Might be joining the Bilevel or ASV Club

[newpapper]

Thanks to SleepyHead (yea Mark and Pugsy) I was able to show my Sleep Doctor some of the problems I am having with Centrals
(sometimes including Cheyne Stokes). I am scheduled for a titration for Bilevel and ASV if necessary.

Is there anything special that I should know going into the titration. Are there Bilevel and ASV bricks to avoid? Are there certain masks that are used? My Quattro FF mask moves away and back on my face with CPAP EPR. I imagine this would be really bad with Bilevel. Any suggestions are really appreciated.

[Pugsy]

The 2 main players for Bilevel plain or Bilevel ASV would be Respironics and ResMed.
No need to worry about getting a brick with these as long as you get the latest model...either S9 series in ResMed or the PR System One in Respironics.

It used to be thought that when using ASV that only full face masks would work but that's not the case any more.
We have ASV users successfully using nasal and nasal pillow masks now though it seems like with the higher pressures some people tend to go with full face masks but you don't have to.

I am currently using the S9 Adapt SV (Resmed's ASV) with nasal pillow mask and have no issues at all with wide range of pressures up to 20 cm.

You will likely see pressure changes greater than what you had with EPR so it may be a challenge if you had issues with EPR and the mask inflating and deflating and moving. Sometimes there's a pretty sizable burst of pressure when the machine kicks in to try to treat the centrals. It's big and it's rapid. I have seen it go from 9 IPAP to 20 IPAP in about 10 seconds.
Sleep right through it though. Some people find that the big rapid changes take some getting used to but it was a non issue for me.

ASV machines are bilevel machines with extra capabilities to address centrals along with obstructives.

There are what I call "plain" bilevel machines which don't specifically try to treat centrals but are sometimes successful in treating OSA without triggering centrals. Pressure support (difference between inhale and exhale) is often greater than the 3 cm you had available with EPR. It's going to feel very similar to EPR but to a greater degree.
You may not like your full face mask if EPR was a problem.

It's a challenge to anticipate controlling leaks at those high pressures with the variations that can be seen.

Then there are the high end bilevel machines that function as ASV machines specifically for treating centrals (along with obstructives).

The "Plain" bilevel machines
ResMed...the S9 VPAP S or VPAP Auto
Respironics machines..the PR System One Pro BiPap or Auto BiPap...models 660/760 in the 60 series with heated hose option

the ASV bilevel machines
ResMed...the S9 VPAP Adapt SV
Resprionics..the PR System One BiPap Auto SV

there's also a couple of minor variation models with mainly timed breath functions but I don't know much about those or when they might be indicated instead of these above.

[newpapper]

Thanks as usual for all the great information Pugsy!

[JDS74]

Getting a properly fitted mask is critical with an ASV machine.
At times my pressure switches between 10 on exhale and 24 on inhale and back on a 4 second cycle.
It never wakes me up when it does that. I've had it do this for much longer than an hour at a time.

If you end up with a Respironics ASV machine, make sure it is a 960, the current model, and not a 950, the previous model.
The Respironics machine has a greater range of parameter adjustments than the ResMed one. With those parameters, you can get a better control of comfort issues.

That said, if you are not having these type issues with your current S9, staying with the ResMed will likely be just fine.
Check with the sleep lab about their type of equipment. Usually, staying with the same manufacturer as the sleep lab makes life simpler in terms of setting the parameters correctly.

[letsride]

I sleep longer, deeper and I'm completely rested. The ASV has done this for me.
Hopefully you'll end up with this success too!

[newpapper]

Thanks JDS74 and letsride for the good information

[squid13]

There are two types of ResMed S9 ASV machines, 36007 and the newer ASV Auto 36037. If you get a ResMed ASV I'd make sure they give you the newer ASV Auto which has 3 modes of operation, ASV Auto, ASV and Cpap. The older one has ASV and Cpap.

