Graduating from Bi-pap to ASV (maybe)

Hello to all,
I was diagnosed with OSA after doing a sleep lab test in 1998 and have been on the same Respironics BiPap Duet ever since. It has served me well
and has been a gallant machine all these years. About a month or two ago it started to act up on me by cutting off randomly, making weird noises
and generally not giving me a whole lot of good sleep at night. I could also tell my condition had reverted back to where I was wanting to doze during the day along with not feeling rested or having any energy. Although, in hindsight, I believe this feeling had started to emerge over the last couple of years but not to the point that I was looking at myself in the mirror and saying something was definitely wrong.
On Jan. 20th I spent the night at a sleep lab because I thought instead of obtaining another machine preset with my old settings that it would be a good time to see if the pressures were still accurate from the first sleep lab.
The doctor's office that read the results from the titration contacted me and told me I need to go back and do the test again, only this time with the ASV machine. She explained to me over the phone what this machine is designed to do and I have done some reading about it on-line also.
She said my condition looked more like I had Central Sleep Apnea as opposed to my diagnosis 12 years ago. This Tuesday night, Feb. 2nd, I will return to the lab to undergo the additional test. I could tell after I woke up from the test last week that I still felt the same whereas after my first lab test in 1998 I felt better than I had ever felt before. So I am welcoming the fact I may be on the way to discovering a new way to help my condition.
As I understand from research on-line, these machines have not been around in the U.S. but a few years and were more widespread in Europe before coming over here. What I am wanting to know is, are there questions I need to be asking the tech that will be doing my test next week?
Such as "have they done many of these titrations with the ASV machines?" Or "how many of this type have you personally done?"
Any thoughts would be appreciated.
Fred D

Greetings! And welcome to this crazy place! One quick question before I start answering your questions. Are you sure I didn't post this? I likewise had a BiPAP unit that finally died. Needed to go back for another sleep study to get a new BiPAP. Unfortunately for me, due to a mixup at the doctor's office and with the DME I never went back after that study. So, it was another two years before they went to an ASV unit.

Fred D wrote:... What I am wanting to know is, are there questions I need to be asking the tech that will be doing my test next week? ...

If I read this correctly, yes, you want to talk with the sleep lab BEFORE you go for the sleep test. You want a very experienced sleep tech working with you. You might even want to request a prescription for Ambien (or Lunesta or Sonata). An ASV unit is QUITE different feeling than a straight BiPAP. Having something to help you go to sleep will help you and allow them more time to titrate the therapy to your needs.

Fred D wrote:... Such as "have they done many of these titrations with the ASV machines?" Or "how many of this type have you personally done?" ...

Yup. Also:

• How many years experience does this sleep tech have?
• How many titrations has this tech done on an ASV unit?
• How many titrations per month does this sleep lab do?
• Are they associated with a DME?
• Does your insurance consider that DME to be "in network"?
• What ASV units does the DME carry (ResMed or Respironics)?
• If they carry both, do they have a loaner of each to allow you to try each?
• If they only carry Respironics, is the the Respironics BiPAP AutoSV Advanced?
• If they only carry ResMed, is the the ResMed VPAP Adapt SV Enhanced?
• What DME coverage is provided by your insurance?
• Would a BiPAP S/T unit be an option?
• How would they tell during the sleep study?

Notes: You would probably want the Respironics BiPAP AutoSV Advanced if only Respironics is available. It offers both Auto Titration for the EPAP value and BiFlex to make the change in pressure easier. Some people prefer the feel of ResMed. Some prefer Respironics, instead. I have fairly severe CSA and find the ResMed unit very comforting when it INSISTS that I maintain my breathing. But others find that insistance both annoying and distrubing as they try to sleep.

Asking questions like these will tend to ascertain you have an experienced sleep tech. They will spot problems and try things that the average sleep tech will not notice. So, you have a great idea to call the sleep lab well in advance. And you will really want to check your insurance on these units. Though expensive, as you can tell from previous posts, there is no doubt in my mind these units are a Godsend for many of us here.

Best wishes along this journey. The good news for you is that these systems can make a huge difference in how you sleep.

Thanks John for the insight into what I need to ask and what I might can expect. I did find out that the tech from last week will be doing
my test next week. I asked the woman I was talking to on the phone if this tech had previous experience with ASV testing and she said "yes, he
had been with them for quite a while". Didn't really answer my question....... but the lady was kind enough to insist I call back if I have any questions so I believe I will give her a ring Monday. I have never taken a sleep aid, such as Ambien, but might see if I can locate it for back up.
Never had much problem going to sleep before but if this is going to feel too foreign when I try and sleep during the test, it might be beneficial to have on hand. That or at least a couple of Tylenol PM's.
FD

For my CSA, I'm using the Respironics BiPAP AutoSV Advanced. Since my sleep study was done on a Resmed VPAP Auto & they had problems and incorrectly translated the settings for my machine. (got it fixed now)

So, if you are interested in the Respironics unit, be sure they use that same unit for the tritation, to ensure you get the right settings.

