ASV users - which machine?

wolewyck wrote:My first night on the new machine (yes, ResMed VPAP Adapt) produced goose eggs-- you got it, an AHI of 0.0! This has never happened before-- my all-time low previously was 0.7, and over the past nine months, about 1.5% of my numbers have been below 1.

Congrats on the goose eggs - we like geese!

This makes my mask (Swift FX) a bit more prone to being leaky, which is annoying, although I was able to readjust it reasonably after some tweaking. The other minor downside is aerophagia, but hopefully that will go away with more use... A really good first night!

I am really disapppointed that for me, the S FX has been so prone to leaks. I did a go-around with the Q FX and did "ok" - better than S FX. Last night was 2nd night on Mirage Quattro. I wore it looser because heaven forbid I would have lines on my cheeks all day! Wearing it looser caused leaks and aerophagia. (I feel pretty strongly that, for some, leaks and aerophagia go hand-in-hand). The first night on M Q was amazing!! Not one awakening due to leaks. I was amazed because I was prepared to dislike the M Q. Go figure

For me, the pillows are too temperamental, so I am wondering about the new Mirage FX nasal mask. I just read the reviews on cpap.com. I think that I will give that a try. Any comments from asv users on this mask?

BrianinTN wrote:... JohnBFisher: Since you're the resident expert with experience on both brands' ASVs, ...

Think of it more as a professional user. I've used xPAP devices for about 20 years. I've had the chance to learn in that time. From my very first sleep study, I had some central apneas, but they were not severe. During the intervening 20 years, I developed a severe neurological problem that made the central apnea worse than my obstructive apnea ... Trust me, if you had heard me sleeping prior to going on xPAP therapy you would also wonder "Who would have thought that anything could be worse than his obstructive apnea"

BrianinTN wrote:... However, is there any way for a prospective patient to deduce which might offer them better therapy? For example (and I'm just spitballing here), does one brand respond better to traditional CSB? Or ComplexSAS? Or hypopneas? ...

You might want to look at Google's Scholar to see if you can sense any difference. I was unable to do so.

BrianinTN wrote:... My question is not entirely academic. There's an outside chance I might get to play switcharoo on my own ASV, so given that the non-System One Respironics ASV hasn't gotten me under control yet, I'm trying to ascertain whether I'd be better served getting the new System One (which I've gathered has some slightly different algorithms) or switching to ResMed. ...

I understand. So, here are some thoughts. Consider the source and what you paid for them (Nada!):

• I find the tight rein that the Resmed unit imposes on me seems to completely eliminate apneas (central and obstructive).
• However, the Remed unit is QUICK to ramp up the pressure. While that's good for CSA, it may not be a good idea for ComplexSAS.
• Hypopneas are generally reduced by increasing the EPAP to help keep the airway open. Again, a bad idea for ComplexSAS.
• But the Resmed unit will also very quickly drop the pressure when you start breathing. A good idea for ComplexSAS.
• I tend to find that my AHI is higher on my Respironics unit.
• I tend to find that I stop breathing and awaken more with my Respironics unit.
• I tend to have my Respironics unit alarm more than I would like. None would be the right amount. So, it's not catching the apneas as well as the Resmed unit.

But my issue is CSA - not ComplexSAS. The advantage for me is that the Resmed unit has fewer dials to adjust. A disadvantage is the Resmed has fewer dials to adjust. If you don't mind that "tight steering" you might like the Resmed unit.

You might want to check with your DME to see if they would lend you a Resmed ASV unit. That might let you learn which is better for you by experience.

JohnBFisher wrote: You might want to check with your DME to see if they would lend you a Resmed ASV unit. That might let you learn which is better for you by experience.

It is my understanding that over the years dsm, Banned, and more recently, JB Fisher, have all spent extensive time on both the Respironics and ResMed ASVs. All 3 gentlemen prefer the sleep architecture provided by the ResMed ASVs.

StillAnotherGuess wrote:

JohnBFisher wrote: You might want to check with your DME to see if they would lend you a Resmed ASV unit. That might let you learn which is better for you by experience.

It is my understanding that over the years dsm, Banned, and more recently, JB Fisher, have all spent extensive time on both the Respironics and ResMed ASVs. All 3 gentlemen prefer the sleep architecture provided by the ResMed ASVs.

