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[Treatment] Ontario Canada Resident--Prescription for APAP, or ASV machine?
#1
Ontario Canada Resident--Prescription for APAP, or ASV machine?
Good day,

My Sleep Doc in Oakville will not prescribe an auto pap, auto or ASV machine to me. He will only prescribe a CPAP machine.  I have severe sleep apnea, and have been compliant foremost 35 years.

Do you have a prescription from an Ontario sleep doc for one of these machines?

Please help. I would like to know a sleep doc that is an expert and who has prescribed one of these machines.  

Dave
DaveL
compliant for 35 years



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#2
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
Wouldn't another ResMed AutoSet or AutoSet For Her, or at most a VAuto for BPAP, do you well? An ASV will be overkill unless you have idiopathic Central Apnea, which I didn't think you have.

Your other thread has you running a minimum of 15. The VAuto would likely be more comfortable. I suppose there's a Canadian aspect I'm missing, but if your sleep doc can't see this as a good idea, he may be sleeping on the job.
Dave

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#3
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
DaveL,
The Ontario Med system has (mis)declared the AutoSet for Her to be a CPAP. INSIST on THAT machine. Not the Autoset (APAP), not the AS11 (APAP) Autoset for Her (CPAP).
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#4
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
It may be very difficult to get an ASV machine in Ontario, as they are not covered by the Assistive Devices Program.

It may well be time to find a doctor who keeps up with new developments... Any of the AutoSet machines can be set to use a CPAP mode, so there is no reason to use an Elite, or worse yet, an An AirSense 10 CPAP model. Unless the doctor doesn't trust you to only use the CPAP mode... in which case you should find a new doctor who doesn't have trust issues.

The doctor I had in 2015 was quite happy to prescribe an Autoset for me; he has since moved to Mississauga, which is almost Oakville Big Grin ... There must be a few others out there.

By the way, there is no longer any price difference on the ADP schedule between CPAP and APAP machines.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#5
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
(12-02-2021, 03:11 PM)pholynyk Wrote: It may be very difficult to get an ASV machine in Ontario, as they are not covered by the Assistive Devices Program.

It may well be time to find a doctor who keeps up with new developments... Any of the AutoSet machines can be set to use a CPAP mode, so there is no reason to use an Elite, or worse yet, an An AirSense 10 CPAP model. Unless the doctor doesn't trust you to only use the CPAP mode... in which case you should find a new doctor who doesn't have trust issues.

The doctor I had in 2015 was quite happy to prescribe an Autoset for me; he has since moved to Mississauga, which is almost Oakville Big Grin ... There must be a few others out there.

By the way, there is no longer any price difference on the ADP schedule between CPAP and APAP machines.

May I ask your doc's name?

I'm in Mississauga.  I went to Oakville/Burlington to find a family doc and a DME supplier.  I had fired my old family doc. And my sleep doc. Both were Dr DoLittles/cwacks.

Thanks everyone for your posts and answers.
DaveL
compliant for 35 years



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#6
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
DaveL - Reading back, I am now puzzled as to why you want to replace a year and a half old Autoset for Her, unless you want to replace it with a VAuto.

In any event, I have forgotten the doc I saw six years ago. I'd recommend you email the Otario ADP and ask for a list of registered sleep clinics in Mississauga. That will be up to date. I have found them to be most helpful when I have written to them.

TO: adp@ontario.ca
Subject: Registered Sleep Clinics - Mississauga
Hello -

Please send me a list of the sleep clinics located in Mississauga.
An email reply is quite acceptable for this question.

Thank you
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#7
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
(12-02-2021, 01:41 PM)DaveL Wrote: Good day,

My Sleep Doc in Oakville will not prescribe an auto pap, auto or ASV machine to me. He will only prescribe a CPAP machine.  I have severe sleep apnea, and have been compliant foremost 35 years.

Do you have a prescription from an Ontario sleep doc for one of these machines?

Please help. I would like to know a sleep doc that is an expert and who has prescribed one of these machines.  

