Back from the Sleep Doc - VPAP Adapt SV

DreamDiver · Post by **DreamDiver** » Thu Mar 18, 2010 3:17 pm

I just got back from the sleep doc. It was a good meeting. I showed him my PSG's and MSLT's, my compliance data for the last 3 years, some example reports of what I could get from Encore Pro compared with the ResScan data. At first, he was thinking about putting me on anti-sleep meds because of the possible narcolepsy as seen in the MSLT, but I suggested that I'm not to keen on drugs and that it might be better to treat for centrals. I showed him some closeups, like the one with a central next to an obstructive, showed him the COS and FOT waves for comparison and told him all but four of the apneas I've had since using this machine were central. He was in complete ascent with the data I showed him, and his immediate response was 'get this man a script for servo ventillation'. Total understanding.

I have to go in for an ECG and MRI sometime next week and see him in two weeks. In the mean time, they're going to work with my insurance to find out what's possible. I told him I was not going to deal with Apria, and that I usually buy online. He suggested someone else local who can work with BCBS and who knows and understands these particular machines.

So... my question is about SV's. I want to stick with ResMed because I feel better with their flow generator algorithms. Is the only option the Adapt SV? I remember there was a thread comparing the Adapt SV with ResMed another model, but I'm having trouble finding it. Knowing that I've got centrals with some possible periodic breathing complications, is this my only choice for ResMed machines, or are there others? This unfortunately looks like a much older model. I know I'll have a lot of questions, but it's the end of the day, and again, I'm fried, so please bare with me.

Looking at the info on the ResMed site, it looks like I could get the ResLink attachment to measure other data including oximetery, if I wanted to buy the Nonin oximeter. Will it capture flow and all the other data I'm used to with the S9? No FOT. I guess it doesn't matter if all my apneas are central. It probably treats all apneas as central. Is this the case? Please please please tell me it captures flow data.

jmelby · Post by **jmelby** » Thu Mar 18, 2010 3:35 pm

Wow--that is great that you were able to provide your doctor all of the information he needed to understand your situation and make a better diagnosis and prescription. It's too bad you won't be able to continue using the S9 you bought, but it seems to have paid off in letting you find out what your real apnea issues are about by providing better data.

JohnBFisher · Post by **JohnBFisher** » Thu Mar 18, 2010 3:42 pm

DreamDiver wrote:... So... my question is about SV's. I want to stick with ResMed because I feel better with their flow generator algorithms. Is the only option the Adapt SV? ... Looking at the info on the ResMed site, it looks like I could get the ResLink attachment to measure other data including oximetery, if I wanted to buy the Nonin oximeter. Will it capture flow and all the other data I'm used to with the S9? ... It probably treats all apneas as central. Is this the case? Please please please tell me it captures flow data.

It captures flow data. Not quite the same way or at the same level of granularity.

The VPAP Adapt SV comes in normal (without efficacy data) and enhanced (with efficacy data and a higher top pressure range).

The VPAP Adapt SV is essentially a CPAP with the adaptive SV on top of it. The Respironics BiPAP AutoSV Advanced unit is an BiPAP Auto with Adaptive SV on top of it.

You can buy the ResLink module, but I think it is quite expensive. I just use a null modem serial cable (DB9 to DB9). I have a Serial to USB adapter to connect it to my computer.

I will also send a PM with pointers to the provider manuals. That might be informative as well.

Of course, the AdaptSV (as an older unit) should be less expensive.

If you purchase online, you want check with your insurance company to be certain they will reimburse you for the cost. Some will not.

unadog · Post by **unadog** » Thu Mar 18, 2010 3:49 pm

Congrats! Good job with the data!

Now, really, I need that machine more than you, so could I borrow it for a while? No? Um, how about if you lend me the data then?

Glad you are moving forward - I hope it leads to you feeling great!

Do you have co-pays? What percent?

You may also want to have a look at the Respironics Bipap Auto SV Advanced. These are really different beasts than the regular CPAP. Good information here on the pros and cons of both, and how folks have adapted to them. You may as well evaluate both fully before you pull the trigger.

Good luck!

Best,
Michael

dsm · Post by **dsm** » Thu Mar 18, 2010 6:09 pm

DreamDiver wrote:I just got back from the sleep doc. It was a good meeting. I showed him my PSG's and MSLT's, my compliance data for the last 3 years, some example reports of what I could get from Encore Pro compared with the ResScan data. At first, he was thinking about putting me on anti-sleep meds because of the possible narcolepsy as seen in the MSLT, but I suggested that I'm not to keen on drugs and that it might be better to treat for centrals. I showed him some closeups, like the one with a central next to an obstructive, showed him the COS and FOT waves for comparison and told him all but four of the apneas I've had since using this machine were central. He was in complete ascent with the data I showed him, and his immediate response was 'get this man a script for servo ventillation'. Total understanding.

