BiPAP ASV and gas?

[Gbmaryland]

Hi folks,

First time post, and my first question (forgive me if I'm ignorant):

I have had several ASV units (an older Respironics unit, an older ResMed unit, System One unit, and now an AirCurve 10 ASV).

Recently, if got an AirCurve 10 ASV, and the tech indicated that the "pressure was bumped up slightly." I previously had a System One ASV unit, and my complex arena was perfectly controlled with that unit. It was just getting old...

I've noticed that I burp a lot with the new unit, and almost not at all with the old one. In fact, the new one is messing up my sinuses and, possibly helping creat GRED. (The later wasn't napping before, or at least wasn't noticeable.)

The pressure on the AirCurve is only slightly more... I have to look it up, but I think about an inch.

1) Is it common to have sinus issues?

2) Do CPAPs tend to help create acid reflux or burping?

3) Is the ResMed ASV algorithm more aggressive than Respironics?

I do sleep better with the older unit (which I've been trying to about 5 days). [I used the new unit for several months before I had the "ah ha" moment...]

Any feedback or insight would be well appreciated!

[Pugsy]

1) Is it common to have sinus issues?

Yes. Google "cpap rhinitis"
I suspect that you need to make an adjustment in the humidity setting...either more less humidity.
The older Respironics machines without heated hoses cranked out a lot more humidity than these newer machines with fancy ambient humidity sensors.

Some people need more humidity and some need less.
What setting are you using on the new AirCurve and are you using a heated hose with it.
And what setting did you use on the older Respironics machine?

2) Do CPAPs tend to help create acid reflux or burping?

Sometimes...we call it aerophagia...more pressure will increase the chance of having more issues.
Some people will have problems with even the slightest pressure and some won't have any problems even at max pressure. It just happens.

3) Is the ResMed ASV algorithm more aggressive than Respironics?

Yes, in both the cpap and ASV models ResMed is a little bit quicker to respond and thus might be considered a bit more aggressive in how it goes about its job. It might be that with the slightly more aggressive ResMed machine that you could get by without that pressure increase and maybe lessen the aerophagia issues.

I have used both the System One ASV and the ResMed S9 Adapt (which is the ASV) and I had to use a minimum EPAP of 10 on the Respironics System One to get the same overall results as minimum EPAP of 6 on the ResMed. It is possible that your body just likes the way the Respironics does its job but you might be able to tame the AirCurve just a little and still do quite well.

[Gbmaryland]

A googling I will go! Thank you kindly.

Interestingly, the difference in setups between the two are no as described by the tech...

System One:

Max Pressure 25.0
Min EPAP 10.0
Max EPAP 15.0
PS Min 0
PS Max 15.0
BPM Auto
Flex Type BiFlex
BiFlex 2
Ramp Time 0:20
Ramp Start 4.0
G type lock ON

(The rest are incidental settings that you can change, mostly the humidifier.)

AirCurve 10 ASV:

Mode ASVAuto
Min EPAP 9.0
Max EPAP 9.0
Min PS 0
Max PS 15.0

(That's all there is in the therapy section... Everything else is related to tubing and humidifcation.)

[Pugsy]

AirCurve 10 ASV:
Min EPAP 9.0
Max EPAP 9.0

System One:

Max Pressure 25.0
Min EPAP 10.0
Max EPAP 15.0

Interesting that with the AirCurve the max EPAP is actually lower than it was on the System One.
But without reviewing the software data we don't know how important that max EPAP is because with PS being so variable with both EPAP may not need to move.
A lot would depend on how much of the obstructive stuff is going on or how much central stuff.
EPAP for the obstructive stuff...and PS burst to treat the centrals.

BiFlex exhale relief would have lowered the pressure just a little and maybe that is what is missing in this situation.

Also interesting that with both they set minimum PS to 0 which really just makes the machine work like a fancy apap until a central occurs and PS kicks in with a big burst.

The AirCurve machine doesn't have a separate exhale relief like the Respironics BiFlex.
Instead it offers PS which effectively will yield some exhale relief when it is set to something other than 0.
So maybe that's what is missing...the exhale relief you had with the Respironics and don't have with the ResMed. It isn't a huge amount of reduction because Flex relief is flow based (how forcefully you breath) but there's going to be a 1 or 2 cm reduction and maybe that was what kept the aerophagia away with the Respironics use. It wouldn't be impossible...you aren't getting any exhale relief now with the AirCurve.

