New ASV: Dreamstation or Aircurve 10?

[BrianinTN]

Hi friends! I'm about to get a new ASV and am trying to decide between the Respironics Dreamstation BiPAP autoSV and the Resmed Aircurve 10 ASV. I know lots of people have asked this question, and I've read many of the threads on it. While the answer has generally been, "It comes down to personal preference," I'm hoping that some of you may be able to say which way you'd go given my specific situation.

The quick version:

• I was diagnosed about 9 years ago with severe apnea.
• Most of my events are hypopneas. In the original diagnostic PSG, hypopneas outnumbered obstructive apneas more than 6 to 1.
• I have treatment-emergent central apneas, and higher pressures always generate more centrals and a higher overall AHI. I also subjectively sleep much worse and feel much worse the next day when this happens (i.e., at higher pressures). As such, I was put on ASV therapy.
• I have always felt at least a little worse on xPAP than without it. I tried a couple different oral appliances and even surgery several years ago, but (as expected) those did not treat the SDB side sufficiently.
• I have no (known) heart or cardiovascular conditions (aside from hypertension), and my breathing is not of the Cheyne-Stokes variety.
• Based on lots of historical data, my AHI numbers are the best and I subjectively feel better (albeit not great) when the ASV min settings are kept low (min EPAP=4, min PS=2, backup rate=8 bpm). Auto bpm seems a little disruptive for whatever reason, and even at the min bpm, PTB is still >=98%.
• I've been most comfortable using a nasal pillow mask (the AirFit P10). I've tried several different full face masks and found all of them very disruptive. That said, things go haywire when air escapes through my mouth (the leak numbers go up, the pressure skyrockets unnecessarily, and my numbers and sleep quality get worse). A chinstrap and/or taping are required.
• As long as the leaks/mouth breathing situation doesn't happen, my AHI is <5 most nights, and my residual events are almost entirely hypopneas.
• Even when things are going well, 2-5% of the night in periodic breathing is pretty common. The PB number shoots up with leaks/mouth breathing, higher EPAP, and/or higher min PS.

I've been on a Respironics System One 60 Series ASV for several years. My doctor thinks that as my sleep quality is always iffy and prone to interruption and arousals (which may explain my relative intolerance to xPAP therapy), a new ASV with newer improved algorithms, quieter operation, etc. might help. And as insurance should cost most (if not all) of the expense, I'm game to try it.

Unfortunately I don't think I can try both machines, so I need to choose which way to go.

I'd welcome any advice or thoughts. Thank you!!!

[Jas_williams]

I am a fan of the Resmed ASV it works great for me and I would expect it to reduce your AHI to less than 1 but will it be disturbing to your sleep I don’t know

[metsfan302]

I have been using Resmed Aircurve ASV’s for 3 almost 4 years now. On my second one more (thank you new insurance lol). I was also debating this same question, to a point we’re it’s all I thought about. But I am so glad I decided to get the same exact ASV vs switching to the Philips.
I’ll try to sum it up this way -
The Philips - you have to adjust yours to it and it decides based on the settings when it does what and what it does when.
The Resmed - it adjusts itself to you breath by breath and responds quicker without you noticing. You don’t have to change the way you breath etc.

Hands down, Resmed Aircurve ASV.

Asked the same thing on a diff forum, About a dozen or more people all replied Resmed, not 1 person said get the Dreamstation BiPAP AutoSV

[palerider]

a new ASV with newer improved algorithms, quieter operation, etc. might help.

Well, if you want improved algorithms and quieter operation, then you have to go with the Resmed Aircurve 10 ASV.

The Dreamstation uses very much the same algorithms as the PRS960 model, though there were (I believe) some minor tweaks.

On the other hand, Resmed invented the ASV, and do it better, the water tank holds a bit more water, the machine is quieter, it takes up less space on your side table, and the auto on auto off works WORLDS better on Resmed than Respironics.

[BrianinTN]

Thanks all for the comments so far! It sounds like all votes are for the AirCurve.

Let me ask one follow up here. The faster breath-by-breath responsiveness in the AirCurve’s algorithms — is that usually a good thing, or can it be disruptive? As I mentioned in my first post, I seem to be an extremely light sleeper, which is part of the issue with xPAP for me; subtle position shifts and the changes they create in the airflow sounds wake me up. At the same time, I hang around those low minimum EPAP and PS values most of the night — except for when I don’t, at which point the PS in particular can go up quickly.

Those two things seem to be at cross purposes for me.

Thank you again!

[palerider]

Thanks all for the comments so far! It sounds like all votes are for the AirCurve.

Let me ask one follow up here. The faster breath-by-breath responsiveness in the AirCurve’s algorithms — is that usually a good thing, or can it be disruptive? As I mentioned in my first post, I seem to be an extremely light sleeper, which is part of the issue with xPAP for me; subtle position shifts and the changes they create in the airflow sounds wake me up. At the same time, I hang around those low minimum EPAP and PS values most of the night — except for when I don’t, at which point the PS in particular can go up quickly.

