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BiPAP ST to ASV - Optimizing
#31
RE: BiPAP ST - almost there - please help
(07-28-2021, 01:08 PM)fikus56 Wrote: alright - email sent as I can barely do my job currently.  hopefully this gets me some resolution soon.

Did you include that in your email?  That is significant!
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#32
RE: BiPAP ST - almost there - please help
Yes, i did.  And really dont want to boast but I have a fairly high-up position, hyper sensitive to my attentiveness throughout the day.... basically managing large sums of money at a time.

The RT has already responded... They are quite kind and helpful but I think too focused on her perception of what constitutes proper treatment from an insurance perspective.

They were able to get me an appointment with the Doctor but its literally not for another month. 

They were adament that the BiPap ST was the proper treatment for my condition based on the sleep study and that I am being treated. 

I debated this fairly effectively and at least got them to agree that the ASV MIGHT be the best treatment for me. 

They seem to think in order for me to get that , I need to use the bipap for a full 30 days, fail, and then get another sleep study, which they proclaimed my insurance "would not" approve it.  Based on what you all are saying, Im already approved.  Is this correct?  I sent all the coding etc to her.

It also seemed like the reason they wanted to get me in to see the doctor is to medicate me.  Presumably with modafinil.  

Anyways, in the meantime , ill go back to sleeping like 10 hours per night bc I seem to feel fine if I do that with the Bipap.   I have made a lot of progress but will not give up until i treat the underlying issue as best as possible.
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#33
RE: BiPAP ST - almost there - please help
Thinking out loud, I think you should prove that ST is NOT good enough. I would ask them the chance to prove ASV is right and will help by getting the ASV titration. Sleeprider is correct on the HCPCS codes, you already are approved for that class of machine that the ASV resides. Just change machines on the script. Dr. Ducky Doolittle and Nurse McQuack strikes again.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#34
RE: BiPAP ST - almost there - please help
that's good to know regarding the approval. 

how does one prove that the bipap isnt working if they are insisting it is by the AHI number. 

The symptoms that I just want to medicate me for?   Coffee
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#35
RE: BiPAP ST - almost there - please help
Rely very heavy on your subjective, I don't feel better, I'm EXTREMELY fatigued stuff. IMO you have no positive thing to say about your ST therapy.

Even if you think it's helping, don't lie but rather don't mention the positive, only focus and discuss negatives on the ST.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#36
RE: BiPAP ST - almost there - please help
Im going to do everything I can to get the best treatment available. 

Having said that, Im not lying to say that the BIpap ST yielding an AHI of <5 and allowing me to sleep upwards of 10.5 hours per night is not helping.

It's a drastic improvement from my APAP therapy where I basically slept 7 hours max , always got a 5-10 AHI and was noticeably tired by lunch time 4 out of 5 days per week. 

Now im tired like 1 out of 5 days per week.  While that's not ideal, it is definitely better than where I was at over the last year and I would say it's at least "progress"
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#37
RE: BiPAP ST - almost there - please help
Oh wait , I see what you're saying. 

There is no reason to emphasize what is working when discussing with doctor/ RT
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#38
RE: BiPAP ST - almost there - please help
The ASV will get you to less than 2 AHI, but the key difference is that the pressure support is not delivered the same on every breath.   Currently you are getting 11 cm EPAP and 16 cm IPAP on every breath, and the machine switches to IPAP when you don't take a breath within the backup time.  With the ASV, your pressure will likely be lower. EPAP is set to whatever is required to avoid obstructive apnea, and with autoASV mode the machine will titrate to deliver the correct EPAP if you have obstructive events.  You can decide to set a comfortable minimum pressure support like 3.0 cm, then the machine will deliver between 3.0 and your maximum pressure support setting to ensure you take a breath where spontaneous effort is not present or insufficient.  Most importantly the ASV uses the EasyBreathe™ algorithm to shape the pressure support delivery. This makes breathing much more natural than the on/off pressure of the ST.  Again, read the clinical protocol document and you can see the graphs, understand how this works and why it is more comfortable.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#39
RE: BiPAP ST - almost there - please help
^ thanks for that explanation -

Is it cool to use nasal pillows with ASV ? I’ve had way more success with those
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#40
RE: BiPAP ST - almost there - please help
without question, the mask of your choice.
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