This is for John Fisher...Question for you...

[TmjTerri]

Hi John... I was given your name from another member here. She told me you know ALOT about ASV machines and I am going to see my new sleep doctor tomorrow to get a prescription for one of these machines.. I wanted to see what you thought about these two machines and which one is better.. They are..

S9 VPAP Adapt is ResMed's ASV machine. It works with the ResScan software.
http://www.resmed.com/us/products/s9_vp ... c=patients

Philips Respironics System One BiPAP Auto SV Advanced is Respironics' newest ASV machine.
http://www.healthcare.philips.com/wpd.a ... fault.wpd&

I already have the ResScan software on my computer but have never used it because my old vpap was not really working for me. I have severe complex sleep apnea and my old sleep doctor gave me the machine listed below and it never really worked for me. I never go into REM sleep and never achieve stage N3 sleep and my sleep is abnormal. So I went for a second opinion and I had a repeat sleep study on the 20th of Dec. I was told that my sleep was normal for once and I went into REM sleep and stage N3 sleep. My old sleep doctor did 4 sleep studies and even being tested on the vpap that I have now I NEVER went into REM or stage N3 but being on the ASV I did! I was in shock. So if you could pick one machine out of these 2 what machine would you pick for yourself? I was told you know alot about ASV and you use one yourself. I appreciate any and all advice you can give to me. My appointment is tomorrow at 3pm so hopefully you will get this before my appointment. Thank you SO much John!! Terri

[jamiswolf]

Hi Terri,
Mostly I wanted to suggest that you send John a PM since that will generate an email to him. He apparently missed this thread...but perhaps my bumping it will catch his eye.

I used a Respironics ASV advanced for awhile. A difficult machine to set up since it has many different parameters. If you have an unusual breath rate though, that machine has a manual setting option. I have noticed at least one member who had to switch to the Respironics because he needed that.

If you're used to a Resmed machine, you probably would adjust to the adapt easier...just a thought.

There's an old thread that gets activated occasionally. Lots of ASV info there.

viewtopic.php?f=1&t=65791&st=0&sk=t&sd=a

Good luck,
Jamis

[TmjTerri]

Thank you SO much for your reply and for bumping me post up. I really appreciate that so much. I am just so confused and I want to get the best machine that I can and I have NO clue what to ask for. I will PM John Fisher to see if he would contact me back. Thanks again... you are a gem for doing that for me!! Greatly appreciated!!

[JohnBFisher]

I already provided a brief response via PM. In essence, between the two, I would recommend the Respironics unit for most users. I also recommend that the OP use the second sleep doctor / sleep lab / DME, who helped uncover the complex sleep apnea issues.

Later tonight I will provide a more detailed answer to the OP and to the forum.

[NotSleepingBeauty]

I'm sorry, but what is ASV? I couldn't find it in the CPAP Definitions section.

[ameriken]

Click on the machine in my sig. It's typically for other-than-obstructive apneas, such as complex sleep apnea, central sleep apnea, and other periodic breathing disorders. It does the job when CPAP cannot.

[JohnBFisher]

... Hi John ...

First of all, let me welcome you to the forum. Hopefully by hearing about the experiences that others have you will (a) become a more educated patient and (b) help yourself maximize your therapy.

... I was given your name from another member here. She told me you know ALOT about ASV machines and ...

Hmmm.... While I have had the chance to learn via the school of hard knocks, I want it to be clear that I am not - in any way - a medical professional that can help you sort through your situation. Instead, think of me as someone who has been in your shoes, who can help ask the questions you would - if you were feeling more rested - ask yourself.

But when in doubt, trust your doctor - IF THEY ARE ADDRESSING YOUR PROBLEM!!. I do not think that I can stress that clearly enough. If you have a problem, and your sleep studies showed that you do, but the therapy is not working and the doctor is not changing the therapy to address the problem, then you should always consider hunting for a doctor that will address the problem.

This is exactly what you did do. You worked with one doctor for many months. However, at the end of the day you were not able to get restful sleep. In fact, you developed complex sleep apnea. Essentially, your body reacts negatively to the increase in pressure when breathing. It reacts by stopping breathing. Yikes! The therapy only makes the matter worse.

Until about three or four years ago, you would have had about three options. First, oxygen could have been introduced to your current therapy. This help reduce the impact of the apneas. But it does not work with your body to reduce the apneas. Another option would have been to have a trache tube installed. This would allow you to breathe at night without any obstructions. However, by avoiding the normal nasal passages, you can become more prone to lung infections. And finally, the other option would have been to use a ventilator. That's a very expensive option as you can usually only rent ventilators. Since the rental cost also includes the respiratory therapist, the rental cost is not cheap.

