The Journey from CPAP to APAP to Auto BiPAP to Auto ASV

[STL Mark]

I have been asked on more than one occasion to provide information on how ASV therapy compares to traditional Auto CPAP or Auto BiPAP therapy. I believe that the answer to this question is different for each person. When the question is asked of me it is typically by a reader of the thread Could AutoASV machines be used for everyone.

My journey into CPAP therapy began in May of 2010. I found this site and did a lot of reading. Interviewed/Made appointments with several sleep doctors and finally had my sleep study. I knew I had apnea for years and had been in denial. But if I was going to do it, I wanted to do it right. My titration pressure was 18 and CPAP therapy was prescribed. I was able to convince the doctor to write it for an S9 Autoset and my first month was in CPAP mode on that machine with a setting of 18. I was lucky, I enjoyed my new found energy and benefited from the start. Once my compliance period was over and the machine was mine I began playing with settings.

In June of 2010 I changed the mode on my Autoset and changed the settings to 16/20 with EPR of 3. It was a relief after being at my previous setting of a straight 18 pressure (leaf blower mode). At the start of my evening I would exhale into a pressure of 13 with the assist of EPR and inhale with a pressure of 16. As the evening would go on the pressure would increase but the EPR was an amazing thing and my compliance seemed assured. As I used various software packages to monitor my therapy I became aware of the leaks everyone was talking about. I set out to eliminate them. The more I read and tried the more I wanted to throw the mask off during the night. After a period of time I decided to be a rebel and accept a level of leaks that would allow me to remain compliant and my style of therapy was established. My acceptable leak level was determined to have a top limit of 30 and typically floated between 15 and 25. I stayed in this manner of therapy until December of 2011 when other options became available.

One evening while looking at the forum I saw a post for a used S9 VPAP Auto for sale from a family member of a deceased user. I decided to get the machine and paid $750 for it. I set it to VAuto, Max IPAP 20, Min EPAP 12, PS 5. At the start of the evening I would exhale into a pressure of 12 and inhale with a pressure of 17. as the evening would go on the pressure would increase but the difference between inhale and exhale pressures was always 5. I found this quite comfortable and my AHIs tended to be less than what I had on the APAP machine now averaging 3 where I averaged about 4.5 under my APAP settings. As time went on I monitored my therapy with software. After dealing with swallowing a large amount of air and the discomfort and embarrassment associated with the air escape during the day I decided to make changes to my settings in December of 2012. I changed my settings to VAuto Max IPAP 16, Min EPAP 11, PS 4. This seemed to correct my problems with aerophagia and surprisingly my AHI suffered very little. The settings remained there until July of 2013 when an opportunity presented to acquire a S9 VPAP Adapt with ASVAuto mode for a reasonable price. I posted the above mentioned thread and had a desire to play with something new.

Once I brought the S9 VPAP Adapt 36037 home I reset it to factory defaults and erased all data. I set the mode to ASVAuto and set Ramp off, and turned Sleep Quality on. This resulted in the following settings: Mode: ASVAuto, Min EPAP: 4, Max EPAP: 15, Min PS: 3, Max PS: 15, Ramp: Off. I put on my favorite mask and 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 was a easy experience. Inhaling was assisted but not forced. My apnea is positional. This machine decides what pressure is necessary for each breath. This means that if my inhale pressure at one point needs to be over 19 and later I wake up, it is not still at 19. It is back to where it was when I went to sleep. Since when I am awake all the machine needs to do is match or slightly exceed my normal intake of air. These breath-by-breath decisions on pressure therapy are not made by other types of machines. When I am deeply asleep, the machine is working to keep my airway open. My AHI readings now are sometimes 0.0 other times 0.4 and the peek AHI I have seen is 0.9.

I believe I adapted easily to the ASVAuto mode because I had been through years of therapy with APAP and auto BiPAP machines. After having the leaf blower in my face this thing is a dream. I don't know that someone that is struggling with CPAP therapy in general would see the same advantage I did to this machine. I am also sure that someone that truly needs this machine (with a high percentage of central apnea) may find the road to its use much less comfortable. But for me at the high pressures I was requiring, this is my dream machine. I could never justify meeting insurance requirements for having the machine paid for by them. But it is very comfortable and very effective at treating my apnea.

Feel free to ask questions or list your experiences. I wanted a thread to point to when someone asks about my story and why I liked this machine.

[Olivia]

Thanks for sharing. I love the "leaf blower" analogy.

[TahoeGal]

I took to the ASV like a fish takes to water. I have severe csa. I'm in love with my machine. I wish everyone could have the positive xpap therapy you have had. If only the VPAP was cheeper...

[danielqk]

I think every sleep apnea patient should have Auto ASV machine at the first time.
In my case, I started in 2005 with CPAP machine followed by Respironics APAP, followed by Resmed autoset and now BIPAP but not tolerate the high pressure. I asked my Dr for an Auto ASV but rejected since my central apnea is less than 5. I am looking for to buy a used one with resonable price.

