Got new ResMed VPAP AdaptSV unit and mask ...

[JohnBFisher]

... Keep us posted on how your therapy goes. After Respironics latest trick with machine pricing, I am hesitant to buy anything from them, should it turn out I need one of these beasts. ...

Whoops! I forgot to answer your post. I fully expected to need to use one of these units. I was pleasantly surprised (based on my research) to be offered the ResMed version.

I was also surprised the price was much better.

It is harder to pull data from the ResMed unit than from the Respironics version. More current ResMed systems (not their ASV unit) address that problem. But with the current ResMed ASV unit, it requires either a module called the ResLink or a null modem cable. Of course using a null modem cable means you need to take the unit to the computer (or laptop to the unit).

So, you win a few and you loose a few. But the important thing for any of us is that it works.

[timbalionguy]

... Keep us posted on how your therapy goes. After Respironics latest trick with machine pricing, I am hesitant to buy anything from them, should it turn out I need one of these beasts. ...

Whoops! I forgot to answer your post. I fully expected to need to use one of these units. I was pleasantly surprised (based on my research) to be offered the ResMed version.

I was also surprised the price was much better.

It is harder to pull data from the ResMed unit than from the Respironics version. More current ResMed systems (not their ASV unit) address that problem. But with the current ResMed ASV unit, it requires either a module called the ResLink or a null modem cable. Of course using a null modem cable means you need to take the unit to the computer (or laptop to the unit).

So, you win a few and you loose a few. But the important thing for any of us is that it works.

Thanks, John. My original titration had to be terminated due to the emergence of a lot of centrals at a pressure of only 13 cm H2O. The study reading doctor's notes on the study suggested that BiPAP or ASV might be needed, but my doctor tried just APAP which seems to work to some degree. She remarked that I was 'hard to titrate'. Now, I have moved (slowly and carefully) from an original range of 10-13 to a range of 14-18. Although centrals have not been a serious problem, my response to therapy has not been what I had hoped. At the conclusion of the 14-18 test, I am suspecting that the result show my best pressure range to be 12.5-17 or 18. Although centrals have actually decreased with pressure, I have occasional bad nights, and last night was one of them. So when this experiment sequence is finished (going to also try straight CPAP at around 13 for starters), I am going to ask my sleep doctor if the current machine type is really giving me the best therapy. (BTW, other than being obese (and I am finally losing weight thanks to CPAP), I have no other significant heath issues.)

Should it be needed, a BiPAP machine or a servo ventilator represents a substantial investment, and I am learning all I can. I have always favored the Respironics machine because of its ability to be fine tweaked. But your experience, and the experience of CROWPAT, DSM and SWS (and a few others) with the two ASV's is making for interesting and thought-provoking reading.

The serial cable thing is interesting. A bit old fashioned, although not a problem for me. I am an electronics technician, and Assistant Chief Engineer of a TV station. I have seen-- and built-- more serial data cables than most IT professionals! I don't like 'wireless', which so many people here talk about because I am a ham radio operator who does 'weak signal' work in the microwave bands where the wireless stuff is used (almost all current wireless technology operates in an amateur radio band ). Not only does this noisy, poorly engineered wireless stuff interfere with state-of-the-art receivers for weak signal microwave work, but the high transmit powers used would fry the receivers of most wireless gear.

[JohnBFisher]

... The serial cable thing is interesting. A bit old fashioned, although not a problem for me. I am an electronics technician, and Assistant Chief Engineer of a TV station. I have seen-- and built-- more serial data cables than most IT professionals! ...

Amen!

I had pulled a null modem cable (DB9 F/F) off another computer. But the ResMed rep provided me with a cable. But I understand. I assume I've grown horns or something by the looks I get from others when I ask "Why don't you just wire up a cable for that?"

Fortunately, my DME arranged for me to talk with the ResMed rep in my area. I think he was surprised / delighted to have an ASV user ask some REALLY in depth questions.

