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Otolaryngologist Appointment!!!
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archangle Offline
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Machine: ResMed S9 AutoSet
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Post: #11
RE: Otolaryngologist Appointment!!!
(12-21-2012 09:45 AM)Ugly Wrote:  I took special notice of the ResMed AutoSet CS but after further investigation it may not even be available in North America.

AutoSet CS may be the same machine as S9 VPAP Adapt in the US.

Or not. ResMed is pretty darn confusing about which machine is which.

AutoSet CS is definitely a machine for central apnea/Cheyne Stokes Respiration, and will be MUCH more expensive. Maybe 5X more expensive.

Get the free SleepyHead software here.
Useful links.
Click 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.
12-21-2012 05:19 PM
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TheWerkz Offline

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Posts: 261
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Machine: ResMed S9 AutoSet
Mask Type: Full face mask
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Post: #12
RE: Otolaryngologist Appointment!!!
(12-21-2012 09:45 AM)Ugly Wrote:  I took special notice of the ResMed AutoSet CS but after further investigation it may not even be available in North America.

Oh great, now you've got to move to another country just to get the machine you want. Dielaughing
12-21-2012 05:26 PM
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vsheline Offline

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Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #13
RE: Otolaryngologist Appointment!!!
(12-21-2012 05:19 PM)archangle Wrote:  
(12-21-2012 09:45 AM)Ugly Wrote:  I took special notice of the ResMed AutoSet CS but after further investigation it may not even be available in North America.

AutoSet CS may be the same machine as S9 VPAP Adapt in the US.

Or not. ResMed is pretty darn confusing about which machine is which.

AutoSet CS is definitely a machine for central apnea/Cheyne Stokes Respiration, and will be MUCH more expensive. Maybe 5X more expensive.

Hi Sean,

Congratulations on your approval for an S9 AutoSet! That's great!

I think your having taken an assertive stance on this was probably a major factor in your success. Good going!

By the way, to qualify for a machine which treats Cheyne-Stokes Respiration and Complex apnea, I think insurance companies require our CAI (Central Apnea Index) all by itself to be above 5.0 while we are being treated with a more standard (more economical) xPAP machine.

The S8 AutoSet does not report data on the various types of apneas. If a CAI of less than 5 is considered normal and would prevent insurance coverage for something like the S9 VPAP Adapt model, your trial with the S8 AutoSet would not have given your DME or anyone else enough data to determine that you actually need the more expensive model, even if your AHI while being treated with the S8 AutoSet was higher than 5.

However, after you start using your S9 AutoSet you will be able to monitor for yourself (thanks to the knowlege available from this forum) how well your therapy is working for you, and whether you need an even more capable machine.

If it wouldn't benefit us more to use a more capable model than the S9 AutoSet, it wouldn't make sense for us or for our insurance to pay more for one, to pay today several times as much for a more capable machine which we might never need. And if in future our need for a better machine becomes clear, by that time perhaps a newer and more capable (and maybe also more affordable) model may be available.

Take good care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
12-23-2012 02:01 AM
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Ugly Offline

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Other Comments: Hydrocephalus, myopia, depression, chronic ugliness, stupidity, tinnitus, mixed sleep apnea.

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Post: #14
RE: Otolaryngologist Appointment!!!
(12-23-2012 02:01 AM)vsheline Wrote:  
(12-21-2012 05:19 PM)archangle Wrote:  
(12-21-2012 09:45 AM)Ugly Wrote:  I took special notice of the ResMed AutoSet CS but after further investigation it may not even be available in North America.

AutoSet CS may be the same machine as S9 VPAP Adapt in the US.

Or not. ResMed is pretty darn confusing about which machine is which.

Let's see how they do in side by side taste tests.
Obviously I don't have one of each but I printed out the ResMed "fact sheets" on every model I could find.

They both weigh 835g.
AutoSet CS has ASV, ASVAuto and CPAP modes.
Actually they both do. I don't know, although I was warned that if I wanted a VPAP and was permitted by the doctor, I would have to pay three, maybe four fifths of the cost since disability only has an allowable amount and I'd have to fork out for the rest.
Regardless, a "regular" AutoSet will probably do fine.

Quote:Hi Sean,

Congratulations on your approval for an S9 AutoSet! That's great!

I think your having taken an assertive stance on this was probably a major factor in your success. Good going!

Assertiveness isn't my strong point but I try. And I have to make sure I have the "ammunition" to argue my point. My information provided by the S8 helped immensely.

Quote:By the way, to qualify for a machine which treats Cheyne-Stokes Respiration and Complex apnea, I think insurance companies require our CAI (Central Apnea Index) all by itself to be above 5.0 while we are being treated with a more standard (more economical) xPAP machine.

I may have to go the dangerous route to find out.
Set the machine for as low as it will go to find out what my AHI is with minimal assistance. That certainly wasn't done during my sleep study. My successful AHI numbers, USUALLY under 5 are while the CPAP was in use so I don't have a real number as to where I'm at.
Then again I don't know if I'm comfortable with finding out since I'd rather use the machine at a functioning level. Regardless, I was never diagnosed with Cheyne-Stokes (the "CS" in the AutoSet CS).