It's hard to say what might be going on in terms of aggressiveness without being able to compare software results from both machines to see if we spot anything that might be different...like an overall higher pressure average being used or something like that.

It might be possible to lower the EPAP on the AirCurve a little and even maybe add some real PS and still get results similar to what you used to see without having the aerophagia issues annoy you.

[Sir NoddinOff]

I have used both the System One ASV and the ResMed S9 Adapt (which is the ASV) and I had to use a minimum EPAP of 10 on the Respironics System One to get the same overall results as minimum EPAP of 6 on the ResMed. It is possible that your body just likes the way the Respironics does its job but you might be able to tame the AirCurve just a little and still do quite well.

I have both a ResMed ASV and a Phillips ASV and I'll back up Pugsy's statement. I have a harder time adjusting with my ResMed ASV since it doesn't wait around to give you a full breath if its air circuit program deems it necessary. On the other hand, my Phillips ASV starts off with sort of a half pressure breath/boost and then will go to higher pressure if warranted. However, people do swear by the ResMed ASV methodology, so it has its fans. I do keep it for a backup.

[klv329]

Wow, they switched you over to resmed after success with respironics. Any chance of complaining and getting switched back to respironics? May be worth a try.

Or maybe try like Pugsy said about reducing epap?

I get air in the tummy if my head leans forward too much. And I use a soft neck brace to hold the head and chin up on this incline bedframe for gerds.

[Gbmaryland]

Folks, thanks a ton for the help. I'm waiting for them to call me back...

I've considered the idea of giving the a hard time for changing the brand of system.

They have a real thing for ResMed devices, and I was somewhat annoyed when they gave me one... But it's leaps and bounds better than a ResMed unit they gave me about 8 years ago. (I mean, that thing was an ASV type unit and it was rough.)

I don't dislike the AirCurve 10 ASV... The features are awesome. ...but as was pointed out, it's a bit of a rougher ride; though not horrible it's just enough.

Interestingly, the System One was dealing awesomely with my central apneas. So I think they just wanted to slip in a ResMed unit because that's what the like to sell...

I'm gonna mention some of this, and see how they respond.

When I called today, someone answered the phone and then hung up. I called back 30 seconds later, and suddenly there was no one. Soooooooo... I think I need to call the boss.

So what is the current Respironics servo-ventilation unit? Does it have heated pipes and sent your information back to mother Russia via the cell phone network?!

[Pugsy]

So what is the current Respironics servo-ventilation unit? Does it have heated pipes and sent your information back to mother Russia via the cell phone network?!

As of right now the PR System One AutoSV model 960 is what is the latest available in the ASV line.
There is a newer model line called the Dream Station model line but at this point the only bilevel machines available in the DreamStation line are the regular bilevel devices...no ASV yet in the ASV model.
Now the 960 has the heated hose option but no communication to DME via cell network but for someone like you...I don't see it being something that is critical.

Your DME probably got a better deal this time around with ResMed brand equipment...next time they might get a better deal with Respironics again and be pushing Respironics.
I have seen my DME go through 3 cycles...when I first went there they had ResMed...then a couple of years later it was Respironics...I jokingly said "hey, they gave you a better wholesale price and he confirmed"...then early last year they went back to ResMed.

The System One that you had...was it a 950 or 960? The 960 was the latest and as of right now the only ASV considered currently produced. We don't know when there might be a DreamStation in the ASV model...in the past Respironics has been known to skip a model line with the ASV.
Like there never was an M series ASV.

Your DME could get you a model 960 if they really wanted to. They might squawk a lot because of profit margin but they could do it if they just would.

Your body got used to the Respironics way of doing things. You used their equipment for years.
It's not unexpected that your body might rebel in this situation.

[Gbmaryland]

Well, you are quite knowledgeable: it's a 950P unit.

So I'll see what they've got in the 960 series....

------

For what it's worth I'm a computer security expert, and when I got the ResMed unit the tech glossed over the fact that it had cellular communications. (He made it sound like you connect it to your home wireless, but in hindsight it was that he wasn't technology savvy and didn't use the proper terms.)

I said to him, "well, that needs to be turned off permanently. What if someone could update the setting remotely for a malicious purpose." He looked at me an said "that's very paranoid."

So I said " imagine a situation where the CEO of a large company is discussing merger with another company. Company B figures out that the CEO of company A uses this type of BiPAP. They are not going to hack into ResMeds cloud computing infrastructure, they're going to hack into this office because you are the easy target. Then they are going to figure out how to slightly skew the settings on the machine the night before the big important meeting, In order to put the man off his game." Then they are going to put everything back the way it was...