When using the resmed unit, I felt like I was fighting it over who was in control of my breathing; but with the Respironics unit I never have that problem. (I think its great).

Respironics documents:
Prescription conversion guide:
http://bipapautosvadvanced.respironics. ... _Guide.pdf

If you they do use the Respironics model for the sleep study, here is the triation protocol for the Respironics BiPAP AutoSV Advanced:
http://bipapautosvadvanced.respironics. ... otocol.pdf

Respironics BiPAP AutoSV Advanced user manual:
http://bipapautosvadvanced.respironics. ... Manual.pdf
(all thanks to JohnBFisher previous posting ) Thanks John.

Thanks, will definitely find out what machine they plan on using during the titration and make sure it will be the same that is provided for me.
Does there seem to be a consensus on which machine is more user-friendly/comfort-friendly or is it based more on individual preferences?
There may already be a thread asking this question but after reading mdboze's reply; it got my curiosity up.

Fred D wrote:Thanks, will definitely find out what machine they plan on using during the titration and make sure it will be the same that is provided for me. ... Does there seem to be a consensus on which machine is more user-friendly/comfort-friendly or is it based more on individual preferences? ... There may already be a thread asking this question but after reading mdboze's reply; it got my curiosity up.

LOL! With the length of these ASV threads you would be hard pressed to find an obvious conclusion like that. You might say we tend to chat a lot!

mdboze loves the Respironics BiPAP AutoSV Advanced. There are others who also prefer that model. The love the way the unit works and how it feels breathing with it.

Banned, I and others tend to prefer the ResMed VPAP Adapt SV units.

What's the difference? Personal preference and probably also individual need. I know that I personally NEED a unit that keeps track of the volume of air that I breathe. I don't mind that it is a harsh taskmaster when it comes to breathing. Though the fairly quick change from minor pressure swings to large pressure swings bothers some people, it does not bother me. But I've been using xPAP thereapy for almost 20 years. Let's put that in perspective. That's almost 40 percent of my life !!!!

And yes the ResMed ASV unit is leak intolerant. But if you get that handled, it does a GREAT job of bringing my severe obstructive and central apneas to zero. Yup. Severe to zilch. Nada. Keine!

I had reached a point where I was getting perhaps two to four hours of bad sleep every night. I was an absolute wreck. Unable to concentrate. Unable to really work. Afraid I would loose my job. Afraid I would loose my insurance. And afraid that if I did not stop the downward spiral of my health, I would soon no longer have to worry about the situation.

But I've started to once again to slog back toward decent health. And the ASV unit is responsible.

So, how do you choose? Well, I've seen two different approaches. Both seem to work well.

First, you can request use of each unit. One way to do that is during the titration. But that's probably the hardest to do (setup each ASV unit and either move from room to room or swap units. Not likely that will often be done. Instead some DMEs offer loaner systems (or even rental). You can try each that way.

The second (which my DME uses) is to place the ResMed unit on a rental basis. It is cheaper and tends to be effective for most people. It also has the fewest "knobs to wiggle". There is a LOT to be said about KISS. So, if it works, then everyone wins. If it does not work, then they will swap you to a Respironics ASV unit.

I had used the Respironics ASV unit (not the Advanced) during the sleep study. I personally found the way it worked to be more disconcerting than the way the ResMed unit works. But that's me. I would have done well with the Respironics unit. I would have eventually adjusted to the way it works.

And the point is your needs might ... no, will be different than mine. So, talk with your DME about this. See if you can use both. Remember that price will be a big factor. Even if you have very generous DME coverage, these units tend to exceed those thresholds. But in all honesty, I would have paid out of pocket to get good sleep every night.

Hope that helps.

Fred D wrote:Thanks, will definitely find out what machine they plan on using during the titration and make sure it will be the same that is provided for me.
Does there seem to be a consensus on which machine is more user-friendly/comfort-friendly or is it based more on individual preferences?
There may already be a thread asking this question but after reading mdboze's reply; it got my curiosity up.