The "sleep architecture", you say? You don't have a very good understanding of what that term means or how sleep architecture is seen (via PSG, not via a treatment machine) do you? I think you meant to say "prefer the therapy" ...

Or, maybe you've read posts on this forum by a sleep professional (nicknamed "StillAnotherGuest" ) correctly writing about "sleep architecture" and you decided you'd just toss that phrase into yet another of your mimicking-his-name posts.

Let's see... you mention the cpaptalk members nicknamed "dsm" and "Banned."

dsm and Banned both had their posts criticized frequently by StillAnotherGuest.

And you've chosen a nickname -- StillAnotherGuess -- that could easily be mistaken for the name StillAnotherGuest.

Interesting (and sad) name game you're playing.

Thank you, JohnBFisher, for your well reasoned, well written post - as always.

JohnBFisher wrote:You might want to check with your DME to see if they would lend you a Resmed ASV unit. That might let you learn which is better for you by experience.

Excellent suggestion.

rested gal wrote: Let's see... you mention the cpaptalk members nicknamed "dsm" and "Banned."
dsm and Banned both had their posts criticized frequently by StillAnotherGuest.
And you've chosen a nickname -- StillAnotherGuess -- that could easily be mistaken for the name StillAnotherGuest.
Interesting (and sad) name game you're playing.

None of which seems to have any particular bearing on my understanding that a number of forum members have extensive documented history using both Respironics and ResMed ASV units, and the nod seems to fall in ResMed's court.

Should somebody refuse a Respironics ASV because they heard on an internet forum that a few people had tried both the Respironics ASV and the ResMed ASV and the perception was that the ResMed ASV gave them better "therapy"? Probably not.

adipasqu wrote:
I have free access to the article:

http://www.4shared.com/document/z-Y-6PZu/asv.html

-A

Thanks for that. It is an interesting read. Here's a brief summary as I see it:

The study was not truly randomized.

Both machines were considered by study reviewers to be equally effective at treating obstructive and central events, so no significant advantages of one machine over the other.

Interesting notes:

Patients requiring expiratory pressure > 10 cmH2O were placed in the Respironics group because the ResMed units tested maxed at 10 cmH2O while the Respironics units tested maxed at 15 cmH2O. This accounted for the appearance of higher residual AHI after titration in the respironics group. In short, the Respironics group had tougher duty. Newer models of both unit now have higher expiratory capabilities: ResMed = 15 cmH2O while Respironics = 20 cmH2O. So this can not be seen as an advantage for the ResMed ASV.

After study follow-up suggested greater compliance in the Respironics group (e.g. 31.2% of ResMed and 51.2% of Respironics patients were compliant with Medicare criteria at time of follow-up). But it is not clear if higher compliance in the Respironics group is a result of the unit's abilities or of this patient group's higher AHI, inferring higher AHI patients may be more motivated to continue therapy. So this can also not be seen as an advantage for the Respironics ASV.

End of summary.

Based on this information (no clear winner) and personal preferences, I'm planning to request a Philips Respironics System One ASV machine because I'm familiar with my Respironics CPAP unit, and I like the PRS1 feature set, unless someone can kindly point out something substantive that I missed from this study or has some other compelling personal information they'd care to share.

StillAnotherGuess wrote:

JohnBFisher wrote: You might want to check with your DME to see if they would lend you a Resmed ASV unit. That might let you learn which is better for you by experience.

It is my understanding that over the years dsm, Banned, and more recently, JB Fisher, have all spent extensive time on both the Respironics and ResMed ASVs. All 3 gentlemen prefer the sleep architecture provided by the ResMed ASVs.

Definitely not the "sleep architecture"! Rather, it is the breathing waveform the Resmed uses that I find easier / more natural.

However, you will also note that I've stated quite clearly that I used the Respironics units for years with and without various "flex" modifications to the breathing waveform. And I sleep just as easily with my Respironics unit as my Resmed. Once I am asleep, I really don't care!

Still, given the choice, I *do* prefer the Resmed breathing waveform. If I need a new unit, I would go with the S9 ASV unit. But that is based on my unique set of needs.