Could AutoASV machines be used for everyone?

STL Mark wrote:I'm wondering if the difference is the new ASVAuto mode that is being offered in the 960 and 36037. I have read much about the previous generation of ASV machines, but little seems available on these models as far as methods of treatment. I do think that my acceptance of this is directly related to my years of using other machines.

Mark,

I don't know anything about the 960s, although I hope to have one in another few months. I've been using my Beastie -- A Bipap ASV, not even an Advanced -- for almost 5 years.

I love it.

They initially set me to EPAP = 10, MinIPAP = 10 and MaxIPAP = 14, and I could not, COULD NOT breathe out against it. And, in fact, treatment at those settings triggered more events than I had in the original study.

I requested my current settings, and they worked perfectly.

Now, for a few weeks, I did have waking episodes, about every three hours, probably due to the 7+ years I spent waking up at about every three hours with hip pain from low oxygen. When I did, I decided I wouldn't use it as an excuse to take off my mask. (That way lies failure.) So I would settle myself, and just start breathing, counting the breaths, and eventually, I fell asleep again.

I couldn't have managed, I don't think, with either a plain CPAP or a plain BiPAP. I need a changing inhalation pressure, and I can't exhale at the lowest IPAP.

Kiralynx wrote:

STL Mark wrote:I'm wondering if the difference is the new ASVAuto mode that is being offered in the 960 and 36037. I have read much about the previous generation of ASV machines, but little seems available on these models as far as methods of treatment. I do think that my acceptance of this is directly related to my years of using other machines.

Mark,

I don't know anything about the 960s, although I hope to have one in another few months. I've been using my Beastie -- A Bipap ASV, not even an Advanced -- for almost 5 years.

I love it.

They initially set me to EPAP = 10, MinIPAP = 10 and MaxIPAP = 14, and I could not, COULD NOT breathe out against it. And, in fact, treatment at those settings triggered more events than I had in the original study.

I requested my current settings, and they worked perfectly.

Now, for a few weeks, I did have waking episodes, about every three hours, probably due to the 7+ years I spent waking up at about every three hours with hip pain from low oxygen. When I did, I decided I wouldn't use it as an excuse to take off my mask. (That way lies failure.) So I would settle myself, and just start breathing, counting the breaths, and eventually, I fell asleep again.

I couldn't have managed, I don't think, with either a plain CPAP or a plain BiPAP. I need a changing inhalation pressure, and I can't exhale at the lowest IPAP.

I hope you are able to get a new machine when you desire one. I am hoping that the current series of machines will also last 20,000 hours plus like the previous ones have. I know very little about the ASV machines and can not offer suggestions for your situation. You may want to address your situation to JohnBFisher for an expert opinion.

Kiralynx wrote:... I don't know anything about the 960s, although I hope to have one in another few months. I've been using my Beastie -- A Bipap ASV, not even an Advanced -- for almost 5 years. ... I love it. ...

In another post for johnthomasmacdonald, I posted a pointer to the specs for the 960 ASV unit from Phillips Respironics. It's the latest replacement for the unit that you have. I've been pleased with my 950 version of the unit. In fact, the 950 unit did so well, Resmed had to upgrade their S9 ASV unit to be more like the Respironics ASV unit. That is both Resmed and Respironics now include the Auto EPAP feature. That is, you can define an EPAPmin and an EPAPmax. Then the unit acts as a Auto BiPAP when it handles obstructive apneas. That is as your obstructive apneas increase, the units increase EPAP pressure (upto EPAPmax) to help keep the airway open. But as the obstructions decrease, the units will also decrease the EPAP pressure (down to EPAPmin).

But as I noted to johnthomasmacdonald, that's the same thing that you have right now.

The advantage of the 950 and 960 models is that it is a much smaller/lighter footprint. When/if you travel that's an important feature.

Kiralynx wrote:... Now, for a few weeks, I did have waking episodes, about every three hours ... eventually, I fell asleep again. ... I couldn't have managed, I don't think, with either a plain CPAP or a plain BiPAP. I need a changing inhalation pressure, and I can't exhale at the lowest IPAP. ...

It's quite possible you need another sleep study (and/or some careful experimenting) to change your pressure to address this problem. As I remember, it's been a few years since you had a sleep study. And sadly, I've noted that our pressure needs change (typically upwards) as we age.

SeekSleep wrote:... I'll learn Monday if I have to try and adapt to an ASV machine or not. Having tried one once, I'm not looking forward to it, although I'm the type that will adapt, it doesn't mean I'll like it. My first impression though is that CPAP or BIPAP is the way to go if you can get results with them. They seem much easier to adapt to. ...

You are correct that leaks were one thing that takes quite a bit of fidgeting and fussing to get under control.

But you don't have to "go it alone" as you adjust to ASV therapy. There's quite a group of us, who try to help each other. It makes it much easier when you hear from others, who've been there and have a closet full of T-Shirts. .. .. For example, I *highly* recommend mask liners to help with leaks. It's not perfect, but it does help.

I'll also PM you, so you know I responded to this (a little late).

STL Mark wrote: I hope you are able to get a new machine when you desire one. I am hoping that the current series of machines will also last 20,000 hours plus like the previous ones have. I know very little about the ASV machines and can not offer suggestions for your situation. You may want to address your situation to JohnBFisher for an expert opinion.

Well, I have to get around to making an appointment with my GP and try to wangle a script out of her.

And yes, I hope the newer models last as well as my Beastie has -- I was fortunate to get a second Beastie as a back-up which probably has less than 200 hours on it, but but the primary Beastie has something 14,000.

The major thing is that I was fortunate enough to find CPAPTalk between my sleep study and my titration and so was able to learn what I needed to make a success of things.

