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[split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
As both of you know, the cost of a single sleep test often exceeds the price of advanced therapy machines like this, yet insurance will pay for
1. a diagnostic test
2. a titration test
3. CPAP machine and accessories
4. follow-up doctor's appointment for failed in intolerance to CPAP
5. BPAP test.
6. Bielvel machine and accessories
7. another physician followup
8. advanced titration on bilevel with backup
9. BPAP ST or ASV
10. another physician follow up and possible tests for LVEF% and a whole lotta "you should not do this"
11. ASV titration if they got it wrong at 9.
12. ASV machine and accessories.

I have seen individuals hit all 12 and often with more than one intervening physician appointment. The "system" is designed to frustrate, and I think very very few people without support like is offered on this forum ever get past step 3 before concluding CPAP doesn't work and it's no use. They take the failure on themselves and are shoved out of treatment by noncompliance. We do our best here to let central and complex apnea suffers know what they are up against, and frequently recommend short-cutting the "system" and just buying out of pocket. This is why.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Very good points Sleeprider. I can verify I would likely not have an ASV today if not for you and others here on A.B. and reasonable and wise coaching. I would have been "stuck" on the wrong machine at the BPAP stage or your #6 on the list. The original pulmonary Duck was determined he had me on the right machine (BPAP) until I brought back my copy of the BPAP PSG showing 124 Centrals to 24 Obstructives. And the Duck saying "successfully treated with BPAP pressure of x and y". Nope.

Coffee

PS I think I did dance through all 12 stages with the ASV path. Took about 2 years to get to #12 BTW.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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RE47: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
I was severely beating myself for getting us off topic on my last post where I made a suggestion to improve our American healthcare system.  My underlying assumption was those of us reading the suggestion were not among the 30% to 50% of the users who stop using pressure therapy to combat sleep apnea.  But rather we are dedicated to getting and consistently using the best machine and mask combination possible for our diagnosis.  However, had I not written my previous post, we may have not received one of the most significant (in my opinion) posts from Sleeprider.  He summarized how sleep apnea is treated in a way in which all Americans treated for sleep apnea can easily relate.  Dave immediately could see his ASV sleep apnea story where he had to go through all 12 steps outlined by Sleeprider.  I can show my story that took me through step 9 to get an ASV machine.  I can show my wife’s story by short circuiting the process from step 3 directly to step 9 with the associated cost and time savings. 
 
Sleeprider’s post outlined the process by which all of us Americans diagnosed and treated for central apnea and/or complex apnea currently have to travel unless we take actions recommended by this Apnea Board to short circuit the process.  The underlying assumption is the ASV machine is the best for combating these apnea types unless there is a heart problem; in which case the ST machine is the next best machine (step 9).  I recommend Sleeprider’s previous post be included on his “should read” list associated with each of his posts. Those of us diagnosed with central and/or complex apneas should be trying to get an ASV machine as soon as possible after diagnosis. I had the chance to get an ASV at step 5 but my pulmonary specialist instead prescribed a bi-level machine.  I lost an entire year of better therapy because of my lack of knowledge that has since been provided by this board.  My wife was able to take advantage of this knowledge as well as hopefully my youngest son and one of our grandsons.  Paul T.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Paul, a very well stated point there. Kudos.

I think IMO that this also, even at seeming to be off topic, therapy for xPap is a unique specific to the individual therapy. Nobody can successfully be treated via the "cookie cutter" AKA one therapy good for all approach.

I realize insurance laid out the 12 step situation path Sleeprider posted. They think they're saving money, but I'm certain if more were able to bypass several steps, overall savings would be realized. AND more would have been treated instead of quitting.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
While I don't disagree with anything that all of you have said I do want to point out that the "discovery" of complex apneas is a recent development. Per an article on the mayo website dated Sept. 2006

"Researchers at Mayo Clinic have identified a new type of sleep apnea they call "complex sleep apnea." The newly discovered type, complex sleep apnea, is a combination of both obstructive and central sleep apneas."

"The study involved a retrospective review of 223 patients consecutively referred to the Mayo Clinic Sleep Disorders Center over one month, plus 20 consecutive patients diagnosed with central sleep apnea. The investigators found that complex sleep apnea comprised 15 percent of all sleep apnea patients, while 84 percent had obstructive sleep apnea and 0.4 percent had central sleep apnea."

I am not trying to stick up for insurance companies but they procedure they use may be the best for the majority. And yes there is plenty of room for improvement on their part and the doctors.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
(09-21-2018, 09:24 AM)SarcasticDave94 Wrote: Paul, a very well stated point there. Kudos.

