Advise a New Guy [on high pressure readings]

[zzzZorro]

BiPAP (Respironics) and VPAP (Resmed) are the same thing, and are proprietary terms for a device with inhale and exhale pressure.  You need a bilevel with backup rate, and preferably something with intelligent pressure support...ASV.  When you finally talk to the doctor, let him know that simple bilevel isn't going to cut it.  Get a titration for ASV or he is wasting both of your time.

Scheduled for another sleep-over Friday with a Bi-Level ST [going to request AirCurve10 ST if not ResMed].  My Echo EjectionRate is 40-45 so I was told the ASV is ruled out and the BI-Level ST is the best we can do.  Apparently the brief test with ST on the first sleep-over showed it to manage the Centrals.

I got home from the second SleepStudy this morning. [Miserable experience]  The BIPAP and ST modes did not stop the Centrals.  I was told that the Centrals are heavy while trying to fall asleep, then go away after I fall asleep.  Was told SleepStudies are prohibited from testing ASV by the prohibition on LVEF<45%, so it is unknown IF that would have been a viable solution      Maybe this week we will see what the Doctor thinks the best (available) route is going to be.

ST at higher pressures were comfortable but weird.  An interesting challenge to the 'ASV in CHF recommendations' makes one have to wonder what the real purpose of it was.  Smells like an INSURANCE escape route to me..

[SarcasticDave94]

BiPAP (Respironics) and VPAP (Resmed) are the same thing, and are proprietary terms for a device with inhale and exhale pressure.  You need a bilevel with backup rate, and preferably something with intelligent pressure support...ASV.  When you finally talk to the doctor, let him know that simple bilevel isn't going to cut it.  Get a titration for ASV or he is wasting both of your time.

Scheduled for another sleep-over Friday with a Bi-Level ST [going to request AirCurve10 ST if not ResMed].  My Echo EjectionRate is 40-45 so I was told the ASV is ruled out and the BI-Level ST is the best we can do.  Apparently the brief test with ST on the first sleep-over showed it to manage the Centrals.

I got home from the second SleepStudy this morning. [Miserable experience]  The BIPAP and ST modes did not stop the Centrals.  I was told that the Centrals are heavy while trying to fall asleep, then go away after I fall asleep.  Was told SleepStudies are prohibited from testing ASV by the prohibition on LVEF<45%, so it is unknown IF that would have been a viable solution      Maybe this week we will see what the Doctor thinks the best (available) route is going to be.

ST at higher pressures were comfortable but weird.  An interesting challenge to the 'ASV in CHF recommendations' makes one have to wonder what the real purpose of it was.  Smells like an INSURANCE escape route to me..

Sincerely wishing you the best on the resolution for this.

[Sleeprider]

There are many issues with the sleep study that resulted in the LVEF recommendation. Hopefully they get that figured out and refine the real problem. The cohort that was studied, was considered compliant with only 3.3 hours per night of therapy, and really was not designed to evaluate CHF patients, individuals with CSR or low ejection fraction. That was just what fell out in the statistical analysis. If I was in your position I would put some serious research into the study conclusions and decide if the risks and benefits balanced out in favor of getting effective treatment. The real question in my mind is, would non-treatment have a better outcome, than effective treatment with ASV, and what is the increased risk, specifically for individuals with LVEF below 45%. I think Dave who responded above, is on the borderline for that risk group as well and has decided, he'd rather live his life with the therapy, then suffer without it.

I hope you can find some comfortable treatment using an alternative, and we will all do our best to help you make that happen.

[zzzZorro]

Thanks SR.  Then here is one for DAVE;  Please 'splain yourself.  I see you are on ASV, but do you have a LVEF<45? 
This morning before departing the Study, the Tech was adamant that 'THEY could not test me with ASV (I requested it be included with the BIPAP/ST) and that Doctors would require all sorts of red-tape liability releases so they won't get involved.  And, insurance companies probably still will refuse to accept the prescription.  Went on to comment, she has seen cases where ASV wouldn't correct the situation anyway'.  I don't know if she was only giving lip service or not but seemed to be a pretty cut-and-dried topic there.

