Looking to trade a Resmed S9 ASV for a Respironics ASV

[cronoclone]

So, okay. I was titrated for ASV to treat my UARS and OSA/CSA at a Min PS of 10, but my doctor told me that I could make my own mind up about which machine to use. After reading just about everything I could find on these boards (thanks, guys!) I settled on the Resmed S9 VPAP Adapt. After jumping through hoop after hoop to get my hands on one, I finally did...only to learn that the MAX min PS on this unit (if you follow me here) is 6. So, I believe I'm correct in assuming that this machine is pretty much worthless to me at this point -- and it's my understanding that the Respironics ASV unit allows a higher min PS (though I'm having trouble confirming this).

So if anyone out there wants to trade, straight-up, please let me know. Alternately, any advice that anyone could give me on how to accomplish my goal of sleeping at my titrated pressure as soon as possible would be very much appreciated!

[cronoclone]

If anyone's got an AVAPS they're willing to trade, I'll consider taking that too. I have a lot of problems with shallow breathing and inconsistent tidal volume leading to frequent arousals in the middle of the night. Even though I was titrated for ASV, it's the ventilator action that I'm most desperately in need of. I had to stamp and shout to get an ASV titration in the first place, so it may be that AVAPS is more suited to my needs anyway.

Again, if anyone has any opinions on this, you'd be making my day. Seriously. I'm a zombie here, people. I don't have much to look forward to in the morning.

[Grand-PAP]

Sent PM.

[Grand-PAP]

Hi cronoclone,

I have TWO WHOLE days experience with the S1 BiPAP autoSV and know absolutely NOTHING about setting pressures. But FYI . . .

I just checked my machine and (without any understanding of how the PS might be impacted by other pressure settings) I have the ability to set:

Min PS from 0 to 10

Max PS from 4 to 17

[Banned]

So, I believe I'm correct in assuming that this machine is pretty much worthless to me at this point -- and it's my understanding that the Respironics ASV unit allows a higher min PS (though I'm having trouble confirming this).

The only constraint on the S9 Adapt algorithm is that EPAP + Max PS will never exceed 25cmH2O. So, until you tell us what your prescribed EPAP setting is, your thoughts of abandoning your S9 Adapt, are unfounded at best, and ridiculous, at worst.

[NateS]

So, okay. I was titrated for ASV to treat my UARS and OSA/CSA at a Min PS of 10, but my doctor told me that I could make my own mind up about which machine to use. After reading just about everything I could find on these boards (thanks, guys!) I settled on the Resmed S9 VPAP Adapt. After jumping through hoop after hoop to get my hands on one, I finally did...only to learn that the MAX min PS on this unit (if you follow me here) is 6. So, I believe I'm correct in assuming that this machine is pretty much worthless to me at this point -- and it's my understanding that the Respironics ASV unit allows a higher min PS (though I'm having trouble confirming this).

So if anyone out there wants to trade, straight-up, please let me know. Alternately, any advice that anyone could give me on how to accomplish my goal of sleeping at my titrated pressure as soon as possible would be very much appreciated!

The machine you already have will do exactly what you want. I have the same machine you do, and learned on this board that you raise the Min iPAP on your pressure by raising the EPAP. I raised mine gradually from 5.0 to 8.0, which raised my iPAP to 11, and if you would look at my Pressure chart on SleepyHead you would see that that is as low as my pressure goes now. That is the best I can explain it. For a better explanation, you might read JohnBFisher's replies to my questions on this thread:

viewtopic.php?f=1&t=74537&p=683842&hilit=nates#p683842

wherein John explains that:

The odd thing about the ASV units is that the PS value is ADDED to the EPAP value to yield the IPAP value.

So, a prescription for a Resmed unit would show the EPAP value (in this case 15) and a MinPS and MaxPS value. The MinPS value is ADDED to the EPAP value to yield the lowest IPAP value. The MaxPS value is ADDED to the EPAP value to yield the highest IPAP value.

So, EPAP of 15, MinPS of 5 means that the EPAP is 15 and the minimum IPAP is 20.

- Quote from JohnBFisher

Regards, Nate

[Guest]

So, okay. I was titrated for ASV to treat my UARS and OSA/CSA at a Min PS of 10.. only to learn that the MAX min PS on this unit (if you follow me here) is 6. So, I believe I'm correct in assuming that this machine is pretty much worthless to me at this point..

You are correct. The S9 Adapt is worthless to you.

[Banned]

You are correct. The S9 Adapt is worthless to you.

But before you throw your S9 away, Lets look at the critical parameters of the device:

EPAP: 4cmH2O to 15cmH2O
Min PS: 3.0cmH2O to 6cmH2O (in 1/10th increments, i.e. 3.0, 3.1, 3.2...)
Max PS: 8cmH2O to 16cmH2O
EPAP + Max PS is equal to, or less than 25cmH2O.

Have you looked at your AHI scores with Min PS set at 6cmH2O?

[NateS]

You are correct. The S9 Adapt is worthless to you.

I would respectfully disagree with "Guest" aka "Banned" unless he/she can back up that statement with documentation from the Clinician's Manual and/or the Titration Manual.

Respectfully, Nate

[Banned]

If anyone's got an AVAPS they're willing to trade, I'll consider taking that too. I have a lot of problems with shallow breathing and inconsistent tidal volume leading to frequent arousals in the middle of the night. I'm a zombie here, people. I don't have much to look forward to in the morning.

I will trade you my Respironics AVAPS, for your S9 Adapt. I think you are a good candidate for AVAPS. Provider Manual included.

[dwlima2]

" your thoughts of abandoning your S9 Adapt, are unfounded at best, and ridiculous, at worst."

I am not a doctor, but I can read. Increasing EPAP to accomodate a higher minimum IPAP is exactly the wrong approach. You should learn to read too.

In patients with neuromuscular disease, higher NPPV
settings are not necessarily better. These patients usually
do not require PEEP unless they also have OSA or COPD.
In patients with neuromuscular disease, higher PEEP
(EPAP) can result in expiratory-muscle activation
. Moreover, higher PEEP results in a higher
inspiratory pressure, which may decrease patient tolerance. It is noteworthy that bi-level ventilators commonly
used for NPPV have a threshold PEEP (EPAP) setting of
4 cm H2O to minimize rebreathing. This PEEP level may
be unnecessary and uncomfortable for some patients with
neuromuscular disease. There can also be problems from
too high an inspiratory pressure, including greater leak,
less comfort, ineffective inspiratory efforts, central apnea,
and glottic closure.
For most patients with neuromuscular disease and otherwise normal lung function, a PEEP
(EPAP) of 4 cm H2O, or lower if possible, and an inspiratory positive airway pressure of 12–14 cm H2O is often
sufficient. This results in a pressure support of about
10 cm H2O. Because of the potential for ineffective triggers and central apnea, a backup rate should be set at about
12–16 breaths/min.