Resmed VPAP Adapt SV - for Central Sleep Apnea

[dsm]

CQ,

Re your comment on Nasonex, I am on that (daily) but only because Otrovin has such problematic side effects after 3 continuous days use. Otrovin works magnificently to clear my nose (for about 3 days i a row). Nasonex was put to me by a new GP who asked me to persist. I have persisted but am not confident it is the ideal.

DSM

[Lubman]

Have there been any studies that look at EERS for SBD for more then a night or two in the lab? Anything that tracks pCO2 at home, over time? Lot's of things can look like they help in the lab, in preliminary studies, but don't pan out over time- like some of the medications they have suggested for apnea in the past or the pacemaker connection they thought they saw at one point.

Christine, nice to hear from you

I really think you have hit on it. Any unique treatment, no matter what it might be, can have one result in the relatively controlled lab environment and a different result in the home environment.

I would love to be involved in a test to make some measurement of the pCO2 levels with my home set up.

And it compliments nicely with the suggestion some time ago from SAG
- why not try EERS paired with other treatments, to see if it would help.

Maybe some good things will come out of SLEEP 2007.

Lubman

[christinequilts]

Believe me, Lubman, I considered EERS seriously when it first came up. I'll even admit I experimented with it very cautiously a couple times, but even with my situation being as bad as it was before the Adapt, I didn't feel the there was enough data to really support its use, IMHO. I am pretty cautious when it comes to my health care, I have to be- I have so many issues going that its a constant juggling act and throwing a big unknown into the picture didn't seem prudent. My 'experiment' was nothing like FQ did, but did show changing my CO2 levels could help the periodic breathing I use to have as I would fall asleep.

I do hope we see some research soon on how EERS does in the home environment or at least over time. Like SAG has suggested, does the body adjust to the new levels after so long? Is it something that needs changing up every so often? Like I know with Ambien, if I take it every night, it starts losing its effectiveness. I did the higher dose bit at one point years ago, but realized that wasn't the answer. What I've found works better for me is to take a night or two off, even if it means taking Lunesta or the like, which isn't as effective as Ambien for me.

Besides, we know in the sleep labs they tend to put the masks on tighter to prevent leaks, which is fine for one night to get the best possible PSG data. But wearing a mask that tight at home doesn't work for long. Have you been able to get your leak rate under control yet? Other then the kitty accident, I've never had very bad leak rates- and even then I think the highest I had was 25-30 at most for a single night. I just checked my weekly, monthly, 3 month averages and its in the 15-20 range. Do you recall what your leak average was preEERS?


Did you catch this article on this guy invention? I sure think it would affect CO2 exhaust, wouldn't you? Maybe that's why only some of the feedback from his limited testing has been positive?

[Justin_Case]

I haven't read through the 33 pages. What is the criteria/measures used to determine if you have Comp SA?

[dsm]

I haven't read through the 33 pages. What is the criteria/measures used to determine if you have Comp SA?

This is a partial answer (my own understanding),

CompSA is determined by the patients reaction to use of CPAP or BiLevel.

If the initial sleep eval study shows OSA & minor CA but when the person is placed on cpap or bilevel, they exhibit clear CAs (not sleep onset or post arousal CAs) that were not there before & if the CAs increase as CMS is increased, then the person is a candidate for CompSA

MixedSA is of course a different matter. Also Pressure induced centrals are yet another matter.

DSM

[Justin_Case]

Thanks DSM. I thought mixed apnea is another name for "Comp SA"?

[jammin]

Just curious whether anyone knows of non-Resmed masks that can pass the Learn Circuit test on the adapt sv, and what experiences they might have had with them.

[dsm]

Thanks DSM. I thought mixed apnea is another name for "Comp SA"?

Justn,
Mixed Apnea can mean 2 things -

1) Someone who experiences OSAs and CAs - cpap can treat the OSAs & often a Bilevel with timed mode can treat boath OSAs and CAs

2) An apnea that starts off as a Central - & during it, the soft palate closes (airway flops shut) & when the central ends the person can't breathe - the OSA turned into a CA.

