S9 VPAP Auto vs S9 VPAP Adapt

[cjc]

Hi Guys,

I have been combing over this forum for a few weeks now and have only now decided to jump into the fray and start discussing

Basically, My name is Chris and I am a 27 year old male who last year was (finally) diagnosed with Sleep Apnoea (or Apnea for the American readers). I went down the path of talking to a Maxillomandibular surgeon to see if there was some sort of permanent fix but after his distinct lack of enthusiasm about how effective the surgery would be I have resigned myself to the fact that CPAP will be a part of my life (For the better I hope).

I have recently been working with my local CPAP supplier in regards to machine type and setup. After initially trying CPAP and APAP for approximately a month and wanting to tear my mask off and throw it across the room night after night I asked if there was an alternative. I then tried a Resmed S9 Adapt and instantly loved how much more comfortable it was (Like night and day really). After discussing price, the $4100 was a bit of a shock to the system but I decided I needed this machine and I was on a crusade to get a better price. After looking online, I found a place selling the S9 VPAP Auto and stupidly assumed it was the same as the Adapt (The VPAP Auto is not available in Australia hence my confusion) and ordered it. I then discovered while the unit was in transit that there was a very important difference in the machines. I am able to send the Auto back and exchange it for an Adapt and this is my major dillema.

I now know that the VPAP Auto is a BiLevel device and the Adapt is an ASV but I cannot for the life of me figure out if the Auto will suit me or if I indeed need the Adapt. The main feature I loved was the lower Exhalation pressure of the Adapt but I now know that it is supposed to be gold at treating any Centrals as well as the Obstructives. Unfortunately the Sleep Apnoea system in Australia is not quite as developed in the states and I am essentially left to decide what machine I need on my own.

The item on my sleep study (attached below) that is throwing me is the Centrals/hr value of 9. When I was on APAP my AHI dropped to a lowest value of 6.5 but an average of about 11. This was significantly different to the 2.6 I was seeing on the Adapt unit. Can anyone tell me if I am on the right track in assuming that I have enough Centrals to warrant sending the VPAP Auto back and getting the Adapt ?

Thanks alot to everyone who managed to read the mountain of text

Chris

[cjc]

In addition, my APAP settings were Min:8cm Max:16cm with a 95th percentile of 10.5

The settings on ASV were EPAP: 6.0, Min PS: 6.0 and Max PS: 11.0

[avi123]

If you were tested in the U.S. then you would probably be prescribed a regular CPAP. But many of us are using an APAP such as the S9 Autoset which could be switched between CPAP and APAP modes. Those VPAP machines that you're talking about would be considered as subsequent machines if the person shows the need for it in a repeat sleep test in a clinic. As you see in the link below, those VPAPs are BiLevels machines and cost almost twice than ordinary CPAPs and APAPs.

http://www.resmed.com/us/products/s9_vp ... nc=dealers

[cjc]

If you were tested in the U.S. then you would probably be prescribed a regular CPAP. But many of us are using an APAP such as the S9 Autoset which could be switched between CPAP and APAP modes. Those VPAP machines that you're talking about would be considered as subsequent machines if the person shows the need for it in a repeat sleep test in a clinic. As you see in the link below, those VPAPs are BiLevels machines and cost almost twice than ordinary CPAPs and APAPs.

http://www.resmed.com/us/products/s9_vp ... nc=dealers

This is true avi123. I'm not concerned about cost to be honest and have already paid for (and received the S9 VPAP Auto). The extra for the Adapt is also not a problem at all. The category I probably fit into is the "Non compliant" users of CPAP as I found when using the APAP machine (A F&P Icon Auto) I would wake up during the night take off the mask and fall back asleep without having ever remembered I did so. When using the Adapt I never had this particular problem and as a result my compliance was much higher and so I guess I'm hoping that the machine I already have sitting here on the floor will be a perfect fit for me despite being the VPAP Auto and not the Adapt. I'm happy to send the VPAP Auto back for the Adapt, i'm just one of those people that need to understand everything 100% before I do it

[robysue]

The item on my sleep study (attached below) that is throwing me is the Centrals/hr value of 9. When I was on APAP my AHI dropped to a lowest value of 6.5 but an average of about 11. This was significantly different to the 2.6 I was seeing on the Adapt unit. Can anyone tell me if I am on the right track in assuming that I have enough Centrals to warrant sending the VPAP Auto back and getting the Adapt ?

Do you have all the data from the Adapt that trialed?

An important piece of data for answering your question is the percentage of patient triggered breaths data. The real difference between the VPAP Adapt and the VPAP Auto is that the Adapt will attempt to trigger you to inhale if your breathing becomes sufficiently ragged and the Auto will not. (And this is the reason the Adapt is so much more expensive---it has the software that allows it to act as a noninvasive ventilator at times, and the Auto does not.)

