Resmed VPAP Adapt SV - for Central Sleep Apnea

dsm · Post by **dsm** » Sun Jul 30, 2006 6:35 pm

-SWS wrote: <snip>
Comparing this machine to the previous VPAP models is like comparing apples to oranges in my opinion. This machine is all about preventing ventilatory overshoot as it achieves respiratory synchronization. It will be very interesting to see what this machine can do for Christinequilts, Frequenseeker, and other likely candidates for adaptive servo ventilation.
<snip>

SWS,

I want to see what this baby could do for me

Re justification for one ...
I can say though that based on Resmed pricing in Australia, I won't be able to afford one (justify it that is ). A few months back I phoned up Resmed to ask their price for the VPAP III - they quoted me (IIRC) $A8,000. The S/T was dearer. Needless to say the one I have today came off Yahoo Auctions .

DSM

StillAnotherGuest · Post by **StillAnotherGuest** » Sun Jul 30, 2006 6:35 pm

frequenseeker wrote:IPAP of 21.8???
Did they intend to beat the apnea into submission to get numbers that look right?? Or am I misinterpreting something?

If you blow up the HeartPAP .pdf, you'll see that the 21.8 mbar (it's close enough to cmH2O) represents IPAPmax. That's really not all that different from the Resmed ASV CS-2, where EEP + MAX PS is 20 cmH2O. That does not mean those pressures are actually used, they are simply available to achieve volume targets. What they are in HeartPAP, tho, I don't know, but I would think ASV is pretty much ASV.
SAG

frequenseeker · Post by **frequenseeker** » Sun Jul 30, 2006 6:48 pm

Yes, I suspected it was the limit not the average, but nowhere in the article were study pressures detailed.. I'd like to see a comparison chart showing pressures used with each machine, ResMed and Respironics.
I don't know if we can say

ASV is pretty much ASV

- are there proprietary algorithms and engineering that could be different between different brands/machines?

-SWS, did you say there was an additional EPAP pressure boost at the end of the expiration in the ResMed machine, a PEEP? I would think this would be very helpful, and we could look to see if it is included in the Respironics.

When I used a VPAP ST briefly I thought the backup IPAP was nice as it kind of jump started my inhalation and counteracted my slow respiration/hypopnea tendencies. My respiratory doctor was not impressed, she was concerned about some sort of dependence and blood gas disturbances leading to more CSAa or such. But I liked the way I felt with it. Probably the ST setup was more conserving of my CO2, now that I know to put that lens on my past experiences..
To have a bit of an increased pressure within comfort levels at the end of the expiratory phase would be interesting and not the same as a timed inhalation would it.

dsm · Post by **dsm** » Sun Jul 30, 2006 6:58 pm

StillAnotherGuest wrote:Course, we could always wait to see what Respironics does:

HeartPAP
SAG

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

Begin

Looks like they my be playing catch-up to me

The machine in the doc looks like the same-old same-old with a few added algorithms.

The release of this class of machine really does now explain to me why Resmed led the charge to get xpaps off eBay & why they are now beating up on-line sales orgs & seeking to squash cross-border sales. Am willing to bet they may gain partial or temporary success but where there is a will there is a way & Resmed will eventually get circumvented.

This reminds me of the never ending battle Sony faces with Digital Rights Management & trying to introduce copy protection mechanisms. Magic Gate failed, Sony's hidden CD DRM software go them sued in a class action this year, their DVD copy protection software continually gets routed. I am not approving copying here just highlighting the near impossibility of enforcing something people don't want.

DSM

dsm · Post by **dsm** » Sun Jul 30, 2006 8:20 pm

SWS,

New terminology now better understood.

The term 'Adaptive Servo' now has some context for me. Until I read the Resmed remark (posted by me above) that they had released an 'AUTO Bilevel with integrated Backup timing', I hadn't full associated the term Adaptive Servo to being equivalent to AUTO in the sense of being adjustable varying pressure as required by the user.

I half grasped that the Adaptive Servo meant varying the pressure but didn't relate this to the simpler and easier understood principle of the Bipap AUTO.

I suspect a lot of us people reading here would have missed this as well.

