Could AutoASV machines be used for everyone?

[STL Mark]

I have been attempting to search and better understand the functions of the AutoASV machines. I was attempting to determine assuming the cost was not an object if the Resmed 36037 or the 960 type machines could be used for everyone. Would a patient with a prescribed need for a BiPap Auto machine like myself find this type of machine more comfortable? I have some centrals that go untreated but my AHI is always below 3.

So help me understand what are the negatives to using this type of machine other than cost?

On another topic entirely. When a Auto Cpap or Auto Bipap user has their machine wide open (4/20) the AHI generally suffers as compared with adjusting the lower number closer to the 95% requirement. Considering how the AutoASV machines work is this also true? Could one leave the machine wide open and determine the proper settings from the data?

[JohnBFisher]

Completely aside from cost is that the machine is a bear to adjust to for a lot of people. Some give up completely. It is much, much easier to adjust to either a single CPAP pressure or a dual BiPAP pressure - even if the EPAP varies a bit to address obstructive apneas.

And unfortunately, cost is a big issue for lots of folks.

[STL Mark]

Completely aside from cost is that the machine is a bear to adjust to for a lot of people. Some give up completely. It is much, much easier to adjust to either a single CPAP pressure or a dual BiPAP pressure - even if the EPAP varies a bit to address obstructive apneas.

And unfortunately, cost is a big issue for lots of folks.

Wow! Thank you very much for your prompt reply. I highly respect your opinions on matters.

My initial thought with my limited knowledge was that an ASV machine would be more comfortable. I was assuming that a person waking up to roll over would experence on their first breath a reduced pressure from the machine being supplied. Where an AutoBipap user would still have their machine operation at the requirement for pressures during sleep after becoming awake. Is this a valid theory?

I agree that some people give up entirely. In my case this resulted in a low hour machine being offered to me at a low cost. I was considering using it for my treatment.

[sleepinow]

From my experience, using an ASV is hard to adjust to in the beginning. But then your body unconciously learns how the machine works and then everything works wonderfully. So I would in a way think an ASV would work better

Oh and if it is for health purposes I do not think cost should be a factor. Health is more important than money. Obvious but true

[JohnBFisher]

... My initial thought with my limited knowledge was that an ASV machine would be more comfortable. I was assuming that a person waking up to roll over would experence on their first breath a reduced pressure from the machine being supplied. Where an AutoBipap user would still have their machine operation at the requirement for pressures during sleep after becoming awake. Is this a valid theory? ...

Nope. In fact, most people experience a "sleep onset" central apnea as they fall asleep. While perfectly normal, it typically causes the machine to ramp upto your maximum pressure (typically about 25cm H2O) within about three or four breaths!! .. .. So, it can be very difficult to get used to sleeping with an ASV unit. By comparison, an Auto CPAP or Auto BiPAP changes the exhalation pressure over the period of several minutes. And even then the exhalation pressure rarely goes above 15cm H2O. And typically the inhalation pressure is either the same (in the case of CPAP) or about 4 to 6cm H2O over the exhalation pressure. When the ASV is helping support respiration an ASV might swing from an exhalation pressure of 8cm H2O to 25cm H2O for the inhalation pressure. That is why I tend to say it can take two or three months to adjust to ASV therapy. And we haven't talked about leaks yet. Boy howdy! That type of pressure swing would tend to yield all sorts of leaks .. just as you are falling asleep. Yep. It takes a bit to adjust to ASV therapy.

While it might help you, you might find that it is more of a wild ride than you would expect.

[JohnBFisher]

... Oh and if it is for health purposes I do not think cost should be a factor. Health is more important than money. Obvious but true ...

True ... But then reality hits. When someone has no insurance and no job .. let's just say an ASV unit is well beyond the reach of the reality that far too many people face.

[sleepinow]

Yes it indeed is the case. But when a sleep study costs just as much as the actual therapy. Then there are definetely some money woes. And on top of that all the crap needed to get your therapy on an optimum level

Oh and my ASV unit does not reach a maximum of 25 pressure when my breath stops. It only bursts in 5 above my set EPAP pressure of 5.5 Which would be 10.5. Which is enough. But I am thinking about raising it .5 more due to the fact that the pressure surge does not ALWAYS tackle my breathing cessation.