... I don't like 'wireless', which so many people here talk about because I am a ham radio operator who does 'weak signal' work in the microwave bands where the wireless stuff is used (almost all current wireless technology operates in an amateur radio band ). Not only does this noisy, poorly engineered wireless stuff interfere with state-of-the-art receivers for weak signal microwave work, but the high transmit powers used would fry the receivers of most wireless gear.

Poorly engineered? No, couldn't be? I never had any problem with my wireless phones causing problems with bluetooth or wireless network connections. Nor has my microwave ever had problems bleeding signal across most of the spectrum. Nor a neighbors ham radio triggering my kids wireless toys. Nor ...

Worst problem with wireless is that unless they are VERY, VERY good, it will be hacked. Not may be hacked. Will be hacked. So, NO, THANK YOU! I would rather an SD or SmartCard or Smart Media Card. Even a serial cable is a better option.

[JohnBFisher]

Well, a one week update is in order ...

I just spent most of the day sleeping! Whoooo Hooooo!!

And when I was not sleeping, I took the time to figure out how to install the ResScan software and download data from the unit. Some observations from that:

The VPAP Adapt SV Unit

1) It only stores three days of detailed data. It might be a certain number of sessions. I'm not sure yet. My sleep is still very fragmented. I tend to sleep two to four hours at a time, then get up and wander for a bit, then sleep more.

2) Since it is an older machine, it certainly does not have all the bells and whistles on the reporting that newer model systems have. But it's enough to start to show some patterns.

3) Since I need to use the null modem cable and connect it to my laptop, I will probably only occassionally collect the data. But it is good to know that it is there to help identify patterns as they might arise.

On my Sleep

1) As I've noted, my sleep is still very fragmented. I think it will take me a while to work back toward more "normal" sleep patterns.

2) Still, I am sleeping more deeply and peacefully than I have in years. It is wonderful.

3) I've been able to get the Quattro FF mask to work. As I fall asleep and need more ventilation support, it leaks horribly. But as I head toward deeper sleep it seems to leak much less.

4) The "need more ventialation support" is an understatement. As I fall asleep it appears to jack the inspiration pressure up toward 22. I'm glad I had 18 years to become accustomed to xPAP. That would have shocked me when I started using CPAP.

5) My wife notes I still snore lightly with this system. But it is light and even. And it appears to be every 90 minutes or so. Sounds as if it occurs during REM sleep.

6) As I fall deeply asleep, my breathing stabilizes (respiratory rates and tidal volume). It's interesting to see. The variance in pressure needs also drops. Then, the pattern starts all over again ... It appears to follow the sleep stages. Fascinating to see.

7) Seeing from the graphs how the machine tries to stabilize my breathing, it is fascinating to see my reaction to it. My breathing pattern is ALL over the place in light stages of sleep. Both rate and volume of air exchanged. I was not attaining deep sleep because I could not get past those stages. This machine helps stabilze my breathing and attain deep sleep. And the graphs show it.

Overall Impressions & Results

1) DSM felt this VPAP Adapt SV can be a tough task master. I agree. But my problem for the past several years is that I just stop breathing as I fall asleep. Not a little bit, but ALL the time. It is so comforting to know this machine will help me get past that barrier.

2) And the proof is in the pudding! My apnea index (AI) since starting? 0.0 !! Exactly! Zero. I have a few hypopneas every now and then. They appear to occur toward the end of REM sleep. But we are talking about an AHI value in the single digit range!!

3) More importantly, the fog is starting to lift. I feel much more refreshed and able and wanting to accomplish things. I've not had this amount of energy in years. I'm only in my fifties. But I was seriously worried I would not make it another five years, let alone ten. Though I've got a long way to go to erase the years of poor sleep, I feel hopeful for the first time in a long time.

The Undiscovered Country

Now to get back to my walking to drop this weight... Fortunately, I've got hundreds of hours of stories to which I can listen as I walk off these pounds. And of course, that will help the high blood pressure and blood glucose control and depression and energy and ...