Fortunately, your second sleep doctor (and the sleep lab) recognized the complex sleep apnea. The "gold standard" therapy for this condition is an Adaptive Servo-Ventilator (ASV) unit. Essentially, it is a BiLevel unit with a respirator grafted onto it. When you fail to breathe it helps sustain your breathing. Why this, in addition to the BiLevel unit? Well, sometimes people have central sleep apneas. Central sleep apneas become repetitive due to an unershoot / overshoot repetitive cycle. The undershoot sets up the conditions for the overshoot. The Overshoot sets up the conditions for the undershoot. And so on... During a central sleep apnea there is NO effort to breathe. In the case of complex sleep apnea, the increase in pressure confuses your body. It thinks it does not need to breathe. This is the undershoot side of the cycle. Thus the CO2 builds up until the point that your body must arouse itself to help you breathe better. You restart breathing - hyperventilating a little. That is you breathe faster than normal. This is the overshoot side of the cycle. Now, with the increased respiration, your body blows off too much CO2. This decreases the drive to breathe. Yup. You guessed it. You suddenly slid into the undershoot side of the cycle. You stop breathing for a while and the process repeats over and over and over ...

The constant arousals (going from a deeper level of sleep to a lighter level of sleep) results in very, very poor sleep. You will rarely get to N3 and/or REM sleep. It does not take more than a few months of that before you can barely think things through. So, don't feel bad that you had a hard time thinking clearly when dealing with your doctors. Remember, sleep deprivation is used as torture the world over.

... I am going to see my new sleep doctor tomorrow to get a prescription for one of these machines.. I wanted to see what you thought about these two machines and which one is better.. They are..

S9 VPAP Adapt is ResMed's ASV machine. It works with the ResScan software.
http://www.resmed.com/us/products/s9_vp ... c=patients

Philips Respironics System One BiPAP Auto SV Advanced is Respironics' newest ASV machine.
http://www.healthcare.philips.com/wpd.a ... fault.wpd& ...

As I noted above, in this instance, I would recommend the Respironics unit. I use the older generation of both. (I have one of each). I have just about decided to use the Respironics as my primary unit. I've discussed this with my doctor and he noted (as have others here) that the Respironics unit uses a very sophisticated set of algorithms to attempt to regulate your breathing. But the major difference is that it allows more variation between in your breathing. That is, you never breathe at the same pace all night long. The Respironics unit allows that natural variation to occur.

Unlike the Respironics unit, the Resmed unit is a harsh task master in regards to breathing. It INSISTS on a certain volume of breathing within a certain period of time. Oddly, when my neurological problems are at their worst (due to degeneration of my brainstem), I actually find the Resmed unit a better unit for my needs. When I have a flare of other symptoms, I am certain my breathing will be all over the place. That is when my Resmed unit is best. It helps guarantee that I breathe as I should.

But due to the wild pressure changes on the Resmed unit, I find that I *must* use a mask liner with the Resmed unit. The Respironics unit tends to not have as much of a problem with the pressure change.

In short, if you had severe central sleep apnea (such as due use of opiates), then the Resmed unit is a good choice. If you have complex sleep apnea, where you need it to better allow for some variance - to encourage natural breathing - then the Respironics unit is a better choice.

... I already have the ResScan software on my computer but have never used it because my old vpap was not really working for me. ...

Fortunately, that should work with this unit if you go to the Resmed unit.

... I have severe complex sleep apnea and my old sleep doctor gave me the machine listed below and it never really worked for me. I never go into REM sleep and never achieve stage N3 sleep and my sleep is abnormal. ...

Unfortunately, not all sleep doctors get the training they really should have. Not all problems are nails. Given a hammer, some people assume the world must be made of nails and they start hammering away. The better professional keeps exploring new methods. They find that if the problem is not a nail, then the use of the right tool makes all the difference in the world.

Sometimes these doctors will learn. Often not. In that case, you did absolutely the right thing. You got a second opinion.

... So I went for a second opinion and I had a repeat sleep study on the 20th of Dec. I was told that my sleep was normal for once and I went into REM sleep and stage N3 sleep. My old sleep doctor did 4 sleep studies and even being tested on the vpap that I have now I NEVER went into REM or stage N3 but being on the ASV I did! ...

Yup. It can be a night and day difference. I awoke from my ASV titration study and wondered when I could get a unit. Of course, it will take some time (days, weeks) before you can think clearly again, but it should make a difference right away.

... I was in shock. So if you could pick one machine out of these 2 what machine would you pick for yourself? I was told you know alot about ASV and you use one yourself. I appreciate any and all advice you can give to me. My appointment is tomorrow at 3pm so hopefully you will get this before my appointment. Thank you SO much John!! Terri

As I noted, I would provide this more detailed answer to help you understand your situation. As I noted, always remember this is just based on my own experience and what I've researched. Always work with your doctor to get the most out of your therapy. But that's exactly one thing we can do to help improve your situation. We can tell you the problems we encountered and what we've done to address them.

Best of luck in your adventures with your ASV unit. And now, welcome to the gang of happy ASV users!!

[JohnBFisher]

Whew!! Was that a longer answer, or what!