DSM

#1 Found this interesting article - can't recall if someone else has already linked to it ...

http://www.epilepsy.com/newsfeed/pr_1153229417.html

#2 Maybe this is of interest too

http://heart.bmjjournals.com/cgi/conten ... 5.060038v2

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, bipap, auto

Guest · Post by **Guest** » Sun Jul 30, 2006 9:17 pm

I read somewhere the Respironics BiPAP autoSV (aka HeartPAP) has been in testing since 2002 and is currently available in Europe. Has anyone found any information about the USA launch?

frequenseeker, the chart is easier to read in this link, but the text is in Deutsch!
http://www.saegeling-mt.de/pdf/bipapautosv.pdf

Respironics BiPAP autoSV

IPAP Min.....4 to 30 cm H2O
IPAP Max....4 to 30 cm H2O
EPAP .........4 to 25 cm H2O

AUTO

-SWS · Post by **-SWS** » Mon Jul 31, 2006 12:47 pm

SAG, has your clinic had a chance yet to trial the very latest Adapt-SV version on any patients? The first clinical-research anecdote I have regarding Adapt-SV in relation to CSDB is less than favorable. Any clinical-research anecdote is absolutely no substitute for a well-designed, reputable medical study (let alone multiple independently replicated studies). Regardless this was a pretty credible clinical-research anecdote in my book. I'll ask this person if they are at liberty to release details beyond what I have said here without breeching either confidentiality or their own legal liability. The jury's still out regarding this machine in relation to CSDB in my opinion.

Regardless, I will still place a couple/few more posts in this thread better describing exactly what adaptive servo is and the importance of the algorithm driving that adaptive-servo impeller mechanism. Indeed, ensuing research data will portray this new Resmed machine for exactly what it is. More later...

StillAnotherGuest · Post by **StillAnotherGuest** » Mon Jul 31, 2006 7:03 pm

Unfortunately, we have yet to initiate ASV in the laboratory. A review of several hundred cases in searching for candidates (and they've got to be good candidates) yielded only 5 possibilities, and none of those wished to participate. Since then, two more outstanding candidates were uncovered, but they turned out to be non-compliers.

These numbers may reflect what's out there, tho. In the abstracts this year in SLEEP, Bijan Sadmoori, M.D., of Holy Family Hospital, Methuen, MA, showed an incidence of 1.6% for CSBD in a community hospital [0487]. And because of the nature of our patient base, we could be even lower than that.

Now don't get me wrong, I'm sure this technology will work quite well in a select group of patients. But the key word is "select." In the cross section of the Holy Family caseload, of the group of 30 patients, 12 were cardiac, 7 CNS, 5 CNS + cardiac and 8 medications (yeah, I know it don't add up right, there's probably some more overlap).

guest wrote:Always? {re: circulatory delay)

"There's always circulatory delay" might seem to be stretching it a bit (a leftover from the chemical responsiveness/circulatory delay exchange on TAS)(and if you look at the loop diagram it's effect is probably more like a catalyst vs a principal component)(but then how do you explain the improvement following pacemaker insertion in those cases?)(and also in this year's SLEEP abstracts [0536] Drs. Mendez, Kagramanov and Morgenthaler from Mayo Rochester showed an increase in circulatory time (CT) in CSBD compared to OSA patients)....well anyway, CT seems to be taking on more significance. The only thing that's holding us up is a standardized way to accurately reproduce results.
SAG

-SWS · Post by **-SWS** » Mon Jul 31, 2006 8:35 pm

StillAnotherGuest wrote:Unfortunately, we have yet to initiate ASV in the laboratory. A review of several hundred cases in searching for candidates (and they've got to be good candidates) yielded only 5 possibilities, and none of those wished to participate. Since then, two more outstanding candidates were uncovered, but they turned out to be non-compliers.

SAG, thanks very much for that reply. Can you elaborate: 1) what your clinic's patient criteria is for your ASV trial, and 2) why your clinic's ASV patient-trial criteria is implicitly such a narrow subset of those patients targeted by Resmed for their ASV? Thanks.

frequenseeker · Post by **frequenseeker** » Mon Jul 31, 2006 9:07 pm

Some of us need the pap machine to keep us breathing but suffer from the adverse effects of that therapy creating depletion and imbalance.

I was treated for CO2 deficiency induced by pap therapy using insight related to CSR/CHF respiratory syndromes. There are those of us who need more CO2 retained in our system than the pap and vented mask allow. Thank goodness the researchers/developers understood that others besides the extremely ill could be in need of the specific treatment. My mental well being was regained with that treatment.

