[Treatment] Advice Please

[Ryan needs to Sleep]

Morning-

Last night is attached.  My plan this week:

1)Soft cervical collar (already ordered)
2)Get appt. with my sleep doctor asap to push for ASV

Should I stay with the same settings until then?

Thank you!

[Sleeprider]

It's not clear to me that a settings change would be productive at this point. With pressures of only 7-12 and PS 0-2, you are addressing all of the issues about as well as can be expected. The occasional PS is increasing for hypopnea and decreasing for CA. Once you incorporate a SCC to the therapy, the OA problem should nearly fully resolve. This therapy is a compromise approach to the suite of conflicting events you are experiencing.

[Ryan needs to Sleep]

Doctor has set up another sleep study with just ASV. He is balking at the ResMed machine, preferring the DreamStation as it is easier to navigate and program (in his opinion). It seems that you all prefer the ResMed. The patient has a choice in this, correct?

[Gideon]

The doctor can circumvent this by making the prescription DAW, Dispense As Written. Your 'choice' is typically limited to machines within the CPAP class. If the prescription says 'ASV' without a brand you have a choice.
You always have a choice of going outside the system, and we can help with that.

[SarcasticDave94]

Absolutely. You are the patient and your choice is what should count. FWIW the ResMed AirCurve 10 ASV has up to 5 pressure/therapy settings (depending on run mode), Mode then EPAP Min/Max and PS Min/Max if in the suggested ASVAuto Mode. How can that be too hard to program? I did my own when the RT at Apria said she had to guess at the settings when I received mine in 2017. It's easy enough for you to set your own as well and if you want assistance, we're here.

[Ryan needs to Sleep]

Good Morning-
Here are the results from my second sleep study.  This time they used the ASV machine.  This machine is on its way to me.  Do you agree with the MD pressure settings?

[Sleeprider]

Titration indicates non-auto ASV mode, EPAP 7.0, PS 4-20.  Based on those settings, I suspect they are setting you up with a Philips BiPAP Auto SV. My preference would be the Resmed Aircurve 10 ASV for comfort, with settings of ASVauto mode, EPAP min 6.0. EPAP max 8.0, PS min 3.0, PS max 15.0  The problem with the study is that all evaluations use a PS max of 20 and that is usually not needed, and we don't see what was actually delivered.  In other words, it is the best result they got, but it is biased to Philips.  The Philips BiPAP SV titration guide is compared to the Resmed ASV titration guide below.  I think it's obvious where this is going. If you have a preference for a Resmed, you will have to speak up loudly and quickly.

[SarcasticDave94]

I'll throw 2 more cents in. I would call the DME/supplier now/ASAP to find out which ASV they're sending. If you learn it is a Philips, and if you prefer MesMed, tell them loud and clearly you request the ResMed. If you get to the place where you sign and accept it, then it is almost 100% at the point of no return. At that point, they may refuse a swap. I have gotten great results with my ResMed ASV until my COPD complained about it. It was good enough that if I needed to do it over, I would still choose ResMed ASV.

Thumbnail sketch if this were me:

1. Call the DME now, find out if it is Philips Respironics SV Auto (it may be a DreamStation) or the ResMed AirCurve 10 ASV.
   
   
2. Have them tell you exactly the full name of the machine that was ordered, when it will arrive, how it will be delivered as in at office or at home
   
   
3. IF it is not the machine YOU choose, tell them right then NO I want machine (enter full name ASV or SV Auto). Do not accept delivery of that which you do not want. No exceptions, say no I will wait on ...
   
   
4. If the DME is supplying ResMed or Philips and it is not your choice, you may need to touch base with Docs office and tell them and/or get a specific script for ResMed or Respironics of your choice. The script may be worded to name ResMed and DAW/Dispense As Written.
   
   
5. Above all, act immediately on this.
   

Best of luck in success. Update us on how it goes. And if you have questions, feel free to ask.

[Ryan needs to Sleep]

Thank you for the responses.  I called my Dr. and it was indeed a Phillips.  After a little finagling, they changed the order to the Res Med!  Thank you both for the sound advice.

[SarcasticDave94]

Excellent Ryan. Congrats on the win. Keep us updated please. And again if you have any questions, post em here. We'll all do our best to get you through the minefield relatively unhurt. BTW, keep pressure on DME to deliver the ASV. Somehow my DME forgot what it was doing if I didn't call daily to remind them they were working on my ASV order, filling insurance paperwork, and scheduling my delivery. Non-sarcastic I seriously called them every day.