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self titrating an ASV
#1
I recently just had a sleep lab titrate a bipap
it was at TOTAL FAIL 
possibly because i cant sleep at the hours the sleep labs want us to

i have central apnea,  had it for decades.  OSA is new.
doctor wrote Rx for an ASV

now they want me to do another sleep study to titrate the ASV
WTF!
a couple hours sleep in a strange environment is not going to be typical
I think a month sleeping at home and adjusting the ASV if necessary would be more realistic and likely to succeed

Is there any reason not to start at the bipap numbers
and turn on all the automation they blocked on the bipap
and lower some numbers to help avoid CAs

has anyone self titrated an ASV
is there any valid reason not to try that 

Or maybe I should forget the whole thing
high enough pressure to help the OSA will cause more CA
so maybe I can't do any better with a machine

all advice sincerely appreciated
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#2
My doctor required me to undertake a sleep test using the ASV machine before he would give me an Rx for the machine.  He wanted to see how I would respond to ASV therapy.  I responded very favorably, reducing my events from 24 per hour to under 3 per hour.  I have been on this machine now for about 6 months and love it. Also, Medicare probably wants such a test before approval of this very expensive machine.
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#3
(05-13-2017, 12:09 PM)jerrydaw Wrote: My doctor required me to undertake a sleep test using the ASV machine before he would give me an Rx for the machine.  He wanted to see how I would respond to ASV therapy.  I responded very favorably, reducing my events from 24 per hour to under 3 per hour.  I have been on this machine now for about 6 months and love it. Also, Medicare probably wants such a test before approval of this very expensive machine.

mine gave me the Rx for an ASV because the bipap failed
he wrote up a justification for it
i do NOT have medicrap

it may or may not work
but trying it at home for a month will prove more than one night without much sleep in some lab that is totally different environment and bed etc
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#4
xxyzx,
Well, some day you may have to settle for Medicare and be thankful for it.

The bottom line is there are rules to follow when it comes to dealing with insurance, and most insurance follow Medicare guidelines, and I have no doubt your doctor is aware of that.

If they require an ASV titration, then just do it.  
You have been bucking the system for some time now, and still don't have your ASV.  Hammer
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#5
(05-13-2017, 01:25 PM)xxyzx Wrote:
(05-13-2017, 12:09 PM)jerrydaw Wrote: My doctor required me to undertake a sleep test using the ASV machine before he would give me an Rx for the machine.  He wanted to see how I would respond to ASV therapy.  I responded very favorably, reducing my events from 24 per hour to under 3 per hour.  I have been on this machine now for about 6 months and love it. Also, Medicare probably wants such a test before approval of this very expensive machine.

mine gave me the Rx for an ASV because the bipap failed
he wrote up a justification for it
i do NOT have medicrap

it may or may not work
but trying it at home for a month will prove more than one night without much sleep in some lab that is totally different environment and bed etc

Are you buying fully out of pocket, or insurance?
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#6
(05-13-2017, 02:58 PM)Sleeprider Wrote:
(05-13-2017, 01:25 PM)xxyzx Wrote:
(05-13-2017, 12:09 PM)jerrydaw Wrote: My doctor required me to undertake a sleep test using the ASV machine before he would give me an Rx for the machine.  He wanted to see how I would respond to ASV therapy.  I responded very favorably, reducing my events from 24 per hour to under 3 per hour.  I have been on this machine now for about 6 months and love it. Also, Medicare probably wants such a test before approval of this very expensive machine.

mine gave me the Rx for an ASV because the bipap failed
he wrote up a justification for it
i do NOT have medicrap

it may or may not work
but trying it at home for a month will prove more than one night without much sleep in some lab that is totally different environment and bed etc

Are you buying fully out of pocket, or insurance?

i am getting ready to ask insurance to pay for it
so far the lady i talked to did not want to see what the doctor wrote up
the DME fed her a line of crap that i think i got undone
then she called the sleep lab and got confused about what they had done
but sent me approval for a PSG for a CPAP

WTF!!

they gave me a bipap the first time
it failed
the doctor said so and justified it

There is no need to redo a useless test when i cant sleep at that place when they want you to.
and the environment is totally different so the results are more questionable.
Also one night is not as good as a month.

It would be cheaper to let me try the ASV at home and see how it works. 
It is possible that no machine can fix the CA and the OSA for me. 