[TmjTerri]

John.. I wanted to really thank you for taking the time to really explain complex sleep apnea and how the ASV machine works. They way you described it made me finally understand how all of this works. When I was given your name I knew you were not a but a patient who uses the same machine that I need and I loved that because you really understand how I feel and what I am going through on a different level. In my pm that I sent you a few minutes ago I told you that I was given an oxygen concentrator and I am supposed to use it with my vpap. The thing I don't understand is why my old sleep doctor would give me a machine that would allow me to stop breathing over 90+ times an hour and like you said it made things worse. When I was tested on the ASV on the 20th of December I only had 8 apneas an hour compared to 90+ and that is a HUGE difference. The morning that I woke up from my sleep study and I felt AMAZING the whole entire day. It has been years since I have felt that good and I woke up over 6 times and had a hard time going back to sleep. It was not a good nights sleep but I felt so amazing that whole day. Like I was in total shock the whole day over how I was feeling. It was such a weird feeling and I want to feel that way everyday. Anyhow, I just want to thank you for ALL of the great advice and info that you gave me John. I really understand how all of this works now..for the first time ever. Thanks... Terri

[Kody]

John also wanted to thank you for your laymen easier to understand explanations regarding ASV machines, complex sleep apnea, etc. Seems like I learn something new or pick up more each time you post, thanks again.

[TmjTerri]

Kody.. I agree with you! It is amazing how John described things in such a way that I was finally able to understand how complex sleep apnea works and I appreciate that SO SO much! It is so nice to talk to someone who is going through or had gone through the things I am going through right now. For those who do not have sleep apnea of any kind cannot really understand how it feels to be sleep deprived and how doing your normal daily tasks feels almost impossible. At least that is how it feels to me. I was explaining to John that I feel like when I do something simple like doing a very small load of dishes (rinsing them and putting in the dishwasher) makes me feel like I am climbing a huge mountain. That is how tired I am. I have lived with this since 1996 when I had my very first sleep study. My cental apnea was only mild at the time and it has gone from mild to severe complex sleep apnea. I went about 6 or 7 years feeling so exhausted and I never knew why. I had a bilateral total joint replacement on my jaw/tmj area in 2002 and I have chronic pain from that. But by not being able to sleep I just feel miserable.. I cannot remember things like I used to.. I have daily headaches or migraines now and I just want to get this ASV machine so I can feel better. I am just so frustrated because I trusted my old sleep doctor and he put me on the wrong machine that made my centrals 100 times worse. My sleep studies show that I had central apneas or obstructive apneas about 100 times an hour. I wish I was given the ASV machine to begin with. So now I own this ResMed VPAP machine that is basically useless to me plus an oxygen concentrator. I am going to sell it and I want to add that I have NOT used this machine at all. I had the same machine before this one and it stopped working so I had to trade it in but ever used it because I always felt much worse after using it. I should have went for a second opinion 6 to 8 months ago. But I trusted my sleep doctor because I thought he knew what he was doing and I believed I was given the correct machine. Not so and boy am I frustrated right now!

[jamiswolf]

Terri,
Just so you know, the machine you have is also a rather high end machine with capabilities of handling central apneas. So your first Doc didn't really drop the ball. Just seems like it either wasn't set up right for you or somehow wasn't doing the job. I use a Respironics version of that, and it handles my central apneas nicely. But my initial apnea numbers are lower then yours. And I obviously don't have a complete picture of your situation.
J

[JohnBFisher]

... Just so you know, the machine you have is also a rather high end machine with capabilities of handling central apneas. ...

Actually, one could say that it used to be considered the high end. The use of an ST and oxygen was once considered the gold standard for treatment of central apneas. However, a lot of patients found they continued to have problems. Thus, research started to focus on how to break the cycle that triggers continuous central apneas (regardless of the cause). This led to the development of the ASV unit. During the development of the ASV technology there was some very extensive research that demonstrated the ASV as a much better choice to treat central apneas. The following graph from a study captures this.



As you can see from the graph, ASV consistently does a better job of treating central apneas, regardless of the cause. Better than ST alone and better than ST with oxygen.

Unfortunately, not all doctors keep up with latest research and technology. There is no requirement for them to do so. Nor is there any method (other than trial and error) for the average patient to find a doctor that does stay current. So, while the therapy prescribed was once the "gold standard", there have been quite a few studies since that show it is not as effective as ASV therapy.

[jamiswolf]

Thanks John,
I was aware that ASVs were used more frequently...but not why. I assumed it was the ability for ASV machines to break up periodic and CS breathing. For me personally, the ST with O2 is working great, but my apnea isn't too severe. So are ST's going to become a thing of the past?
J

[ameriken]

When I was tested on the ASV on the 20th of December I only had 8 apneas an hour compared to 90+ and that is a HUGE difference. The morning that I woke up from my sleep study and I felt AMAZING the whole entire day. It has been years since I have felt that good and I woke up over 6 times and had a hard time going back to sleep. It was not a good nights sleep but I felt so amazing that whole day.

Terri, you mentioned a couple of times how well this ASV worked...if you are thinking about getting another machine, have you considered finding out which ASV you were titrated on and getting that particular machine? Since they're all slightly different, another brand ASV may not give you quite the same results or be as comfortable and now that you had a good experience, I wonder if that may be the right machine for you? Just a thought, Good luck!