Difference between ASV and C-Flex

[nightveil]

Hi...

I'm new to all of this and a little buried by all the terminology right now. I've been recently diagnosed with complex apnea with numerous central apneas, and my sleep study indicates a non-responsiveness to CPAP even at psychotically high pressures.

My doctor wants to put my on an ASV device, but I'm not sure the home healthcare company that my case has been given to clearly understands this.

Can someone tell me if the Remstar M-Series with C-Flex is actually using asv technology? That is what the company I'm working with is saying I'll be getting. I'm not really clear on the differences between an AutoPAP and ASV technologies, and I know some manufacturers use proprietary terms to describe what is basically the same thing. I can only find the term ASV in reference to the ResMed VPAP products is why I'm posing this question.

I just want to make sure that I'm actually ending up with what my doctor prescribed versus what a nurse who may not be up on the latest technologies transcribed, or versus a brand that a HHCP wants to push.

Any help would be appreciated.

Joe

[Snoredog]

No comparison.

CFlex is exhale relief found on a basic CPAP or AutoPAP machine from Respironics. It is used to treat obstructive sleep apnea.

AdaptSV is a special machine is used to stabilize breathing when you have the disorder known as Complex Sleep Disordered Breathing (CSDB). Patients with CSDB have a mix of obstructive sleep apnea and central sleep apnea at the same time. While the Bipap S/T can be used for Central Apnea, they seem to be moving towards the AdaptSV machine for those cases as well.

These patients generally don't respond well on straight CPAP and even worse on AutoPAP.

If you have CSDB they need to supply you with a AdaptSV machine NOT Cflex:
https://www.cpap.com/productpage-advanced.php?PNum=2471

You need to call your doctor and confirm the machine you are supposed to get, there is quite a bit difference in cost.

[rested gal]

Joe, an ASV (adaptive servo ventilation) machine is a completely different type of machine from the one you said the DME is talking about giving you. No Respironics machine that has C-Flex (or A-Flex, for that matter) is an ASV machine. Nor is an "autopap" an ASV machine.

When talking "ASV", the specific machine your doctor probably means for you to have is the ResMed VPAP Adapt SV.
Shown Here

If that is not the machine the DME intends to set you up with, I'd not accept what they offer until you get everything absolutely clear between the doctor and the DME as to exactly which machine (specific manufacturer and specific model) the doctor wants you to have.

If the DME is so hazy about what is, or is not, an ASV type of machine, I'd also want to know how experienced they are at setting one of those machines up right and whether they understand the importance of using a mask that can pass the Learn Circuit routine on its own.

Actually, I'd think the doctor would have wanted you to be titrated AT a sleep lab WITH the ASV machine rather than relying completely on having even a DME experienced with that machine set it up. Let alone a DME who is confusing "autopap" with "ASV." Do you know if an Adapt Servo machine was used at all on you during your titration?

Do a search for posts by christinequilts on this message board with keyword Adapt or SV. She is the most experienced poster actually using that machine.

To give you a jump start toward christinequilts' excellent posts in the very long thread titled Resmed VPAP Adapt SV - for Central Sleep Apnea click here to begin on page 21.

Pay special attention also to the posts in that thread by StillAnotherGuest and -SWS.

[Snoredog]

Joe, an ASV (adaptive servo ventilation) machine is a completely different type of machine from the one you said the DME is talking about giving you. No Respironics machine that has C-Flex (or A-Flex, for that matter) is an ASV machine. Nor is an "autopap" an ASV machine.

When talking "ASV", the specific machine your doctor probably means for you to have is the ResMed VPAP Adapt SV.

Doctor could have easily been talking about the Respironics Bipap Auto SV, it has designed specifically for treating CSDB:

https://www.cpap.com/productpage-advanced.php?PNum=2471

I have no idea which one is better, but Resmed is no longer the sole supplier of that equipment.

[nightveil]

Rested Gal/Snoredog:

Thanks for all this great info. I think the problem here is actually a nurse at my sleep center who isn't familiar with the technology and may not have filled out the script properly. I have not actually seen the script that was sent to the provider and I think that may be part of the problem. I'm going to call them back today and try and get some clarification.

I do know that I was not tested on the ASV during either of my sleep studies as it was not suggested until after the analysis of the study. In fact, my existing pulmonary specialist is referring me to the sr. partner in their practice because in her eyes my case is unusual enough to warrant it. The first sleep study I had incurred some problems with the baseline and was done by a lab who seemed to have more interest in selling me a CPAP machine than in my overall health. Seems to be a little bit of a conflict of interest there, but I digress.

Regardless, I am in agreement with you guys that I need to get this sorted out explicitly because I have definitely read that treating central apneas with CPAP can actually significantly worsen the situation.

Thanks again,
Joe

[Snoredog]

[quote="nightveil"]Rested Gal/Snoredog:

Thanks for all this great info. I think the problem here is actually a nurse at my sleep center who isn't familiar with the technology and may not have filled out the script properly. I have not actually seen the script that was sent to the provider and I think that may be part of the problem. I'm going to call them back today and try and get some clarification.

I do know that I was not tested on the ASV during either of my sleep studies as it was not suggested until after the analysis of the study. In fact, my existing pulmonary specialist is referring me to the sr. partner in their practice because in her eyes my case is unusual enough to warrant it. The first sleep study I had incurred some problems with the baseline and was done by a lab who seemed to have more interest in selling me a CPAP machine than in my overall health. Seems to be a little bit of a conflict of interest there, but I digress.

Regardless, I am in agreement with you guys that I need to get this sorted out explicitly because I have definitely read that treating central apneas with CPAP can actually significantly worsen the situation.

Thanks again,
Joe

[nightveil]

Snoredog:

I do have the results from both of my PSGs.

The interesting points out of the report:

Sleep-disordered breathing for the entire study revealed 131 central apneas, 3 mixed apneas and 302 hypopneas. Mean duration of all events was 19 seconds. Longest hypopnea was 41 seconds, longest central apnea was 34 seconds, longest apnea was 34 seconds.


Conclusion:

"Severe sleep disordered breathing (Diagnosis Code 327.23) with an overall apnea/hypopnea index of 86 events per hour and a desaturation nadir to 86%. Mild 1+ snoring. No improvement with CPAP/BiPAP to 20/16 suggesting "complex" sleep apnea."

Does that offer any clarity on the situation?

Thnx,
Joe

[Lubman]

No improvement with CPAP/BiPAP to 20/16 suggesting "complex" sleep apnea

Call or go see your sleep MD.
From this statement, it says that a conventional CPAP or BiPAP over a wide range of values did not help you. Suggesting "complex" sleep apnea.

Ask your MD if he meant you need an Assist SV and if so, go to another DME that has experience with them. From what you said, the DME you were sent to doesn't understand very much about ASV. Ask the MD to send you to someone who has experience with the machine he recommends -- if he doesn't then post here for an ASV experienced DME in your area or go to a local sleep apnea AWAKE group and ask.

Lubman