I think IMO that this also, even at seeming to be off topic, therapy for xPap is a unique specific to the individual therapy. Nobody can successfully be treated via the "cookie cutter" AKA one therapy good for all approach.

I realize insurance laid out the 12 step situation path Sleeprider posted. They think they're saving money, but I'm certain if more were able to bypass several steps, overall savings would be realized. AND more would have been treated instead of quitting.

Actually I think Medicare laid out the criteria for issuing machines and requiring patients to fail CPAP to move to BPAP and fail BPAP to move to BPAP advanced, and specify the diagnostic criteria for approval of each level of therapy.  Note most Medicare patients must rent for up to 13 months, so they never own their machine. The private insurance companies, DMEs, clinics and doctors all adopted that as a great idea to both save money by frustrating patients and maximize profits through maximum studies, doctor visits, and equipment sales.  We have seen individuals come to this forum, diagnosed with pure central apnea that were issued CPAP machines and wondered why it doesn't work!  No one was helping them understand.

For an individual with central or complex apnea, all they know is when they use the CPAP they are very uncomfortable and can't breathe with this contraption. That is what a central apnea feels like as you both know. Therapy feels worse than no treatment.  Without looking at data or getting coaching or a physician's help, they simply quit, become noncompliant and turn in the machine.  No one ever looks at why they fail, and they don't get a second chance unless it is on their own dime.


There is plenty of blame that can be directed at insurers, but where it really gets appalling is the number of doctors that refuse to acknowledge central apnea, and have no clue how to treat it.  To these doctors, all apnea is obstructive, and the best treatment is fixed CPAP with no data, and only they can order changes in pressure through appointments, tests and prescriptions.  It seems this standard of care is actually more prevalent than the doctor that actually practices sleep medicine with knowledge, experience, concern for the patient's welfare, and an open mind.
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Agreed there Sleeprider. Thanks for the correction on Medicare setting the guidelines, as when you mentioned it, that's also the basis on the supply, machines, etc. replacement schedule.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Sleepyhead Chart Organization
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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
jminminnesota, this isn't important enough that I'm willing to go to the effort to document / confirm this point and it's not my intent to argue. however, I'm pretty sure mixed apnea was a known thing well before 2006. I was diagnosed central in 1987 but there was discussion from my then sleep doc about mixed apnea. note that (to the best of my knowledge) mixed and complex apnea are different. the first is oa and ca occurring 'natively' while the latter refers to pressure induced ca.
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RE48: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
My wife was prescribed a sleep study in Feb 2018 to get a new machine.  She had been using the same Respironics Solo LX CPAP machine for about ten years and we thought it was time for a replacement.  Even though her sleep study showed a few central apneas, she was once again prescribed a CPAP machine to be set at 8.  We are eligible for Medicare but have retained our private BCBS insurance to avoid all the Medicare coverage hassles.  Our DME decided to let us buy a new Resmed Airsense 10 For Her CPAP (at our request) outright with which our health insurer concurred.  My wife started having central apneas in clusters which were eliminated when she borrowed my ASV machine.  Now that she has her own ASV machine (purchased new on Craigslist for $450) we have the For Her CPAP as a spare machine.
 
Our oldest son’s health insurance will not cover sleep apnea related items for his teenage son.  Our grandson has been diagnosed with dyslexia and attention deficit disorder and just started high school.  So with the knowledge gained during the past few months from this forum, we loaned our grandson my wife’s spare For Her CPAP machine and trained our oldest son on the adjustment procedure.  The attached Sleepyhead graph is typical of our grandson’s progress during the past two weeks.  He is using the machine on average seven and half hours nightly and feeling more alert during the day.  No more snoring throughout the night or frequent thrashing around while trying to sleep.  He is working on sleeping on his side to reduce mask leaks.  We are hopeful this machine will improve his school studies. This is one good use for the spare machines that are accumulating during the 12 step process previously outlined by Sleeprider.  It is also advocacy for in home sleep studies vice those currently accomplished in a lab for just hours one night. We intend to buy a used ASV machine to eliminate the central apneas if the centrals get worse.  The two centrals on the attached were 11 and 13 seconds in duration, only happen during half the nights and no more than three in eight hours. Children can be helped by CPAP, even teenage boys!


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RE: [split] ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea
Paul, I would not consider ASV for the grandson. His results look great, and any centrals are probably sleep disruptions or movement. This does not fit the pattern for a central apnea problem you should consider treating.
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