For those of you who have not read the prior post, my doctor started me on a S9 straight CPAP therapy. I spent the next couple of months going over multiple hurdles to get the doc to finally conduct an ASV sleep study. Ultimately it resulted in him ordering an ASV machine. Then the ordeal began with Medicare to get authorization for changing the machine.Grand-PAP wrote:I'm going to begin this thread by repeating these comments from that original post:Several of you have asked me about my ASV experience since my original post: "My Rocky Road from CPAP to ASV Therapy." This is a follow-up to that post. If you're interested in reading it:
viewtopic.php?f=1&t=75762&p=692914&hili ... d+#p692914
I want to THANK many of you who have helped me on my journey to successful ASV therapy. Those of you who so generously shared your time and advice will immediately know who you are. Those of you who frequent this forum can probably guess. I owe each of you a great deal of gratitude!
First an important caveat: I am NOT suggesting than anyone read this and decide to venture into this degree of self-directed therapy. I did it with a LOT of research and I was VERY CONSERVATIVE in my approach. My motive was simple: Neither the doc nor the DME were concerned with my therapy. That became abundantly clear from day ONE. It was my problem to deal with and resolve!
Eventually, Medicare approved and, against my objection, the doc ordered a PR System One autoSV Advanced. The reason for my objection was because during my "Rocky Road" journey, I bought prior models of both the PR auto and the Adapt SV. The results were similar, but I felt much more comfortable with the ResMed. Because I am so sold on it, I bought a ResMed S9 Adapt SV.
Monday I have my compliance appointment with my doc, so I have begun to compile my statistics "for his review." Here are the results for your review:
Again, for those of you who didn't read the original post. Below I have posted a jpg. The first two graphs are the ONLY TWO APNEAS I have had during the 22 nights with the new Adapt SV. The bottom three graphs are of three "typical" nights with the S9 Elite.
From the above you can see why I had to persist in getting the doc to order the ASV sleep study. In addition to the number of events, often there were CAs that last from 45 to 60 seconds.
The following jpg is of the results with all three machines:
For those of you who are not familiar with the ASV machine, it is a little difficult to directly compare apneas to apneas, and AHI to AHI, because ResMed and PR use different pressure thresholds for both apneas and for hypopneas, plus ResMed does not score Clear Airway Apneas (Centrals) separately. Regardless . . .
As you can see both machines have virtually eliminated all apneas: ResMed: .02, PR: .32. With the ResMed I have had almost no events, including hypopneas. With the PR, I have had excellent results with apneas, but it was not as effective at resolving hypopneas. Some of difference with regard to hypopneas may well be the difference with pressure threshold that PR uses. The other reason is probably because of my inability to effectively tweak the pressure settings.
For the following comments, keep in mind that the only pressure settings for the S9 are EPAP and Pressure Support (PS) Min and Max. The PR settings include EPAP Min and Max, PS Min and Max, Breath Per Minute -- Either auto or, if not auto, you have to set the Timed Inspiration)
Many ASV thread questions ask for users' opinions regarding the comfort of the two machines. I know with this comment, I am somewhat swimming up-stream, but my experience has been that the S9 is considerably more comfortable. It will become my primary machine with the PR as my backup.
The starting S9 pressure settings were:
EPAP: 6
Min PS: 4
Max PS: 8
(NOTE: I am not going to complicate this posting by discussing the S9 pressure settings that I have changed. I intend to write a second post to specifically discuss the S9 setting and compare and contract them with the PR settings.)
The first night with the PR autoSV, I used my Doc's pressure settings:
Max Pressure: 25.0 cm H20
Max EPAP: 15.0
Min EPAP: 8.0
Max PS: 15
Min PS: 4.0
Bi-Flex: Off
BPR (Breaths per Minute): 11
Timed Inspiration: 2
Rise Time: 5 minutes
That lasted a total of ONE NIGHT. Throughout my therapy, on all the machines, my breath rate has averaged about 13.5 to 14.5 BPM. You would "think" that that would not impact the autoSV, with a BPR set at 11. But, from the beginning of the night, it was constantly trying to "force" me to take a premature breath. It was extremely uncomfortable and I had a great deal of difficulty getting to sleep. From the 2nd night on, I set the BPM to AUTO. It has been a LOT more comfortable, but occasionally, it still tries to "interfere" with my normal breathing rate and begins increasing pressures. It can be very distracting and makes it difficult to get to sleep. After I fall asleep, it works fine for me.
With the S9, the breathing rate has NEVER been an issue, before falling asleep, during sleep nor after awakening. Maybe I have been lucky, but it does seem to "adapt" to my breathing rate. I am able to go to sleep as normally as I did before therapy. Additionally, when I awaken, for the few minutes I lie there before getting up, it is as though there is ZERO pressure -- totally comfortable.
So, for those who have asked, that has been the results.
Hope it helps some of your as your therapy proceeds.