And with all that new found energy, I've got lots of plans for family, home and work. Time to actually start to accomplish some of those plans.

The Moral of the Story?

It's just this. You must assume responsibility for your health. It took me years of instansance before my problem was addressed. Even after my first sleep study, I had to push my sleep specialist to address my basic problem. Though he is one of the best sleep specialists I have seen, I had to insist that just another titration study would not do the job. So, he listened again and saw the results from the first sleep study and suggested the ASV unit to address dysregulation of my breathing (probably due to neurological issues). And this time it worked.

But it was not quick. I've had problems with falling asleep for years. It just finally got so bad that I either had to get it resolved, or I would have faced an early death. The stress on my body showed up as both diabetes and high blood pressure. Serious cardiac problems would be the most likely next problem.

So, hang in there. Remember, how you feel is just as important, or more so, than the tests. The tests are intended to help track down the problem that leads to your poor sleep. Once they can identify that issue, it can be addressed.

Anyway, here's hoping this will help others take courage and keep working toward better sleep.

[timbalionguy]

Very good, John. Glad to see that this machine is working for you. I wonder if a more up-to-date machine is in the works from ResMed.

As far as wireless gear goes, they may meet spec for 802.11x, but the phase noise, etc tends to cause broadband noise for many megahertz in both directions. 2 GHz wireless band is same as the 2450 MHz ISM band. This is shared with microwave ovens and amateur radio. Most work in this band by amateurs is further down around 2304 MHz, which is reasonably 'quiet' from an RF standpoint. The front ends used by many microwave hams are nearly radio astronomy grade. They will pick up any and everything. So, a piece of wireless gear with poor phase noise performance will raise the noise floor down even at 2304 MHz, and even if the amateur receiver has superior selectivity. On the transmit side, I can run 50 watts there, which would be a very bad thing to poorly protected wireless gear front ends. And this is even with highly directional antennas in use. So, just like you, it is 'get out the 'ole soldering iron' when a serial cable is needed.

[meusion]

Hi John,
I just got the same machine. The sleep clinic said it was not capable of giving me data and that only the sleep clinic could do that. But you are able to do that with a cable of some sort? Could you help me out?
Thanks,
Heather

[Guest]

1) It only stores three days of detailed data. It might be a certain number of sessions. I'm not sure yet. My sleep is still very fragmented. I tend to sleep two to four hours at a time, then get up and wander for a bit, then sleep more.

2) Since it is an older machine, it certainly does not have all the bells and whistles on the reporting that newer model systems have. But it's enough to start to show some patterns.

3) Since I need to use the null modem cable and connect it to my laptop, I will probably only occassionally collect the data. But it is good to know that it is there to help identify patterns as they might arise.

John,

I'm curious as it has been awhile since the ResMed VPAP Adapt SV "Enhanced" model has been available. Were you not given the "Enhanced" VPAP Adapt SV?

And what EEP and PS Min pressures are you currently using on your VPAP Adapt SV?

Banned

[JohnBFisher]

... The sleep clinic said it was not capable of giving me data and that only the sleep clinic could do that. But you are able to do that with a cable of some sort? Could you help me out? ...

You need to use ResScan software and a null modem cable to download the data. I requested this from my DME, so I could monitor my therapy. They checked with my doctor. I had already discussed this with my doctor, so he was not unprepared.

The null modem cable uses two db9 connectors and is a F/F cable (two female ends). It connects to a serial port on your computer. (Or you can find a Serial to USB connector that works well).

To download the data, you need to:

• turn off your VPAP Adapt SV
• Move either the Adapt SV to the computer or the computer to the Adapt SV
• Connect the null modem cable
• Turn on the Adapt SV
• Start the ResScan software

By default, it will recognize the machine and ask you if you want to create a new patient. Do so, and there after it will recognize if there is new data to receive when it is connected.

