Changeover from CPAP to VPAP (ASV) - Why? How good?

[Papit]

I see a very large preponderance of CPAP machine users here, but relatively few (ResMed) VPAP or (Respironics) ASV machines. These machines are relatively new, about 4 years now I believe, and are made thus far by only these two companies. They are both considered Auto or Adaptive Servo-Ventilation machines. They adjust the machine generated airway pressure on a breath by breath basis in contrast to holding the pressure constant in CPAP machines.

A few questions for those on the board using VPAP (ASV) machines: What condition(s) or observations did your sleep doctor say you have in advising you to discontinue using CPAP devices and change your equipment and therapy over to VPAP (ASV) machines.

I've been advised there's a 50-50 chance that I'll have to do the same. I wonder what will happen to the benefits I've gotten from using CPAP if I need to switch over to VPAP (ASV) equipment. My obstructive apnea events have come down very significantly thus far with the use of CPAP and my sleeping regularity has improved. But I have way more central apnea than obstructive. Way, way more.

My OAs were always about 10 to 20% of my total events. Central apneas were and still are around 80% of total apnea events, going back to my first Lab tests; and they continue to be about the same portion with ongoing use of CPAP for over a month now since I began therapy.

Any insights and input re. why you folks had your equipment changed from CPAP to VPAP (ASV)? How has it worked out? Were there clear and dramatic benefits (or were they subtle and gradual) after the equipment change? Did your Centrals or any other numbers change significantly? Did they change quickly or was the change in figures a gradual thing?

[Pugsy]

The ASV users will come along later I am sure. I will defer to their explanations and answers to your questions.
I just have one question. Can you give us an average AHI night for you and the breakdown in how the events are scored as in the central index and apnea index and Hyponea index?
We don't know how many events you have overall each night and it might help to know this. Hard to judge 10 to 20% of something when we don't know what the something is.

[teknomom]

I have been on ASV for 4 weeks and never used Cpap. My baseline study showed very few obstructive apneas and 50% central events (the rest were hypopneas) so I was titrated onto the ASV in a 2nd overnight study. I can't imagine why they put you on Cpap in the first place. Your pressures will be adjusted on the ASV machine to both prevent obstructive apnea and to recognize and treat your central apnea. I have no experience with Cpap but had no trouble adjusting to my machine even with the wide variation in pressures through the night. I am at about 5 cm when I'm breathing on my own but can get up to 15-20 or even 25 cm when the machine has to kick in. So far no problems. I wish the same for you!

[jilliansue]

I have never been on CPAP. During my titration study, due to central apneas, I was switched to a BiPAP machine, and then that is what I got when I received my equipment. I really like the exhalation relief that is provided by BiPAP. I have tweaked some of the settings on the machine, based on information I got from a very helpful group member here. Things I would not have thought to adjust, like breaths per minute, and the amount of time the machine can blow on the inhale (which, initially, was too short a time). I can't recall what that is called. But adjusting those things and a few others made all the difference in comfort for me.

Good luck!
JILL

[Papit]

Re. "Can you give us an average AHI night for you and the breakdown in how the events are scored as in the central index and apnea index and Hyponea index? "

Sure, Pugsy. Here are the broken down index numbers averaged for Jan. 1 to Jan. 10, 2012 as displayed by ResScan 3.14 software.

AHI & AI
(events/hour) Apnea index: 9.7 Hypopnea index: 1.1 AHI: 10.8
Obstructive: 1.8
Central: 6.2
Unknown: 0.0
Leak (L/min) Median: 0.0 95th Percentile: 4.8 Maximum: 8.4

[Pugsy]

Thank you. I will let the ASV users speak. Hopefully John Fisher will see your request. He has a really good handle on centrals and the machines. If he doesn't respond soon I will try to remember to bump this thread if it gets close to the bottom of the page so he will see it.

A Central Index of 6.....I don't know all the circumstances but maybe a regular BiLevel (not the ASV bilevel) machine would be enough to keep the centrals under control. It works for some people who don't have an extremely large number of centrals. Perhaps your insurance requires going through all the hoops to satisfy requirement for ASV due to their cost. Anyway, I digress..hopefully John will be along soon. He knows a whole lot more about the ins and outs and which works better than I do because he lives it.

[Pugsy]

bump bump bump

[osmium sleeper]

Wow. My centrals range from 7 to 13 per hour, and I hadnt even heard of an ASV until I started reading this forum.