Quote:The S8 AutoSet does not report data on the various types of apneas.


I learned that. So I had to take the numbers at face value realizing that it's the best information I had available. It was, however, enough to argue my point to the RT and the doctor.

[qutoe]
If a CAI of less than 5 is considered normal and would prevent insurance coverage for something like the S9 VPAP Adapt model, your trial with the S8 AutoSet would not have given your DME or anyone else enough data to determine that you actually need the more expensive model, even if your AHI while being treated with the S8 AutoSet was higher than 5.

The woman at VitalAire didn't even have a clue I was dealing with mixed apnea. It never registered during the sleep study. But then again, neither was anything else so I wasn't surprised.
Until the time comes when I duke it out with the powers that be, at least I can work with the prescribed pressure of 11.0 (up from what I had previously, 8.0 although I had it on 8.2 for the past few days.
Actually I think it's starting to help although it's not instant.
12-23-2012 04:08 PM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #15
RE: Otolaryngologist Appointment!!!
(12-23-2012 04:08 PM)Ugly Wrote:  
(12-23-2012 02:01 AM)vsheline Wrote:  By the way, to qualify for a machine which treats Cheyne-Stokes Respiration and Complex apnea, I think insurance companies require our CAI (Central Apnea Index) all by itself to be above 5.0 while we are being treated with a more standard (more economical) xPAP machine.

I may have to go the dangerous route to find out.
Set the machine for as low as it will go to find out what my AHI is with minimal assistance. That certainly wasn't done during my sleep study. My successful AHI numbers, USUALLY under 5 are while the CPAP was in use so I don't have a real number as to where I'm at.
Then again I don't know if I'm comfortable with finding out since I'd rather use the machine at a functioning level. Regardless, I was never diagnosed with Cheyne-Stokes (the "CS" in the AutoSet CS).


Quote:If a CAI of less than 5 is considered normal and would prevent insurance coverage for something like the S9 VPAP Adapt model, your trial with the S8 AutoSet would not have given your DME or anyone else enough data to determine that you actually need the more expensive model, even if your AHI while being treated with the S8 AutoSet was higher than 5.

The woman at VitalAire didn't even have a clue I was dealing with mixed apnea. It never registered during the sleep study. But then again, neither was anything else so I wasn't surprised.
Until the time comes when I duke it out with the powers that be, at least I can work with the prescribed pressure of 11.0 (up from what I had previously, 8.0 although I had it on 8.2 for the past few days.
Actually I think it's starting to help although it's not instant.

Hi Sean,

Simply using the regular S9 AutoSet with an appropriate (normal) minimum pressure and maximum pressure and looking at the SD card data will show clearly whether you have any Complex Sleep Apnea and how much (if any) of your AHI is attributable to clear airway events. Same thing if using it in CPAP mode at normal CPAP pressure, the data in the SD card will be able to show you what you need to know.

It will be totally unneccessary to lower the pressure or anything like that. The S9 AutoSet reports a breakdown showing Obstructive Apneas separately from Central Apneas separately from Unknown type Apneas, so it is immediately obvious how many of your apneas are clear airway apnea events. And the waveforms show when during the night each event occured, and its type (OA, CA, or Unknown), and what the pressure was during each event, and pretty much everything else you would want to know except Pulse rate and Oxygen Saturation levels (have to use separate Pulse-Ox for those).

I think I may be missing something, because you seem to strongly suspect you have Complex Sleep Apnea, yet I do not yet see in the data you have shared any basis for your concerns.

Can you explain for me what makes you suspect you have anything more than common Obstructive Sleep Apnea?

You certainly have at least Obstructive SA because the S8 AutoSet raises the pressure only in response to obstructive events.

Although the S8 AutoSet does not *report* a breakdown showing the number of obstructive events versus Unknown or Cental events, the S8 AutoSet and S9 AutoSet only raise the pressure when they classify an event as being obstructive in nature. I know this because I have Complex Sleep Apnea and for years I used an S8 AutoSet II with the special card reader and ResScan software sold me by my doctor, and the machine would often decline to raise the pressure in response to clusters of apnea events. With my S9 machine, I now can see that when this occurs these are clusters of what the S9 reports as being Central Apnea events. Looking at the high rate Flow waveforms in ResScan or SleepyHead, I can now see that I often have long periods of Periodic Breathing or Cheyne-Stokes Respiration. I have been working for 3 months on getting this diagnosed, getting an ASV Titration done and getting a new machine ordered, and I expect to receive an S9 VPAP Adapt machine soon.

By the way, I cannot imagine that if data from your new S9 AutoSet were to establish that you need the more expensive machine, that you would somehow get "stuck" with having to use the standard S9 AutoSet until the end of its expected 5-yr life. Undoubtedly, the standard S9 AutoSet could be returned for credit toward the more expensive unit.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 12-23-2012 11:52 PM by vsheline.)
12-23-2012 06:19 PM
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