New machine: Philips Respironics A40

[Chalkie]

Today I was expecting to get an ASV machine but instead was fitted up with an A40.

An employee of Respironics was there with the sleep nurse and they spent an hour fitting me up, optimising the settings (I hope).

AVAPS instead of ASV. The PR guy explained why he felt it was a better bet for me than AASV. They have cut pressure support to 17-8 - i.e. raised than IPAP) as I was at 17-6 on the old machine.

My first question is whether the A40 is compatible with SleepyHead?

[palerider]

Well, it is an older, previous generation machine... it's possible.

I think you got suckered.

[Wulfman...]

Doesn't look old to me for that type of machine. Service manual is dated 2015.
I seriously doubt that Sleepyhead would work with it. But, you never know until you try.

Some links to some documentation/information:

https://www.philips.ca/healthcare/produ ... ventilator

http://www.westcaremedical.com/wp-conte ... Manual.pdf

https://www.respimedicalsystem.com/non- ... bipap.html

https://www.westcaremedical.com/wp-cont ... AP-A40.pdf

https://www.supermedicare.in/Philips-Re ... -BiPAP-A40

http://www.compassmedical.com.my/wp-con ... ochure.pdf


Den

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[palerider]

Doesn't look old to me for that type of machine. Service manual is dated 2015.

It looks like it's from the System One line, not the Dreamstation line... ergo, 'older', it looks to take a SysOne60 series humidifier.

[Wulfman...]

Doesn't look old to me for that type of machine. Service manual is dated 2015.

It looks like it's from the System One line, not the Dreamstation line... ergo, 'older', it looks to take a SysOne60 series humidifier.

I don't think that the A40 was actually available in the U.S.
I kept running into an abundance of material referencing other countries and in this link, there's a statement which I also saw previously in my searches. (last paragraph)

https://www.philips.com/a-w/about/news/ ... tment.html

"BiPAP A40 (available outside the United States)"

"Chalkie" is in the U.K., so that may be one reason.

But, he could very well ask his equipment provider (DME) to see if a similar Dreamstation may be available on that side of the pond.

And, then there's this press release from the U.K.

https://www.philips.co.uk/a-w/about/new ... P_A40.html


Den

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[Chalkie]

Doesn't look old to me for that type of machine. Service manual is dated 2015.
I seriously doubt that Sleepyhead would work with it. But, you never know until you try.

Your idea was correct, Den - as soon as I tried to import last night's data from the SD card SH displayed a message saying that it does not support this machine.

Thanks for the links though.

Not sure about getting suckered - either there has been a miscommunication between sleep doctor and nurse or the doctor simply went back on her word/changed her mind. I will have to wait until my next appointment witht he doc to find out.

In the meantime I a booked for an overnight inpatient stay where I will be monitored re: the apnea and the PLMD by another doctor in a top London hospital who specialises in both the disorders I mentioned above. He seemed to be in favour of ASV.

tbh I don't care what machine I use as long as I feel better. Is the A40 really older than the C Series BiPAP? I still have the old machine for now. but an going to persist with the A40 as it's too early to say yet how effective it is. last night I only got five hours as I was getting used to the new machine and pressure.

One interesting thing that emerged from the fitting out session yesterday was that my leak rate got down to 29 l/min using the Wisp mask, whereas it was mainly over 50 with the Comfort Gel (which the nurse described as "knackered").

So I cannot see any reason not to revert to the Wisp, especially as the other model mask has been withdrawn anyway.

[metsfan302]

This video is dated 2018. https://m.youtube.com/watch?v=dPoHla4xDZo

But yes seems to be avail outside the us, seems nice

[rick blaine]

Hi Wulfman,

In the UK, the hospital – through its sleep medicine department – is the 'distributor of medical equipment'. The hospital employs the doctor and he or she writes the scrip. And then the hospital supplies what the doctor (or his staff) requested.

And hi Palerider,

As for 'being suckered", Chalkie is already benefitting from an 'individual funding request' – ie, more money is being spent on him than on the average patient.

