Resmed ASV machines. What's the difference?

http://www.resmed.com/us/products/s9_vp ... c=patients
The VPAP™ Adapt is an adaptive servo-ventilator specifically designed to treat central sleep apnea (CSA) in all its forms while providing quiet and comfortable therapy.

http://www.resmed.com/us/products/vpap_ ... clinicians
VPAP Adapt SV™ is an adaptive servo-ventilator designed specifically to treat central sleep apnea (CSA) in all its forms, including complex and mixed sleep apnea.

Does the S9 deal with complex and mixed apneas?

I've been using APAP for nearly 3 weeks, my OAs are now below 1, but CA >10 and H >5. I know I shouldn't be self diagnosing from the internet, but I'm not stupid and I've done a lot of homework in the last few days. I'm seeing the sleep tech tomorrow, and unless he sees something different in the data I'll probably be looking at an ASV machine. So knowing what features particular machines have empowers me when and/or if an ASV machine is discussed.

The VPAP™ Adapt is an adaptive servo-ventilator specifically designed to treat central sleep apnea (CSA) in all its forms while providing quiet and comfortable therapy. The VPAP Adapt algorithm adapts to the patient’s ventilation needs on a breath-by-breath basis, and is synchronized to the patient’s own recent breathing rate and flow pattern to maximize comfort and compliance.
•Ultra quiet Easy-Breathe motor
•Intuitive menu settings and color LCD display
•Seamless integration with optional H5i™ heated humidifier with Climate Control


This is a S9 machine- info from ResMed's site.

Sorry for my last post, when I reread your post I realized I hadn't read your question properly.

131 wrote: Does the S9 deal with complex and mixed apneas?

ResMed makes an entire series of S9 machines...so your question makes no sense. It's similar to asking if a System One treats complex apnea. Can't be answered.

The servo ventilation component of an asv machine is more for periodic breathing...but many central or complex apnea patients have periodic breathing.

So just like my answer on your other thread, you have to have a machine with a timed back-up rate to treat centrals. A simple cpap or bilevel will not.
J

131,
I realized that you may not know what I mean when I say Timed back-up rate. Central or complex apnea deals with a form of apnea where the brain does not send the "breath" signal to the body. These so-called central apneas are also called open airway apneas which is more descriptive. So no amount of pressure from a cpap machine or a bipap machine will allow breathing to occur since there's no breathing effort.

So a type of machine that can initiate a breath is needed. Often, just a small burst of pressure will trigger the brain to initiate a breath. The machines use either an automatic or a manual system involving a breath per minute rate. So if you have the BPM rate set at 10 breaths per minute...if no breath is sensed by the machine in 6 seconds (60 divided by 10) then the machine initiates breathing. How that is done is varied, but often with a three pulse system...each one at a higher pressure then the next.

There are several ASV threads that have good information...though lots of reading.
Hope this makes things more clear,
Jamis

jamiswolf wrote:ResMed makes an entire series of S9 machines...so your question makes no sense.

The first link points to the S9 VPAP Adapt, the second link is the VPAP Adapt SV, I just want to know if there's a major difference between the 2, or if they both do the same thing but one is a newer model.

http://www.resmed.com/us/products/vpap_ ... c=patients

S9 is new technology
the other is old technology.

You can compare features line by line at above link by comparing the 2. Have you seen that page?

Pugsy wrote:S9 is new technology
the other is old technology.

You can compare features line by line at above link by comparing the 2. Have you seen that page?

Thank you! No I hadn't seen that page. I hadn't seen the shape of the older one previously so I assumed it was a new model. I've already got the S9, H5i and climateline etc. unopened in a box. All I have to do is exchange the pump, if that's what's recommended.

I saw my sleep tech today, he said I probably know more about sleep apnea than he does, which scared me! He's primarily a Financial Advisor.

The seller I bought my S9 Autoset from has agreed to exchange it (with monetary adjustment) for an S9 VPAP S, not the VPAP Adapt that I'd prefer, but at least I'll have a unit that while not ideal it better suits my treatment requirements.

131 wrote:... The seller I bought my S9 Autoset from has agreed to exchange it (with monetary adjustment) for an S9 VPAP S, not the VPAP Adapt that I'd prefer, but at least I'll have a unit that while not ideal it better suits my treatment requirements. ...

An ASV machine requires a specific sleep study, proof of central sleep apneas (either "as is", with obstructive, or as a result of increased pressure) and a prescription for the therapy. These are extremely expensive devices that provide ventilation support in the event of central sleep apneas. Unless you face that as an ongoing problem, there is no need for this therapy. In fact, it might well trigger additional problems (central apneas!) - if the titration study was not done.

If your last sleep study and prescription was for a BiLevel device, then the VPAP S is more appropriate for your needs.

131 wrote:I've been using APAP for nearly 3 weeks, my OAs are now below 1, but CA >10 and H >5.

131, the machine you were listing in your equipment profile is presumably the one you have been using for nearly three weeks - a Philips Respironics System One Auto with A-Flex -- and is the machine you got your reports from, showing a "CA" (Clear Airway apnea) index of more than 10.

Some (perhaps all) of those "CA's" may, or may not, actually be "central apneas."