The entire point of an ASV is that it responds with sometimes violent IPAP swings in a single breath, in order to force air into you try to breathe on your own.

If it didn't do that, then it would be worthless at treating central apnea.

[beautifuldreamer]

The past 3 years I was using the PR System 1 60 Series ASV - and just a month and half ago I switched to the ResMed ASV.

I had an overnight sleep study with both Devices (Algorithms) on January 7th at our overnight sleep lab to see which device was better for me. The sleep study showed that I slept better with the ResMed. When they switched to the Respironics, I was unable to sleep the rest of the night. (Started with the ResMed Algorithm)

I am so glad they were able to switch me to the ResMed ASV - I have been sleeping so much better with the ResMed - my AHI is .43, with several nights of 0 AHI. I feel it is quieter and so much easier to breathe with. It is much easier for me to sleep through the night.

When I was using the PR1 Series 60 ASV, I felt like I was often awake at night and fighting against the breathing of the device. My AHI was higher averaging below 5, but sporadic nights would be up to 7, 10 or even 14 . . .

Recently I obtained my report from the titration, and it said that:

ResMed Titration: Patient tolerated the therapy well that obtained SWS and REM in supine with absence of neither apnea nor obstructive respiratory events from the initial to max EPAP 9 cmH2O.

Respironics AutoSV titration: Residual flow limitations RERA's and few obstructive arenas and hypopnea observed from initial to maximal EPAP levels tested. No possible effective therapeutic pressure was noted due to the Poor sleep efficacy and residual obstructive events and snoring. PLMS were noted only during the second half of recorded sleep (during the Respironics Titration)

All that to say is I highly recommend the ResMed AirCurve ASV

[palerider]

The past 3 years I was using the PR System 1 60 Series ASV - and just a month and half ago I switched to the ResMed ASV.
...
All that to say is I highly recommend the ResMed AirCurve ASV

Thanks for posting that, I read it, without noticing what thread it was in, and said to myself "self, there's someone that's trying to decide which to get, I should point 'em at this post", then I noticed that you'd posted it in that thread

[Sleeprider]

Something not yet mentioned is the delivery of pressure support by Resmed uses the very natural and comfortable Easybreathe wave-form. It looks like a cresting wave as pressure increases rapidly at first, slowing near the apex of IPAP, then dropping off quickly at expiration cycle and eases into the EPAP trough. In contrast, the Philips pressure is delivered as a square-wave, modified by their BiFlex which rounds off the edges a bit. The comfort difference is reported to be significant.

[bwexler]

I have been using the PRS1 960 ASV for the past four years with AHI below 2 with occasional ZERO.
At the end of December 2018 I acquired a Resmed Aircurve 10 ASV. I am glad I switched, the Resmed is much gentler and more comfortable.
During this period I had my first upper respiratory infection/ stuffed, runny nose in many years. This lasted almost 3 weeks an required a switch to a full face mask which I do not enjoy.
My AHI has been all over the place as high as 10 and several ZEROS. Most of the bad nights occurred during my illness.

Bottom line I am glad I switched to Resmed.

[palerider]

. It looks like a cresting wave as pressure increases rapidly at first, slowing near the apex of IPAP, then dropping off quickly at expiration cycle and eases into the EPAP trough.

I wouldn't call this "increases rapidly",

easybreathe.png

I'd call it a smooth gradual increase that peaks towards the end of your inhalation. (that's from a Resmed ASV).

[BrianinTN]

This is great. I'm grateful for all the input and information. Thank you all!

[BrianinTN]

Finally got the new ASV — after initially being given a VAuto last week and not realizing it until, of course, Saturday morning when there wasn't anything that could be done. Ugh.

Last night was rough and I feel pretty cruddy today, although the AHI value of 1.04 would make the doctors happy. The AirCurve is being much more aggressive with IPAP than my old PR System One. That said, SleepyHead reports 6% of the night in Large Leak — despite taping — so maybe I need to tape harder tonight to ensure I'm not having air flying out the edges of my mouth.

Did anyone else who's done the PR-to-Resmed ASV transition find it tricky at first, and if so, any suggestions?

[Pugsy]

Not all leaks are mouth breathing leaks.
Remember there are also mask movement leaks as well.
Unless your tape came loose....

[CreativeChris]

AIRCURVE! I used to use a Dreamstation which I thought I liked until I was moved to an Aircurve. Truly night and day difference. It's quieter, has more bells and whistles, the app is better for quick knowledge of the night before, my AHI is almost non-existent now, and IMHO prettier! The unit even blows cool air through the system to dry out the hose and mask. The only way anyone could get it back is from my cold dead hands!

The only drawback is the water tank is much more cumbersome to clean and get in and out of the unit.