I remember my first sleep doc being so puzzled that my Epworth scores kept worsening each time I returned after a trial of yet another pap machine until I completely distorted the usual programming for the VPAP III which allowed me to function physically (like being able to stay awake after suppertime).

My CO2 was washing out nightly, which led me into hypopneas to conserve the CO2. When I defeated the hypopneas through bizarre settings of the VPAP, my respiratory rate went down to half of what it needed to be...My mental state, my competence in certain activities including social/business demands on "bad" days, and therefore my self confidence, became undependable. When I plugged up half my Swift vents and felt better, this act of desperation evoked extreme reactions, even threats, among message board participants.

Thank goodness some sleep docs realize syndromes can be more generally expressed than with only the extremely ill.

In related news, I am in discussions to do a sleep study with the ASV..this could show its efficacy with the less severe subgroup of OSA sufferers..will keep you posted.

-SWS · Post by **-SWS** » Mon Jul 31, 2006 9:20 pm

StillAnotherGuest wrote:and if you look at the loop diagram it's effect is probably more like a catalyst vs a principal component)(but then how do you explain the improvement following pacemaker insertion in those cases?)(and also in this year's SLEEP abstracts [0536] Drs. Mendez, Kagramanov and Morgenthaler from Mayo Rochester showed an increase in circulatory time (CT) in CSBD compared to OSA patients)....

Thanks again for posting that, SAG. I just read abstract 0536 and noted a sample of 13 CompSAS and 8 OSA, comparing LFCT (lung to finger circulation time). Of course, plenty more epidemiology data is needed to draw any conclusions. There's little doubt in my mind that circulatory delay can be principal or catalyst in CSA. However, two questions arise for those of us who suspect more than one central apnea sub-phenotype: 1) is circulatory delay always present in CSA, and 2) when circulatory delay is present in CSA, can it be symptomatically related while being neither principal nor catalyst?

The reason I suspect there are likely several CSA etiologies relates to a multitude of ways in which the human respiratory drive can be dysregulated if
genetic diversity is simply parameter-remiss in one of many possible regulating mechanisms. Mother nature's rule is that if it is a physiologic mechanism, it is virtually guaranteed to fail in a certain percentage of humanity. Take any chemoreceptor, and neurological process, any organ and devise a physiologically reasonable way for it to fail. That reasonable model of physiologic failure is almost guaranteed to manifest in some epidemiological percentage IMHO. If you can devise multiple highly reasonable physiologic respiratory drive failure scenarios, there is a better than fair chance more than one CSA etiology exists. Haven't noticed too many physiologic traits that don't manifest with both diversity and failure.

Thanks again.

-SWS · Post by **-SWS** » Mon Jul 31, 2006 9:27 pm

Frequen, I noticed a definite increase in your cognitive abilities after BI treatment. However, your abilities were pretty darn good before treatment.

A little additional background about Frequenseeker. She holds a medical patent for a frequency-spectrum therapeutic device that she invented and continues to develop to this day. She is a very bright women who loves to think "outside the box" so to speak. Wonderful sense of humor too... .

frequenseeker · Post by **frequenseeker** » Mon Jul 31, 2006 9:29 pm

Oh shucks, -SWS
I was just about to post this challenge for you..
Here, see what you (and other good minds here) think of this:
http://www.itamar-medical.com/

-SWS · Post by **-SWS** » Mon Jul 31, 2006 9:29 pm

DSM, thanks for those links. I'm just getting ready to delve into those articles.

frequenseeker · Post by **frequenseeker** » Mon Jul 31, 2006 9:34 pm

Oh, and by the way, it is a diagnostic device that I invented. Detects and measures all those dysfunctions that don't show up on X-ray, ultrasound, MRI. Identifies tissue that is in trouble, and also what kind of tissue is involved (nerve, connective tissue, blood vessels, organ, etc.). Will be the next major imaging technology.
The therapy I invented to fix alot of the above employs manual skills, not machines..
All very based in physics, established science, very provable, and accurate/efficacious in 8 years of clinical development/practice.
Now you know what I do when I am not posting here..

Thanks for the mention.

Resmed VPAP Adapt SV - for Central Sleep Apnea

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