cheyne stokes

[jerry1967]

My AHI is different on my machine vs. sleepyhead. Maybe it was just a fluke I will check again tonight.  The Machine was 2 points higher. No big deal just wondering. Thanks for your answers.

[jerry1967]

Going to Dr. Wed are my Centrals enough to qualify for a AVS machine, I average about 5 per hour?

[Sleeprider]

If your results have dropped to 5/hour then that is near the borderline; however you have also had event rates well over 20/hour. With complex apnea including centrals, hypopnea and obstructive events, your nightly results will be inconsistent.  So, ask yourself if the AHI at 5 is a trend showing progress , or a data-point on a scattergram.  What are your current settings, and do you have a 7-day average AHI, CAI and OAI you can provide?

A member with a relatively low event rate that was approved for ASV was Spy Car.  You can look up his therapy threads and follow that story to where he was provided ASV http://www.apneaboard.com/forums/Thread-...where-I-Am http://www.apneaboard.com/forums/Thread-...-Adventure .  For him it has been a life changing experience for the better.  It's a very good success story to read, but if you start at the beginning, he had considerably lower AHI than yourself.

[jerry1967]

If your results have dropped to 5/hour then that is near the borderline; however you have also had event rates well over 20/hour. With complex apnea including centrals, hypopnea and obstructive events, your nightly results will be inconsistent.  So, ask yourself if the AHI at 5 is a trend showing progress , or a data-point on a scattergram.  What are your current settings, and do you have a 7-day average AHI, CAI and OAI you can provide?

A member with a relatively low event rate that was approved for ASV was Spy Car.  You can look up his therapy threads and follow that story to where he was provided ASV http://www.apneaboard.com/forums/Thread-...where-I-Am http://www.apneaboard.com/forums/Thread-...-Adventure .  For him it has been a life changing experience for the better.  It's a very good success story to read, but if you start at the beginning, he had considerably lower AHI than yourself.

Sorry Sleeprider, I was not very clear in my question. My average AHI is about 12 which includes centrals, hypopnea and obstructive. 99% are central and hypopnea. I might get just one obstructive in a night most of the time I don't get any obstructives. Would this be enough to qualify for a ASV machine in medicare's eyes?

[Sleeprider]

Jerry, yes.  The event rate and type is plenty to qualify for ASV.  Medicare has multiple requirements, and you have already met most of those.  First, you must have a diagnosis of central or complex sleep apnea based on a clinical PSG and physician interpretation.  You must have a titration sleep test that shows improvement on a HCPCS Code "E0470 or E0471".  E0470 is a bilevel without backup, and E0471 is a bilevel with backup rate like the ASV, ST and other ventilators.  An outline of the requirements is here: https://www.resmed.com/us/dam/documents/...elines.pdf

This document is adapted from the National Government Medical Services, and shows the requirements for central and complex apnea in Section III https://www.healthplan.org/sites/default...evices.pdf  

All of this is achieved by reviewing and perhaps revising the conclusions of your previous diagnostic sleep study, with consideration of your failure of CPAP, followed by scheduling another titration study to evaluate efficacy of BiPAP E4070 or BiPAP with backup rate E0471.

III. Central Sleep Apnea or Complex Sleep Apnea:
An E0470 or E0471 device is covered when, prior to initiating therapy, a complete facility‐based, attended PSG is performed documenting the following: (A and B)

A. The diagnosis of CSA or CompSA 2 and
B. Significant improvement of the sleep‐associated hypoventilation with the use of an E0470 or E0471 device on the settings that will be prescribed for initial use at home, while breathing the member’s prescribed FIO2.

If all of the above criteria are met, either an E0470 or an E0471 device will be covered for patients with documented CSA or CompSA for the first 2 months of therapy. If all of the above criteria are not met, then E0470 or E0471 and related accessories will be denied as not meeting coverage guidelines.

Medicare coverage is normally for a rental which converts to ownership after compliance and efficacy are demonstrated.

[jerry1967]

which ASV should I try and get from the Dr.?

[DeepBreathing]

which ASV should I try and get from the Dr.?

Jerry, people seem to have most success with the Resmed Aircurve 10 ASV: https://www.resmed.com/us/en/consumer/pr...0-asv.html

[jerry1967]

Does this one work in Bi-Level and Auto if set to it?

[Sleeprider]

There are ways to set this machine to resemble bilevel auto, if that's what you need, you can save several thousand $$. The Aircurve 10 ASV has three modes: ASV, ASV Auto and CPAP. We can use ASV auto to simulate Vauto and VPAP-S mode, but there may be minor differences.

[jerry1967]

Dr. said I need a machine that helps with Central Obstruction, and Cheyne- Stokes, Hypopnea, and Obstructive.

Which of these are the best E0470 or an E0471 o is there another?

Resmed Aircurve 10 ASV is ok?

BiPAP with backup rate E0471. I guess is the best?