Colorado Apnea Journey - Complex and Mostly CSA Questions

[CLCCW]

An interesting thread came up recently by someone claiming to be a physician. I have elaborated on some of my thoughts on therapy in that thread https://www.apneaboard.com/forums/Thread...erspective  Loggerhead's take on the pulmonologist sleep specialists should be relevant to you.

Yes! I actually have been following that convo. I am so new to this all. I am a social science/public health researcher and program evaluator by trade, so am naturally curious about all this stuff. I had a "crop" of CA's (a "forest" I call it!) last night and tired today.

Sleeprider, do you think the APAP (CPAP) is just not doing much and should I just stop using it until I get the ASV? Maybe it tamps down any OA I have (minimal). I know you can't tell me but any thoughts?

[SarcasticDave94]

Is the CPAP AutoSet torture or not? Yes, then maybe quit till you get ASV.

[CLCCW]

Is the CPAP AutoSet torture or not? Yes, then maybe quit till you get ASV.

Hey Dave -- I wouldn't say torture... I am actually fairly comfy with my F40 and the system, but still wake up here and there. Just don't know if the APAP is giving me any sort of anti-CSA benefit at all... I mean, my AHI did go down some since testing but not enough and def not enough CSA droppage. Today I feel like junk because it was not a good night last night at all. I wish I could just swap the machine and start the ASV Auto therapy right now. Have to jump thru a few hoops it seems.

Cheryl

[SarcasticDave94]

I was basing comment off my own static bilevel without backup rate. Absolute terrible. If it's not that, then your call on using or not.

Regardless of what some doctors think, CPAP therapy isn't a torture device.

[CLCCW]

Can't get into sleep lab until FEBRUARY! I wrote doc and asked him to advance me the AirCurve 11 ASV with auto sooner than later, will see how that goes. I suppose I could buy but want my good insurance to cover it.

[Sleeprider]

Have a frank discussion of self-titration. As I have said, the automation of the Resmed ASVauto is very good and with only 4 settings for EPAP min, EPAP max, PS min, PS max, it is just begging for self titration. I'll give you the same link I gave Loggerhead as a basis to discuss this with your doctor. Take a look at the titration guidelines and understand clinical titration is very unlikely to do anything more than manually adjust EPAP to resolve any obstruction, while the PS automatically maintains the rate and volume of respiration. I can honestly say, we can normally identify the actual needs of someone using ASVauto in one or two sessions and optimize that range. In the hundreds of ASV patients I have coached, I have never seen anyone harmed by ASV, although there is a range of comfort and tolerance. Go to page 28: https://www.resmed.com/us/dam/documents/...er_eng.pdf

[CLCCW]

Thanks, Sleeprider... Yes, saw this link and saved it the other day. I plan to self-advocate the best I can! Appreciate that I can come back with questions!
Cheryl

[CLCCW]

Doc prescribed the ResMed AirCurve 11. Yay! Should not be long, now, but will have to see if I need to fight the insurance company.

For the Diagnosis codes he put:

• OSA Obstructive Sleep Apnea  G47.33
  

• Treatment-emergent Central Sleep Apnea (CSA) G47.39
  

Why would he call my CSA "Treatment-emergent" when I had complex apnea in my original (first) sleep test? There it said, "Severe Obstructive and Central Sleep Apnea, with an AHI of 37.8 events/hour and an RDI of 41.5 events/hour (normal < 5 events/hour). The scored respiratory events included 10.0 central events/hour. ICD-10 G47.33, ICD-10 G47.31."


I will see if that is an oversight. Don't know if it will make a difference with machine switching approval or not.

Cheryl

[SarcasticDave94]

It might mean a big difference. If my search was correct, G codes are ICD-10 billing codes. Secondly if your Central Apnea appeared in the diagnosic sleep study, they're not treatment emergent, and will have this bill code for Primary Central Sleep Apnea - G47.31.

I would act on this, and get doctor to correct this information.

PS, not only is treatment emergent not accurate, attempting to get ASV with the code your doctor chose will likely be rejected.

[CLCCW]

It might mean a big difference. If my search was correct, G codes are ICD-10 billing codes. Secondly if your Central Apnea appeared in the diagnosic sleep study, they're not treatment emergent, and will have this bill code for Primary Central  Sleep Apnea - G47.31.

I would act on this, and get doctor to correct this information.

PS, not only is treatment emergent not accurate, attempting to get ASV with the code your doctor chose will likely be rejected.

My suspicion exactly.... they might say "oh, those pesky CSA's will resolve with APAP tweaks. No ASV for you!" In fact, in the ORIGINAL sleep study (home) it says this:

"The patient should be referred for an in-lab CPAP/ASV (adaptive servoventilation, effective at treating both central and obstructive sleep apnea) titration. Alternatively, the patient could be placed on an auto- titrating CPAP. However, CPAP may not be effective at treating the central component to the patient's sleep apnea. Close clinical follow-up, including a review of CPAP data downloads to assess treatment efficacy, is recommended. If the patient continues to have signs/symptoms of untreated sleep apnea or a CPAP download demonstrates ongoing respiratory events, either the pressure should be adjusted or the patient should be referred to the sleep lab for CPAP/ASV testing."

I should have been on the ASV path initially, it seems. OK! have messaged the MD about the potential mis-diagnosis. Thanks, Dave!

Cheryl