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asv to bipaps
#1
I was misdiagnosed with complex apnea and given a Dreamstation asv.  The only time I got an AHI below 6 was with the following settings: Max P=14, Eepap max=11, epap min=8, emax=3, epap min=0 and bph at auto. It has now been determined that I have no centrals so I am getting a Dreamstation  Bipap s tomorrow what should the settings be for it. This is a long and complex story and I have no charts or data to provide at this time. I'm  just interested in information on settings and operation of this machine. Will accept answers using the SWAG method of diagnosis I often used in my dental practice ie. scientific wild ass guess.
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#2
The Dreamstation Auto SV Advanced could have been set in CPAP mode or with BPM off to simulate a fixed or auto bilevel. You indicate you are getting a BiPAP S, and frankly, I think you should ask for the BiPAP Auto to help you dial in your pressure needs. Like the ASV, the BiPAP auto would allow you a range of EPAP pressures from 8-11 to resolve obstructive apnea, and a pressure support of 0-3 for hypopnea, flow limits and anything else. The big difference being no BPM (backup breaths).

Given what you are saying, you don't need a bilevel at all, and could probably do fine with Auto CPAP. If you are getting an auto CPAP, then a pressure range of 8-14 will probably let you dial in the correct therapy pretty quickly using Sleepyhead or one of the other software packages, depending on what brand and model you are getting.
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#3
Good advice but I am under Medicare and they will not cover those machines without a diagnosis of centrals so I'm going to have to deal with the bipap s for now and I don't know any thing about that machine. What can you set?
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#4
The BiPAP S is a fixed bilevel machine with no backup rate. The cost is no different, and the HCPCS reimbursement code is the same, E0470 (E0470 - Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device).  This is similar to fixed CPAP vs Auto-CPAP which both use the code E0601.   In other words, you can get the Auto BiPAP approved with the same diagnosis, and gain additional flexibility and auto-titration.  I think auto-titration makes sense for you since your doctors apparently don't know what you need.   Dont-know

The major adjustments on a BiPAP S is the EPAP pressure and IPAP pressure.  BiPAP is a Respironics trademark, so that machine also allows adjustment of a comfort feature called BiFlex.

A BiPAP Auto allows a minimum EPAP to be set, a maximum IPAP and a minimum and maximum pressure support.  The purpose of that range is to allow the machine to self-adjust EPAP to resolve obstructive apnea, and to adjust the pressure support to resolve snoring, flow limitations and hypopnea.  EPAP+PS=IPAP.  So if you have a minimum EPAP of 8 and PS min of 2, your IPAP minimum is 10 cm.  If we set the IPAP max to 15, then your EPAP can self-adjust according to your needs.  It is a much better solution for titration than fixed bilevel, and it includes a BiPAP-S mode.  So you get two machines in one, for the same price.

The Resmed version of BiPAP is called VPAP.  It also comes in an Aircurve VPAP-S and Vauto.  Again, the same things apply.  I use the Vauto and it includes the ability to operate as a VPAP-S at fixed pressure.  The major difference between Resmed and Respironics auto bilevel machines is the Resmed uses a fixed pressure support, while Respironics allows a range of pressure support.
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#5
I'm confused? Medicare usually will only cover ASV with centrals. I've never heard of not covering APAP because of no centrals.

Can you clarify that?
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#6
you can mimic your current settings with an auto bipap machine with:
max ipap 14, min epap 8, min ps 0, max ps 3.

with a straight bipap you can only set the ipap and epap. we cannot recommend that setting because we would need to look at a report. possible settings could be... (ipap/epap) 8/8, 9/8, 10/8, 11/8, 9/9, 10/9, 11/9, 12/9, 10,10, 11/10, 12/10, 13/10, 11/11, 12/11, 13/11, or 14/11.

auto bipap adjusts for you, bipap s doesn't. what you set is what you get with the bipap s.
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#7
Well it turns out they can't get a Dreamstation bipap s whatever that is so they are going to give me the auto and that looks like a great machine as it will work in several modes.
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#8
That will work best in the long run. The BiPAP auto will allow the settings of the SV to be duplicated except for backup rate (BPM), which you don't need without central apnea. Let us know if you have any questions.
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#9
I agree. Will it handle any centrals if there are only a few?
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#10
No. It has no capability to increase pressure for centrals, and relies on a spontaneous breathing effort to trigger IPAP and cycle to EPAP.
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