[SarcasticDave94]

Thanks SR.  Then here is one for DAVE;  Please 'splain yourself.  I see you are on ASV, but do you have a LVEF<45? 
This morning before departing the Study, the Tech was adamant that 'THEY could not test me with ASV (I requested it be included with the BIPAP/ST) and that Doctors would require all sorts of red-tape liability releases so they won't get involved.  And, insurance companies probably still will refuse to accept the prescription.  Went on to comment, she has seen cases where ASV wouldn't correct the situation anyway'.  I don't know if she was only giving lip service or not but seemed to be a pretty cut-and-dried topic there.

Although I should know the answer to if my LVEF<45 was or not, I must admit I do not know that. I can, and will find out that definitely. I approached my echo test and results somewhat lazily and/or hastily, I assume. I just asked in regards to ASV and the echo test, is it a go or no-go in regards to ASV. The cardiac doc gave me the go directive. As I said, I will clarify and educate myself, and therefore you, with that answer, in more detail, later this week. I have to contact his office anyway on my heart attack tests.

Respectfully,
Dave

PS regardless of results, I'd choose ASV despite risk, I've seen results of ASV vs BiPAP/CPAP. Wouldn't trade it period.

[zzzZorro]

Thanks SR.  Then here is one for DAVE;  Please 'splain yourself.  I see you are on ASV, but do you have a LVEF<45? 
This morning before departing the Study, the Tech was adamant that 'THEY could not test me with ASV (I requested it be included with the BIPAP/ST) and that Doctors would require all sorts of red-tape liability releases so they won't get involved.  And, insurance companies probably still will refuse to accept the prescription.  Went on to comment, she has seen cases where ASV wouldn't correct the situation anyway'.  I don't know if she was only giving lip service or not but seemed to be a pretty cut-and-dried topic there.

Although I should know the answer to if my LVEF<45 was or not, I must admit I do not know that. I can, and will find out that definitely. I approached my echo test and results somewhat lazily and/or hastily, I assume. I just asked in regards to ASV and the echo test, is it a go or no-go in regards to ASV. The cardiac doc gave me the go directive. As I said, I will clarify and educate myself, and therefore you, with that answer, in more detail, later this week. I have to contact his office anyway on my heart attack tests.

Respectfully,
Dave

PS regardless of results, I'd choose ASV despite risk, I've seen results of ASV vs BiPAP/CPAP. Wouldn't trade it period.

Thanks Dave.  I am most curious just what your LVEF is.  I am not positive that the Sleep Doc subscribes to the LVEF<45% study/theory but the Sleep Clinic is basically 'His' (for practical purpose) from what i have deduced, so I would be surprised if he would waiver from their dismissal of my request to at least try ASV while I was there Friday night.  I do not know this for certain as so far 'He' has only been an elusive image of 'knuckles on the door jamb'.
I guess I mainly want to know if (1) The ASV was prescribed while you had a LVEF< 45%  (2) If Medicare will honor the prescription against the "study" recommendation?

[SarcasticDave94]

I'll try to dig my test info ASAP to satisfy both of us. Tomorrow maybe?

[zzzZorro]

BiPAP (Respironics) and VPAP (Resmed) are the same thing, and are proprietary terms for a device with inhale and exhale pressure.  You need a bilevel with backup rate, and preferably something with intelligent pressure support...ASV.  When you finally talk to the doctor, let him know that simple bilevel isn't going to cut it.  Get a titration for ASV or he is wasting both of your time.

I got home from the second SleepStudy this morning. [Miserable experience]  The BIPAP and ST modes did not stop the Centrals.  I was told that the Centrals are heavy while trying to fall asleep, then go away after I fall asleep.

And one for SLEEPRIDER;  Would using the ramp feature at the beginning of a treatment possibly ward-off  the Centrals during the transition to N-1?


(My purpose of openly pursuing here is that I AM QUITE SURE THIS INFORMATION CAN BE OF HELP TO OTHERS WITH PRIOR M/I HISTORY and now have lowered LVEF readings limiting their treatment options)

[zzzZorro]

I'll try to dig my test info ASAP to satisfy both of us. Tomorrow maybe?

STELLAR

[Sleeprider]

Ramp has no therapeutic value for centrals. It is there to ease the transition to sleep providing a more consistent, low pressure until you are asleep. Transitional centrals would be treated by ASV. It's hard to know whether the treatment or centrals would be more disruptive, but I normally coach users not to use ramp.