Why is there such a fuss about giving a CPAP with ASV?

[tsesow]

I'm just finishing the 3 months on APAP (Resmed Airsense 11 autoset) even though my original sleep study
showed CSA with some OSA. AHI 84, O2 down to 84%

As was explained to me, I could do 3 months of CPAP/APAP, or I could try to get an authorization from insurance to go straight to ASV, however
the DME said authorization for ASV might take 3 months. So I decided NOT to fight the system, do the CPAP route, which helped somewhat (although I still wake with a headache and tired, but not as tired in the evening).

On the APAP, my OSA is gone, but my CSA-based AHI is remaining between 20 and 40, with OSCAR showing peak hours around 60-90 for 2-4 times per night.

Using the Resmed reports after about 3 months, my PCP referred me to a Pulmonologist/Sleep specialist. Saw him, was told I needed an ASV, and I am waiting for the titration study to be scheduled now.

[mugen4u]

Your 11 Central Apnea is at least half the events. It's possible this medical team doesn't know what Central Apnea is and/or how to treat them.

Here's the ResMed basic description for ASV

"AirCurve 10 ASV
Leveraging adaptive servo-ventilation (ASV) to target a patient’s recent minute ventilation, the AirCurve™ 10 ASV offers truly personalized therapy for obstructive sleep apnea (OSA), central and/or mixed apneas and periodic breathing. Auto-adjusting pressure support is designed to treat central breathing disorders, while auto-adjusting EPAP is suitable for upper airway obstruction."

Maybe either share this with the medical team, or you may need to look somewhere else that knows about Central Apnea and how to treat them.

she knew about it but she kept telling me that the air pressure can also fix the central apnea events as your body does get oxygen, which means your brain also get oxygen and should not cause central events (or something like that). she was very sure of herself....

[mugen4u]

i'm a bit at the point of giving up and losing hope, now that people keep telling me that the resmed airsense 11 does NOT help against central sleep apnea.

If this really is the case then why do most doctors prescribe anything but an ST or ASV device if they know someone has mostly centrals? it blows my mind that i have to go through ANOTHER CPAP trial even after the first 2 CPAP devices failed to help me (i could not sleep with it).

can anyone please give me some hope when it comes to central sleep apnea and a device like Resmed Airsense 11? is it really doomed to fail?

[SarcasticDave94]

In most cases, insurance requirements dictate you try cheaper CPAP first, wait to fail CA treatment here, bilevel without backup breath rate, again wait to fail or treat CA, then possibly ST ditto the prior - note that while ST treats due solely to the timed breath rate it's rather dumb in therapy and will be pretty uncomfortable. Finally ASV is specifically made to treat Central Apnea. It'll feel different than standard bilevel without backup breath rate, but not as far off as the ST. And the ASV is capable of using 3 variables for pressures, EPAP exhale, PS pressure support, and IPAP inhale, on ResMed ASV at least and in ASV Auto mode.

You'll need to get demanding. Tell the medicals this therapy result on CPAP is not acceptable. Require them to treat your Central Apnea.

[Sleeprider]

We have a wiki discussing how to justify advanced PAP devices https://www.apneaboard.com/wiki/index.ph...P_Machines Since testing and the cost of a device can be prohibitive for many individuals with no insurance or high copay/deductible plans, we often coach members on how to obtain ASV without going through insurance or their doctors. Many of these members have demonstrated efficacy with ASV to their doctors and ended up with a Rx without going through the sleep test. The private resale market on Marketplace, Craigslist, Offer-up have risks, and the site "DotMed" has proven to be a reliable source of advanced devices. That said, you have offered no charts or evidence of your actual problem like a sleep study, or charts from Oscar suggesting you have tried CPAP and have a need for a more advanced device. While CPAP offers no guarantee to resolve CSA, it is effective in 30 to 50% of individuals that try it.

[mugen4u]

We have a wiki discussing how to justify advanced PAP devices https://www.apneaboard.com/wiki/index.ph...P_Machines  Since testing and the cost of a device can be prohibitive for many individuals with no insurance or high copay/deductible plans, we often coach members on how to obtain ASV without going through insurance or their doctors.  Many of these members have demonstrated efficacy with ASV to their doctors and ended up with a Rx without going through the sleep test.  The private resale market on Marketplace, Craigslist, Offer-up have risks, and the site "DotMed" has proven to be a reliable source of advanced devices.  That said, you have offered no charts or evidence of your actual problem like a sleep study, or charts from Oscar suggesting you have tried CPAP and have a need for a more advanced device.  While CPAP offers no guarantee to resolve CSA, it is effective in 30 to 50% of individuals that try it.

Tahnks for your reply.

30 to 50%? i'll take those chances. If it fails then i guess they have to give me ASV.

[CLCCW]

tsesow: Coloradoan here, too. Yes, making the leap to ASV... after just 3 weeks on the APAP. I kept messaging my nice pulmonologist, noting my compliance, comfort under the mask, but OSCAR numbers not going great. He agreed. He ordered a "fractured" ASV titration test in the lab. I think that means they are going to fiddle with the ASV settings all night to find my best settings. Now hopefully my insurance company will agree with all this.

Your apnea pattern is very similar to mine. The machine tamped down any OSAs (still a few), but the cluster of CSAs are quite prolific, in batches throughout the night. Usually around 3:30am is most common for me!

I hope you get on the path to ASV sooner than later!

[mugen4u]

tsesow: Coloradoan here, too. Yes, making the leap to ASV... after just 3 weeks on the APAP. I kept messaging my nice pulmonologist, noting my compliance, comfort under the mask, but OSCAR numbers not going great. He agreed. He ordered a "fractured" ASV titration test in the lab. I think that means they are going to fiddle with the ASV settings all night to find my best settings. Now hopefully my insurance company will agree with all this.

Your apnea pattern is very similar to mine. The machine tamped down any OSAs (still a few), but the cluster of CSAs are quite prolific, in batches throughout the night. Usually around 3:30am is most common for me!

I hope you get on the path to ASV sooner than later!

most apnea events start during REM sleep, and with the previous CPAP trial (twice) i never even got that far as i couldn't sleep that long before i stopped trying so i have no clue if CPAP ever worked for me. 

i dont care about the OSA, 1 year ago i didn't have any OSA at all and still felt like sh*t (the same way as i do now, maybe a tiny bit worse). The OSA is explainable tho, as i got kinda fat.

you talk about 3 weeks, my doctor said to try it at least 3 months!

[SarcasticDave94]

Maybe complain to their office more if you think it'll help speed things along. I called the doctor and DME daily to see when ASV was going to be ordered. They eventually ordered one, like a month I think. I did not stop at ST, as I flat refused it, explaining ASV treats CA.

[mugen4u]

i called them but i have to go through a 3 month CPAP trial, if that fails then maybe (MAYBE????!!!) i qualify for an ASV device.