(03-31-2015, 05:19 PM)slumberdog Wrote: @Sleeprider: In their defense, I didn't tolerate the apap too well. But if there are devices that do both, I would have thought that was the way to go. Even the cardiologist who prescribed the cpap also prescribed a CNS category sleepaid (when I asked for a sleepaid to help with the adjustment to the device), even though the study specifically mentions to avoid cns sedatives. Further, how does one monitor for central events if there is no detailed data available?
I finally decided that my sanity and my health warranted just letting it go, dealing with it and monitoring my own progress. With the information available in this forum, I feel confident that I can. There really was no useful info forthcoming from the 'entities'.
For central apnea, normally you want to avoid increased pressure during the exhale part of respiration, and possibly, using increased pressure during the inhale to induce respiration. We don't know anything about your health history or the cause of central apnea, but it infers a lack of effort to breath long enough to be scored as apnea. Unlike obstructive apnea which involves effort to breath against a closed airway, central apnea is lack of effort to breath with a clear airway. CPAP does nothing for CA.
I truly wish you the best, but with the finding of complex apnea, there should have been a titration evaluation that looked at bilevel and non-invasive ventilation (pressure and timing) to mitigate central apnea. If CPAP brought that to acceptable levels, then that's fine, but the original post didn't discuss titration, just diagnosis.
bilevel will not treat central apneas and therefore is not what it takes to treat complex apnea. I don't know if you had a split sleep study or what but they should have given you a machine that treats complex apnea and what you have and the bilevel (bipap) will not treat centrals.
I think what bothered me most is that they pushed a complex apnea patient into the cheapest CPAP brick they could find, that doesn't even record data. Not only a device inappropriate for treating the apparently diagnosed condition, but one unable to produce a report of its failure.
(04-01-2015, 08:12 AM)Sleeprider Wrote: I think what bothered me most is that they pushed a complex apnea patient into the cheapest CPAP brick they could find, that doesn't even record data. Not only a device inappropriate for treating the apparently diagnosed condition, but one unable to produce a report of its failure.
While there's no excuse for prescribing an AirSense 10 CPAP for anyone instead of an Elite, it DOES record nightly averages of AHI and some other info. I believe it will give an AHI and CAI nightly average, which is all the information most "sleep doctors" will bother to look at.
I'm not 100% sure what it records. I'm still looking for someone to send me a zip file of an SD card from an A10 CPAP model.
Get the free SleepyHead software here
for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
Slumber, you mentioned you have "Complex Sleep Apnea." If that is the case, then the machine you have will probably not be effective. Nor would the Elite model.
What Mr. Rider was trying to point out is Medicare/Insurance rules require failure before success. Therefor by prescribing the lowest possible cost machine for you, perhaps failure can be assured, which would then allow them to prescribe an ASV machine which would treat your condition properly.
It seems a rather silly way to run a pirate ship, but that's how they do it.
........and I do agree, it's pretty hard to monitor your Central events, or any events for that matter, if the data are not available.
Thank you for your responses. The information is much appreciated. I did talk to my cardiologist yesterday (who I do trust). They referred me back to the sleep study facility, and sounded a bit defensive, as though this is not their first experience of that sort.
retired_guy: Yes, that makes sense, although we have not had issue with our ins. co in the past (not of age for medicare).
Does anyone have any advice on the best way to approach this? It would be nice if I don't end up paying for the 'game'. I think it a given that I try to avoid putting them on the defensive. Thanks for any ideas!
Going back to the sleep clinic is a good idea. Ask them straight out: "You said I have complex sleep apnea. Will this machine successfully treat COMPLEX sleep apnea?"
Then go from there.
(04-02-2015, 12:02 PM)retired_guy Wrote: Going back to the sleep clinic is a good idea. Ask them straight out: "You said I have complex sleep apnea. Will this machine successfully treat COMPLEX sleep apnea?"
Then go from there.
Been there, done that. Actually, I'm full circle now. I started a day or two ago by calling my cardiologists. Today, I called the sleep lab, they referred me to the DME, they referred me back to my cardiologist, who wrote the Rx (possibly by recommendation).
Having talked to the DME, they state there's a chance that the insurance will credit me for the difference paid. I shouldn't have any trouble getting the new RX from my Cardiologist, so hopefully it will work out. Thanks to you and all for your helpfulness. I'll post back after the dust has settled and the end results are known.
Again, thanks to all!
Nice to have a forum that can fill in the blanks. Truth is, between the 'shuffleboard' between the entities involved and their seeming lack of knowledge of the equipment they deal with, it's nice to have a place to get solid info.
04-02-2015, 03:08 PM
(This post was last modified: 04-02-2015, 03:14 PM by Sleeprider.)
I'm glad you raised the issue with your cardiologist. Heart patients often have complex apnea that requires ASV (Adaptive Servo Ventilation) to treat. The mismatch between your diagnosis and equipment was frankly head spinning. In this case a CPAP is not a CPAP (for cardio patients), and your cardiologist needs to do some reading and research.
Are you being treated for A-fib?
@Sleeprider: After I knew the facts, I was puzzled myself. Hopefully, it will be straightened out next week. What surprises me is that 3 different professional entities involved, yet none seem truly informed. Perhaps I'll email them a link to this forum. : )