JohnBFisher wrote:In another post for johnthomasmacdonald, I posted a pointer to the specs for the 960 ASV unit from Phillips Respironics. It's the latest replacement for the unit that you have. I've been pleased with my 950 version of the unit. In fact, the 950 unit did so well, Resmed had to upgrade their S9 ASV unit to be more like the Respironics ASV unit. That is both Resmed and Respironics now include the Auto EPAP feature. That is, you can define an EPAPmin and an EPAPmax. Then the unit acts as a Auto BiPAP when it handles obstructive apneas. That is as your obstructive apneas increase, the units increase EPAP pressure (upto EPAPmax) to help keep the airway open. But as the obstructions decrease, the units will also decrease the EPAP pressure (down to EPAPmin).

But as I noted to johnthomasmacdonald, that's the same thing that you have right now.

The advantage of the 950 and 960 models is that it is a much smaller/lighter footprint. When/if you travel that's an important feature.

I often don't comment on the ASV threads, but I do read them for information's sake. I'm more apt to hypopneas than apneas.

I quite like the idea of a smaller footprint, because one thing I cannot do is go without the humidifier.

It's quite possible you need another sleep study (and/or some careful experimenting) to change your pressure to address this problem. As I remember, it's been a few years since you had a sleep study. And sadly, I've noted that our pressure needs change (typically upwards) as we age.

Well, I am NOT having the every three hours waking at this point -- that was five years ago!

My current battle is with the residuals from last year's Hurricane Isaac, when I had to go without the Beastie for a full week. I don't recommend it. I've finally gotten a handle on the muscle pain, and I'm implementing plans to make a liar out of the orthopedist who said I would need a knee replacement within the next year.

I will probably discuss with the GP whether I need the sleep study -- I am not thrilled with the idea because my senior Hound, Mr. Shadow, is likely to get upset if I disappear for the night, which will mean my poor husband will be up all night with him. Plus, I won't sleep well without him tucked up next to my back. (Mr. Shadow is 15 years and almost 5 months old, and I'm in no hurry for him to follow his sister to the Rainbow Bridge.) My AHI is consistently 1 or less at my current settings and my leak rate is easily within the parameters for whatever mask I'm using at the time.

My experience with my new ASV was similar to StormyNights' and STL Mark's relatively easy transition. It took me three to five days to get comfortable with the unit. It reduced my average of around 15 AI (mostly centrals) and brought it down to the .1 to 2.0 range, quite a drop; -- hypopnia ranges from about 1 to 4.

I think of it this way:

The Auto CPAP or Auto bilevel machines encourage you to breathe normally.

The ASV machines encourage you to breathe normally, but if you don't breathe the way they want, they twist your arm really hard.

Some people will never trigger the serious arm twisting mode. Some people will react better to the arm twisting.

Some people will do OK on an APAP or CPAP, but will occasionally trigger "arm twisting" mode and not react well to it. The ASV will be uncomfortable and doesn't give them a better outcome.

As best as I can tell, there's some degree of adjustability in the triggering of the arm twisting mode, but not a lot of adjustability in the strength of the arm twisting mode.

The APAPs also don't react as quickly. A short duration period of bad breathing will not trigger the APAP to try harder. The response will be more gradual and may be more comfortable.

It appears to me that the ASVs cannot be adjusted to work the same as an APAP, but they may be able to run manual CPAP mode.

It appears that the difference is all software. It seems to me that software could easily make a machine that does everything from manual CPAP to full ASV/AVAPS. Probably not going to happen, though.

The idea of a convertible unit for many levels seems wise from the economy side;
--unless the cost for the universal machine is substantially higher than the dedicated machines.
Then again, there is also the breakdown/service issue. (Murphy?)
It has been said that the more complex a device, the more frequent breakdowns.
For example, CR has done reliability tests on refrigerators, which strongly indicate
that the most common (by far) breakdown of refrigerators is the icemaker.

chunkyfrog wrote:The idea of a convertible unit for many levels seems wise from the economy side;
--unless the cost for the universal machine is substantially higher than the dedicated machines.
Then again, there is also the breakdown/service issue. (Murphy?)
It has been said that the more complex a device, the more frequent breakdowns.
For example, CR has done reliability tests on refrigerators, which strongly indicate
that the most common (by far) breakdown of refrigerators is the icemaker.

It appears that the hardware for the ASV is the same as the fully data capable manual CPAP machines. It's just a software difference in how you vary the fan speed in response to airflow and pressure changes.

chunkyfrog wrote:The idea of a convertible unit for many levels seems wise from the economy side;
--unless the cost for the universal machine is substantially higher than the dedicated machines.
Then again, there is also the breakdown/service issue. (Murphy?)
It has been said that the more complex a device, the more frequent breakdowns.
For example, CR has done reliability tests on refrigerators, which strongly indicate
that the most common (by far) breakdown of refrigerators is the icemaker.

Should I return my machine and get one without the ice maker?

archangle wrote:It appears that the hardware for the ASV is the same as the fully data capable manual CPAP machines. It's just a software difference in how you vary the fan speed in response to airflow and pressure changes.

It would be interesting to see both the adapt and elite inside and compare them.

A mini icemaker, or a refrigerated hose might be a solution for people sensitive to the heat;
although there is the possibility that problem is largely mental.

i called Respironics a couple of days ago to find out exactly what the differences were between the ds950 and the ds960 and the person at technical support told me that it is ONLY the heated tubing, nothing else.

johnthomasmacdonald wrote:i called Respironics a couple of days ago to find out exactly what the differences were between the ds950 and the ds960 and the person at technical support told me that it is ONLY the heated tubing, nothing else.

The 950s may not be the most recent model, but they are excellent machines. I believe people with them are receiving excellent therapy. There may be a few other differences but I that is not to say the 950 is not a great machine.