BiPap not helping?

[Sleepster]

Sometimes CPAP therapy can induce central apneas. Often, but not always, it subsides. You will just have to stay with it and see what happens. Meanwhile, it wouldn't hurt to get a second opinion.

[Sleeprider]

An AHI of 70 is not treated. You have complex apnea. About 15% of patients do have this form. A few can be treated with BiPAP, but most will fail CPAP and BiPAP and require ASV (Adaptive Servo Ventilation). Because the ASV machine costs more, most insurance companies require that the medical necessity of ASV be demonstrated by failing CPAP and BiPAP. That is where you are. You need to talk to your doctor and make him aware that bilevel therapy is not effective and you require a different approach (ASV). Call him now! Call him every day until he is sick of hearing about it. This therapy will work great for you once you have the right one.

[PaytonA]

Sounds to me like your doctor is trying to make sure that you fail with the Vauto in S mode to make it easier to justify the ASV. I would not let it go too long before I would start pushing my doc to go after the ASV.

Best Regards,

PaytonA

[PoolQ]

You do not have to wait a month. Be nice, but push. AHI of 70 is not great, good or anything else. You are a long way from 5 and the chances of it going from 70 to 5 in a month just by getting used to it is almost zero. You have central apnea and an ASV machine is the only treatment for that. Be nice, but push.

[Gshell]

Y'all are great. Thanks for your comments and advice. Getting a new doc who will prescribe a servo is not a problem, my pulmonologist, not the neurologist who is currently treating me, has already said he thinks a servo may be what I need but MEDICARE- who knows - they won't budge on lots of issues and I don't know if this is an issue or not. My average events are 77.3 with 76.5 being central events. I am on some pretty heavy duty medication and I am sure that is a main contributor to the central apnea. The meds cannot be changed so I need the machine to work for me. It's a bit scary to still be having this many events while using a machine.

[richb]

Y'all are great. Thanks for your comments and advice. Getting a new doc who will prescribe a servo is not a problem, my pulmonologist, not the neurologist who is currently treating me, has already said he thinks a servo may be what I need but MEDICARE- who knows - they won't budge on lots of issues and I don't know if this is an issue or not. My average events are 77.3 with 76.5 being central events. I am on some pretty heavy duty medication and I am sure that is a main contributor to the central apnea. The meds cannot be changed so I need the machine to work for me. It's a bit scary to still be having this many events while using a machine.

With Medicare you have to jump through some hoops. Generally you need a sleep study with both a standard Cpap machine and an ASV machine. You have to fail with the standard machine and then succeed with the ASV machine. This can be done in a split study. The same machine can be set for both standard Cpap/Bi-pap and ASV. You then need a follow up visit with the sleep doc at 61 days where the doc certifies that your machine is providing therapeutic treatment. You already have data (and probably a sleep study) showing that standard Cpap does not work. Read as much as you can so that you can have a good conversation with your new Doc. Best of luck.

Rich

[justMongo]

... The ResMed AirCurve 10 VAUTO should have 3 pressure numbers.
IPAPmin, IPAPmax, and PS (Pressure Support.)

Minor correction- the settings on the AC 10 are >EPAPmin<, IPAPmax and PS.

Typo.

[Ghost1958]

As my medicare advisor provider says,
" A Dr can get done thru Medicare whatever he wants if willing to fill out a form to get it done".
Its finding a Doc willing to spend 10 minutes to fill out the form.

[Gshell]

I think you are right about the Medicare. Everyone's input has made me aware of what to ask and what I should expect. Thanks

[Gshell]

In an earlier comment to my post some suggested I share a waveform - just installed Sleepyhead and I can't find a waveform. the daily reports are great. Printing them out and taking to my doctor.