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Mark
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letsride wrote: and the machine is set to auto,

[/quote] Is this what is I do not understand? With the machine on Auto, some settings may allow the machine raise both the pressures together, While maintaining the difference between IPAP and EPAP to be maintained.

There is no guarantee that either pressure was correct for the same person asleep in the first place. Raising another scenario, as an individuals muscles get more tired during the night, what started as doable for exhale, becomes too difficult to exhale.

Let us look at a simpler case. If a person gets a straight APAP machine which is set on 4-20, which some are dispensed with. Then an individual can spend quite a while at pressures which will not allow them to breathe well. A clear example for many of us being when we did an over nite sleep study, and spent hours not being able to sleep because the pressure was suffocatingly low. Internal organs need air, if a person actually did that routine every nite, then their organs will not get the O2 they need. That is damage, even if no one documents it. What doctor is going to document problems which are the result of their failure to do their job competently?

Keep in mind that the frequent user of a vent, now, is an individual who has secondary health issues. Such as a person who has MS. There are settings on a Vent which are meant to allow the individual time to breathe, and then if necessary to force a person to breathe.

I think much of this discussion is about an individual using a AutoASV in a non-invasive manner with a mask. Another version of what a Vent is capable of doing is to like the Vent that was used when I had Open Heart Surgery. While in Surgery and afterward, I had a tube stuck down my windpipe, and the machine is going to make my lungs breathe in and out. While that sounds simple, the machine was settings with delays and tidal volume especially for me. Put another way, there seems to be a tendency on this board to feel that putting a machine on 'Auto' allows the machine to replace all that is done in a sleep study by knowledgeable personell.

Did you notice some of the posts by those who went through a sleep study, were prescribed a Vent, and then were unable to get their breathing in sync with the Vent. Some quit, some got it sorted out. The human body does have an ability to adapt to strange situations. Like wearing a mask with a wind like a hurricane blowing into their nose.

If you want to suppose that the case in this thread is that the person using the vent is using it in a non-invasive manner, who has no special health issues. I say, that the only way to be really likely to be sure, is to have a complete sleep study in a good lab, which a lot of folks here claim they did not get even when they paid all the money and went to the over nite lab.

Yes, a Vent, or autoASV can be set to make up for all kinds of health issues, but if it is not set correctly, which a person who is sleep deprived is not likely to be able to do, or who does not have special knowledge of their individual health situation, then an autoASV can be miss Set in a manner that is dangerous, perhaps fatal to the individuals health.

Let us be positive thinking an look at the design specifications of a machine which an individual can take home, and it will quickly select the right options for that individuals current health issue, which constantly monitoring for the need for change, with the ability to possible make that change, or call for help.

The final part of why we will not have autoASV (plus a few tweaks to meet with other treatment modalities) being sent home with all users is that insurance companies: Now use Sleep Lab testing as a hoop to force everyone to jump through as a means of their trying to keep individuals from costing them money by getting machines, masks, hoses, filters. Future visits to sleep docs. Also because as long as the brick machines can be pushed by insurance companies, the insurance companies will not pay fifty cents more for better machines if they can avoid it.

EDIT: Yes, MarkSTL, I think that in most cases a autoASV could be a great idea for nearly any user, and it can be more effective as well as more comfortable, altho I have not used a Vent at home. I could still configure it like the machines I do use, and some of the other options an autoASV look really interesting and it is good that you brought up this topic. Much of what I have done is forecast some scenarios of disaster which are likely to be infrequent, rare, but I suggest good methodology in setting machines, and using xPAP equipment.

purple wrote:An ASV, without the proper settings, combined with some health problems can kill people, or cause real physical damage to the patients bodies.

Not likely. Aren't most ASV machines limited to 25 or 30 cmH2O pressure? That's like blowing air into a straw in a 12 inch deep glass of water. There's not enough pressure to do any serious damage to the body unless you have some other serious medical condition. You get a LOT more than that when you sneeze or blow up a balloon.

The risk is to end up not treating your apnea, or inducing central apneas.

purple wrote:On the other hand, the RT for my DME said that over ninety percent of her clients have compliance only data, and are perfectly happy with their treatment. If one was to make an argument for the use of such machines, if they have problems they could have another sleep study, which should be more valuable the doc getting all the info from a full data machine.

