+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: Father Bipap AutoSV Advanced (/Thread-Father-Bipap-AutoSV-Advanced)
Pages:
1
2
Father Bipap AutoSV Advanced - kevrx - 06-07-2020
Hello all,
I am trying to help my father out with his central/obstructive sleep apnea. He was in the severe category in his sleep study and has been treated for many years. He is in his mid 70's. He falls asleep often even when I am talking to him and may have narcolepsy. He has congestive heart failure and atrial fibrulation with ejection fraction > 45. His settings are: epap min 5 max 15, ps min 3 max 15, max ipap 30, bi-flex 1, backup rate 12, Ti 1 second.
His Central apneas and obstructive apneas are relatively low, but his hypopnea score is high. It seems the leak rate is very high. I am not sure what an acceptable range is for this machine, but 50 L/min seems high. He prefers the resmed f30 full face mask and said he is willing to shave his beard if it will help with leaks. He says he wakes up 4-5 times a night to go to the bathroom which I believe would be a symptom of untreated SDB. He sees the MD in 3 days and is due for a new machine. From what I have read from people here, an Aircurve 10 ASV is preferrable, but I am afraid his DME will give him a Respironics. I am not sure which would be best for him or how he could insure getting the one he wants. I have included some data from his DME and if anyone has some thoughts on improving his treatment I would appreciate it.
Thank you,
Kevin
[attachment=23647][attachment=23646][attachment=23648]
RE: Father Bipap AutoSV Advanced - SarcasticDave94 - 06-07-2020
I'm not sure what choices there are with his healthcare insurance, but to get a ResMed, there's 2 possible answers. One is to work with the doctor and have him or her to write ResMed and the model including the phrase Dispense as Written on a script for the new machine. Second is to ask the current DME if they will issue a ResMed. If they say no, you will likely need to replace the DME with one that dispenses ResMed machines.
RE: Father Bipap AutoSV Advanced - Sleeprider - 06-07-2020
Unfortunately, we often see a high residual hypopnea index with the Philips machines which is why we try to move members towards the Resmed Aircurve 10 ASV. Since your dad already uses ASV he can get one from SecondWindCPAP who sells a gently used ASV for $1319 with a warranty. If you go through insurance or your doctor, things will take longer. Anyway, the therapy is noticeably different, and the Resmed is faster to ramp pressure support, usually avoiding the hypopneas.
If you really want to see, just swap machine for one night.
RE: Father Bipap AutoSV Advanced - kevrx - 06-09-2020
Since his machine is slow to respond, could it help if he set epap min up from 5 to 6? His 90% pressure is around 7. I sent him the resmed prescription guide to take to his MD so hopefully a resmed avs will be in his future.
Thank you,
Kevin
RE: Father Bipap AutoSV Advanced - Sleeprider - 06-09-2020
The man problem is the lack of response with pressure support when a spontaneous breath does not occur, however, I have seen higher EPAP pressure help with the Philips machines when a number of hypopnea are present. I can't see that hurting anything.
RE: Father Bipap AutoSV Advanced - kevrx - 06-10-2020
Thanks Sleeprider. I ended up finding that raising min PS might be the best thing to try. He raised it from 3 to 4. I am also thinking the auto backup rate would be better if he could get used to it to help him breath in a more normal rythym. I have been telling him about how much better the resmed is and I sent hime the pdf for how to write a prescription going from respironics to resmed asv. I think he is feeling a lot better now that he shaved around his mouth for a better seal. He has only gotten up once for the last 2 nights instead of around 4 times. Unfortunately, he can't get any useful data out of his machine on a daily basis, but he should get a newer machine soon.
Kevin
RE: Father Bipap AutoSV Advanced - Sleeprider - 06-10-2020
Increasing PS min to address hypopnea is a logical strategy, consistent with the titration protocols. It would be great if you dad could eventually replace with the Resmed ASV. Users of both Philips and Resmed have pretty consistently reported greater comfort and efficacy with the Resmed
RE: Father Bipap AutoSV Advanced - kevrx - 06-11-2020
He is heading in the direction of getting a resmed; however, I remembered that he had some sort of nasal surgery in the 60's and I think that could affect snore. Does anyone know if the algorithms for either machine would work better with this issue? I have seen that surgery can change dynamics like snore or hypopnea that could make it difficult for the epap algorithm to work well.
Thanks,
Kevrx
RE: Father Bipap AutoSV Advanced - SarcasticDave94 - 06-11-2020
I'm not aware of any aspect within this issue that would sway me from still saying get the ResMed.
RE: Father Bipap AutoSV Advanced - Sleeprider - 06-11-2020
Philips is more sensitive to snores to increase pressure, Resmed tends to respond to flow limitation. That is the Cliff's Notes version. There are bigger differences than that like the shaping of the pressure support wave,d responsiveness to a missed breath, adaptive pace and minute vent and simplicity that favor Resmed. On the other hand, if a set pace (breaths per minute) is needed, the Philips is hte only one that does that.