I proceeded to tell him that we see stuff like this all the time. Not through the manipulation of a BiPAP, but with plenty of other things that would lead me to believe it's only a matter time.

Now, I'm not a CEO or anyone really important, but yeah I'd rather not have a machine phoning home. I have 100% compliance for last five years, so I don't think it's a big deal. ...and read an SD card doesn't seem like a huge inconvenience.

[Pugsy]

You probably already know this but you can keep the AirCurve from phoning home by keeping it in airplane mode. I think it will nag you about it each time you turn it on but just takes a millisecond to tell it to stay in airplane mode.

If you can sweet talk them in to a 960 bear in mind that some of the 960 machines came already setup to accommodate the heated hose and some didn't.
The heated hose requires an 80 watt power brick and the other power brick for non heated hose capable machine is 60 watt.
Not a big deal to upgrade a 60 watt machine though...just need a heated hose , an 80 watt brick and a special lid for the humidifier that has electric to where the hose goes. It's available in an upgrade kit.
That's what I did to my 960 machine that I had. It came with regular setup but I wanted to use the heated hose.
I use my heated hose year round. Cooler in the summer and warmer in the winter but my humidity is the same no matter what. I found my nose doesn't like my messing with humidity settings.

The 960 can be made to phone home with a special modem that can be attached to it but I don't know that it is used very often. It's not built in to the machine like the AirCurve's phone home system.

[Gbmaryland]

Yep... The machine has been out of airplane mode about two times.

I know that they want to read it remotely to report compliance. They have told that they can change the setting remotely, so I use air plain mode so they have to call me.

It's interesting to me that computer security is such an afterthought in an industry that's dealing with so must PII.

[Bons]

The 960 ASV I picked up in June came with a heated humidifier and heated hose. It was turned on- who needs a heated hose in the summer?

It also came with a modem to communicate with the mother ship. When the ASV malfunctioned and gave the mothership different information than it displayed for me I exchanged it. My new one does not have a modem. So so far they do not know I unlocked the thing and reset my minIpap! The insurance company hasn't asked the DME to verify my compliance. I guess they figured since this is my second machine after six years on the old one I'm trustworthy.

[Sir NoddinOff]

The heated hose requires an 80 watt power brick and the other power brick for non heated hose capable machine is 60 watt.
Not a big deal to upgrade a 60 watt machine though...just need a heated hose , an 80 watt brick and a special lid for the humidifier that has electric to where the hose goes. It's available in an upgrade kit..

You can use a Hybernite heated hose, like I do. Had mine for maybe four years so far. There's also another similar heated hose out there; can't remember their name at the moment.
http://1800cpap.com/hybernite-universal ... upply.aspx

[Pugsy]

You can use a Hybernite heated hose, like I do. Had mine for maybe four years so far. There's also another similar heated hose out there; can't remember their name at the moment.
http://1800cpap.com/hybernite-universal ... upply.aspx

Yes, I am aware of the Hybernite heated hose but I assumed OP was talking about the ResMed heated hose that came with his new AirCurve machine and wondering if Respironis offered something similar. That's why I only mentioned the integrated heated hose for the Respironics machine.

I actually used a Hybernite hose with my 50 series machine. In fact I have one that I probably should just sell because I won't ever be using it again. The integrated heated hose suits my own personal needs better than the Hybernite because it allows for more consistency in humidity delivery plus I have control over the hose air temp which of course we don't with the Hybernite since it is either on or off with no way to alter the air temp.

[klv329]

Mode ASVAuto
Min EPAP 9.0
Max EPAP 9.0
Min PS 0
Max PS 15.0

Yeah, Min EPAP of 9.0 seemed too much for me, too. Tried it before, and just tried it a couple of nights. Too much discomfort. So I'll go back down to 8.0, and maybe try MIN PS of 0.0 for the heck of it. I can go a little lower than Min EPAP 8.0, but I get a lot of flow limitations. The EPAP doesn't go too much towards the Max EPAP for me, so those brief periods of higher EPAP don't seem to bother me.

You may be able to lower Max PS. At least for me, I found that Max PS of 7 or 8 was too low and produced daytime sleepiness, and that 10 and 11 were good enough.

Everybody is different, though. I just experiment around to see what works and re-check things from time to time.