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+--- Thread: going from cpap to bipap (/Thread-going-from-cpap-to-bipap)
RE: going from cpap to bipap - ckingzzzs - 12-29-2015
(12-29-2015, 03:44 PM)vsheline Wrote:(12-22-2015, 12:06 PM)Sleeprider Wrote: I have personally seen very severe complex apnea resolved with ASV, and have also seen people with mild occurrence of centrals and OA have near-zero AHI using these machines. About 15% of the population using CPAP would benefit from ASV. So it may not be as unusual as some think.
Before switching to an ASV machine I used a standard bilevel Auto, the S9 VPAP Auto. Although I much preferred the easiness of breathing with Pressure Support set to 4 or 5 (and the higher PS also beneficially boosted my SpO2), I found that PS higher than about 0.6 increased the number of Cental Apneas I would get. (Having a few short CA events, though, is no cause for concern.)
I no longer take my backup machine with me when traveling; instead I take my ASV with me, because I feel significantly better on ASV than when on APAP or standard bilevel. Every few months I'll have really huge Leak or while asleep will roll over onto my back, and will have some apneas or hypopneas. Other than that, week after week my AHI is always zero. And I can use all the Pressure Support I like.
When my present ResMed ASV machine wears out I will probably replace it with one from Phillips Respironics, because they are far more adjustable, far less one-size-fits-most. Unlike Philips Respironics ASV models, ResMed ASV models cannot be set up to work like an APAP or like a standard bilevel.
Also, in fixed-pressure CPAP therapy mode (their only non-ASV therapy mode) ResMed ASV machines cannot even distinguish between central apneas versus obstructive apneas. On an expensive machine specifically designed for patients with central apnea issues. Simply shameless.
My sleep tech told me that the ASV machines are very difficult to get use, is this true??
Also I recently read an article noting that Auto ASV advanced appears to work better than simply auto ASV?? who makes auto ASV Advanced anyway??
RE: going from cpap to bipap - Sleeprider - 12-29-2015
ckingzzzs, the answer is no. The ASV machines are the most versatile bilevel positive air pressure machines ever made and can act as CPAP, APAP, BiPAP and will assist with a breath in ASV mode. The ASV works like the best auto bilevel machine with the simple addition that it can interpret on a breath by breath basis, the occurrence of a central apnea or hypopnea, and provide ventilation support to eliminate it. Most ASVs work right out of the box to sync perfectly with the patient's breathing to produce the lowest AHI and RERA of any therapy available. It can however be optimized.
The only person who would say what your sleep therapist said, "ASV machines are very difficult to get used to", is someone with very limited experience who is intimidated by the wide array of available manual over-ride settings. These machines work for the most difficult cases of apnea, as well as very simple cases where the user chooses to invest in these features, even though they are not "medically necessary". Insurance does not approve very many of these machines, so many therapists and technicians never see them in practice.
The "advanced" version is a Philips Respironics trade name for their Auto SV Advanced machines. It is somewhat different and has more custom settings than the Resmed Aircurve 10 ASV, but both machines tend to work best for most people without using these custom timing and pressure triggers, that very few people know how (or why) to manipulate. The treatment algorithms are very effective unless there is a good reason to intervene. My impression is that the Resmed model is best at automatically syncing to a patient, while Respironics seems to be somewhat more versatile if needed.
RE: going from cpap to bipap - ckingzzzs - 12-30-2015
(12-29-2015, 10:06 PM)Sleeprider Wrote: ckingzzzs, the answer is no. The ASV machines are the most versatile bilevel positive air pressure machines ever made and can act as CPAP, APAP, BiPAP and will assist with a breath in ASV mode. The ASV works like the best auto bilevel machine with the simple addition that it can interpret on a breath by breath basis, the occurrence of a central apnea or hypopnea, and provide ventilation support to eliminate it. Most ASVs work right out of the box to sync perfectly with the patient's breathing to produce the lowest AHI and RERA of any therapy available. It can however be optimized.
The only person who would say what your sleep therapist said, "ASV machines are very difficult to get used to", is someone with very limited experience who is intimidated by the wide array of available manual over-ride settings. These machines work for the most difficult cases of apnea, as well as very simple cases where the user chooses to invest in these features, even though they are not "medically necessary". Insurance does not approve very many of these machines, so many therapists and technicians never see them in practice.
The "advanced" version is a Philips Respironics trade name for their Auto SV Advanced machines. It is somewhat different and has more custom settings than the Resmed Aircurve 10 ASV, but both machines tend to work best for most people without using these custom timing and pressure triggers, that very few people know how (or why) to manipulate. The treatment algorithms are very effective unless there is a good reason to intervene. My impression is that the Resmed model is best at automatically syncing to a patient, while Respironics seems to be somewhat more versatile if needed.
thanks sleeprider for your time. WOW it seems that your very knowledgable in this area. I start the Bipap tonight for the first time. Will try it for several months to see, and then if it does not work well, may then consider ASV. thanks again for your input its much appreciated.