I am getting all my ducks lined up information wise to be prepared to see their approval guy and bypass the so called service rep.
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#7
I know, and you are right.  BUT, most doctors are bound by Medicare dictates and have to follow the rules.  And truthfully, I can see the need for such a rule.  Medicare is a program that is full of fraud and needs corrective  action. I too had a problem sleeping in a foreign situation.  However, the few hours of sleep that I got, I responded favorably to the ASV machine-and that's what they are looking for.  I bet that I slept less than 3 hours total that night of the test.  It was awful.  I had the Phillips machine for the test, and it had a very slight delay in responding to the inhale breath.  That factor probably kept me awake more than anything.
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#8
(05-13-2017, 07:19 PM)jerrydaw Wrote: I know, and you are right.  BUT, most doctors are bound by Medicare dictates and have to follow the rules.  And truthfully, I can see the need for such a rule.  Medicare is a program that is full of fraud and needs corrective  action. I too had a problem sleeping in a foreign situation.  However, the few hours of sleep that I got, I responded favorably to the ASV machine-and that's what they are looking for.  I bet that I slept less than 3 hours total that night of the test.  It was awful.  I had the Phillips machine for the test, and it had a very slight delay in responding to the inhale breath.  That factor probably kept me awake more than anything.

only if you are on medicrap !!!!!!!!!

some people have real insurance
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#9
(05-13-2017, 07:19 PM)jerrydaw Wrote: I know, and you are right.  BUT, most doctors are bound by Medicare dictates and have to follow the rules.  And truthfully, I can see the need for such a rule.  Medicare is a program that is full of fraud and needs corrective  action. I too had a problem sleeping in a foreign situation.  However, the few hours of sleep that I got, I responded favorably to the ASV machine-and that's what they are looking for.  I bet that I slept less than 3 hours total that night of the test.  It was awful.  I had the Phillips machine for the test, and it had a very slight delay in responding to the inhale breath.  That factor probably kept me awake more than anything.

been there done that

3 hours sleep and they woke me up
almost 7 hours with zero sleep 

their machine was not bad once i fell asleep and they had stopped hunting for a baseline number
they started at 5 and worked up slowly
i needed 14
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#10
(05-13-2017, 04:10 PM)xxyzx Wrote:
(05-13-2017, 02:58 PM)Sleeprider Wrote:
(05-13-2017, 01:25 PM)xxyzx Wrote: mine gave me the Rx for an ASV because the bipap failed
he wrote up a justification for it
i do NOT have medicrap

it may or may not work
but trying it at home for a month will prove more than one night without much sleep in some lab that is totally different environment and bed etc

Are you buying fully out of pocket, or insurance?

i am getting ready to ask insurance to pay for it
so far the lady i talked to did not want to see what the doctor wrote up
the DME fed her a line of crap that i think i got undone
then she called the sleep lab and got confused about what they had done
but sent me approval for a PSG for a CPAP

WTF!!

they gave me a bipap the first time
it failed
the doctor said so and justified it

There is no need to redo a useless test when i cant sleep at that place when they want you to.
and the environment is totally different so the results are more questionable.
Also one night is not as good as a month.

It would be cheaper to let me try the ASV at home and see how it works. 
It is possible that no machine can fix the CA and the OSA for me. 

I am getting all my ducks lined up information wise to be prepared to see their approval guy and bypass the so called service rep.

Hi xxyzx,

The PSG is usually the first overnight test, given to monitor your sleep without any CPAP machine.

You may be able to find a different sleep lab covered by your insurance which, after you show them the ASV prescription, will be able to help get an ASV titration preauthorized by your insurance.  Titrations are usually ridiculously expensive and I suggest not scheduling one unless it is preauthorized with insurance paying for it. 

You already have the prescription for an ASV machine, and if you want to pay for the machine out of pocket without help from insurance Supplier #2 on our supplier list presently has available relatively inexpensive gently used ResMed S9 Auto ASV machines for US$ 1,249 (REF# 36037).

But if you would want an insurance company to reimburse you, you would need to follow whatever rules they may have, which usually say an ASV titration is needed first to prove benefit, or else no reimbursement.

Your present bilevel settings are 11/14, which I suppose means 11 while exhaling and 14 while inhaling. This implies you need up to 11 while exhaling in order to prevent most obstructive events, and 3 higher when inhaling in order to avoid Flow Limitations.

The ResMed ASV machines have only a few settings and are largely self-titrating.  Settings of 9 for Min EPAP and 13 for Max EPAP would be two lower and two higher than your present EPAP setting of 11. A setting for Min Pressure Support of 2 or 3 would be around the same as your present PS of 3.  The Max PS setting must be at least 5 higher than the Min PS setting, and I would suggest using a Max PS setting of 10 or higher (but higher than 10 is usually not needed unless you have COPD or another unusual lung condition).

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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