Some (perhaps all) of the CA's marked by your machine, if they even are "central apneas," may be normal central apneas, and nothing to be concerned about. By normal, I mean some (maybe all) of the apneas marked as "clear airway apneas" could be times when you hold your breath in your sleep from the effort of turning over. Some (maybe all) could be "sleep onset" central apneas. Those would be normal, too. Some could be post arousal centrals, following deep recovery breaths after an obstructive apnea ends....in which case it's the obstructive sneaking through (not the accompanying "post arousal central") that needs to be addressed.

Only a PSG sleep study can identify true centrals, and identify which of them are "normal centrals" and which are problematic ones.

What I'm getting at is that what you're regarding as "centrals" on your autopap therapy results data, may -- or may not -- be significant. I would not jump to the conclusion from just that machine data that I needed either a bilevel with timed backup rate or an ASV type of machine.

The S9 VPAP S you'll be receiving does not offer a "timed" mode, by the way. The "S" stands for spontaneous, meaning that particular VPAP (bilevel) machine will simply follow your breathing.... your breathing in and out... as the cues for the machine to switch to IPAP (the higher pressure for inhaling) and to EPAP (the lower pressure for exhaling.) A bilevel machine that includes "T" tacked onto the end of the name ( like a VPAP ST) offers both Spontaneous and Timed modes.

All that said, you may find that a bilevel machine like the ResMed VPAP S suits you fine and treats you fine. That particular model is not for treating "centrals." But, you may not even have problem centrals, anyway, and you'll almost certainly enjoy the comfort of the "this feels like natural breathing!" of using a regular bilevel machine.

The autopap you've been using is making an educated guess, at best, about what the "clear airway apneas" it has been marking might be. And even if the clear airway apneas are actual central apneas, some/all of them might be perfectly normal ones.

Good luck!

Links to Central Apnea discussions
viewtopic.php?p=22702

131, in your signature you mentioned:

Additional Comments: Very severe OSA, 95 episodes per hour on sleep test.

From one of your first topics:

Interpreting data?
topic started by 131 - Nov 15, 2011
viewtopic.php?p=656798#p656798

131 wrote:Patient exhibited fragmented sleep architecture throughout his home diagnostic sleep study. He had a sleep efficiency of 86% with a prolonged sleep latency of 60 mins. Rem proportion was reduced. Sleep was predominantly in the lateral positions and supine REM was not seen.
Severe respiratory disturbances were noted with an AHI of 95/hr, 97/hr whilst supine and 95/hr in REM. Central events were predominantly apnoeic in type, worse in NREM and whilst sleeping laterally. These events were associated with an average oxyhaemoglobin desaturation of 5% with a nadir saturation at 84%. Average saturation during the study was 93%. The desaturation index was elevated at 84 events/hr.
Mild snoring was observed throughout the night. ECG normal sinus rhythm was observed throughout the study with a baseline heart rate of 87bpm.

Sleep period 420 minutes.
Respiratory events.
Obstructive 169
Central 205
Mixed 253
Total apnea 627
Hypopnea 18
Total 645


Conclusion:
Given the severity of sleep apnea, treatment with CPAP is indicated. If there are residual central apneas despite CPAP, recommend sleep physician review.

This looks to me like one of the cases where the results from a "Home Sleep Test" indicates that the person really should go in for a full PSG sleep study in a sleep lab. A full PSG diagnostic study and titration study in a sleep lab. The centrals and "mixed" apneas scored in the Home test might be incorrect -- perhaps an effort belt that was not placed correctly or was slipping. Is going in for a PSG study in a sleep lab a possibility for you?

I'm not a doctor or anything in the health care field, but results like those (particular the number of centrals and "mixed" ) from a portable Home Sleep test machine fairly scream, "Have this person come in for a FULL attended diagnostic PSG in the sleep lab."

rested gal wrote:I'm not a doctor or anything in the health care field, but results like those (particular the number of centrals and "mixed" ) from a portable Home Sleep test machine fairly scream, "Have this person come in for a FULL attended diagnostic PSG in the sleep lab."

Again, thank you all very much for your feedback. I was considering going back to my GP to ask for a referral to a specialist, the "sleep tech" that provided the gear for my home sleep test is primarily a financial counselor! After a phone call today I'm even more inclined to go elsewhere, he suggested the number of CAs and Hypopneas in my data may be due to me hyperventilating because I'm not used to the machine. It was suggested that I use the machine while watching TV until I get used to it. After changing masks I don't find using the machine grossly intrusive and I'm definitely getting better quality sleep than I did without it. I haven't noticed my breath rating increasing when I start using the machine, so I don't see why I would start hyperventilating when I get to sleep.

131 wrote:... I haven't noticed my breath rating increasing when I start using the machine, so I don't see why I would start hyperventilating when I get to sleep. ...

You would not notice it. It is not at all unusual to hyperventilate (a little) in response to an apnea. However, I agree with Rested Gal. Based on the results from your home study, you would definitely be a candidate for a full in-lab sleep study.

Though it's possible you might not have central apneas, it is also possible you have Complex Sleep Apnea - essentially as the pressure increases, you start to develop central apneas. An experienced lab can help sort out the problems.

Best wishes.