[JohnBFisher]

... Oh and my ASV unit does not reach a maximum of 25 pressure when my breath stops. It only bursts in 5 above my set EPAP pressure of 5.5 Which would be 10.5. Which is enough. But I am thinking about raising it .5 ...

Remember, your issue is complex sleep apnea. So you are sensitive to higher pressures. Others with central sleep apnea are not sensitive to those higher pressures. But your point is well taken that the units can be set to have a lower pressure. It's just that by default most DMEs would NOT set a lower pressure, they would probably run it wide open. Just saying ...

[STL Mark]

I purchased the machine (36037). I think the only thing I changed after restoring the default settings was setting mode to ASVAuto, setting Ramp off, and turning Sleep Quality on. I spent about 30 to 45 minutes with the machine on laying awake and wondering what it was doing. It all seemed so magical. It took zero effort to exhale (compared to what I was used to) and inhaling while assisted was a easy experience. A few times as I got drowsy it had done something but I'm not even sure what. I got up and really wanted to look at the data but accepted that it would tell me nothing. It was an interesting experience. I showered and got ready for bed. I slept about 10 hours and feel wonderful this morning. I'm downloading ResScan to see what it has to think. SleepyHead reports are attached. I've never seen a 0.0 AHI before. I don't think there is a chance this machine is going to be resold.

[Bons]

I've had my ASV for nearly 3 years, and I still pretty much hate it, and am trying to get a new sleep study to see if my doc can convince my insurance company to let me go back to bipap. The biggest problem with the ASV is that I have very fragmented sleep, and am frequently semi-awake when dreaming (ex. if I am having a nightmare I can tell myself that and try to change the focus of the dream or force myself to wake up). Anyway, that triggers sleep onset/ sleep transition centrals, and my ASV rushes in to rescue me and instead drives me nuts with pressure surges and the leaks that come from power surges. I wouldn't recommend them to anyone who doesn't absolutely need them.

[STL Mark]

I've had my ASV for nearly 3 years, and I still pretty much hate it, and am trying to get a new sleep study to see if my doc can convince my insurance company to let me go back to bipap. The biggest problem with the ASV is that I have very fragmented sleep, and am frequently semi-awake when dreaming (ex. if I am having a nightmare I can tell myself that and try to change the focus of the dream or force myself to wake up). Anyway, that triggers sleep onset/ sleep transition centrals, and my ASV rushes in to rescue me and instead drives me nuts with pressure surges and the leaks that come from power surges. I wouldn't recommend them to anyone who doesn't absolutely need them.

I'm wondering if the difference is the new ASVAuto mode that is being offered in the 960 and 36037. I have read much about the previous generation of ASV machines, but little seems available on these models as far as methods of treatment. I do think that my acceptance of this is directly related to my years of using other machines.

[Pugsy]

Can you color me pea green with envy?

[Sir NoddinOff]

Other than a super nasty leak at about midnight, things look great. Your tidal volume, minute ventilation and respiratory rate are all in optimum zones. It's hard to argue with 0.0 AHI. Ha, ha... you've been threatening to try ASV for ages and now your hooked. You sure you don't want to give it another night before you sell your old workhorse machine (I assume that's the one in your signature).

[letsride]

Mark you're having the same results that I have with my S9 Vpap adapt sv. I think you'll find that you'll sleep deeper then you did with your other machine.

I often wonder if the ASV machine would work for everybody. With the new models i believe the answer is absolutely! If you decide to part with you S9 vpap adapt in the future I'd be interested.

Congradulation on the Flat line AHI of 0.0!

[STL Mark]

Other than a super nasty leak at about midnight, things look great.

I have to admit I am not the poster child for low leak rates. I worry more about comfort and remaining compliant than what is necessary to remove all leaks.

I do think that one reason for my extreme satisfaction with this machine is that I already had pressures near 20 at night, so the ones that occur with this machine are already something my body has adapted to.