[newpapper]

I had my titration last night and was on "plain" bilevel the whole time. Started out at 8/4 and ended up at 13/9. Easier to exhale than CPAP. I am at 8 on CPAP. Hopefully will not have to wait too long to hear the Sleep Doctor's decision.

[JDS74]

Sounds great!
Bi-level at the pressures you mention is much easier to get used to than ASV pressures.
So your study results are good news from two points of view.

[newpapper]

Thanks JDS74. Glad to hear it's good news!

[Pugsy]

Sounds like the plain bilevel was sufficient to keep the centrals away. It sometimes works out that way and that's why it is often the first thing to try. Sometimes easy works great.
Not everyone just HAS to go to ASV to get the job done and yes, much easier to exhale using bilevel pressures because it is the difference and the way that it is dropped during exhale that offers the comfort.
I am like Rested Gal was...first time I used a bilevel machine I said "self, you gotta get one of these things" and I didn't even have any issues with APAP.
Pure comfort no matter what the pressure. Probably why I suggest that people wondering about which machine brand to get..when they are using pressures in the teens and will be using cpap/apap I suggest the S9 as it's EPR of 3 closely mimics how bilevel feels...comfortwise.

[SleepWrangler]

I had my titration last night and was on "plain" bilevel the whole time. Started out at 8/4 and ended up at 13/9. Easier to exhale than CPAP. I am at 8 on CPAP. Hopefully will not have to wait too long to hear the Sleep Doctor's decision.

Thanks for sharing your progress. I've been following avidly because my situation appears similar to yours. My prescription is for CPAP @ 8cm H20 and have noticed a lot of CA events. During your time on CPAP did you have really good nights or were the CA events consistently high? What was your EPR setting?

[newpapper]

Thanks Pugsy. I felt bad for a little while not needing the ASV because Dr.Krakow is so in favor of them. But I believe that I have read here that they are the hardest to get used to. They used a Resmed S9 titration model at the sleep lab. I need to read up to see if I can understand the differences between the S9 VPAP Auto, S and ST.

SleepWrangler - You're welcome. A pressure of 8 and lots of CA events sure sounds familiar. I have had maybe one "good" night where I slept through without any disturbance. The CA events were fairly consistent at a pressure of 8.
I have tried either no EPR, or mostly a setting of 3. Right from my first breath on CPAP I have been both uncomfortable exhaling against pressure and feeling somewhat starved for air on inhale. I did find that setting the inhale part of EPR to "Fast" instead of "Medium" felt better for me.

[squid13]

If you get an S9 get the S9 Vpap Auto that way you'll have the best of all worlds. You'll have Auto Bilevel, Straight Bilevel and Cpap modes all in one machine.

[Pugsy]

I need to read up to see if I can understand the differences between the S9 VPAP Auto, S and ST.

The S9 VPAP S and S9 VPAP Auto
The "S" offers straight regular fixed single pressure cpap mode plus fixed bilevel pressure mode.
The "Auto" offers same thing that "S" offers plus auto bilevel mode which is auto adjusting bilevel pressures
Those 2 choices are pretty simple and straight forward and not hard to figure out.

The "ST" has a back up breathing rate setting that gets figure into things that I don't really understand where, why or how it is indicated or works...haven't studied it at all since I never used it.
http://www.resmed.com/us/en/consumer/pr ... vices.html
I don't even see the ST listed here and links to old S9 ST pages are broken..looks like Resmed may be redoing their website or it's broken for now.

I know that the ASV models can be harder to get used to...but I hit the ground running with mine and never looked back.
No issues at all with the widely varying pressures...slept right through them from the first night...and I know others who have adjusted easily as well.
So it's another one of those YMMV things that all this sleep apnea stuff comes with.
I know of people coming home from an ASV titration in sleep lab saying they slept the best that they have in like forever...and others it does take some time to get used to.
Not sure what the deal is...only that it just happens to some and not others.

Most people find that they like any form of bilevel over single pressures but even then there are some who prefer straight CPAP...it's a good thing we have so much to choose from...better chance of making everyone happy.