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new to bipap, lots of central apneas
#11
RE: new to bipap, lots of central apneas
(04-14-2019, 01:41 PM)bonjour Wrote: This is an article we put together outlining justification for getting an ASV machine.

Justifying_Advanced_PAP_Machines

What you are showing in your latest charts is exactly what you need to qualify for ASV.  


  • Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment
  • Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)
  • Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
  1. Sleepiness, "How do you feel?"

  2. Awakening short of breath, "How do you feel?"

  3. Difficulty initiating or maintaining sleep, "How do you feel?"

  4. Frequent awakenings, or "How do you feel?"

  5. Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing

  6. Snoring, Can be documented on Sleepyhead

  7. Witnessed apneas Most of us have this one with our significant others

Wow. So my answers would be:
1. Sleepiness in the upper teens/lower twenties on Epworth most days.
2.Not so's I've noticed
3. Most nights
4. Most nights
5. Almost always
6. Occasionally
7. No, but my husband I usually sleep apart as he snores (and probably should get checked out, but that's another story)

So I guess I need to have a conversation with my doctor.

But my real question is, would using ASV change my answers to the questions to:
1. Generally alert and awake during daytime and evening hours.
3-5. Occasionally or rarely

What has been your experience?
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#12
RE: new to bipap, lots of central apneas
Another question -- does Medicare require an in-lab study for an ASV?
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#13
RE: new to bipap, lots of central apneas
I'm not sure if you're aware of it, but if you set your VAUTO at PS 3.0 (or less), that's the same as using an AirSense 10 with EPR at 3 (or less).  The setting on the AirSense 10 is the same as the Minimum EPAP + the EPR Level.

In other words, if you set your AirCurve 10 VAUTO in VAUTO mode to Min EPAP 4, Max IPAP 12, and PS 3.0, you can get the very same treatment from an AirSense 10 Autoset in Autoset mode by setting EPR  to 3.0, and setting your low pressure to 7.0 and your high pressure to 12.0.  EPR 2 is Pressure Support of 2.0, EPR 1 is Pressure Support of 1.0.
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#14
RE: new to bipap, lots of central apneas
(04-14-2019, 03:45 PM)bemused Wrote: Another question -- does Medicare require an in-lab study for an ASV?

That is the MediCare guideline!

As for how you feel after getting an ASV, I'll leave that for those users here.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#15
RE: new to bipap, lots of central apneas
After a while, It took some time! After getting used to the idea of sleeping with the mask and hose I started to get real rest, I managed to get to be able to sleep sound for about 4 hours a night, this, as it turned out was not cutting it for all day though, my body was used to being in bed for 10 hours or more every night. Getting four hours of restful sleep was all I could handle at first!

After some persistence I found I could sleep longer and longer, this took time. I know get a full nights sleep, 7 to 8 hours, and I feel great and am more alert and active during the day. Stick with it, for me getting used to healthy sleep took time, but has paid off!
"Right wrongs nobody" 
Mountain Charlie McKiernan 
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#16
RE: new to bipap, lots of central apneas
Thanks, that's encouraging. I actually am not minding the mask and hose all that much-- the nasal cushion is a big improvement over what I had with CPAP in the past. And would be worth it to get consistent sleep.
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#17
RE: new to bipap, lots of central apneas
Thanks so much for all this information, it's hugely helpful. I've emailed my doctor and am trying to get things going for the ASV. But in the meantime, can you tell me tell me how many nights I need to be on the bipap and showing the high centrals for it to be officially deemed a failure?
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#18
RE: new to bipap, lots of central apneas
That is up to your doctor as he needs to write the justification.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#19
RE: new to bipap, lots of central apneas
Just remember when it comes to complex apnea, most of the doctors seem to have no clue whatsoever. We have consistently see incorrect prescription and uncertainty on the part of most professionals, and they tend to error on the side of making the wrong and conservative decision for ST BiPAP rather than ASV, even when confronted with Bilevel failure.
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#20
bemused
So my doctor wants me to use the bilevel for a month to see if the CAs resolve, before looking at the ASV. They don't seem to be showing any sign of doing that, however. I had set the maximum IPAP to 12 because I didn't want any big pressure surges, and left the PS at 3 and max EPAP at 4. I had one night (Monday) with near zero OAs and a CA index of about 8, and the max pressure was just above 8. But I only used it about 5 1/2 hours and a chunk of that I was awake but meditating. Last night was one of the worst numbers-wise, though subjectively I felt quite comfortable Thinking-about CAs were way up, but OAs and flow limitations went up too. The thing is that the largest number of supposed OAs occurred when I was awake, which shows in the graph -- the gap is when I took off the mask to pee. That happened another night, too, that the chart showed OAs when I know was awake.

   

The second time I woke up and saw the AHI was over 24 I decided to go without for the rest of the night until I could see what was going on.

So what should be my strategy here? I seem to be stuck with the bilevel for at least a month, probably a chunk longer by the time I go through all the hoops, though if this keeps up I will probably reach out to the doctor sooner. Oddly enough subjectively I am feeling a bit better -- I am speculating that could be because the CAs don't cause arousals like OAs, hypopneas and RERAs do, so I am getting a little more sleep.

I am thinking keep the settings as-is and see what happens, since there seems to be so much variation night to night, rather than trying to chase the OAs and flow limitations. But do I limit the time on therapy? - that is, once I hit 4 hours, when I wake up again turn it off to limit my exposure to CAs, or stay on it all night? I don't have an oximeter so can't tell if my saturation is going down much, but it doesn't seem like a month could do all that much damage even if it is. I assume that is the primary concern with CAs, or is there more to it?
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