CENTRAL APNOEA - Which Resmed?

[Centralia]

I have had one night so far on a ResMed Auto which I can have for a week or so past my one-month CPAP machine trial (I missed some days of therapy because the consultant forgot to include a water tank with an exchanged machine and had to post one). My impression from reading is that even people with obstructive apnoea are liable to prefer the ResMed - certainly my 81 year old friend with OSA did well with it, but is having to use a different make, pulls it off at three in the morning every night because she can't bear it any more, and wants to buy a ResMed somewhere. I was already prejudiced in favour of the ResMed from my reading, and am very impressed with it in the flesh.

I would like to hear the experiences and opinions of any CSA users, if I may. Which do you think is the best ResMed for Central SA?

I am trying to ascertain from my reading whether the ideal ResMed for CSA is the same as any other but with different algorithms, and whether all the algorithms are available on all the latest machines, or only some, and which ones. The papers I have read are interesting and convincing, but make for a stiff read and don't dispel doubts as to whether I am coming to the correct conclusions.

I am using the machine with the same mask I was loaned at the outset, an Opus 360 Nasal Pillow Mask by Fisher & Paykel. I am doing quite well with it, but find it is getting too easy to dislodge from the oval aperture where it fits, and so leaks easily. Still, the readout gives me a smiley face for 'mask' so it can't be too bad.

This one night of use seems to have triggered an unexpected level of sneezing and snuffling - does this pass? I am hopeful that it is getting rid of old gunk, but it might just have triggered some body defenses, I suppose?

I am copying the details from the readout window of the machine, but would like to read the whole story from the SD card. What is the best program for this? Does Sleepyhead do it? I couldn't get it to read data from the previous machine, Respironics, after the first time I downloaded it, so there must be something I am not doing right.

In a week's time I shall be going to see the Sleep Doctor, and would like to be fairly sure of my facts where the ideal ResMed model is concerned. I shall be buying one at twice the price some canny shoppers might pay in order to get the support, though I wouldn't object to getting a spare from SecondWind a little later if one became available. I'm told that my Hospital Benefits Fund will give me $700 odd towards the price of a machine. (This is Oz, folks!)

Is it known how many central sleep apnoea sufferers are on this forum?

Thanks for any input.

Centralia
The avatar is my maternal grandmother. I am old, but not that old.

[BlackSpinner]

If you have mainly centrals, the autoset is NOT the machine for you. You need a much more complex machine that actually handles the centrals. However your insurance may require you to fail this one first.

[Pugsy]

This one night of use seems to have triggered an unexpected level of sneezing and snuffling - does this pass?

You may need either a little more humidity or a little less. The symptoms you are describing go along with what happens to the nasal mucosa with the addition of the humidified air.
Using the S9 are you using the climateline heated hose or the regular slimline hose that is not heated?
You may need to adjust the humidifier setting so that you get either a little more added moisture or a little less.
There is no right or wrong way...people are individuals and some need more moisture and some need less.
Depending on when type of hose you are using the way to alter humidity delivered is different.
If no heated hose...just increase the temp to increase humidity or decrease temp to lower humidity.

Software use...Use the one that you like the best.
I don't know why SleepyHead wouldn't work with your prior Respironics machine...maybe it was the machine or maybe you were doing the import incorrectly.
Try it with your new S9...see what happens.
You can find ResScan in UncleBob's signature memberlist.php?mode=viewprofile&u=38643
and there is a video explaining how to use it here
http://montfordhouse.com/cpap/resscan_tutorial/

Can't help with which model would be better for central apnea in your situation. How many centrals are you seeing being reported now with the S9 Autoset?

[NateS]

I would like to hear the experiences and opinions of any CSA users, if I may. Which do you think is the best ResMed for Central SA?

Thanks for any input.

Centralia

Hi Centralia!

My diagnosis is:

During titration, central sleep apnea and associated arousals limited the patient's ability
to sleep. Use of variable positive airway pressure treatment resolved this problem and allowed treatment efforts to continue.

Therefore I was prescribed a ResMed S9 VPAP Adapt, after having had a terrible time in testing with a continuous pressure machine. I have been using it for nearly a year now, and it has worked out very well for me. Perhaps it would do the same for you.

Best of luck to you in treating your apnea!

Regards,

Nate

[chunkyfrog]

In this case, "failure" is not used pejoratively against the patient, but as a medical term,
actually meaning the cheaper option didn't work, not that the patient "failed"--but the machine did.
(Insurance people like to go the cheap route first, in spite of obvious indications that mean
you suffer longer before hitting the right treatment.)
{{Be patient; and PERSISTENT}}

[Centralia]

Thanks, folks.

