (see Organizing Your Oscsr Chart in my signature links) and some close-ups of the respiratory flow rate that will help me see the pace and volume of your breathing. That means a zoomed view of about 3-minutes length of time where the flow wave is visible.

Preliminary recommendation is the VPAP COPD since it is designed for COPD with Overlap syndrome and will provide more pressure support on every breath, even if your respiratory effort is restricted or weak. Both the Vauto and VPAP-S will follow your inspiration with pressure support proportional to your effort. This can leave you with little or no pressure support at times when inspiration is restricted.  Another difference is that the VPAP COPD does not use the Easybreathe flow algorithm (looks like a wave) but uses more of a square wave for pressure support. That means more of an on/off feel compared to the tapered pressure support of the Easybreathe.  All of these machines have time of inspiration controls, which are important if you need longer expiration time due to COPD.  Resmed has not produced the VPAP COPD in the Aircurve 10 series. Compared to ST-A it does not have any intelligence in targeting your minute vent, automatic pressure adjustment or a backup breath rate capability. The cost of the VPAP COPD is the highest of the NIV units you are looking at.  The more complete answer to your question is, the Vauto is more comfortable and is very effective as long as your spontaneous effort is sufficient to trigger and cycle the machines pressure. The VPAP COPD is a fixed pressure, square-wave VPAP S that will deliver stronger pressure support and more total pressure. Your charts should help us better understand your needs.

Looking forward to seeing some charts.