Dave

I just looked up Ontario and it appears that Ontario has an extensive Assistive Device Program (ADP) that covers a large range of equipment.
Below is the complete list of what Ontario Health Insurance covers which by the way includes all sorts of BIPAP machines.
They do NOT cover ASV machines, i guess because they are so incredibly expensive in comparison.
Get your doctor to at least prescribe a BIPAP machine. Its not as if HE /SHE is paying for it, is it?:-)
Here is the link to the pdf list of devices covered by Ontario government:

https://www.health.gov.on.ca/en/pro/prog...manual.pdf

Through the Assistive Devices Program (ADP), we help you cover the cost of:

  • cardiorespiratory monitors

  • suction devices (stationary and portable) and the supply items used with the device

  • medication compressors (stationary and portable)

  • high output air compressors

  • airway clearance devices (percussors and postural drainage boards only)

  • Positive Airway Pressure (PAP) systems, including

    • Continuous Positive Airway Pressure (CPAP) systems

    • Auto-Titrating Positive Airway Pressure (APAP) systems

    • Bi-Level Positive Airway Pressure (BPAP) systems

  • [size=undefined]tracheostomy equipment and supplies, including[/size]

    • tracheostomy tubes

    • speaking valves

    • supply items used with the tracheostomy
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#8
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
Thanks S. Manz.

The secret is to find a sleep doc that is really interested in improving patient care. I spent a lot of time on rate my doc trying to do that. I also work in a large corporation. Years ago I asked everyone I saw with mask strap marks whether they had a good sleep doc and a good DME supplier.

First improvement--I changed DME suppliers. A friend answered positively to both questions. I changed DME suppliers, and that made a huge difference in equipment selection. I still go there to select masks.

Second improvement--when my new family doc referred me to his sleep doc I went there. I had a sleep study. I did get an S10 *for her* but the prescription is for a cpap, with pressure=13.

Third improvement--I got the clinician report here; I set up the machine and asked for help. I'm still asking for help! I'm embarassed how little I know about apap therapy. I'm learning slowly.

Fourth improvement--I'm paying attention to how I feel; not as much to numbers.

And yesterday I made a setting change, and the effect was positive! I woke up feeling rested! That's happened about 10 times in almost 35 years of treatment.

Dave
DaveL
compliant for 35 years



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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#9
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
I hear you Dave. Sleep docs all over the world seem to be a league of their own. My expedience dealing with them has been how secretive they are and how hard it is to get advise, which explains why forums like this exist.
As for PAP therapy I think of bare bone CPAP machines that don't do anything other than blasting a continuous flow of air down a patient throat without providing so much as a small relief for exhalation, as early dinosaurs of the CPAP therapy world until it flashed in an engineer's head that it may be a good idea to provide exhalation relief by dropping the pressure down for exhalation via the employment of a "Pressure Relief Valve" which was of course not even a new invention by the time CPAP designers thought of using them for their CPAP machines and that's how A(uto) PAP machines or APAPs were born.
It wasn't too long before someone else thought about employing an algorithm to finely control an APAP to a point where the patient could choose not only what pressure to choose for inhalation (IPAP) and what pressure to set their machine to for inhalation (EPAP) and that's how BiPAP machines (or BiLevel PAP machines) were born..(there's a lot of "PAP" terminology in this respitory world, isn't there?:-)
Anyway not long after that these  companies started looking at their own line of clinical ventilators (like Philips) and thought why not design a machine for home use that can monitor feedback from the patient's own breathing pattern and then continousely (and automatically) adjust machine respitory parameters such as max/min pressures for both inhalation and exhalation , on a breath by breath basis and that's how Auto Servo Ventilation or ASV machines were born which fundumentally changes at home pap therapy altogether.

I believe that a large number of graduate sleep doctors and clinicians never even receive ASV therapy as a formal curriculum and a part of their graduate studies which can explain why they shy away from ASV therapy for the most part as conventional PAP therapy is what they are most comfortable with.

All the best finding a good doc but in Ontario you have to have a pretty understanding family doctor to refer you to a sleep doctor of your choice. Isn't that still the case in Ontario?
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#10
RE: Ontario Canada Resident--Prescription for APAP, or ASV machine?
S. Manz

"All the best finding a good doc but in Ontario you have to have a pretty understanding family doctor to refer you to a sleep doctor of your choice. Isn't that still the case in Ontario?"

When I lived in London ON I had a good sleep doc; however, I got a brick.

When I moved to to Mississauga I had to wait a long time to get a family doc. Doc DoLittle was a quack. He referre me to Dr Inouye. My sleep doc for a long time.He was a quack too. 

So I didn't have an understanding family doc. I didn't have any say picking a sleep doc. I complained regularly to family doc.  Turns out he sent a report after every visit. I never knew that.  My sleep quality was terrible.  During that period---total of 20 years I can count the number of times I felt refreshed the day after therapy on fingers of one hand.

It takes a long time to get a family doc in the Greater Toronto Area. Years.  

Dave
DaveL
compliant for 35 years



I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

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