Respironics PR System One REMstar BiPAP Auto SV Advanced

Summary Version:

I've been prescribed ASV therapy. Respironics brand will likely be offered.

The newer System One ASV seems to be an evolution of their two earlier ASV machines, and thus superior in that it appears to sport a “super set” of their functions (plus improved humidifier, SD memory card, smaller form factor, and simplified 12 volt battery operation). Is this correct?

If the above is NOT correct, what capabilities do the older Respironics ASV machines have that the newer PR System One ASV does not?

I'm trying to decide how to respond to my DME if they offer one of these older machines:
1. Respironics REMStar BiPAP AutoSV, or
2. Respironics REMStar BiPAP AutoSV Advanced

Thanks.
End of Summary Version.

Incredibly Long and Detailed Version That Could Help You Sleep: ;o)

I've been on CPAP therapy for nearly 3 years (8.5 cm H2O) using a Respironics M-Series RemStar Pro with data software. I'm 100% compliant. Never missed a day. But I regularly awaken feeling tired, fall asleep in the afternoon, have low energy, etc.

I did a third sleep study last week for an ASV titration. I was told I may benefit from ASV therapy. Details were sketchy at study exit debriefing. I seem to get stuck in some sort of central apnea loop during sleep onset, possibly stage transitions, and have wide pressure requirements depending on my sleep position. For these and/or other reasons not communicated, I was told ASV might help me.

However, I don't believe very much was definitively determined during this study. Disappointing, but by now not all that surprising. I was told they “failed to even successfully titrate my obstructive apnea while on my back”, which is weird since I deliberately spent a lot of time on my back. I'm not sure what questions to ask them. I understand a bit about obstructive, central, and complex apnea, hypopnea, etc. from reading the William Dement book, _The Promise of Sleep_ and reading cpaptalk.com posts, but I'm largely ignorant of ASV clinical diagnostic and treatment methodologies. Any-hoo...

I'm expecting my local DME, brick and mortar, in-network, insurance affiliated provider to attempt, once again, to steam roll me into a machine that maximizes their profit while meeting my minimum medical requirements as specified by my doctor, just as they did with my current CPAP machine. Luckily, before obtaining my CPAP machine, I found cpaptalk.com and learned enough to request, fight for, and eventually, grudgingly receive, a data capable CPAP that has served me well and kept me interested, engaged, and compliant in my therapy, which while perhaps not ideal, has improved my sleeping noticeably.

Since the sleep lab and doctors seem so unsure about what is going to help me, I can see machine requirements changing with time. So the machine I get today may not be the one I need tomorrow.

I may sound cynical, and perhaps that's fair, but I think of myself as a discriminating consumer. At the least, I want to be somewhat less than totally ignorant of everything ASV during the upcoming and dreaded negotiation process with the DME. In that regard, and based on my previous DME encounters, I feel like a heavyweight boxer, preparing for a first title shot. I need enough information and training to prevent them from delivering a quick knock-out punch early in the fight while I'm still overwhelmed by the smoke and lights of this new, higher stake$ environment.

I haven't talked with the DME yet, but they're calling me every day. I'm guessing these ASV machines mean serious potential profit. At several thousand dollars a pop, the margins are likely handsome. I want to make an intelligent decision with what little information I can gather before “round one”.

As far as I know the doctor simply specified an ASV machine, likely one of the following. The first two appear very similar, perhaps identical, to the one used in my sleep study.

1. Respironics REMStar BiPAP AutoSV, or
2. Respironics REMStar BiPAP AutoSV Advanced,

Looking around cpap[talk].com I see two additional ASV machines:

3. Philips/Respironics PR System One REMstar BiPAP Auto SV Advanced, and
4. ResMed VPAP Adapt SV Bilevel Machine.

In a follow-up phone call with a sleep nurse I was told these were to be my ASV settings:

Inspiration = 8 to 18 cm H2O
Expiration = 8 cm H2O

That's all I was told.

I thought I'd start the discussion by asking the DME which machine they are planning to “give me”. Then I'd come here to see if a more capable or appropriate machine exists that:

(1) costs me the same co-payment ($300 + 10% of device cost = ~$650 - $880 depending on which machine I get);

(2) satisfies the current prescription; and

(3) has additional functionality that could be brought to bear later, should currently prescribed measures prove insufficient to resolve my sleep issues, thus requiring the purchase of yet another ASV machine with additional, incremental functionality.

This post is pretty long, but I'll wrap it up if you're still with me...

As stated above, Respironics brand will likely be offered, so I'm assuming the ResMed machine #4 is a non-starter, leaving the three Respironics ASV machines #1, #2, and #3 to choose from.

Reading the literature, it appears machines: #1, #2, and #3 represent an evolution of an ever increasing set of functions with each new machine containing the functionality of it's predecessors as a subset. If I'm right (am I right?) I'll fight for machine #3 since it's the newest, most improved, and most advanced, containing all the features of machines #1 and #2, while adding things like: smaller form factor, improved humidifier, SD memory card, easier 12 volt battery operation.

If I'm wrong about the evolution of these machines, and #3 is really a different animal from #1 and #2, then I suspect I'll be offered #1 (if it's still in production, if it's still in the sales channel, or if there's even one left on a shelf somewhere), in which case, I'll fight for #2.

So, if you made it this far, I thank you, and...

What do I have right?

What do I have wrong?

What can you suggest or recommend?

Snooze_Blues wrote:
(3) has additional functionality that could be brought to bear later, should currently prescribed measures prove insufficient to resolve my sleep issues, thus requiring the purchase of yet another ASV machine with additional, incremental functionality.

Whatever you say..

Snooze_Blues wrote: As stated above, Respironics brand will likely be offered, so I'm assuming the ResMed machine #4 is a non-starter, leaving the three Respironics ASV machines #1, #2, and #3 to choose from.

#1 is the non-starter.
You will get #3 or #4. Both are excellent machines and you will not need to replace unless they wear-out.
You will get #2 if you are a little less lucky. Still a great machine.

Snooze_Blues wrote:Summary Version:

I've been prescribed ASV therapy. Respironics brand will likely be offered.
......
.......
I'm trying to decide how to respond to my DME if they offer one of these older machines:
the one used in my sleep study.
.....
.....
1. Respironics REMStar BiPAP AutoSV, or
2. Respironics REMStar BiPAP AutoSV Advanced,

Looking around cpap[talk].com I see two additional ASV machines:

3. Philips/Respironics PR System One REMstar BiPAP Auto SV Advanced, and
4. ResMed VPAP Adapt SV Bilevel Machine.

I agree with StillAnotherGuess
1. is not an ASV machine and so is a compete non starter do not let them give you that one.

I have 2. which is the older version of 3. and I like it very much. The main difference between 2 and 3 is that 3 offers waveform data and has SD storage instead of just a smart card. Either one would be fine but it might be nice to see those breathing wave forms.

4. is the Resmed version of an ASV. It would be fine.

I use #2 and ABSOLUTELY LOVE IT!!! I dreaded starting therapy, but this machine made it an easy transition for me. I breathe normally, and the machine is running in the background...... ready to breathe FOR me when I quit. My doc fought long and hard for me to get this machine. He went the extra mile to fight for me with my insurance company to show them that this machine was "medically necessary". He stressed to me over and over that this machine was the "Rolls Royce" of machines in functionality and durability.

I also have their software and can stay on top of my therapy very easily. On the rare occasion that there's a problem, I can usually figure it out very quickly by looking at the machine's data log. The only problem I ever have is the occasional mask leak.

Other people may have other opinions, but I know the Respironics Advanced is a good, solid machine.

Hope this helps!

Jeff