Resmed AirCurve 10 ASV vs. Respironics 960T BiPap AutoSV

Question -
What differences are there between the current Resmed ASV and the Respironics ASV?

In January, I had an overnight sleep study that was to be followed up by a day time nap study (MLST). My Day study was canceled since I had no N3 sleep during the night study. Afterward, the sleep doc called to say they felt I needed an ASV instead of my bipap auto because of mixed sleep apnea, and set me up for an overnight titration with an ASV in February.

After the titration, I asked my doc to let me try the Resmed ASV, but he said since I was titrated on the Respironics, he felt I should stay with the Respironics. So, I have the Respironics 960T.

The only thing I have noticed that irritates me about my current respironics ASV is that during the night, sometimes the device will blow air too strong for my preferences, and wakes me up- so I press the ramp button to make the pressure less so I can fall back asleep. Some nights I have to press the ramp button a few times consecutively to fall back asleep. . .

In a few weeks, I am scheduled for another night study with the day time MLST (nap study)- If I can get enough N3 sleep. My doctor has recommended that I use my home (respironics) ASV for the night study, so that I should be able to get a better night of sleep during the night study.

So, here is my idea- I wonder if I can request to use the resmed asv for the night study, or at least the first half of the night, and if they see that i am not sleeping well, to switch back to the respironics asv. Then at least I would have a better understanding if I would sleep better with the Resmed vs. the Respironics?

Or is it better just to keep with the respironics since that is what I am currently using . . . Before ASV, I was using a Respironics 760 Bipap auto - I had a lot of trouble sleeping because the noise level would keep me awake a lot.

My DME told me that my medical provider has been giving out more resmeds than respironics lately (in the past it was only respironics), and that since my device is being rented, there should not be much of a problem to switch over if my doctor was ok with that.

Anyhow, I want to know, is the grass really greener on the other side? Or are both brands more or less the same?

Is having the ability to flag centrals important to you or not?
The 960 separates the Obstructive Apneas from the Central Apneas. The ResMed ASV does not...they both get dumped into the Apnea Index category.
It might be important to your doctor.

The ResMed ASV is going to be more aggressive with the pressure changes. It will go higher a little faster and come down a little faster. The algorithm is different.
They go about doing the same job but they get there by a slightly different road.
I liken the 960 to the "kinder, gentler" algorithm.
I have used a 960 and the previous S9 Adapt (equivalent to the AirCurve 10 ASV). ResMed didn't change the algorithm when they went to the AirCurve model. The changes were cosmetic.

I actually prefer the ResMed to the 960 but that's me and probably because I was using ResMed plain bilevel before the ASV...so I was sort of used to the more aggressive/faster response.
I think a lot of the "comfort/adjustment" factor is related to what the body is used to.
Now I have known some people go from the 960 to the ResMed and love it...and some hate it.
Not many people get a chance to use both so there's not a lot of people using ASV who have had the opportunity to use both. When I say "some people" I am talking about 2 or 3 people...not a huge number.

I don't know if using a ResMed unit the night before the MSLT test is a good idea...it is different and more aggressive in its response and it might cause sleep disruptions since you are not used to the way ResMed does its job. I would stick with tried and true the night before the MSLT test.

Otherwise to know if that grass is greener for you....you would just have to try it out to see if you like it better/the same/or worse. The fact that it will go higher faster...could be a potential problem since you mention high pressures waking you up already BUT by the same token it might be that the fact it will lower faster might mean that it has less chance of staying higher longer which could potentially mean that you might not wake up with the pressure change. It all depends on if you are waking up because the machine goes higher or because it is staying higher longer. Tough call because there's no way to evaluate that potential factor ahead of time.

Due to the cost of these machines DMEs are hesitant to let people try both brands (if they even have both brands) but you might ask if your DME has maybe a S9 equivalent to the AirCurve ASV...that they would let you try. The basic functions will be the same. They didn't change how the machine does its job when they came out with the AirCurve.

Thanks Pugsy,

I do like seeing the clear apneas and obstructive apneas as separate rather than together, and I wasn't aware that the Resmed is more aggressive with pressure changes.

The information you provided helps me a lot - and I agree, it may not be a great idea to change up on the night before the MLST, as it could truly add to disrupting my sleep. It will be good to see how I sleep through the night with my device at the sleep lab.

Pugsy wrote:Is having the ability to flag centrals important to you or not?
The 960 separates the Obstructive Apneas from the Central Apneas. The ResMed ASV does not...they both get dumped into the Apnea Index category.

I believe that is incorrect. the resmed machine simply does not flag central apneas, because it doesn't allow you to have them. to properly flag a central apnea, you'd have to wait 10 seconds, while probing to see if the airway is open or not, and the machine does not wait, at the first sign of decreasing breath effort, it starts to increase IPAP to keep ventilation up. since you never spend 10 seconds or more with an open airway and without air moving, you technically don't have any central apneas.

the respironics does record 'patient triggered breaths', and every one that's not patient triggered is one that the machine had to supply, so you could assume that it might be part of an apnea prevented.

the resmed machine counts patient triggered breaths, and shows it on the display, but I haven't seen any evidence of that data being recorded on the sd card.

palerider wrote:I believe that is incorrect. the resmed machine simply does not flag central apneas, because it doesn't allow you to have them. to properly flag a central apnea, you'd have to wait 10 seconds, while probing to see if the airway is open or not, and the machine does not wait, at the first sign of decreasing breath effort, it starts to increase IPAP to keep ventilation up. since you never spend 10 seconds or more with an open airway and without air moving, you technically don't have any central apneas.

