New ASV for CSA, suggestions for machines and masks?

I was diagnosed with central sleep apnea back in August. It took nearly 2 months to start CPAP, which hasn't been working - my AHI on CPAP is ranging from the low 20's to mid 60's (approximately 90% centrals) and my O2 is dropping to the low 60s and 70s. I discovered that I don't have a great nose for full face masks, but I wouldn't keep my mouth closed during my sleep study, even with the chin strap. I finally found the Liberty Hybrid mask, which works great for me; however, when I tried to use it during my 2nd sleep study to titrate the ASV, it wouldn't handle the high pressure at all. To be honest, the sleep study felt kind of traumatic - it took 92 minutes to fall asleep, and I pretty much started freaking out at the pressure shifts and speed of the ASV. I pretty much lost it, so I called for the tech and she switched it to biPAP, which allowed me to fall asleep, after which she switched to ASV again, and it wasn't quite as bad. I started feeling more hopeless when the tech came in though, because she insinuated that maybe my centrals weren't "real" and I should keep going with CPAP, to which I thought, "CPAP is not working, my headaches are out of control, and I can barely function - if I can't find a solution with this sleep study, what am I going to do!" Anyway, I guess my centrals were sufficiently real enough during the study, so now I have orders for an ASV - base pressure 10 with the variable pressure ranging from 3 to 12 (put on auto setting) - I don't have the orders with me at the moment or I'd provide better info.

Anyway, the purpose of my post is that I would really appreciate input on the various models of ASV machines and full face masks that are effective with them. I have a narrow and prominent bridge of my nose, and the full face mask (Quattro) I was using was the only one I could get to seal to where it didn't leak around my eyes, but caused horribly painful sores on my nose. I tried the Resmed hybrid mask, and it gave me a really bad sore on my upper lip. The liberty hybrid is great, but I don't know if it can handle the pressure without causing the nasal pillows to blow out of my nose. The DME people are scheduled out a month for me to get my ASV (this has been such a frustratingly long process), so I figured that if I want to put in any requests for a machine type, now is the time.

I'm really trying not to feel too hopeless, but my depression and anxiety have been so out of control. I'm worried that I'm going to lose my job - they keep piling work on me (I work as an environmental scientist), but I can't seem to focus on even the simplest task. I've heard that it can take time to adjust to the ASV, so if anyone has suggestions on how to ease the transition, I would appreciate the input - I need to have some semblance of normalcy return to my life so I can function at my job and be a better mother to my children. My life certainly doesn't feel much like living these days.

Thanks in advance for your time and advice.

To help secure the nasal pillows of the hybrid type of mask check out Rooster's tips.
wiki/index.php/Hybrid_Mask_Modifications

You are most likely going to be looking at getting a Respironics PR System One model 960
https://www.cpap.com/productpage/pr-60- ... anced.html
or the comparable machine in ResMed line...the S9 Adapt Auto SV model 36037 and I don't have a link for it handy. ResMed is supposed to be coming out with the new AirCurve VPAPs soon but I don't know when those will be released and it's unlikely that the initial release will include that particular model since it is the high end model.

Which brand is probably going to depend on which brand your DME seems to do business with.

Those 2 brands though are pretty much it for what your needs are.

There are currently 2 machines to look at the Resmed VPAP Adapt 36037 or the PRS1 960TS ASV.
I have the PRS1. My original machine was very noisy and after exactly one year I convinced Apria to replace it with a new one which is much quieter.
Each brand has its pros and cons, like comparing a Cadillac and a Lincoln, some will prefer one over the other. The differences are subtle. It might help to know which equipment they used in your sleep study. Since you did not do to well the opposite brand might suit you better.

Resmed is comming out with it's new Aircurve 10 ASV, but it won't be available until after the first of the year. You don't want to wait that long.

I would become a very squeaky wheel and tell the DME to simply give you the machine in the box and you will set it up yourself. This will freak them out, but with your sleep/titration report, many folks here can help you with the setup. If you can operate a DVD player you can set up your PAP machine.

The mask selection is far more difficult. after 4 years, I still have not settled on my perfect mask, and I have about a dozen. Currently I am having good success with the Wisp and a chin strap.

I have been on my ASV for about 44 days now. I went from finding out I have sleep apnea to failing the titration for both CPAP & BIPAP and went straight to the ASV. My pressures are very high starting at 21 and going up to 25 max. Most nights are closer to the 25 than the 21.

I have read on the forum several times that masks are individual - What works for one may not work for another. Mask have been quite a problem for me. I have tried 4 Full Face mask and 3 pillow masks. I tried a pillow mask at Pugsy's suggestion when I thought I couldn't use one. I tend to breath through my mouth when I started but am training myself to keep it closed and that is going really good.