Dead wrong. If a patient has a problem with his CPAP treatment on a data capable machine, the doctor can look and see what, if anything, might be causing the problem. You can see whether the patient had bad leaks. You can tell what happened every night for a week or so. Some patients sleep well one night, but not another.

With a brick CPAP machine, the only way to find out what's going on is to take another sleep test. The patient's insurance will probably not pay for another in-lab sleep test. Even if it does, the patient will usually have an expensive copay. Many patients will not go through the horror, cost, and inconvenience of another in-lab sleep test, and will quit CPAP. Many doctors will not order another sleep test unless there is a serious problem.

The brick CPAP/sleep lab model makes money for the medical community, but it kills patients because they drop out. Non compliance with CPAP is the biggest problem in apnea treatment. Brick CPAPs kill apneacs.

Then when you get the additional sleep test, it will be in an uncomfortable lab, in a strange bed, with wires all over the patient, with a stranger hovering over the patient, probably not at the patient's normal sleep time, etc. The patient probably won't sleep the way he normally does. For instance, he may get no REM. The patient will probably not be connected to the same CPAP machine he uses at home.

Many patients end up not getting ANY sleep during a sleep test, or only get a few hours. That further invalidates the in-lab sleep test.

It's doubtful how well lab results will map to the home. For instance, many people find that sleeping position, different pillows, what they eat or drink, when they sleep, etc. has a big effect on their therapy results.

Many patients find they have vastly different AHI from one night to another. It's a crap shoot (with the patient's money) trying to find the problem on the one night in a sleep lab. Then many patients find their pressure needs and therapy results change over a few days or weeks when they start. Then pressure needs change over time as they age. The sleep test probably costs more than the cost of a fully data capable CPAP machine.

Even if the in lab sleep test does find something wrong, there's no way to monitor whether the treatment is working once the patient goes back home, and sleeps for a few nights with the new pressure settings. Many patients find that their AHI and other results don't settle down for days or weeks after they change their therapy.

If you give all patients a data capable CPAP machine, you can monitor their progress, and if something goes wrong, you can STILL do an in-lab sleep test if necessary. It's entirely possible that a data capable CPAP will spot problems like pressure induced central apnea that would be missed entirely by the brick CPAP/in-lab sleep test model.

Treating apnea with a brick CPAP is like treating diabetes without bothering to test blood sugar every day.

Thank you ArchAngel for pointing out how unclear what I wrote was.

I did not say I agreed that patients should be given a brick cpap machine. I said that an RT made the comment that most of her patients had "compliance data only machines" (bricks) "and were perfectly happy."

Putting aside that autoASV as a machine can be more complicated to put settings on. Let us take the simplest case of a APAP that is set on 4-20, as some are. Some people can not exhale against pressure. They put on a mask, the machine keeps increasing the pressure when person does not breathe. Many of us will wake up with a suffocating feeling, some would not. Any machine that is not properly set can be hazardous.

While I do not use a nasal mask, if I did, I might tape my mouth, or use a chin strap. I do that based upon my knowledge of myself that I will wake up if the power goes off, and pull the mask off. BUT I would not push tape and chin straps at a ninety year old grandmother, who was no longer sharp enough to not use these techniques to close her mouth, when she should realize she is not going to wake up if the power goes off.

From the basic question, Could AutoASV machines be used for everyone. Do I infer that the real question is, should we not issue AutoASV machines in place of the other machines, not just bricks, but in place of APAP's, or Bi Level machines (also assuming that the AutoASV is modified to treat the with the modalities offered by those lower machines) Is that the question that you answer? While critically assuming I am suggesting a machine which has fewer treatment options should be used. NOT what I said. I do not say there is additional therapeutic value from using machines, when compared to an autoASV could be called crippled machines. But simple by issuing autoASV (with the added treatment modalities) to everyone, because it can be configured (set) to give the best available, most comfortable treatment, does have risks. While some of you might not have additional health problems, many xPAP users do, and many of those additional problems are not diagnosed. For some of us, our docs clearly take the view that they do not intend to find, or treat all health problems, just the ones that cause me enough pain or symptoms that I can complain about. Put another way, their goal is to help me circle the drain. It is from the certainty of my that "help me circle the drain" experience I suggest caution.