RE: going from cpap to bipap - Sleeprider - 12-30-2015
My "knowledge" is mostly anecdotal based on helping some friends and forum participants get things sorted out. Most adjustments on any CPAP, APAP or bilevel is common sense, and follows a well known sequence of adjustments in response to problems. There are a lot of people that help on this forum with similar experience and knowledge.
There are many doctors technicians and RTs in sleep clinics and DMEs who really know their business, and effectively treat and advocate for their patients. Sadly, there are also a lot in the profession who think the insurance company is their client and treat everything as obstructive apnea and wouldn't know what to do with a complex apnea case if it hit them in the face. Unfortunately, there are a few doctors in that category as well, who are not only incompetent, but arrogant about it because their 'recipe' works for most of their patients, so it is probably the patient's fault if it does not. It's an ongoing problem we see too often on the forum.
RE: going from cpap to bipap - ckingzzzs - 12-30-2015
(12-29-2015, 10:06 PM)Sleeprider Wrote: ckingzzzs, the answer is no. The ASV machines are the most versatile bilevel positive air pressure machines ever made and can act as CPAP, APAP, BiPAP and will assist with a breath in ASV mode. The ASV works like the best auto bilevel machine with the simple addition that it can interpret on a breath by breath basis, the occurrence of a central apnea or hypopnea, and provide ventilation support to eliminate it. Most ASVs work right out of the box to sync perfectly with the patient's breathing to produce the lowest AHI and RERA of any therapy available. It can however be optimized.
The only person who would say what your sleep therapist said, "ASV machines are very difficult to get used to", is someone with very limited experience who is intimidated by the wide array of available manual over-ride settings. These machines work for the most difficult cases of apnea, as well as very simple cases where the user chooses to invest in these features, even though they are not "medically necessary". Insurance does not approve very many of these machines, so many therapists and technicians never see them in practice.
The "advanced" version is a Philips Respironics trade name for their Auto SV Advanced machines. It is somewhat different and has more custom settings than the Resmed Aircurve 10 ASV, but both machines tend to work best for most people without using these custom timing and pressure triggers, that very few people know how (or why) to manipulate. The treatment algorithms are very effective unless there is a good reason to intervene. My impression is that the Resmed model is best at automatically syncing to a patient, while Respironics seems to be somewhat more versatile if needed.
sleeprider I would be interested in your opinion regarding whether I should consider ASV for central apnea events of 4-6. A two night sleep study in the lab (not at home) showed I had centrals of 2-4. My cpap showed I had centrals of 4-6 and an AHI of 7-9 over a 6 month use of cpap. I find the central events a little low to consider ASV, am I wrong? I begin vpap tonight to see.
RE: going from cpap to bipap - Sleeprider - 12-30-2015
ASV is normally reserved for significantly higher CA and H events as well as periodic breathing or respiratory insufficiency. It certainly would not be deemed medically necessary or covered by insurance. That said, I know of several individuals with even lower CAI than you that have purchased their own ASV and are delighted with it. If near zero events would make a difference for you, it would be achievable with that machine, however events are replaced with machine induced breaths. The sensation is that an effortless breath occurs when your respiration stalls. Most don't sense it when they are sleeping, but centrals often occur as people wake or slumber, and that's when it is felt.
RE: going from cpap to bipap - wxmcpo - 12-30-2015
Are the events listed as Clear Airway events in Sleepyhead the same as Central Apnea events? I assume they are, but don't want to make an incorrect assumption. If so then sleepyhead shows 41 clear airway events last night. Typical nights show me with 30-40 events, but have had well over 100 on nights when my AHI gets into double digits.
RE: going from cpap to bipap - Sleeprider - 12-30-2015
The machine detects whether the airway is open (clear airway) or obstructed (OA) using pressure pulses, and sensing the feedback from that pulse. It's a pretty accurate determination, and I think there are studies correlating machine data with polysomnograpy (PSG). Many doctors will not accept the single channel machine data, because it does not record things like respiratory effort, EEG (brain activity), and oxygen saturation. Most of us on the forum see CA events as an indicator of central apnea unless you are in a transitional sleep/wake state. So a little judgement is necessary, but with the level of CA you are seeing, it's worth following up on.
RE: going from cpap to bipap - OpalRose - 12-30-2015
Yes, the terms are interchangeable.
Why not post a couple screenshots from sleepyhead, so someone can take a closer look.
Post the events graph, pressure and flow rate graphs, and leak graphs. Include the detailed
information to the left of graphs.
More specifics on Resmed Aircurve 10 auto settings - ckingzzzs - 12-31-2015
Can someone please point me to the right direction where I can get moe information on the PS, Ti max-min, trigger and cycle settings for the resmed aircurve10 vauto machine. I would like to get an idea as to what the values should be and where they should be set. I thank you.