Newbie to CPAP

[Guest]

I'm really kind of over the whole experimental thing. I'm seriously thinking about buying the ASV machine myself and moving forward from there. If I did this, would it take care of all types of apneas once the correct pressures are found? I'm already out $1,000 dollars in 1 1/2 months time trying 2 different machines when that money could have gone towards 1 that would have worked from the start.

[Guest]

Can someone please tell me how to forward data from sleepyhead to this forum. I have tried and cannot figure it out. Also, when i do send the data what are you specifically looking for? Please advise, thanks.

[palerider]

Can someone please tell me how to forward data from sleepyhead to this forum. I have tried and cannot figure it out. Also, when i do send the data what are you specifically looking for? Please advise, thanks.

join the forum, then:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/resources/sleepy ... screenshot
https://sleep.tnet.com/reference/tips/imgur

[Farmboy]

I have been on the BIPAP machine for 46 days now with an AHI score all over the place. On the machine in the clinical menu it displays the following:

Total AHI average: 22.6
Total central AHI average: 19.8

My sleep doctor has put in for an ASV sleep titration which has been under review for 13 days now and it looks like insurance is going to deny the study. Does anyone know how i can purchase the ASV machine on my own and get this moving along. I also know this is a loaded question but if i did purchase the ASV machine will it for sure take care of my issue?

[Farmboy]

I wanted to mention that I'm the one who started this thread. I finally registered like everyone requested.

[Pugsy]

ASV should be covered by insurance...even Medicare will pay for ASV when needed and the need is documented and your Central Index sure documents it.

That said.

Check out secondwindcpap.com for ASV machines. They are pricey for sure but they have some gently used machines at fair prices for the ASV models.
http://www.secondwindcpap.com/

I am familiar with the various ASV models...I use one myself...so I can help with pros and cons of each brand/model ASV.
You are going to be limited to either ResMed or Respironics.
Pros and cons with either but in general I lean towards ResMed as being my own personal preference for a couple of reasons we can talk about later if you wish once you get an idea if going it on your own is what you are going to do.

Stick with the latest models...in the ResMed line that would be the S9 Adapt or the AirCurve 10 ASV. The Adapt is the old name for the ResMed ASV model.
in the Respironics line....PR System One BiPap AutoSV model 960 or the latest DreamStation BiPap AutoSV and I don't remember that model number right off the top of my head.

I wouldn't be afraid to by gently used from secondwind. They will have less than 2,000 hours on them and sometimes a lot less.
I am on my 3rd ASV now...all were used when I bought them (private party purchase) and I sure can't afford brand new.
There is also the option at secondwind of new open box specials...so brand new zero hour machines if you want to go that way.

We have a forum member who dabbles a bit in the cpap market...I don't know if he has any ASV machines at the moment...typically if he does they will be used and in the $700 to $800 price point (I think).
No warranty at all when going with private purchase...but sometimes you save enough and it doesn't matter.
Forum member grayghost4. Send him a private message if you want to check out what he might have and price.

[Farmboy]

Pugsy,
Do you know if i can buy this machine without a prescription? The doctor said you would not order the machine for me without doing the titration. I really don't I know what direction to go from here.

[Pugsy]

Pugsy,
Do you know if i can buy this machine without a prescription? The doctor said you would not order the machine for me without doing the titration. I really don't I know what direction to go from here.

Technically from a DME or normal supplier...a RX is required. That said...there's always a way to bend some rules but you need your doctor's help if you are going to try secondwind because I think they will likely require a RX if you are in the United States.

And if your insurance won't pay for the ASV...will they at least pay for the titration sleep study?
Is a titration sleep study REALLY mandatory...well..it's likely the "best" way to go but a person can do it themselves with some education and proper support and again it would be best if the doctor was on board.

You can buy privately without a RX. That's what I did. I don't have an official RX and in all honesty don't really need ASV for centrals but there are other uses for ASV and that's why I am using it.
Figuring out pressure settings takes more time when you do it yourself but it can be done.

I don't understand what your insurance's problem is. It's not like your central index is just marginally bad....it's really bad.

You don't have any history of cardiac problems like congestive heart failure do you?