In general, if you've got some periods where the percentage of patient triggered breaths drops down, that means the Adapt was triggering your breathing during those periods of the night. And that's how the Adapt prevents the CAs from happening. And if you can provide that data, then one of the posters who has dealt with central sleep apnea for some time can likely give you a better answer of whether the Auto will suffice or whether you are better off with the Adapt.

[cjc]

Hi Robysue,

Thanks for the quick reply

I have the printouts for the time that I used the unit but unfortunately it does not show this statistic (I'm not even sure if the S9 will record this as the ResMed site indicates that the Adapt does not record Central Apnoea events ). I am actually borrowing the device again in another 2 days and now have access to the ResMed software so I will download it and go over it with a fine tooth comb. I guess that despite all the research i've done (Including countless hours on this superb forum) I am still somewhat confused by how many variables there are when it comes to CSA, OSA induced CSA and Complex Apnoea.

[Mary Z]

Unfortunately most of us learn by doing and experimenting with different pressures and machines to find what works for us. You can do the research, but all of us don't fit the established mold. After four years of trying CPAP, Auto, and Bilevel and never being able to get my AHI into a normal range I had a sleep lab trial of a Respironics ASV. I didn't have central or complex sleep apnea and the majority of my events were hypopneas. This seems to be an effect of medicines I am on long term. Though I basically felt ok I wanted to see if I could sleep less at night (averaged 10- 12 hours) and get rid of a drug resistant lingering depression. After one month on the ASV my AHI has decreased from an average of 28 over six months to 10.9 over one month. I sleep less and can stay up later. I figure it will take three to six months to completely experience the benefits of the ASV. I don't think an ASV is inappropriate for any kind of sleep apnea (experts comments welcome). The big difference other than performance is cost, and of course what works best for you. This can't be determined in a week or sometimes even a month if you're having problems. For others it's smooth sailing from the start with a data capable CPAP. Good luck.

[idamtnboy]

Hi Robysue,

Thanks for the quick reply

I have the printouts for the time that I used the unit but unfortunately it does not show this statistic (I'm not even sure if the S9 will record this as the ResMed site indicates that the Adapt does not record Central Apnoea events ). I am actually borrowing the device again in another 2 days and now have access to the ResMed software so I will download it and go over it with a fine tooth comb. I guess that despite all the research i've done (Including countless hours on this superb forum) I am still somewhat confused by how many variables there are when it comes to CSA, OSA induced CSA and Complex Apnoea.

The Adapt does not differentiate between OAs and CAs. See this discussion viewtopic.php?f=1&t=74249&st=0&sk=t&sd=a

[cjc]

Hi Robysue,

Thanks for the quick reply

I have the printouts for the time that I used the unit but unfortunately it does not show this statistic (I'm not even sure if the S9 will record this as the ResMed site indicates that the Adapt does not record Central Apnoea events ). I am actually borrowing the device again in another 2 days and now have access to the ResMed software so I will download it and go over it with a fine tooth comb. I guess that despite all the research i've done (Including countless hours on this superb forum) I am still somewhat confused by how many variables there are when it comes to CSA, OSA induced CSA and Complex Apnoea.

The Adapt does not differentiate between OAs and CAs. See this discussion viewtopic.php?f=1&t=74249&st=0&sk=t&sd=a

Awesome, thanks idamtnboy

[JohnBFisher]

... Though I basically felt ok I wanted to see if I could sleep less at night (averaged 10- 12 hours) and get rid of a drug resistant lingering depression. After one month on the ASV my AHI has decreased from an average of 28 over six months to 10.9 over one month. I sleep less and can stay up later. I figure it will take three to six months to completely experience the benefits of the ASV. I don't think an ASV is inappropriate for any kind of sleep apnea (experts comments welcome). The big difference other than performance is cost, and of course what works best for you. ...

In general I tend to agree.

You can use an ASV unit to address simple obstructive sleep apnea. But it's about like saying you can drive a tank to work. Sure, you could do it. Not sure you would WANT to do that. In your case, you needed the tank to address your lingering issues. Having tried the sedan, you determined it was not the right answer. And that's the key. Start with the cheaper option and work toward what addresses the problem. Sometimes a tank is necessary. But if the lower cost sedan does the job, go with that.

But getting an ASV unit "just because" .. nope. The more complicated a unit becomes, the more chance someone will have problems. So, my concern in that case is both cost and the fact that those bells and whistles can be "mis-set", making matters worse.