But first you will need to sweet talk your DME into providing the ResScan software. Some are very reluctant to do so, since it can be used to change the therapy settings of the unit. I explained that I fought so hard and so long to find something that works, that I won't change those settings. And frankly with the VPAP Adapt SV there does not seem to be much need to do so (at least for me).

Oh, another point that seemed to help. I explained that I wanted to be a low maintenance customer, who could collect and provde them the data, without having to see them periodically to do that. I think that argument helped as much as anything.

Hope that helps.

[JohnBFisher]

... I'm curious as it has been awhile since the ResMed VPAP Adapt SV "Enhanced" model has been available. Were you not given the "Enhanced" VPAP Adapt SV? And what EEP and PS Min pressures are you currently using on your VPAP Adapt SV? ...

Banned, it appears this is an enhanced unit. I am not 100% certain, but from what I've read online, the fact that it tracks the Apnea and Hypopneas and AHI index (AI, HI and AHI) and can display it indicates it probably is an enhanced unit.

I am leaving the EEP and PS Min values at their default. The default of EEP is 5 and not sure of the PS Min default.

However, I find the unit to be incredibly aggressive at keeping my breathing when I start to fall asleep. It will take some time before I am completely accustomed to that. Still, I find I can fall asleep with the machine, whereas without the machine the constant central apneas put my body under so much stress that sleep is not an option.

So, there sure does not seem to be much need to adjust the unit. I want to monitor it. I note a fairly consistent pattern in the data. It appears to follow the same as the sleep study showed. Due to central apneas (and dysregulation of both sleep and breathing) my early stages of sleep are horrible. So, I probably was getting almost no deep sleep before. Now you can SEE when I reach deep sleep. My breathing (frequency and volume) settles down. The variance is very small.

Over the long haul, I will want to periodically monitor my progress to keep an eye out for any changes in this pattern. I don't want my sleep to fall apart again, without me trying to proactively address new problems.

[dsm]

John,

It is worth adding that IIRC when the data is downloaded using ResScan 3.7 you need to select a check box that says 'Download Detailed Data' else IIRC the default (that shows up each time you do this) is to only extract summary data from the Vpap.

Also, the data doesn't get wiped from the Vpap but accumulates in a 'round-robin' fashion (when memory is full, new data overrides the oldest data ) - restating: after a download, the data on the machine doesn't get erased which is good if you realized later that you had not extracted the detailed data at the last download.

Cheers

DSM

[JohnBFisher]

... It is worth adding that IIRC when the data is downloaded using ResScan 3.7 you need to select a check box that says 'Download Detailed Data' else IIRC the default (that shows up each time you do this) is to only extract summary data from the Vpap. ...

Good point. Click Download (or connect the machine), Click "Select", Click "All Available Data". It takes quite a bit longer to download (five minutes or more compared to 90 seconds or so for the summary data).

... Also, the data doesn't get wiped from the Vpap but accumulates in a 'round-robin' fashion (when memory is full, new data overrides the oldest data ) - restating: after a download, the data on the machine doesn't get erased which is good if you realized later that you had not extracted the detailed data at the last download. ...

Also a good point, that I gratefully discovered. You CAN erase all data, but it is a seperate button you must click to do that. You go to the "Settings" button (at the top of the screen) to change the settings on the unit. To the bottom left of that menu is the "Erase Data" button. However, as you note, it is not really needed. It is just there as an option for the DME, who might provide a previously used unit to another patient.

[rested gal]

I am not 100% certain, but from what I've read online, the fact that it tracks the Apnea and Hypopneas and AHI index (AI, HI and AHI) and can display it indicates it probably is an enhanced unit.

If it displays those things, you're correct about it being the "enhanced" model, John.

[Guest]

[If it displays those things, you're correct about it being the "enhanced" model, John.

And if you squint, you will also see 'Enhanced' between 'Status' and 'Alarm Mute' on the right side of the dark blue cover panel.

Banned