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[christinequilts]

Just curious whether anyone knows of non-Resmed masks that can pass the Learn Circuit test on the adapt sv, and what experiences they might have had with them.

A couple of months ago I would have said any mask with a fairly standard design that didn't have any major restriction of airflow, like the Swift, Comfortlite, Breeze, etc have with their smaller mask lead hose, would probably work. In fact I purchase a number of more traditional masks to add to my mask collection, since 'standard vanilla' style masks were sorely lacking. Then I did the infamous experiment with the Swift, running the Learning Circuit with a Vista as some supposedly highly respected doctors had recommended to more then one patient, according to what they have posted. When I experienced first hand my trusty little Adapt turning from Dr. Jekyll to Mr. Hyde just from the mask, it opened my eyes to just how important the mask is to the function of the Adapt. Since then I've went back & tried some of the nonResMed masks I'd used prior & thought had worked fine and now I notice a slight difference in how my Adapt reacts when I use a non-approved mask. Nothing as big as the Swift mind you, but then I always knew to stay away from masks that dramatically different, but its just not the same. Its real subtle differences, its slightly more pushy & such. I still might pull some of those non-approved, but similar to ResMed masks out in a pinch, but I wouldn't rely on them as my primary mask.

My feeling on it is, for the most part, any mask that's going to pass LC on its own is basically going to look pretty much like a ResMed mask, sit on the same place on my face, and act like a ResMed mask. If there are no real big differences, no real advantages, then why bother risking my therapy over it?- its taken me too long to reach this point & Adapt is complex enough on its own- Why add to the complexity?
On the other hand, if the only way I could absolutely use the Adapt was with a non-recommended mask, I would. But only as a last resort & after I had exhausted all other options. I know we hear a lot that mask is everything in regard to xPAP, but if you're at the level of needing the Adapt, mask has to be secondary to the machine...at least until technology catches up in a few years.

Now if you're interested, I do have some masks I need to get rid of

[christinequilts]

Thanks DSM. I thought mixed apnea is another name for "Comp SA"?

Very different things. Mixed Apnea is technically when a person has apneas that start as central but end as obstructive when the airway collapses because there is nothing in it. Its one event that morphs. Mixed Apnea is not when someone has both obstruction and central apneas as separate events, though many people mistakenly use the term this way. We would have to ask SAG, but I'm not certain 'Mixed Apnea' exist as an actual diagnostic code, like OSA & CSA do.

You asked earlier what the criteria are for CompSA/CSDB- at a minimum, there needs to be clear cut apnea that when xPAP pressure is applied, central events either emerge for the first time or worsen, and those central events are regular & persistent. US Medicare uses a central AHI of 5+ while on appropriately titrated xPAP as a major diagnostic criteria, but from what I've heard SAG say & from reading both research articles & interviews with sleep physicians, the number of persistent centrals per hour is much, much higher usually. One of the studies I posted about just a couple pages back had central AHI's of 30 or more while on CPAP or BiPAP. One thing CompSA/CSDB is not, is an occasional central here & there or centrals that only occur when xPAP pressure is raised to high.

[Lubman]

When I experienced first hand my trusty little Adapt turning from Dr.
Jekyll to Mr. Hyde just from the mask, it opened my eyes to just how important the mask is to the function of the Adapt. Since then I've went back & tried some of the nonResMed masks I'd used prior & thought had worked fine and now I notice a slight difference in how my Adapt reacts when I use a non-approved mask.

Christine,
Can you elaborate on what you sensed was different?

I notice that the UMNVFFM leaks - just like the vented version did.

But I have noted a change in the machine operation lately.
I'm on travel, much closer to sea level than normal for me, and with no external o2.

The smartstart comes on using the UMFFM NV but won't shut off normally.
And when before I could tell the ASV was learning my breathing - a rather
gentle response, now it seems to just blast air out.

I note a higher EEP (8 instead of my general values showing at mid 7's.

As a result I usually have to synch the mask down, which really ruins the seal over time and is not really how the mask is intended for use.

I didn't like the other older Series 2 mask for taking it on and off, but it
didn't do this.

Any ideas?