Fred,

Being an Engineer, I research everything thoroughly before making any significant decision such as this.
Although I ended up getting a Respironics BiPap autoSV Advanced, my research originally led to two the following final two options:
1. Respironics BiPap autoSV (not Advanced, I learned about that one a few days before my purchase)
2. Resmed VPAP Adapt SV - the one I was battled with over who was in charge of my breathing - but still a top candidate

Here is what I found in my final comparison of the two options:
The key reasons I prefer the Respironics BiPAP autoSV (or autoSV Advanced)

[*]Uses standard tubing, allowing use of any mask, any brand; no restrictions.
[*]Target peak flow adapts to SDB event changes
[*]Dynamic pressure support, recognizes and reacts to changing pressure needs
[*]Includes the capability for data logging periodic breathing events. (not an extra purchase)
[*]Build in storage to log data: up to 7 days of intensive details or 6 months of normal usage type data.(AutoSV Advanced)
[*]Smart card slot for data logging.
[*]overall, newer technology, more control, more options; (as an Engineer, I like features and options)
[*]The Respironics machine is reported to be far more leak tolerant than the Resmed machine.
[*]seems to have a better algorithm. (With the Resmed unit, I felt I was constantly fighting it)


About the Algorithms:
Algorithm: ResMed VPAP Adapt SV:
* Minute Ventilation Based
* 3-min moving average
* 90% of the minute ventilation to determine the tidle volume
* Always 90% of MV. No change in response to SDB events

Algorithm: Respironics BiPap autoSV
* Peak Flow Based
* 4-min moving average
* Statistical processing on peak flow data to determine target level
* Target peak flow adapts to SDB event changes
* Allows a EPAP min and EPAP max (provides best comfort (autoSV Advanced))

Pressure Settings & Feature Comparison:
Setting :.. VPAP Auto SV ; BIPAP Adapt SV
Max Pressure:.. 20cm..........; 30cm,
EPAP Limit:.. 10cm.............; 25cm (my EPAP is set min7 to max12 with the Adapt SV Advanced feature),
IPAP Limit:.. 20cm..............; 30cm,
CPAP+SV Mode:.. NO............; Yes (set EPAP = IPAP Min),
Back-Up Rate:.. Auto only......; Off, Auto or Fixed (3-30 BPM),
Tubing:.. Non-Standard.........; Standard,
Humidification:.. optional......; optional,
Masks:.. ResMed masks only...; No restrictions, various mask types and brand options,
Patient Alarms:.. Disconnect, high leak ; Disconnect, low minute ventilation, apnea,
Rise time:.. not selectable......; 100 to 600 msec

Also I read about oher peoples experience:
"The Respironics algorithm tends to be softer and less 'commanding"
"The Resmed algorithm sort of takes control & you follow it rather than it follow you. (probably why I felt like I was fighting it)"

And after all of that.... right as I was about the get the BIPAP Adapt SV; the new BIPAP Adapt SV Advanced was released; and I really like its ability to set a EPap min and Epap Max.

JohnBFisher wrote: What's the difference? Personal preference and probably also individual need.
....
Even if you have very generous DME coverage, these units tend to exceed those thresholds. But in all honesty, I would have paid out of pocket to get good sleep every night.

I agree with JohnBFisher; Personal preference is the difference. Overall both units are top choices.
Both will be able to bring your apneas to zero; and help you feel good again.
If you want simplicity, the Resmed unit may be a good choice.
If leak tolerant and ability to use any brand mask is important, the Respironics unit may be a good choice.

Regarding some people feeling like Resmed struggles with you to control your breathing vs the Respironics; this doesn't really matter because either machine will take time to get used to it.

Here is a thread on the here new Respironics BiPAP AutoSV Advanced:
viewtopic/t48330/Philips-Respironics-La ... p-Sys.html

Regarding Paying for the unit:
If your insurance does not cover the entire purchase (like mine did not due to low DME coverage);
Ask to rent the unit, and have the rental go toward the purchase price; with a goal to get 2010 and 2011 coverage of DME benefits to pay for the machine.
Even though my insurance only covered about half, I got them to pay for most it by renting toward the purchase price in 2009, paying the rest in 2010.

I appreciate the information and the time it took for you to respond more than you can know. I can tell by browsing through the other questions and threads that there are alot of caring and good individuals on this site.

I have a feeling I will be on the phone quite a bit tomorrow with the sleep lab and the referring doctors office hoping to get answers to the questions that you two have helped me formulate.

I like the idea of renting before buying if my insurance will agree to it. Unless they jump up and balk on me for some reason; they are supposed to spring for 80% of it. I met my deductable plus copay at the first night of testing a week and a half ago. I am fortunate to have insurance.
I married in Sept. and have coverage through my wifes work. Up until then for the previous 24 years, I was self employed and could not afford it.
Luckily I have been able to avoid any kind of catastrophic health issues.

Even if I have to shell out more than I want to for this machine; it will be money well spent if it provides me with a good, restfull nights sleep.

JohnBFisher wrote:And yes the ResMed ASV unit is leak intolerant. But if you get that handled, it does a GREAT job of bringing my severe obstructive and central apneas to zero. Yup. Severe to zilch. Nada. Keine!