[Stormynights]

I love my ASV but I am not really sure how I would have adapted if it had been my first machine.

[DeepBreathing]

My AHI was 62, being 50/50 OSA and CSA. Because the ASV machines are so expensive (and insurance only covers a small amount here) I was initially tried on a S9 Autoset. That treated the OSA nicely, but did nothing for the centrals. Next step was a Philips Bipap ASV. That cured the centrals and obstructives but suddenly I was seeing a lot of hypopneas. I found the Philips was difficult to work with - I was always conscious of adjusting my breathing to suit the machine. Given the amount of adjustability on these machines it's possible this could have been overcome. However I then tried an S9 VPAP Adapt and it was a very different experience. I felt the machine was working with me, not the other way around. I could breathe at my own pace and the machine matched me - with the Philips it was always forcing me to match its pace. My AHI dropped dramatically and I now have one or two apneas a night. Some hypopneas are there, but mostly during the ramp period (especially after an overnight pit stop), so they don't really count. I have the ramp set on 10 minutes, which is comfortable.

The Resmed machines are made in Australia, so that was a big factor in my decision. Also a bit cheaper than the Philips, and (if I can believe the therapist) more reliable and with a better backup network here in Australia. I know the Philips is supposed to have more sophisticated algorithms and better reporting, but the Resmed is the machine that suits me and the one that finally got my apnea under control.

[Lazer1234]

ASV strive to maintain the respiratory rate and tidal volume, right? But what is it that determines which level is right? RR, I can understand easily, but tidal volume?
Are there built-in software of the machine normal values ​​or?
I understand that ASV follow my own breathing, but if my breathing goes down slowly towards zero and the machine follows after? Then I die.

[Lazer1234]

But when I start thinking about it then clears the bit. With some min and max pressure with the respiratory rate and the flows in the tubing and mask so it is of course a lower limit for the air flowing in and out. So I survive maybe.

[squid13]

I just acquired my Auto ASV and I've used it 3 nights. My first night I had a AHI of .1 and the next 2 nights have been 0.0. I love this machine, it is so easy to breath with compared to my S9 VPAP Auto. I'm just glad I was able to acquire one. When I see my sleep Doc next August all he'll ask is how do you feel and I'll say I feel great, then he'll take his little rubber mallet and bang my knees and elbows (he's a neurologist) and say make an appointment for another year. I only need him to satisfy Medicare so I can get my supplies other than that I've got all my knowledge from this forum.

[Pugsy]

I feel machine envy symptoms creeping up on me.
Gotta save a lot of pennies to satisfy this curiosity itch.

[Taringa542]

I started using a Resmed Vpap Adapt 36007 about 12 months ago, I had a terrible time getting use to it (Previously using VPAP Auto) It took me about a month before I was comfortable with it & WOW what a difference it made to my life, most days AHI's were less than 1.0 with quite a few days of 0.00

About a month ago I purchased a Resmed S9 Adapt 360037 and was very disappointed as it was totally different to the 36007, long story short, I had to adjust to this new machine all over again, 4 weeks later I am very happy with it & ASV Auto is working a treat, I'm very envious of people (Sleepyhead Mark) that take to ASV like a duck to water

Thanks to STL Mark for the machine

If anyone is interested, the 36007 is for sale, has low hours & please note I am in Australia.

Edit: Machine is SOLD

Merry Xmas everyone

[squid13]

Boy that sold fast, did you sell it in Australia or overseas?

[Pugsy]

Boy that sold fast, did you sell it in Australia or overseas?

Guess who is dancing right now because she got an itch scratched.
I will likely be gone to Vegas when it arrives but when I get back you can bet I will crank her up the first night.

I am going to need to do some reading and probably going to need some ideas for ball park settings...so ideas anyone?

Currently using PR S1 BiPap Auto in auto mode with EPAP 10...PS 4 min and 5 max...Max IPAP 20 and I have hit it on occasion but most of the time IPAP max averages around 15 to 17...with minimal movement except for some probable REM Stage events that need more pressure sometimes.

[95C4]

Boy that sold fast, did you sell it in Australia or overseas?

Guess who is dancing right now because she got an itch scratched.
I will likely be gone to Vegas when it arrives but when I get back you can bet I will crank her up the first night.

I am going to need to do some reading and probably going to need some ideas for ball park settings...so ideas anyone?

Currently using PR S1 BiPap Auto in auto mode with EPAP 10...PS 4 min and 5 max...Max IPAP 20 and I have hit it on occasion but most of the time IPAP max averages around 15 to 17...with minimal movement except for some probable REM Stage events that need more pressure sometimes.

........................................................

What does an Auto ASP machine do that your current setup doesn't??

[Stormynights]

I am anxious to see your review. I know you will love it.