DSM: A fair deduction & well supported by your efforts.

I have to go in for an ECG and MRI sometime next week and see him in two weeks. In the mean time, they're going to work with my insurance to find out what's possible. I told him I was not going to deal with Apria, and that I usually buy online. He suggested someone else local who can work with BCBS and who knows and understands these particular machines.

So... my question is about SV's. I want to stick with ResMed because I feel better with their flow generator algorithms. Is the only option the Adapt SV?
DSM: Resmed only offer the Vpap Adapt SV (& as JohnB pointed out, there is an Enhanced model that goes as high as 25 CMs & provides AHI data - the original model went to 20 CMs & does not provide AHI data. A Reslink module does capture extra data on an SM card (think pre SD). ResLInk is now out of production but slinky & I bought some for around $US200, The matching SpO2 module that plugs into the ResLink unit is grossly over priced & a waste of good money. I remember there was a thread comparing the Adapt SV with ResMed another model, but I'm having trouble finding it. Knowing that I've got centrals with some possible periodic breathing complications, is this my only choice for ResMed machines, DSM: Basically in the US, yes. There are other advanced (but expensive) Resmed home use machines outside the US. or are there others? This unfortunately looks like a much older model. I know I'll have a lot of questions, but it's the end of the day, and again, I'm fried, so please bare with me. DSM: The Vpap Adapt SV is big but is built like a Panzer tank & you can expect it to last a long time. It is deadly quiet. The dual-stage dual impeller blower was the forerunner of the S9 blower. This blower design is a motor/blower combined that has several unique characteristics that may not be in any other brand. The motor has a low inertia rotor/fan assembly that accelerates rapidly & can reach very high speeds whilst making no whining noise. The FOT capability of the S9 was only viable because of this characteristic. I do not know if the Vpap Adapt SV uses FOT. If it does then Resmed has hidden that fact so I tend to doubt that it does.

Looking at the info on the ResMed site, it looks like I could get the ResLink attachment to measure other data including oximetery, if I wanted to buy the Nonin oximeter. DSM: I am not sure if any Nonin oximeter (I have em all) plugs into the Reslink. I tried modifying a Nonin xPOD to plug into the proprietary SpO2 socket on the Reslink but could not get it to work. Slinky bought a compliant one (not a Nonin) but says it adds little value.

Will it capture flow and all the other data I'm used to with the S9? No FOT. DSM: As mentioned above - I don't believe FOT is used. I will dig up a Reslink / ResScan chart from my Vpap Adapt unless JohnBFisher beats me to it (he has lots of good charts). I guess it doesn't matter if all my apneas are central. It probably treats all apneas as central. Is this the case? Please please please tell me it captures flow data. DSM: Flow data & Minute Ventilation & pressure &

http://www.internetage.ws/cpapdata/dsm-vpap-adaptsv/

SleepingUgly · Post by **SleepingUgly** » Thu Mar 18, 2010 8:19 pm

DreamDiver wrote:At first, he was thinking about putting me on anti-sleep meds because of the possible narcolepsy as seen in the MSLT

For my purposes, could you clarify what "possible narcolepsy" was seen on the MSLT? Did you go into REM on 2 or more naps? Was this MSLT the day following a PSG in which they uncovered apnea?

DreamDiver · Post by **DreamDiver** » Thu Mar 18, 2010 9:22 pm

Wow, thanks for all the information.
I've been looking at dsm's reports and the clinical manuals for each of the machines.
Just summarizing for clarity's sake:

Respironics
- Already have smart card reader and EP 1.8.
- Still available on line.
- May actually be more appropriate for my needs, but not sure.
Resmed
- I'd want the Adapt SV Enhanced
- Not available at CPAP.com
- Yet Another Smart Card and Smart Card Reader needed
- Probably less expensive than the Respironics
- Reslink no longer availble.

It's kind of crummy that neither maker has come out with a new SV model in years.
Both of these look like grandma's washing machine, but they probably are built to take a beating too.
Both are 24 volt machines. Neither has high-resolution data.

I also am concerned that setting and self-titrating this type of machine may be a grade above my current fog index. I know there are threads on this forum that explain it, but every time I try to wrap my head around it, I end up discouraged and realizing I'm just to fuddle-headed right now. For this, I'll likely have to talk with an RT. If there's an SV for dummies book out there, please let me know.