Talk about leak intolerant!!! The machine I have now has gotten so bad that if I turn from back-to-side or side-to-side it will shut off on me and I have to reach over and restart it. And it's not a mask issue either. After 12 years of intimacy with it, I can tell it has decided it wants to retire.
Which is actually a godsend because if it had not started acting up, I might not be going through the titration process and have found out my apne problem has progressed into a different stage. It has been a good and faithful friend these past years so I cannot complain.

I will try and find out tomorrow if the sleep lab and tech are experienced in this type of test and to make sure the brand of machine they use will be the same that my provider will supply me with. When I get answers to these I can then get into some specific details that John posted in his earlier reply.

Once again, my sincere thanks!!!

Fred

Good luck on your titration. It will be interesting to read what you think of whatever they set you up with.
Both machines are excellent. mdboze summed up the differences & John has pointed out how well his machine works for him.

I like them both. In fact tonight I am planning on switching back to my Bipap Auto SV as it is some months since I used it & I do like the style of sleep it offers. As for the Vpap Adapt SV, it actually (from my experience) teaches you to breathe better by exercising more control. Once I got used to it & had a good leak free mask (quattro) that worked with it, I really got to like it, but, also like the Bipap Auto SV, so use them both in relays.

The Vpap Adapt SV is though, totally quiet. The Bipap Auto SV has an acceptable level of white noise & always seems to run quieter after a couple of hours use.

DSM

DSM,

How did you happen to arrive at having both the Bipap Auto SV and the Vpap Adapt SV? I guess that's one way of solving the either/or dilemma.

As long as neither one sounds like a jet engine ramping up for take off; I will be happy. The Bipap I used in my lab test a week and a half ago reminded me of what a machine was supposed to sound like. I had gotten so used to the noise from mine that it was almost TOO quiet.

dsm wrote:Both machines are excellent. mdboze summed up the differences & John has pointed out how well his machine works for him.

Thanks to them I feel I have a good chance of a successful result from the test; or at least what to look out for.

Fred

Fred D wrote:... As long as neither one sounds like a jet engine ramping up for take off; I will be happy. ...

The ResMed VPAP Adapt SV enhanced is a bit quieter than the Respironics BiPAP Auto SV Advanced. In fact my wife complains that she feels she needs to check me more frequently with this ResMed ASV unit.

But it's only a matter of a little bit. I found the Respironics ASV unit to be almost as quiet during the sleep study. It certainly is quieter than the first Respironics Remstar Choice CPAP unit that I owned:

http://www.respironics.com/UserGuides/U ... Choice.pdf

[ Now there was a CPAP. You had to use a manometer to adjust the unit when you travelled to a different altitude! Freaked out the DME when I told them what I did and how I did it. He insisted on testing it when I returned. And he was amazed that the pressure was "right on" the prescribed pressure. ]

The Respironics ASV units are even quieter than the Resmtar BiPAP Auto M Series, for that matter. And I don't find the M Series one all that obnoxious. Certainly not when I compare it to my old Remstar Choice unit.

Hey John,

Found out earlier the Resmed is the product of choice I will be using. According to the dr.'s office they have two sleep lab companys they
use here for the ASV titration and depending on your insurance provider network is what determines where you are sent.
They assured me the tech would be competent to handle the study. Also said it would be ok to take an Ambien after I arrive at the lab so
I had her call me in a script that I can pick up tomorrow.

Fred

Fred how are things going for you? Have your follow up scheduled? Have the Ambien prescription? Just checking on you ...

If the ASV unit helps ... and it will take some adjustment to the pressure fluctuation ... you will wake up and feel much more rested than you have in a while. I wondered (only half way joking) if I could take the unit home with me!

So, hope all is going well for you...

Hi John,
I had the sleep study last Tuesday night. Everything went fairly well. I did not take any medication to help me sleep and about half way through
the night I was wishing I had. Was restless and seemed to have more dreams than what I normally have but that is water under the bridge.
The tech that prepared me was the same one from the last time and he said his supervisor would be coming in to oversee the test. I was glad
to hear that although I never saw him. When I awakened in the morning I asked if he had made it in and the tech said that he had.
About the time I was hooked up and ready to lie down the tech received a call from the supervisor to see how it was going and ended up switching me to a different room. The first room had the Resmed in it but the one I was moved to had a Respirionics. I ended up using it instead.

I felt better the next day; more alert until around the middle of the afternoon when I had a sinking spell and started feeling sleepy. Received a call from the sleep specialists office Thursday afternoon and have an appointment Monday morning with the doc to go over the results. I was happy to have heard from them so quickly as the sleep lab office said it might take as long as 7 to 10 days before it is read and I am contacted.
I am anxious to meet with the doctor and see what the result of the titration is. I will let you know what I find out Monday.

Hope you have a great weekend.

Fred

Fred

Hope it is a good visit. Glad to hear you got through ok.

DSM