Yes, I was a bit sick at having to plough through the Respironics unit after having gathered, as I thought, that one of the ResMed units would be better. I think I failed on that fairly well, though! I'm glad to be able to squeeze in a week or maybe more on the ResMed, and halfway through this period the consultant, who will be on holiday, will guide me on her mobile phone to switch the unit to a different configuration (but I forget which!)

Nate, the unit you mention, ResMed S9 VPAP Adapt, is what I was wondering about. I don't want to be guided into buying less than the most suitable it's possible to get right now. Whether I will be able to rent one out to trial I don't know, but I do want to Try Before I Buy.

Happily for me, not living in the US, I am not hemmed in by Insurers. I don't have to convince them of anything. When I have bought the unit, I front up to the Hospital Benefits Fund, hand over my receipt, and they hand over seven hundred bucks as a reward, no matter what unit I get. So, BlackSpinner, I guess the only people I have to 'fail' with are the machine sellers in the sleep shop (consultant), and perhaps the specialist respiratory and sleep physician. He said he didn't know whether the CPAP would help me - I do hope he is an expert on the use of VPAP! Actually, I am rather surprised that neither place mentioned VPAP - they must know it's best for CSA? They must keep up with the literature?

The machine was wonderful during the ramp phase, but the mask last night seemed to have great difficulty in staying in place; I pretty much had to lie with my face on my hand to keep it quiet. I woke up about three, when things were rather noisy and I couldn't fix the mask, decided to switch off, went to the loo, and started up again. It was great again, so long as the mask was helped to stay in place. I have the F&P Opus nasal pillows, and sometimes find them uncomfortable or hard to place, and sometimes think they are making my nose sore. After waking up sevenish, I went back to sleep and slept until nearly eleven. Wow! Lucky I'm retired and didn't have any appointments today.

Pugsy, yes, it's the heated hose. I will lower the temperature to lower the moisture level and see what happens. I must admit I haven't felt strong enough yet to try to download the SD card data. I'm wondering whether I should delete the previous entries in the hope that SleepyHead has a clear run at downloading the records. I will go through the links you give, and see if I can find out what I'm doing wrong.

I'll send this in case something goes wrong and I lose it, and come back with what details I can get of the last few nights.

[Centralia]

This is all that the screen tells me about my overnight results. Only one night was longer than 4 hours, namely last night, Thursday night. I started with this machine on Wednesday night - seems like longer, already.
Wednesday - afternoon nap - 0.8 hrs AHI 5.2
Overnight sleep Wednesday - 5.4 hrs. AHI 2.7
Thursday Night 7.9 hrs average usage. AHI -

I will chase up the links from Uncle Bob now, Pugsy, thanks, but I am still feeling like a stunned mullet and don't promise to do anything clever with it.
At least the sneezing is somewhat less than yesterday.

[Centralia]

VPAP and suitable masks.

From the ResMed site:

VPAP Adapt SV™ is an adaptive servo-ventilator designed specifically to treat central sleep apnea (CSA) in all its forms, including complex and mixed sleep apnea.

The right support at the right time—adapting breath-by-breath
Unlike conventional SDB therapies such as CPAP, adaptive-servo ventilation:
Treats complex sleep apnea syndrome and central sleep apnea
Normalizes breathing, completely suppressing CSA and/or Cheyne-Stokes respiration (CSR)2,3
Improves sleep architecture2 (the amount of time the patient spends in slow-wave and REM sleep increases)

Peer-reviewed literature shows that adaptive-servo ventilation:
Enhances quality of life for patients with CSA3,4
Support when it's needed
The adaptive-servo ventilation algorithm:
Adapts to the patient’s ventilatory needs on a breath-by-breath basis
Automatically calculates a target ventilation (90% of the patient's recent average ventilation)
Adjusts the pressure support to achieve it

Maximizing patient comfort and compliance
VPAP Adapt SV:
Ensures pressure support is synchronized to the patient's own recent breathing rate and flow pattern
Provides a constant, low level of pressure support
Enables AHI tracking

Enhanced VPAP Adapt SV
Natural comfort of Easy-Breathe technology
89% quieter than the competition (based on internal sound comparison testing)
Efficacy tracking with AHI
Increased pressure ranges (see chart below) (not included)

http:// www. resmed. com/us/clinicians/treatment/adapt_sv.html?nc=clinicians
... ... ...