[Farmboy]

Pugsy,

No, I have no history of any other health issues besides dealing with sleep apnea. I did have a physical and full blood panel done yesterday and should have the results tomorrow. I'm 42 years old male, 5' 10' and weigh 215 pounds. I really didn't even know I had a problem with apnea. I have always snored but no one ever mentioned that I would stop breathing. What started this journey was me ending up in the emergency room last February, 2016 thinking I was having a heart problems but everything came back normal.

I ended up going on Prozac for anxiety and depression in April of 2016 when my PCP at the time said I needed help from a Psychiatrist. The Psychiatrist is the one that mentioned sleep apnea maybe being the cuplprit. But i gave it 8 months on the medication with no real change so I weaned myself off the Prozac and started my apnea journey in February of 2017.

My symptoms are:
Tired all the time, low energy and just always feel fatigued
Feel dizzy most of the time, sitting or standing
My body aches constantly
Headaches and weird head sensations
Moody and irritable daily

I'm hoping once I get this apnea thing under control that everything will return to normal.

[Pugsy]

Refresh my memory....I can't see all the thread and very short on time at the moment.

Did you have any centrals on the sleep study done to diagnose sleep apnea or did they all pop up only after you started cpap therapy?

Why is your insurance wanting to deny the ASV? What reason do they give?

Gotta go run some errands...strawberry picking on the list. Be back later.
Did I already give you this video? My apologies if I did.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

[Farmboy]

This was my original post. No nose to the hose when this sleep study was performed!

I have just been diagnosed with moderate sleep apnea. Here is an overview of my results, as I have no idea what any of this means. 1 OSA, 50 Central, 2 Mixed, 69 Hypopnea's & 15 RERA's. I have been sent home with the RESMED 10 AUTO-PAP with settings of 6-16. I have tried to use the machine the last 3 nights with little luck. I just get ready to fall into what feels like a deep sleep and am suddenly awakened by the feeling of not being able to breath. I'm looking for any help.

I'm not sure why insurance is giving me the run around. I did receive a call from my sleep doctor 10 minutes ago and was told that they submitted further information to insurance to try push this sleep titration through with the ASV machine.

[Pugsy]

Here is an overview of my results, as I have no idea what any of this means. 1 OSA, 50 Central, 2 Mixed, 69 Hypopnea's & 15 RERA's.

It means you had the centrals before you were even put on cpap therapy so we can't blame the cpap pressure for causing the centrals in your case (some people the pressure is the trigger).

So you have both central apnea and obstructive apnea....so you need a machine that can treat both and that's ASV and it's no wonder the bilevel trial has failed.
You need something to hold the airway open to prevent the obstructive stuff and something that will give you a big burst of pressure when you have a central and aren't breathing.
The bipap you were given does a good job fighting the obstructive stuff but it is useless in helping with the centrals because while it can go higher...it can't go higher fast enough to breath for you when a central apnea is happening.

That's why ASV...it can function like a normal bipap/bilevel machine when fighting the obstructive stuff and can give you that rapid burst of pressure needed to breathe for you when the central apnea is trying to happen.

Your insurance should cover the ASV machine....they do sometimes put up road blocks because those machines aren't cheap but your situation isn't even "iffy"...it's pretty clear cut and they need to just accept the fact and be prepared to pay for it.
Your doctor hopefully can get them whatever is needed to make them quit using the stall tactics.

[Farmboy]

2 other questions.

I have been reading on the ASV machine and read some alarming things about not using if you have heart issues. Does a person need to be checked out by a cardiologist and get the ok before starting with an ASV?

What is a BIPAP ST machine? Will this machine take care of central apnea or is the ASV machine the way to go?

Thanks!

[Pugsy]

I have been reading on the ASV machine and read some alarming things about not using if you have heart issues. Does a person need to be checked out by a cardiologist and get the ok before starting with an ASV?