I don't suppose there is any possible way either of these machines can be used to record higher resolution data at home, eh?

your friendly neighborhood data junkie

DreamDiver · Post by **DreamDiver** » Thu Mar 18, 2010 9:49 pm

SleepingUgly wrote:For my purposes, could you clarify what "possible narcolepsy" was seen on the MSLT? Did you go into REM on 2 or more naps? Was this MSLT the day following a PSG in which they uncovered apnea?

Yes - they said I slept on two of four, but I dreamt on three of four. They thought I was doing some kind of drug because they wanted a drug test. I told them I wasn't interested in doing a drug test and that I also wasn't interested in being labeled narcoleptic because while I can fall asleep on command at any time of day, I don't fall asleep while driving or talking with people. I didn't know when I started the test that they were trying to find out about narcolepsy. Weird huh? But when you're fog-brained, a lot of stuff slides. I told the doc I wasn't going to be taking any drugs to stay awake during the day because I can stay awake if I have to. I'd just rather go to sleep. I told them I don't do drugs to manufacture results, and that I wasn't interested in being put on disability or being labeled as something that was going to make getting new insurance impossible. I've never fallen asleep at the wheel, and I'm not a danger to others. Maybe I was coming to the wrong conclusions, but the doc seemed surpised. It was like he expected me to just nod and comply.

So the MSLT states that the previous night's testing probably interfered with my data and that more conclusive MSLT testing would be necessary to prove one way or another whether I had narcolepsy.

JohnBFisher · Post by **JohnBFisher** » Thu Mar 18, 2010 9:50 pm

DreamDiver wrote:... It's kind of crummy that neither maker has come out with a new SV model in years. ...

Both manufacturers came out with unit YEARS ago, but only got FDA approval a couple of years ago. Not a lot of reason to invest UNTIL it was approved.

However, Respironics came out with their BiPAP Auto SV Enhanced just a month or two ago. It's pretty new. It also increased the maximum pressure to 30cm H2O.

DreamDiver wrote:... Both of these look like grandma's washing machine, but they probably are built to take a beating too. ...

Yes. It's a LOT to lug around. BUT, I simply do NOT sleep without my unit. So...

DreamDiver wrote:... I also am concerned that setting and self-titrating this type of machine may be a grade above my current fog index. ...

I sincerely doubt it will be that bad for you. Did your doctor order another sleep study ... or just decided to prescribe the ASV unit. If you have another sleep study they will titrate you to the ASV system.

Besides. There are plenty of folks who get help through the process here ... Bleeping Beauty is an example.

DreamDiver wrote:... If there's an SV for dummies book out there, please let me know. ...

I actually am working on a MAJOR writeup on Central Sleep Apnea. It won't be very scholarly. Though it WILL include references to various papers. More importantly, it will try to consolidate the experience and wisdom of this forum. That should make it a LOT easier for someone new along that path.

DreamDiver wrote:... I don't suppose there is any possible way either of these machines can be used to record higher resolution data at home, eh? ...

Nope. At this time you either get S9 with high resolution data or you get an ASV unit that helps you actually sleep. Hmmm... Which do I want? Oh, wait! I've tried the NO SLEEP approach. I will skip it this time...

DreamDiver wrote:... your friendly neighborhood data junkie ...

Data is good. But it's not everything.

DreamOn · Post by **DreamOn** » Thu Mar 18, 2010 10:21 pm

DreamDiver, it's good to hear that your situation is getting figured out. It sounds like you have a very good relationship with your sleep doctor. I hope that the new machine will help you to feel better. I have learned SO much from your discussions here, and I look forward to learning more!

SleepingUgly · Post by **SleepingUgly** » Thu Mar 18, 2010 10:51 pm

Not sure how you dreamed on 3 of 4 naps when you only slept on 2 of them. Did they find apnea the night before? If so, they really should not have proceeded to an MSLT until the apnea was treated.

DreamDiver wrote:
SleepingUgly wrote:For my purposes, could you clarify what "possible narcolepsy" was seen on the MSLT? Did you go into REM on 2 or more naps? Was this MSLT the day following a PSG in which they uncovered apnea?
Yes - they said I slept on two of four, but I dreamt on three of four. They thought I was doing some kind of drug because they wanted a drug test. I told them I wasn't interested in doing a drug test and that I also wasn't interested in being labeled narcoleptic because while I can fall asleep on command at any time of day, I don't fall asleep while driving or talking with people. I didn't know when I started the test that they were trying to find out about narcolepsy. Weird huh? But when you're fog-brained, a lot of stuff slides. I told the doc I wasn't going to be taking any drugs to stay awake during the day because I can stay awake if I have to. I'd just rather go to sleep. I told them I don't do drugs to manufacture results, and that I wasn't interested in being put on disability or being labeled as something that was going to make getting new insurance impossible. I've never fallen asleep at the wheel, and I'm not a danger to others. Maybe I was coming to the wrong conclusions, but the doc seemed surpised. It was like he expected me to just nod and comply.