We assume that is what it does but how come the 960 which does the same thing (supposedly) bothers to flag centrals?
I thought that since FOT needed to be used to tell obstructive from central that for some reason FOT wasn't/isn't used and that was why the no separation thing.
I have never read anything that says for sure that the apneas recorded by my Adapt are for sure obstructive. I also never see FOT...I don't think. I am not a good one to judge with though since I never had many centrals in the first place.

At any rate...if someone wants to know for sure by using the flagging...Respironics does it and ResMed doesn't.
And at any rate if what you say is indeed the rationale behind it...the algorithm is for sure a lot more aggressive than I first thought.

Pugsy wrote:

palerider wrote:I believe that is incorrect. the resmed machine simply does not flag central apneas, because it doesn't allow you to have them. to properly flag a central apnea, you'd have to wait 10 seconds, while probing to see if the airway is open or not, and the machine does not wait, at the first sign of decreasing breath effort, it starts to increase IPAP to keep ventilation up. since you never spend 10 seconds or more with an open airway and without air moving, you technically don't have any central apneas.

We assume that is what it does but how come the 960 which does the same thing (supposedly) bothers to flag centrals?
I thought that since FOT needed to be used to tell obstructive from central that for some reason FOT wasn't/isn't used and that was why the no separation thing.
I have never read anything that says for sure that the apneas recorded by my Adapt are for sure obstructive. I also never see FOT...I don't think. I am not a good one to judge with though since I never had many centrals in the first place.

At any rate...if someone wants to know for sure by using the flagging...Respironics does it and ResMed doesn't.
And at any rate if what you say is indeed the rationale behind it...the algorithm is for sure a lot more aggressive than I first thought.

What I said is based on deductive reasoning and going over a LOT of charts of someone with CSR and heart failure.. the resmed ASV doesn't do FOT, this is true, which is why sleepyhead shows it's apneas as "unknown", they're just apneas.

you can see the machine preventing a couple of centrals below, in the mask pressure trace:


as to the 960, can it really flag, and prevent centrals at the same time? is it just guessing at where a central would be? does it let you not breath for 10 seconds when it flags a central? I know it, like all respironics machines, is a lot slower to react... but I haven't looked at enough 960 traces, in detail, to know those answers.

palerider wrote: as to the 960, can it really flag, and prevent centrals at the same time? is it just guessing at where a central would be? does it let you not breath for 10 seconds when it flags a central? I know it, like all respironics machines, is a lot slower to react... but I haven't looked at enough 960 traces, in detail, to know those answers.

Well they do use the pressure pulse thing and often they starting throwing out the pulses a couple of seconds into the "event".
I could go nit pick my old 960 data but again...I never really had many centrals in the first place and that's a lot of nit picking and putting things under the microscope that I am not inclined to dig into at this time.
I know I would occasionally get a central/CA flag but it was rare.

I would also have to assume that they wouldn't be putting the flagging in there if they didn't have the research to back it up.

Here's the thing that bugs me...we both know that if the ResMed isn't set properly (by allowing PS to do its thing) and if it's hands are tied and it can't prevent the centrals with that big burst of pressure....the centrals will happen if the machine's settings aren't where they need to be...so if it doesn't prevent it...does it even flag it as a regular not category apnea?
We both know that just because a machine can prevent a central it doesn't always prevent it if its hands are tied and we both know that we see people here fairly often using a machine with its hands tied.

Pugsy wrote:Here's the thing that bugs me...we both know that if the ResMed isn't set properly (by allowing PS to do its thing) and if it's hands are tied and it can't prevent the centrals with that big burst of pressure....the centrals will happen if the machine's settings aren't where they need to be...so if it doesn't prevent it...does it even flag it as a regular not category apnea?
We both know that just because a machine can prevent a central it doesn't always prevent it if its hands are tied and we both know that we see people here fairly often using a machine with its hands tied.

I'd have to think that if there's no airflow, because the machine is chained down, then one would think that it would flag an apnea, at least.

Is the Aircurve 10 ASV as reliable as the S9 Adapt?

Any known issues with the Aircurve/Airsense deign?

klv329 wrote:Is the Aircurve 10 ASV as reliable as the S9 Adapt?

Any known issues with the Aircurve/Airsense deign?

I haven't heard of any problems and since it uses the same algorithm I would expect it to work just like the Adapt but in a new package.

There have been random complaints from some unhappy campers with the AirSense and something about humidifier seal but you can't please everyone. A few have said the AirSense is noisier than the S9 and that I find hard to believe but maybe they have superman ears.

Nothing that points to a certain pattern of failure or anything like that. An occasional lemon but you get that with any machine..new or old model.

beautifuldreamer wrote:Thanks Pugsy,

I do like seeing the clear apneas and obstructive apneas as separate rather than together, and I wasn't aware that the Resmed is more aggressive with pressure changes.

The information you provided helps me a lot - and I agree, it may not be a great idea to change up on the night before the MLST, as it could truly add to disrupting my sleep. It will be good to see how I sleep through the night with my device at the sleep lab.

If your sleep lab is using Respironics equipment then they are more likely to have the parameters for your machine set correctly. My lab uses ResMed but I insisted on Respironics for a variety of reasons. The setting from the lab were difficult to convert to the PR machine and I took quite a while before I understood what needed to be set. PR has more settable parameters than ResMed.

On the issue of the ResMed being quicker to respond to centrals that the PR 960, on my machine I frequently see centrals that are responded to within one breath cycle. Looking at the waveform data, you can see the cessation of breathing, and then a few seconds later the pressure increase kicks in. I can't speak to rate of pressure increase in the ResMed as I have never used one but the PR seems to be very smooth as it kicks in. That was one of the reasons I chose PR over ResMed in spite of static from my former DME over the issue (that's another story.)