Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Future BiPAP user.. Which machine to ask for?
#61
I made a mistake copying the table.

The final pressure wasn't a repeat of 11/6 it was 12/8 (line 5)

  1. CPAP 5/0/0, duration 1:24:21 = Hypop - 5, CA -13, OA - 1, AHI 24.2
  2. CPAP 6/0/0, duration 2:36:34 = Hypop - 12, CA -15, OA - 2, AHI 11.6
  3. BIPAP 11/6/0, duration 0:16:26 = Hypop - 0, CA - 2, OA - 0, AHI 7.3
  4. BIPAP 11/7/0, duration 0:19:26 = Hypop - 0, CA - 3, OA - 0, AHI 12.9
  5. BIPAP 12/8/0, duration 2:00:59 = Hypop - 0, CA -31, OA - 1, AHI 21.8
I just noticed the error while copying to my request.

So sorry.

Does this change the picture very much?

I'm working through your post, and imagine this new data changes the "not repeatable" statement.

Just a thought, does this seem like a decent titration study?

Why did they stay on successful settings for only 16-19 min. (line 3 & 4), and on lousy results for 2 hours (line 5)?

Again, I apologize.
Post Reply Post Reply
#62
Just an update...

Got a call from the manager of the sleep center today.

Their other pulmonologist came in and read my ASV request.


Good news... My letter worked! She said it convinced him to OK an ASV.

Bad news... Medicare won't take the previous titration results, so I need another PSG.


Just to make sure, I called the DME provider and talked to someone in their Medicare clearance department.

She confirmed that a new, complete titration study must be performed on ASV, to generate the numbers Medicare requires.

We discussed my condition, and she took time to explain what the study results must show for Medicare approval.

Later, she was nice enough to email the complete requirements along with internet links for more information.


Boy, there very detailed definitions, and specific numbers for AHI, CSA, CompSA and OSA, with and without titration.

But I have to say, they seem pretty well thought out.


At any rate, I have another PSG next Sunday night.
Post Reply Post Reply
#63
Good news for you there. At the very least, some progress for you. Best to you on this. I'm seeing my current pulmonary doc again 5/3 to get ASV change-of-plan from BiPAP evaluation. BiPAP is a definite NO GO here, given the therapy makes me worse instead of better; along with central/mixed that is. Keep us posted for educational purpose please.

Thanks Coffee
I am not a doctor nor do I pretend to be one. Follow my advice as a choice not an order. 2 of these  Coffee Coffee per day keep the bad times away.
Post Reply Post Reply


#64
(04-19-2017, 10:38 PM)SarcasticDave94 Wrote: Good news for you there. At the very least, some progress for you. Best to you on this. I'm seeing my current pulmonary doc again 5/3 to get ASV change-of-plan from BiPAP evaluation. BiPAP is a definite NO GO here, given the therapy makes me worse instead of better; along with central/mixed that is. Keep us posted for educational purpose please.

Thanks Coffee

Sorry to hear that BiPAP isn't going smoothly.

You mentioned central/mixed.

Is this based on your machine data, or from your sleep study?

Maybe the centrals you are experiencing make your condition closer to mine?

If you need any research to convince your doc to look at ASV let me know.

Good luck.
Post Reply Post Reply
#65
Thanks Herb. Both sleep study and BiPAP data via Sleepyhead show central/mixed due to BiPAP usage. Also note that SleepRider believes ASV is my best path, especially the ResMed 10 Aircurve ASV.

I recently (about a week prior to this reply) had a follow-up at my pulmonary doctor's office with a back-up Dr. as the regular doc was vacationing. She was looking at the study print, maybe the titration one, regardless it's the chart from the sleep study that shows pressures times and AHI. She consulted with another doc in office and they had me change setting on BiPAP to Fixed 12/8, stating she questions why Fixed 15/10 was chosen as it was some of my worst central showings. I then asked, because of the Board info A.K.A. "research I've been doing" did this high count of central apnea and likely mixed apnea indicate WE should seriously consider an ASV? This doc says oh yes we really ought to consider it. But first try to build a 30 day report with the 12/8 setting as our next step. Results are I still cannot sleep thru a 3 hour period on the BiPAP. More tired than if not on therapy. I've got pulmonary sleep study office to edit my visit to 5/3 instead of 5/24. I've had all I will take of napping my way thru each night.

I'll post further as it progresses. BTW my insurance wants the ASV too so they get what they're paying for, a healthier patient. 2nd opinion or more sleep studies OK too if using approved referral/pre-auth method.
I am not a doctor nor do I pretend to be one. Follow my advice as a choice not an order. 2 of these  Coffee Coffee per day keep the bad times away.
Post Reply Post Reply
#66
Both of your cases are interesting, and once this is settled, hopefully in your favor, it would be great if we could do a collaboration for an article we could put into a wiki related to ASV Approval Adventures. It's not easy, and you must be educated in some pretty technical aspects of central sleep apnea and the medical system approval process in order to win the argument. Hopefully a guide for future members that will have to follow this path.
Post Reply Post Reply


#67
I'm certainly willing to share what happens. I really don't picture myself as well equipped to be an ASV trailblazer, but I'll push on to get my health back by obtaining the ASV of my desired brand. And at the same time be an in the field reporter for Apnea Board.