Lubman

[christinequilts]

The smartstart comes on using the UMFFM NV but won't shut off normally.
And when before I could tell the ASV was learning my breathing - a rather
gentle response, now it seems to just blast air out.

I note a higher EEP (8 instead of my general values showing at mid 7's.

AutoShut off not working was always a clue to me that something wasn't Kosher- either the mask wasn't fully compatible even though it passed LC or, more often when I was still frequently changing masks at 2 am, I'd forgot to run LC between my Vista & Activa I even had it happen when I put a new a Vista mask on after I'd been running it with my old Vista & had run LC with the old Vista, which was weird. It worked fine when I ran LC with the new Vista, but it opened my eyes that they really mean to run LC if you change anything...even from one mask to another mask of the same type.

With non-ResMed masks, I also notice a change in how the Adapt feels, especially when I initially put it on. It just seems pushier then normal, more aggressive- like I said, nothing like I saw with the Swift, but enough to make me question personally using other mask much, though it hasn't stopped me from still hoping to find another 'perfect mask', like the ComfortCurve was for me for so long-lol. And with my skin sensitivity to pressure, I would like to find another option then the Vista that doesn't use the bridge of the nose at all...which is probably why I gave up on traditional nasal masks fairly early on. In your case, with as high as your leaks are with UMFF variations, it may be worth the slight differences in treatment if the leaks were better controlled- it would be hard to judge without knowing exactly how much the changes affect the stabilization of our breathing, which is so critical for treatment of CSA/CSDB. Its hard to judge when we only have the machines data to rely on, I know when my leaks are higher, my pressure seems to be higher too. But then again, I can have nights when I'm geared up pretty good to not have mouth leaks, but I know I'm having more periodic breathing as I fall asleep then normal with the Adapt, have lower VT, RR, MV, which all indicate I had increased centrals for whatever reason. All that leads to higher average pressure, which in turn can lead to higher leak rate on its own (who can help it with rapid gust from 12/9 to 19/10?). I can tell by looking at all my numbers and if I noticed PB or not, which night is which, and by how I feel, but it would be nice to have more information to know what other masks could change, either good or bad.

[JIMCHI]

Has anyone determined the differences, if any, between the Resmed VPAP Adapt SV and the Respironics BiPAP Auto SV ??

My dr. has prescribed a VPAP machine. The DME called and said they want to provide the Resmed VPAP Adapt SV with humidifier, but I am concerned about the size in the case (which will be 17 x 13 x 7). Is there an equivalent machine with integrated humidifier which will all fit in a smaller case?

[Lubman]

JIMCHI

Has anyone determined the differences, if any, between the Resmed VPAP Adapt SV and the Respironics BiPAP Auto SV ??

We don't believe any comparative tests have been performed. The Respironics BiPAP Auto SV is newly approved in the US. If you read back a few pages in this post, you will find opinions on how the 2 machines might be different.

My dr. has prescribed a VPAP machine. The DME called and said they want to provide the Resmed VPAP Adapt SV with humidifier, but I am concerned about the size in the case (which will be 17 x 13 x 7).

If you were to operate the ASV without the humidifier -- it comes with a smaller blank front. It does reduce the size. One might conclude that if your problem is unique enough for a MD to recommend a VPAP that performance would outweigh size concerns.

I carry my ASV with humidifier in the provided case and have taken it to at least 2 continents. Not sure what your real concern might be with size.

Lubman

[Lubman]

I did this as a separate post - because if anyone who has ASV but isn't reading this thread has run across this error -- I would like to know.

But it does fit this thread so:

I just returned from international travel, taking my ASV, the ResMed humidifier, my EERS tubing and my NV UMFF Mask. It worked well.

Upon return, when I connect up the hose, with the NV UMFF and related EERS tubing, and run Learn Circuit

It fails - and says "Invalid Circuit" "change circuit" and then falls back to the previous Learn Circuit values.

It works fine with and without the humidifier. It works with the ASV tubing
but now it does not work with the EERS Tubing and the NV ResMed UMFF Mask.

Having the DME call ResMed didn't help. They treated the DME like he was stupid and didn't know what he was talking about.

For ASV users, anyone ever seen that message in the display?
This is odd.

Lubman