The VPAP Adapt SV will automatically limit to ensure that:
MAX PS minus MIN PS is greater than or equal to 5 at all times
EEP + MAX PS will not exceed 25 cm H2O

To satisfy these limits:
Setting EEP automatically adjusts MIN PS then MAX PS
Setting MIN PS automatically adjusts MAX PS

Turning to the mask - it occurs to me that one might do better to buy a mask from the people who make the machine.
I've been looking at the women's masks, and notice that the pillows version (Bella & For Her) is not recommended for the VPAP machine.
http://www.resmed.com/us/assets/documen ... er_eng.pdf
These masks are not compatible for use with ResMed
AutoSet CS™ 2 and VPAP™ Adapt SV devices

... the thing to remember is that every mask has slightly different flow characteristics, so if you're using an AutoSet or VPAP series device, you'll need to change the mask setting on the user menu when you switch masks. Remember that when you change masks on the VPAP Adapt device, you will also need to “Learn Circuit.”

http://www.resmed.com/assets/documents/ ... er_eng.pdf only lists full face against the ResMed Adapt.

My reading is telling me that a full face mask is going to be necessary. Does the usage of CSA patients using the VPAP confirm that?

Too much CPAP info in one day - I'm stopping everything - reporting can happen on Saturday if I succeed - now, I think a 'nice cup of tea' might do me good. The first cup of the day got forgotten once I got into cpaptalk.

Sigh.

[Henry Jr]

Be prepared for sticker shock on the S9 VPAP Adapt.

[Pugsy]

Turning to the mask - it occurs to me that one might do better to buy a mask from the people who make the machine.
I've been looking at the women's masks, and notice that the pillows version (Bella & For Her) is not recommended for the VPAP machine.
http://www.resmed.com/us/assets/documen ... er_eng.pdf
These masks are not compatible for use with ResMed
AutoSet CS™ 2 and VPAP™ Adapt SV devices

You might want to check for sure about this but I thought that the S9 VPAP Adapt model no longer had mask restrictions.
The AutoSet CS2 and the VPAP Adapt SV are model names for the machines that were based on the S8 model line and yes, it did have some mask restrictions. If you notice the literature doesn't mention S9 VPAP anything and I believe we have some Adapt users here at the forum using nasal masks.

[jtmarten]

During my sleep study my AHI was 70.3, ~85% of my events were centrals. Straight cpap @7cm controlled them during the study. I'm using the S9 Auto with good results. Generally my CA's are 0, some nights it logs a few.

[Centralia]

JT said: During my sleep study my AHI was 70.3, ~85% of my events were centrals. Straight cpap @7cm controlled them during the study. I'm using the S9 Auto with good results. Generally my CA's are 0, some nights it logs a few.

Wow! That's very encouraging, JT.


Pugsy said: "You might want to check for sure about this but I thought that the S9 VPAP Adapt model no longer had mask restrictions.
The AutoSet CS2 and the VPAP Adapt SV are model names for the machines that were based on the S8 model line and yes, it did have some mask restrictions. If you notice the literature doesn't mention S9 VPAP anything and I believe we have some Adapt users here at the forum using nasal masks."

Funnily enough, Pugsy, after I wrote that I went to another thread and there lo and behold was a message from you saying this very thing. I was glad to see it, but I don't know if I have a way of checking it except, as you say, from some on the forum. So we can't necessarily believe what we hear from the horses' mouth, eh? OK.

Henry said: Be prepared for sticker shock on the S9 VPAP Adapt. - Ah! I haven't seen any prices - where do they get hidden? Only at the local suppliers? On SecondWind? This is all learning curve stuff.

Talking about curves - you may have gathered I simply haven't worked out how to "quote" from previous posts. I dare say it's as simple as . . .

[Henry Jr]

Henry said: Be prepared for sticker shock on the S9 VPAP Adapt. - Ah! I haven't seen any prices - where do they get hidden? Only at the local suppliers? On SecondWind? This is all learning curve stuff.
...
Talking about curves - you may have gathered I simply haven't worked out how to "quote" from previous posts. I dare say it's as simple as . . .

...sticker shock. The DME told me it's $7k. And I always believe my DME.
Haven't found an on-line supplier offering the Adapt for sale, ergo no prices.
I see one on secondwindcpap.com every once in a while but haven't seen a low enough price to acquire a "back-up" unit yet.
"STL Mark" gets one occasionally; currently offering one for $1650.

... how to quote. Simply press the orange <"QUOTE"> button in the upper left corner of the post you'd like to quote and edit away.

[Julie]

I just saw someone selling an adapt for $1,650. here yesterday... use the forum 'search' box on the site and type in that price find it.

[JaxTom]

I use nasal pillows with my Resmed S9 ASV. Love them. Never had a night over 0.8