So far 2 big advantages I've got for my case in getting the ASV, besides medical diagnosis/need:

1) doctor at my current pulmonary facility has stated her opinion is I'm headed to an ASV

2) the insurance would rather pay more for correct device then less for the wrong one

Signing off for now as I've got a back Aqua Therapy session in a bit. Later AB Land  like  Coffee
I am not a doctor nor do I pretend to be one. Follow my advice as a choice not an order. 2 of these  Coffee Coffee per day keep the bad times away.
Post Reply Post Reply
#68
Dave,

Really sorry that you're unable to get a good night's sleep after all you've been through.

The good news is that they're on your side for ASV.

Believe me, that's more than half the battle.

Hope you get one soon, I'm looking forward to hearing a success story from you.
Post Reply Post Reply
#69
Thanks, it really is helpful knowing there's others fighting similar battles as I am. Not that I'm wishing difficulties in others.

The battle right now is time. Time until I see the doctor again, till I get the sleep study to solidify central and mixed apnea and time to get the ASV. I really believe the "doctor" portion of my path onto the ASV will be the biggest hurdle, with the only possible exception coming when I'll require the script to be for a ResMed ASV and heated hose. I'm also opening the conversation about an Oximeter as well, because I currently don't have one. With my COPD it feels like my oxygen levels drop at times during the day. So this is something I'd like to monitor and be well aware of what's going on there. Good afternoon all.
I am not a doctor nor do I pretend to be one. Follow my advice as a choice not an order. 2 of these  Coffee Coffee per day keep the bad times away.
Post Reply Post Reply


#70
Another "ASV QUEST" detour.


I went to the sleep center for my final (so I thought) PSG to determine ASV settings.

The way things have been going, I wanted to be absolutely sure, so I asked the tech if it was an ASV study.

"No, the doctor requested a full night on BIPAP ST".

I told him I don't want a PSG unless it's to determine ASV settings for a prescription.


After a bunch of phone calls by the lead tech, he tells me the doctor requires a BIPAP ST "fail" before I can go on ASV".

"I already have a prescription for a BIPAP ST, I didn't fail the last PSG, how am I going to fail this one?" I ask.

Blank stare.

So then I ask him to describe a "fail".
He said he didn't know. He would have to call the doctor during the night and "if he answers I'll ask him to switch to ASV".

I ask "If you don't know what a "fail" is, what would prompt you to call the doctor in the middle of the night?"

"Well, if you don't pass".

Getting dizzy watching him paddle with one oar, I refused the PSG and went home.



Next morning, center manager calls, says doctor requires a BIPAP ST fail so Medicare will approve ASV.


Since the DME provider sent me the full CMS criteria for E0471 Medicare reimbursement, I knew it was BS.

Medicare doesn't care if it's a BIPAP ST or ASV, both are E0471 devices.
As long as medical necessity is established, it's up to the prescribing physician, not Medicare. 

I point this out.

Now she's cornered and FINALLY admits it's the doctor who wants a BIPAP ST "fail" before he'll prescribe an ASV.
Mumbles something about doctor thinks it's dangerous.

Reading between the lines, I've concluded the Docs want to cover their Azzes with medical proof I failed BIPAP ST rather than taking the chance prescribing ASV first off.

I know that's not happening, I passed BIPAP ST in my last PSG.
He's wants to charge for a needless PSG and say "See, I can't prescribe ASV, you went all night on BIPAP ST just fine!" 

So now, I'm contacting the DME provider to see if all the medical necessity requirements have been met for a E0471 device.

Once I've cleared the medical necessity hurdle with Medicare, I can take the diagnosis I have and shop for a different Doc.
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
Exclaimation CPAP Machine Choices - read this before you accept a new machine SuperSleeper 58 25,470 Yesterday, 10:37 AM
Last Post: Sleeprider
  DC Converter for use with Dreamstation Auto BiPAP BiPAPman 5 135 12-08-2017, 10:33 AM
Last Post: BiPAPman
  [CPAP] new user having a hard time mattm1 22 590 12-07-2017, 02:13 PM
Last Post: mattm1
Smile [Equipment] New to DreamStation Old CPAP user JoGlo 3 202 12-01-2017, 01:53 AM
Last Post: trish6hundred
  [Pressure] Centrals increasing; new to BiPap cdbeardie 39 996 11-28-2017, 04:05 PM
Last Post: SarcasticDave94
  HI! - new user reporting in (FP/Resmed/Philips info) Keljian 12 339 11-28-2017, 03:08 AM
Last Post: Keljian
  New User of 2 Nights Solar Rays 13 480 11-26-2017, 06:42 AM
Last Post: Solar Rays

Forum Jump:

New Posts   Today's Posts




About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.

For any more information, please use our contact form.