One of the mask I tried was suppose to be for high pressure but it wouldn't stay in place with the force of the air. So far the Nuance Pro Pillow mask has worked the best and it is the one I fall back on. I have to tie it down to keep it in place though so I am still looking for that ideal one. Some get lucky with finding their mask right away and then there are others like me that it will take some trial and error. I don't mind though cuz I have faith it will happen.

As far as getting use to it - I was able to look at it that I'm finally getting the air into my lungs that I need to live. The noise and rhythm of the machine as I breathe in and out is almost hypnotic and relaxs me. In fact my hubby says it relaxs him too. He knows that I'm breathing. I've heard others try aromatherapy or playing some relaxing music to put you to sleep. I try to look at things as: This is the first day of the rest of my life! I want to live it to the fullest. I will do whatever it takes to make this work. I want to be around to watch my grandchildren grow up and have my great grandkids.

You can do this so hang in there. You are definitely in the right place to get answers to your question.

Thank you for the insight and sharing your great attitude, Ogeo.

Pugsy - thanks for the info and the link. I tried a rubber band between the nasal pillows, but it didn't help, it actually made it worse, but the panty-hose/tights leg idea is genius! That may just work. I don't think that would have ever occurred to me on my own...

bwexler - I'm pretty sure the DME will fully freak out if I ask to set up the machine, but I'm not worried, because with my CPAP, I took it home with the setup they programmed and figured out how to make changes myself, which is fairly easy to figure out with the help of google and some apt search terms. It is also good to know that there are so many helpful people on this forum - honestly, this forum and the other sleep apnea forum have provided the most useful information I have found by far.

I guess the options are what they are. My cpap is ResMed, so I wouldn't be surprised if I get that version. I am able to contact my respiratory therapist/DME person directly since this is my second time around, so I'll start making my voice heard asap.

THANKS ALL!

Sorry to temporarily hijack this thread, but this *may* still be relevant to the original subject...

bwexler wrote: Resmed is comming out with it's new Aircurve 10 ASV, but it won't be available until after the first of the year. You don't want to wait that long.

Is that information known to be correct? Are you absolutely *sure* that it won't be available until 2015? (Inside info via Resmed?)
People like myself that are needing to replace their machines before year-end really need to know with certainty.

Thanks, and now back to our regularly scheduled program...

ignorant1 wrote:Is that information known to be correct?

I have "sort of inside info" meaning I chatted with someone who did call ResMed week before last to ask about the release of the AirCurve series and was told "don't know yet".

Historically in the past when ResMed releases a new model line the basic cpap machines are the first to be released...and they release the basic VPAPs. If they (ResMed) do it like they have done it in the past the first VPAPs will be the VPAP S and VPAP Auto and the high end ASV type of machines will come later.
Since we are at the end of October and don't have even the regular VPAPs in the AirSense line...I really doubt that we will see the ASV type of machines in the AirSense line by the end of the year.
Now ResMed could surprise us all and release all the VPAPs in one release....and maybe that is what they are waiting on..
Heck...they might release them tomorrow.

Within the past week or so, Resmed removed the "Coming Soon" from their website for the Aircurve models, so maybe they are on the cusp of being available.

I am 90 days into ASV. Same story as you but much lower pressures. I too am a mouth breather. I have had wonderful luck with the Oracle mouth mask and the nose plugs that come with it. This mask tends to get overlooked. I find it extremely comfortable and am not quite sure why it is not used more. No leaks at all. I use the Hozer hose device with it. As long as I use a heated tube and full humidification, I have only minimal dry mouth that is gone once I move my tongue around after removing the mask. The only modification that I made was to make my own mask liners out of old t-shirts because I found the silicone upper lip piece tended to irritate my skin a bit and then it hurt to shave. Problem solved. PM me if questions...

Hi Photonic - thanks for your input. What are your pressure settings, if you don't mind me asking? I'll be honest, it scares me when you say that your settings are lower, when I read your other post earlier about the trouble you're having with pressure.

I've been using a pad-a-cheek liner on my Liberty Hybrid. I had a bad problem with the ResMed hybrid - it really hurt my upper lip, but not the Liberty mask. If I can figure out a way to get it to handle the pressure, I'll probably stick to that, but it didn't do all that great in my titration study. I'll definitely check out the oracle mouth mask - thanks for the tip.

Ogeo wrote:One of the mask I tried was suppose to be for high pressure but it wouldn't stay in place with the force of the air.

To help keep that mask in place you might try the anti leak strap from Pad A Cheek. It's good for leaks but it's also good for keeping the mask in place. http://www.padacheek.com/PAC_AntiLeak_Strap.html I use one and it works very well.