And it looks like he is also benefitting from an 'extra contractual referral' – ie, his first hospital and specialist doctor are sending him 'out of area' to get help from another hospital and another specialist doctor .... AND he is getting the services of a PR expert.

All at no charge, other than his wage-related national-insurance contributions.

I don't call that 'being suckered'. I call it 'going above and beyond'.

[Chalkie]

Hi Wulfman,

I don't call that 'being suckered'. I call it 'going above and beyond'.

Putting it like that, I feel rather privileged They did spend a lot of time with me yesterday setting the machine up and going through my data download with a fine tooth comb, tweaking settings etc. That was two wo/man hours of staff time when I would have expected 15 mins at most.

The Respironics guy also explained in detail why he felt AVAPS was a better bet than ASV, i.e. because ASV is mainly for treating centrals and could miss OSA events. That was my understanding anyway.

[Pugsy]

The Respironics guy also explained in detail why he felt AVAPS was a better bet than ASV, i.e. because ASV is mainly for treating centrals and could miss OSA events. That was my understanding anyway.

Well I would beg to differ with the guy if your take on things was indeed what he meant....and per Respironics own titration guideline
it will also deal with obstructive apneas....Complex Sleep apnea...that's when people have both central apnea and obstructive apnea.
3rd page down...Indications for ASV
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

AVAPS is a ventilator targeted for people with problems moving enough air...lung issues...which you have stated you don't have.
Now there might be some other reason they didn't want to go with ASV in your case....but stating it won't deal with obstructive apnea is simply not correct.

[Wulfman...]

Thank you, Rick Blaine and Chalkie for your follow-up comments/information.

In my opinion, the "appearance" (age) of the machine (box) means little since what it actually does is the most important.
The following are a couple of the machines they (PR) have made for the sleep labs to use.
The first link is the most current one (also looks alot like the A40) and the next link is the model they used up to when they replaced it a few years ago.

https://www.usa.philips.com/healthcare/ ... ion-system

https://mfimedical.com/products/respiro ... ion-system


Den

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[palerider]

I don't call that 'being suckered'. I call it 'going above and beyond'.

by giving him the wrong machine.... (was my point).

[raisedfist]

The A40 is a ventilator designed to augment ventilation. It's primary use is for people with lung or neuromuscular disease who hypoventilate. It's an advanced machine with modes of therapy not included on most bi-level machines and can even be used invasively with a trach.

If the main issue is obstructive sleep apnea, this machine is the equivalent of using a 24k gold boulder to crush an ant. For central apnea, unless it's specifically due to muscular weakness in the diaphragm, this machine will only aggravate the problem. The ASV is much more appropriate for CSA due to neurological reasons and is for normocapnic or hypocapnic patients.

Unless you have a known lung or neuromuscular disease, I would send this back in a flash and demand the ASV if that's what you should have gotten.

[Chalkie]

Thankyou for all the feedback. I definitely don't have a lung issue that requires ventilation.

I am going to phone the hospital on Monday and ask why I didn't get an ASV. I am pretty sure I understood what Mr Respiromnics said.

I am just going to have to use powers of persuasion on the sleep doc as this machine just sounds wrong. The backing of the London specialist could be important here as he has recommended ASV in writing.

I even wonder if the nurse misread "ASV" as "AVAPS" as judging from the conversation it was scribbled on my notes. I queried it and she insisted the doc wanted to try AVAPS first.

To use raisedlist's analogy, is the A40 even more of a boulder to crush an ant than my old machine, the Respironics BiPAP S/T C Series?

btw they raised the "reserve" pressure (no doubt not the correct terminology, sorry) to 22, so although I am at 8-17 I can get up to 22cm EPAP if I need it.

[raisedfist]

The PR AVAPS machines can do everything that a BiPAP S/T can do, and then more. It's not uncommon for a physician or even respiratory therapist to not actually understand what ASV or AVAPS modes of therapy are, how they work, and who they are designed for. The hospital I go to does the same thing. On one page I'd see patient needs AVAPS, then they would write "ASV titration" or tell me that they're working on getting me my ASV machine. I could swear that these people are learning a little bit about a lot of subjects, instead of actually specializing in something.