A couple of years ago a study was released where it was found that a small % of people who had cardiac issues (specifically congestive heart failure with ejection rates below 45 (I think it was 45) who used ASV had a slightly higher death rate than those that didn't.
It was an iffy study...iffy in that ASV compliance wasn't so great on those already pretty sick people anyway so it was up in the air a bit just how much of a part that ASV might have played in things.
But it was enough to cause people to step back and ask about cardiac issues when prescribing ASV.
People in congestive heart failure with cardiac ejection (not sure if that is the right word or not but its something that is measured during a cardiac echo of the heart to get an idea how well the heart is pumping) less than 45 are already pretty sick anyway..and they have some sort of central apnea issues and maybe obstructive apnea issues...so they are already on thin ice.
So...long story short....it was determined that those people might be less at risk if they didn't use ASV and maybe used something else.

If you had heart issues of the magnitude to get that lower than 45 ejection rate...you would already know that your heart was bad.
It wouldn't be something that you had no idea was going on. You would have already most likely seen a doctor for various heart related symptoms like shortness or breath or maybe fluid retention in the extremities..or cough.
I use ASV...I know that my heart is fine and I also understand that there were some gray areas with those studies that got everyone so alarmed....and there are new studies now trying to sort out what the problem is/was or will be.

So even if those studies caused unnecessary alarm...I still prefer to err on the side of caution when it comes to ASV and people with congestive heart failure...just in case.

What is a BIPAP ST machine? Will this machine take care of central apnea or is the ASV machine the way to go?

It would take care of the centrals because it can be set to breathe for you at if you don't breathe often enough. It has what is called a back up rate. It does not do it quite like ASV does...not as big of a jump in pressure but a more consistent inhale/exhale rhythm.
It may or may not work well to fight the obstructive side of things...sort of depends on what pressures you need to fight the obstructive stuff. It can work but finding the right pressures takes more tweaking. I am using one right now...AirCurve 10 ST. Got it used because it was cheap and I wanted to try the AirCurve model. I also have the S9 Adapt....ASV.....think of it as more automated...set the machine some with some basic parameters and let it sort things out. Lot less tweaking needed.

In general if your central apnea was all that you had...the ST model would probably be sufficient and do a good job for you but the obstructive side of things makes it a bit more complicated. You need a machine that will easily adapt/adjust to fight either type of apnea you might have and be able to do it quickly...hence the ASV being number one choice.

I am using the AirCurve 10 ST model in fixed pressure mode. Essentially it is working just like your current BiPap machine...I have made it work but it isn't ideal for me.. I have to use 10.8 exhale and 15 inhale pressure...all night long to get the same AHI that I get with the S9 Adapt set at 6.6 exhale and 9.6 inhale.....and I can tell you that 6.6/9.6 is sooooooo much nicer for the bulk of the night than 10.8/15 is all night. I sometimes need upwards of 16 to 18 cm to hold my airway open and prevent the airway from collapsing...obstructive is my main problem.
With the ASV the machine only goes up to that 16 or 18 when needed...and I normally don't need it except in REM sleep where my OSA is worse. So I use lower pressures most of the night and use higher only when needed.
With the ST machine I have to use higher all night...and while it is doable...I am lazy and actually prefer lower. It's simply more comfortable.
So why did I buy a machine that won't auto adjust and I knew I would have to use more pressure all night you might ask?
Because I knew I could handle it and make it work and the price was too good for me to pass up and I wanted an AirCurve 10 and couldn't afford the AirCurve 10 ASV. My ultimate goal would be AirCurve 10 ASV but the price right now is simply more than I can comfortably afford and they are also as scarce as hens teeth...keeps that price high.

We could likely get you treated for both central and obstructive apnea with the ST model....just takes more tweaking and very likely more pressure all night instead of just some of the night.
If you were my husband...no history of cardiac issues...and knowing what I know about how these machines go about doing things...you would be getting an ASV...it's more of a "set it and forget it" type of thing with a rather wide range of available settings that can auto adjust and get the job done.
Even the back up rate is auto and based on your own average breathing rate instead of some artificial number rate that may not work well for you.

You might find this interesting...it's Respironics titration for ASV but the basic prinicples are the same no matter if it is ResMed or Respironics.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf

[Farmboy]

Pugsy,

As always thanks for all the info. Will keep you updated over the next couple of weeks.