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How/When do you know you need a BiPAP or ASV
#1
If I needed a BiPAP or ASV machine how would I know? What would be the signs or symptoms?

I don't think I do but after 6 months, I don't think I am there yet. My sleep has gotten much better and probably as good as it is going to get. Daytime naps are a thing of the past. But, my AHI is still erratic. On any given day it can be as low as 0 and as high as 7. I have not had a single obstructive event in months. Maybe I am a bit impatient but I would like to know why BiPAP or ASV?
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#2
Given your second paragraph, you appear to not need one.

The ASV would be for a person who cannot get good results due to central or mixed apnea.
They are expensive; and the insurance companies generally make a person fail on every other therapy mode.

Bilevel is used for people who require higher pressures and need more than 3 EPR; or those with other problems like COPD.
At your pressure, you would not need a bilevel.

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#3
Based on your profile, you have EPR switched off. If you were to increase minimum pressure as needed to prevent OA, and turn EPR to 3.0, you would get a sense of what bilevel is all about. Bilevel and ASV are two different animals. An adaptive servo ventilator uses a higher EPAP to cause a breath when a central apnea occurs. Most insurance will not approve reimbursement for ASV unless CAI is regularly over 10. BiPAP / VPAP or bilevel is simply pressure support that makes pressure more tolerable and comfortable. It might be justified for people with aerophagia, or those who don't tolerate CPAP because they feel stressed by exhaling against pressure. It is also prescribed when CPAP pressure is relatively high. I got mine because it's more comfortable, and it actually reduces RDI (RERA) for me. It does not resolve CA, and is still mainly an obstructive apnea treatment device.
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#4
I spent almost a month in the hospital with an ASV bipap. It will force you to breathe even if experiencing central apnea's. My pressures in the hospital were 15 inspiration and 5 expiration. Beside the pressures it also monitors time since you last breath and after a set period will force you to breathe. The hospital thought I needed an ASV for use at home but now doing well with just a type S bipap, which is just an advanced cpap. it does not force breathes.
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#5
The doctor who ordered your study would be one to tell you if you needed a therapy change. that would be the place to start.

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#6
Bilevel PAPs are machines that go higher than 20 and can have exhale pressure difference greater than 3. Other xPAP machines only have an exhale difference of 3 or less. BPAPs are best for those with lung conditions such as COPD.

ASV PAPs are for those with Central or Mixed apnea. They are not for those who only have obstructive apnea.

Both of these kinds of machines are very expensive. A person has to "fail" using CPAP before most insurance will pay for a BPAP. Usually the failure is due to non-compliance due to not being able to breathe against the pressure.

It is fine if your AHI is still unstable after 6 months. It can take a while for everything to settle down. If you are fiddling with the pressure settings, stop. Pick a setting based on your data and leave it. Leave it alone for at least a month, maybe more. Continue to gather data. Continue to watch the AHI and the 95% and all that. And monitor how you feel each morning, during the day, and before you go to sleep. Start a sleep diary. There are so many factors that go into sleep besides the pressure on your machine. Become aware of those other factors while your body and brain adjusts to that.

The problem would be if the AHI is regularly, more than 5 nights a week, over 5. One or 2 nights, not a problem at this point.

I doubt any of us have the same AHI night after night. We have ranges and trends.
PaulaO2
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#7
When your AHI is 7, is that all clear airway events?

(08-12-2016, 08:21 AM)Rcgop Wrote: But, my AHI is still erratic. On any given day it can be as low as 0 and as high as 7. I have not had a single obstructive event in months.

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#8
[quote='green wings' pid='173361' dateline='1471823546']
When your AHI is 7, is that all clear airway events?

Probably 50%
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#9
(08-21-2016, 07:05 PM)Rcgop Wrote: [quote='green wings' pid='173361' dateline='1471823546']
When your AHI is 7, is that all clear airway events?

Probably 50%

My guess is that the "other" 50% are hypopneas. It would be interesting to see a SH printout showing your flow pattern and events. You might have too much differential between EPAP and IPAP. This can cause an increase in CA type events.

Rich
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