Some months ago an individual was on the chat forum, and from his symptoms, a lot of folks suggested the he use a Neti Pot. He was also told to, based upon the experience of a number of individuals, that he could mix the powder in the envelope with tap water. That group saying that had used tap water hundreds of times, and thereby as a group, their experience was that in thousands of times of using tap water, they were never harmed or had they ever heard of anyone from being harmed from using tap water. Some of us strongly suggested he stick with using distilled water. i say use the recommended methodology if at all possible, and a buck for distilled water is not a lot of money.

A few weeks later there was a news story of an individual who died from a brain destroying something that entered his brain from using a Neti Pot. If you can find a million times that people have used tap water, without apparent harm, in a Neti Pot, and I will still say to use distilled water. Use a good treatment methodology.

We have some poor sleep clinics and poor sleep docs, but that does not mean the best way for an individual to treat their sleep apnea is to get a full data machine, put it on auto, and it will do what a good sleep study, and a good doc should be able to do. A brick is poor treatment methodology. Let us understand which question we are asking and answering. I did not say a brick is a good way to do any sleep apnea treatment, I offered the observation that a lot of folks use bricks, and the medical world finds way to justify that as being acceptable. I do not agree any more than ArchAngel that it is a good idea.

But thank you ArchAngel for pointing out how unclear what I wrote was.

I am finding the question 'Could an AutoASV be used for every one' absolutely fascinating.

I am not from the US and things are very different here. In my country an auto titrating cpap is used in an over night sleep study. That is 'IT' that is what is called a 'sleep study'. There are not sleep technicians, nurses or DOCS present during this so called 'study' to tweak anything.

You are then sent home with a machine usually a straight CPAP. There is no choice or discussion.

But thanks to CPAP.com., they were and are my life savers! I was able to buy my own autoPAP at an amazing price,which I used for many years.

All went well for over 10 years and I was rested but in the last few years things somehow changed and are not so good. For three years now I have been feeling very tired and exhausted, most of the time again.

I often woke with my old auto pap hitting 18 but not all the time, just a couple of times a week. Thought my machine was possibly getting too old, so I now have 2 new machines an Resmed S9 and a P.Respironics auto BipapASV Advanced.

I have gone back for several sleep studies, the result of which is always 'all is well, carry on as you are'. They are not interested in exploring things further, as they are only interested in compliance!

My original titration for my staight CPAP was 12, however my Resmed S9 autopap is currently telling me:

Med : 13.10 95% : 15.12 Max :15.86

Leaks 95% : 12 Max: 18

I am wondering if my S9 Autopap is faulty because the pressures seem so high, unless of course I am misinterpreting SH data.I am looking at the 95% pressure.

Tonight I shall sleep with my auto BipapASv Advanced with the following settings to see what happens:
EPAP min 8
EPAP MAX 15
Ps min 0
Ps max 20
max pressure 20

So my question is, in my situation where I do not have the support that I need and I have to pretty much go it alone:
Could an Auto ASV help me or harm me?

Not so sure about the PS what it does.I find that bit still rather confusing.

Any experienced autoASV users, I would very much appreciate your input.

purple wrote:From the basic question, Could AutoASV machines be used for everyone.

Unfortunately, the current crop of ASV machines apparently can't do the same therapy that an Auto CPAP, bilevel, or auto bilevel machine can do. They usually have full manual CPAP, but not the other settings that some of the "intermediate" level machines can do.

The ASV mode might be able to treat almost everyone, but it's uncomfortable to many people. The lower level machines will be more comfortable for many patients. ASV for everyone would probably end up with more patients giving up on CPAP.

Maybe in the future there will be a machine that does CPAP, APAP, bilevel, AVAPS, ASV, etc. in one package. It might even be able to automatically choose the right mode for almost any patient, along with the ability to be tweaked for the individual patient. Even if you have to manually chose what mode, it would still be a great thing.

I don't think any of the current machines fill the bill. I suspect the medical mafia will fight that idea.