What machine should I try?

Hewitt- · Post by **Hewitt-** » Thu May 05, 2011 5:34 am

I saw some definite improvements with the machine used during my at home sleep studies, when I could sleep with the mask on at all. My insurance won't pay for machines, or any more sleep studies this year, so I'm on my own. I have a donated machine that's not too much older than the one from the studies, a Remstar set on 14 with c-flex on 3, the same settings that seemed to work best during the studies. But for some reason it doesn't help. The only difference I see is that the newer model would deliver a strong puff of air if you stop breathing for a few seconds. I think this was to test whether the apnea was obstructive, but I read that sometimes this is done to get air in and maybe remind you to breath. It seems to me that that's what probably was helping me those first few days.

I need to find an older machine that I can get cheap or that the donated machine program might have in stock, one that helps more with the central apneas. Looking around on the forum and elsewhere, I guess what I want is BiPAP with ASV? I had the impression that BiPAP assists breathing more at all times, which might not be what I want, but I'm willing to try it. I'll talk to my doctor after doing my research but she can't do much more than guess either until I can get another study next year. In the meantime, what are my options?

Mary Z · Post by **Mary Z** » Thu May 05, 2011 6:52 am

ASV and BiPAP are different animals. Are you able to use the machine you have now consistently? An ASV is the most expensive of machines.

What is adaptive servo-ventilation (ASV)?

-ASV is an exciting breakthrough created by the ResMed Company specifically for the treatment of central as well as obstructive apneas.

How does ASV work?

-ASV is a new form of positive airway pressure unit that continuously monitors the patient's breathing pattern in exquisite detail.

-Whenever it detects significant reductions or pauses in breathing, it intervenes with just enough support to maintain the patient's breathing at 90% of what had been normal for that individual just prior to the decrease in breathing.

-Then, when the patient's breathing problem ends, the machine "backs out" gently.

-Also, when the patient's breathing is stable, ASV provides just enough pressure support to help maintain airway patency: thereby providing an approximate 50% reduction in the work of breathing.

The machine is subtle in its interventions...and it continuously adjusts itself to meet the patient's needs in a manner that will feel normal for that patient at that point in time: which renders it comfortable.

ASV is the ultimate "smart machine".

How does ASV differ from the positive airway pressure machines that we already had available?

-Until the development of ASV, we had only three basic types of positive airway pressure (PAP) machines:

CPAP (Continuous Positive Airway Pressure): a simple "blower" that delivers the same pre-set pressure continuously.

Bilevel PAP: a machine that senses when the patient is beginning to exhale and responds by dropping the delivered pressure transiently to render exhalation easier.

Bilevel PAP with intermittent mandatory ventilation (IMV): a bilevel unit that also senses when the patient stopped breathing--then responding by delivery of bursts of air at pre-set pressures and a pre-set rate to try to stimulate breathing. Its greatest disadvantage was that it would force the patient to try to adapt to the machine rather than the machine adapting to the patient's rate and depth of breathing. Many patients complain that they are unable to synchronize their breathing with these machines. Also, the abruptness with which these units deliver IMV can trigger arousals which in turn can precipitate more central apneas.
-ASV is unique in that it continuously adapts to the patient. It provides just enough support when the patient needs it...in a manner so similar to the patient's own recent breathing pattern and rate that it is not only comfortable, but also, it is unlikely to provoke arousals and more central apneas.

Which patients with central sleep apneas are most likely to benefit from ASV?

-Patients with complex sleep apnea (central apneas emerging with use of CPAP or bilevel PAP).

-Patients with heart failure or atrial fibrillation who have central sleep apnea - with or without obstructive sleep apneas.

purple · Post by **purple** » Thu May 05, 2011 7:26 am

If you have been recommended for BiPap or ASV, then I know little. What the more knowledgeable people here will need to know to make a good recommend for a machine -will be the exact Settings your doc recommended. Also what machines Doc said would work for you.

Then someone here can help you find a suitable replacement.

I am pretty sure you want an AUTO with full Data reporting, that you can see. Places you can buy a used machine would be CPAP Auction and Secondwind. I have not used these services, but others here seem to think they are reputable and know how to properly QC used machines and sterilize them for the next user. I know nothing about ways to get free machines.

Please call the doc' office and get those exact specifications, and post that here, then people will try to help you who know more than I do.

Edit: Just looked, I was incorrect. CPAP auction says buyer is responsible for sanitation. http://www.secondwindcpap.com/ maybe the one which has the equipment an ordinary person would not have to sanitize a used one. As you probably know, for a baseline, you can use CPAP.com to see prices of new ones.

What machine should I try?

What machine should I try?

Re: What machine should I try?

Re: What machine should I try?