[cjc]

Thanks very muchly for the replies guys. I guess my biggest lingering question I have is why did my sleep study show 9 Central Apnoea's an hour ? Could these have been caused by the constant stop start condition of my obstructive apnoea's or is it just a case that these Centrals will be there even if there was no Obstructions at all ?

I just feel that if I have to throw all this money at a device I would rather get the one that covers all possibilities rather than spend 2/3rd of the cost and end up with a machine that doesn't cover my needs and then really regretting the fact that I still have to live with my poor decision for another couple of years

[JohnBFisher]

Unfortunately, in order to get an ASV unit you would need a prescription for it. So, unless your doctor has prescribed it, you would need to go with the BiLevel unit only. And yes, it sometimes happens that the constant start/stop of obstructive apneas tends to cause the central apneas. Due to that insurance companies and doctors tend to try CPAP or BiLevel before moving to an ASV unit. If the centrals continue after that they will then look at an ASV unit.

If you are concerned that might happen you might want to talk with the DME (Durable Medical Equipment) supplier to see if they have a rent to own program. Thus, you would only pay rent on the BiLevel unit when you had it. If you then need to move to an ASV unit, you would not be out the entire price.

Just an idea ...

[apnea2142]

I've been suffering for years from OSA/CSA, O2 of 72. I've given up hope of ever being healthy again, feel nauseous and foggy.
I got a VPAP adapt which is amazing except the pressure is too high with no ramp on ASV mode; it seems to blast the air out. I'm set on Ipap/epap 5/15 with PS 3. maybe 5/11 is better or ps 6 is better?
I found that taking prednisone helped me to sleep the whole night on the machine, but is that safe to take prednisone 10mg/day long term?

[cjc]

Unfortunately, in order to get an ASV unit you would need a prescription for it. So, unless your doctor has prescribed it, you would need to go with the BiLevel unit only. And yes, it sometimes happens that the constant start/stop of obstructive apneas tends to cause the central apneas. Due to that insurance companies and doctors tend to try CPAP or BiLevel before moving to an ASV unit. If the centrals continue after that they will then look at an ASV unit.

If you are concerned that might happen you might want to talk with the DME (Durable Medical Equipment) supplier to see if they have a rent to own program. Thus, you would only pay rent on the BiLevel unit when you had it. If you then need to move to an ASV unit, you would not be out the entire price.

Just an idea ...

Thanks John (And thanks for linking that article in your other recent post about the finer details of CSA)

I suppose I should further clarify my situation. As I am in Australia, Australian law does not require a Sleep Apnoea patient to have a prescription for any of the equipment involved in treating the condition. I can literally walk in off the street with nothing but a wad of cash and purchase anything from a straight CPAP machine all the way through to an ASV with no questions asked. That being said, the downside to this is that there is nothing like what you guys have in terms of insurance cover. The only time you get anything back is if you have the highest level of health insurance (Our Medicare system does not require someone to have insurance to be treated for anything, you just generally go onto a public list that is typically longer than the private list) and even then you would receive only about $500 towards the typical $2,000 cost of a APAP device. The only reason I even saw/used an ASV unit in the first place was because I was having difficulty adjusting to APAP and the medical store I have been dealing with rolled this out as "The Rolls Royce of sleep machines" and said to try it for a week or two. Needless to say I absolutely loved the ASV as the comfort levels of using it were black and white compared to the F&P Icon Auto I had been trialling.

My AHI on the ASV unit also plummeted to an average of about 2 with some nights at 0 and so I was pretty excited to see those numbers since as like most Apnoea patients I thought I had finally found something that would give me a normal life like everyone else around me seemed to be enjoying.

Apologies if this post is rather long and convoluted but as you can see, despite one of the biggest players (Resmed) being based in my country, the sleep apnoea field is not especially well developed here and patient support and information is rather lacking

[JohnBFisher]

I've been suffering for years from OSA/CSA, O2 of 72. I've given up hope of ever being healthy again, feel nauseous and foggy.
I got a VPAP adapt which is amazing except the pressure is too high with no ramp on ASV mode; it seems to blast the air out. I'm set on Ipap/epap 5/15 with PS 3. maybe 5/11 is better or ps 6 is better?
I found that taking prednisone helped me to sleep the whole night on the machine, but is that safe to take prednisone 10mg/day long term?

Well, I will again repeat ... You do not need to feel despair with CSA/OSA. Both can be treated. You should discuss your problems with your sleep doctor and be certain that your therapy meets your needs. That means you need to be more proactive at managing your therapy. You need to use the software to download and monitor it.

You should also not use prednisone on a long term basis. Get the real issue addressed and you will feel a lot better.