So the MSLT states that the previous night's testing probably interfered with my data and that more conclusive MSLT testing would be necessary to prove one way or another whether I had narcolepsy.

DreamDiver · Post by **DreamDiver** » Fri Mar 19, 2010 6:13 am

SleepingUgly wrote:Not sure how you dreamed on 3 of 4 naps when you only slept on 2 of them. Did they find apnea the night before? If so, they really should not have proceeded to an MSLT until the apnea was treated.

The human mind is funny piece of hardware. They said I couldn't possibly be dreaming either. Often times I fall asleep dreaming. Sleep medicine is still a pretty new field, eh? This was my third PSG, so all they were doing this time was retitrating me. Ironic that they found my best pressure was the one I'd just self-titrated to. I had some understanding that they were going to look for unique problems - not just retitrate me. It is unfortunate that this particular sleep lab was more interested in patient volume than they were in identifying unique situations. The MSLT followed a pretty standard night. Apparently that's what they meant by looking for 'unique' situations - just testing for standard stuff they were used to looking for. I already had the burger. They were asking if I wanted fries with that. I was pretty peeved. It was the biggest waste of my money, just to freakin' retitrate me.

With an AHI of just under 2, that means I'm awoken on average at least once an hour. That's not a long enough time to allow the body to cycle into restorative sleep. It is highly unlikely that I see very much deep-cycle restorative sleep. Ever. Even after three years on CPAP, without treatment for centrals, the body still has to wake up on its own often enough to keep from asphyxiating. Dreams are a powerful way to do that. Especially bad dreams. The worst times for me are as I fall asleep and as I wake up. I get lots of dreams during those times, counter to what the sleep literature may tell you.

When they talk about waking paralysis, that's generally when you've become conscious during a dream. It's happened to me so many times since childhood, I've ceased to be afraid of it. After all, you do have control over your breathing - ironically. Plus, there are fun things you can do when you are consciously dreaming. My favorite is flying. Walking through walls is another. Feels weird, to be sure, because it's like you're actually there. Wind-on-your-face and bugs-in-your-teeth real. If you wake during a bad dream and you realize it, you can mentally snap your fingers and 'change the channel' so to speak. That was a coping mechanism my mom suggested to me at the age of four. I don't always remember to wake up during dreams, but it's a real treat when it happens.

It's made me wonder what it might be like to try to train myself to always conscious dream as I fall asleep and try to remain conscious through to deep sleep. I know there are yogis out there that can do this. Yoga Nidra is the practice of wakeful sleep. And I read a case study some twenty years ago about people who have taken hard drugs that had learned how to be conscious during third- and fourth-stage sleep - back when they believed in fourth-stage, at least. I just wonder if it is something that could be taught as an alternative to using flow generators. I don't know if I'd want to be conscious all the time, but it might beat constantly being partly sub? un? meta? -conscious all day.

DreamDiver · Post by **DreamDiver** » Fri Mar 19, 2010 6:55 am

JohnBFisher wrote: Data is good. But it's not everything.

It's great to hear that you're coming out with a manual. I'm looking forward to it.
I wonder if I can get a chance to try both machines, since they are so drastically different.
Maybe this new sleep doc has suggestions.

SleepingUgly · Post by **SleepingUgly** » Fri Mar 19, 2010 7:14 am

I don't remember your history, but it sounds as if they were specifically looking for narcolepsy in addition to the apnea they already had diagnosed you with. The conditions can coexist. You describe some symptoms that sound like those some people with narcolepsy have.

Personally I am afraid to ever have narcolepsy documented. I don't have any of the core symptoms of narcolepsy other than EDS, but still, I am afraid of an MSLT that would cause them to document narcolepsy. I don't know if it's a legitimate fear or not. Maybe some others who have narcolepsy can speak to whether it's impacted them in terms of driver's license, insurance, etc. Some states require notification of the DMV if you're diagnosed with narcolepsy, sometimes by your doctor and sometimes by you. But this is true in some states even if you have apnea.

jnk · Post by **jnk** » Fri Mar 19, 2010 7:38 am

I wonder if insurance will require an NPSG-verified-and-documented diagnosis of central sleep apnea before it will pay for a machine designed to treat it?

Back from the Sleep Doc - VPAP Adapt SV

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