update on the asv saga for the few who have followed it

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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robysue
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Re: update on the asv saga for the few who have followed it

Post by robysue » Wed Jul 19, 2017 1:38 pm

xxyzx wrote: now an ASV self titrates but the DME and bcbs bureaucrats demand that the doctor tell them numbers to use to set it up
WTF! after 5 seconds those numbers will be changed and the machine will be setting the values automatically
The machine has a lot of settings that can/should be set (based on a titration study) that will help the machine work better when run in ASV mode.

In particular: Setting an appropriate back up rate, and setting appropriate values for TiMin, TiMax, trigger sensitivity, and cycle sensitivity, are all critically important to insure the machine is following the patient's respiratory rate when the breathing is normal, but stepping in correctly to trigger inhalations when the respiration is unstable. Get any of those things wrong, and you can easily feel like the machine is forcing you to breath at an unnatural rate while you are awake as well as making it harder for the machine to correctly respond to the apnea when the respiration is unstable. Get any of those settings wrong, and you can also increase the number of spontaneous arousals caused by discomfort from using a machine that's not properly tracking your breathing.

Also, most patients do better if the minEPAP is NOT left at the default 4cm. And some patients do best if the maxIPAP is NOT set at the default 25cm. And given the connections between PS and central sleep apnea, it's critical to get the min PS set low enough to not trigger the start of strings of CAs and the max PS high enough to step in and trigger inhalations when the breathing is irregular and it looks as though a CO2 overshoot/undershoot situation is starting.
they are waiting for the doctor to fax the numbers to them
the fear is that he wont do that and say that i have to have another overnight test at the sleep lab he is financially involved with
See above: Yes, the doctor could just write a script that says, "ASV with default settings." But you might be much more comfortable while using the machine if a proper titration study was done to determine quality starting values for all the settings that need to be correct for you to get both high quality and comfortable ASV treatment of your problems.

(Comfort while using the machine is critically important: It is impossible to get a good night's sleep if you're uncomfortable all night long because the machine is not set up correctly.)

i did file an internal complaint with bcbs but they will probably give her a promotion and bonus check for doing a good job with their
DIE GRAMMA DIE !!!
policy to making more money by delaying and denying treatment.
This kind of behavior by insurance companies is NOT new. It existed well before the regulations in the ACA/Obamacare were put into place. Should the GOP succeed in repealing the ACA/Obamacare, you may find that other insurance companies will choose to not cover your sleep apnea related expenses as a "pre-existing" condition should you try to switch insurance on the private market. And if your insurance is not through your job, you may find that bcbs will bump your premiums up dramatically based only on the fact that you have been diagnosed with central sleep apnea. Or because you are now between 50 and 65. Or both.
if AHC had not been psychopathic assholes and screwed me over perhaps they would have sent in for approval of an ASV
but they preferred to tell me medicrap bullshit that i had to fail an s and an st first yada yada
Under US law, insurance companies are allowed to set whatever criteria they want to set for determining whether a particular expense is going to be paid for by the insurance company, and many of them do decide to use Medicare criteria. And this happened before the ACA/Obamacare was passed, it happens under the ACA/Obamacare, and it will continue to happen if the GOP repeals the ACA/Obamacare.

The sad fact is that there are no government regulations that prevent an insurance company from setting rules and regulations (such as you have to fail CPAP/APAP, bilevel, and bilevel ST before we will pay for an ASV machine.) The GOP wants fewer regulations on insurance companies, and in the long run, that may mean fewer insurance companies will be willing to pay for an ASV under any circumstances.

And, by the way, Medicare sets up criteria that sound arbitrary to you primarily because Medicare is charged by Congress with minimizing the total costs for covering everybody who is over 65 while attempting to provide reasonably decent care to as many 65+ year olds as possible. The budget limitations on what Medicare can spend are strongly supported by the GOP, and the GOP would love to further restrict Medicare spending. And the only way Medicare can restrict spending is to make it more difficult for people with medical problems to quickly obtain expensive medical treatments.

And should Paul Ryan get his dream of dismantling Medicare altogether, private insurance is not at all eager to sell policies to 65+ year olds with pre-existing health conditions at rates a retiree can afford. And employers are not eager to take on providing lifetime health benefits to retirees. So without Medicare, paying for health care would be a huge financial problem for all but the wealthiest of the wealthy senior citizens.

sorry but ASV is the ONLY FDA APPROVED TREATMENT for primary central apnea
Doesn't matter to the insurance companies. They can choose to deny coverage for FDA approved treatments if they deem them too expensive. They can also require additional hoops to jump through before paying for FDA approved treatments if they deem them too expensive. And again, this phenomenon is not new: It happened before the ACA became law, continues under the ACA, and will continue regardless of whether the GOP manages to repeal the ACA or not. As long as an insurance company's main motivation is to bring in as much or more money in premiums than it spends in paying out benefits, insurance companies will have the motivation to force patients who need expensive equipment to jump through hoops before paying for that equipment.

writing the doctor today to add the oximeter
i may actually have the ASV by next week
Pardon my saying it, but .... My guess is that if/when you are set up with an ASV that has default values for all the therapeutic settings, you will likely find that you still don't sleep well with the machine.

but the way things have gone i expect some jerk will screw it up with some silly bureaucratic rule that he just made up
or the doctor will be unethical and push for another sleep lab study
In my opinion, if the doc wants another sleep study to properly titrate the ASV machine, he is behaving in an ethical fashion.

or my family doctor will just throw up his hands and say see the sleep lab again because he doesnt know anything about sleep medicine
Again, a doctor who is honest about not having the expertise to properly and correctly treat a complex and uncommon medical problem such as central sleep apnea is being highly ETHICAL. The last thing anybody needs is a doc who prescribes something they know nothing about (an ASV) to treat a condition that they know little or nothing about (central sleep apnea.)

worst case i appeal to bcbs and suggest they set up an in home titration if they really feel they need numbers
but never ever going to be tortured in that sleep lab where i could not sleep due to it being 4 time zones ahead of me and a totally strange environment
Why was the sleep lab "4 time zones ahead" of you? Where do you live and where is the sleep lab located?

i hope the RINOs finally grow a pair and kill all the bamacare and medicrap programs completely
and let the free market work without their bureaucratic nonsense screwing things up
Should you get your wish about the GOP killing Obamacare, you will find it HARDER to get the stuff you need rather than easier. The rules and regulations you are complaining about are NOT Federal rules/regulations. They have been set by Blue Cross/Blue Shield. Should the ACA go away, insurance companies will once again be free to set up even more ridiculous rules about what is/is not covered. Insurance companies selling policies on the private market will again be allowed to tell a person with central sleep apnea, "Sorry we won't cover any expenses related to your sleep apnea treatment any more." And they'll be allowed to just drop you outright should they decide that the fact that you've got central sleep apnea makes you way too high of a risk to cover in the first place.

The fact is that a "free market" will never make it easy or cheap to treat a condition like central sleep apnea. And as long as you are relying on someone else (i.e. bcbs or another insurance company) to pay the vast majority of your bills, they're going to make up rules, including arbitrary rules, that will affect your therapy.

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Re: update on the asv saga for the few who have followed it

Post by aspen » Wed Jul 19, 2017 2:49 pm

I'm sorry you've had all sorts of delays as well.

i actually signed up for a provincially funded sleep health research project this week, strictly because it's based out of the hospital where I've been referred for a neuro sleep study; with my weird issues I wanted to talk to a live person who could possibly be helpful.

I was able to get the appropriate docs names for my referral, with her name as recommending them. I agreed to do the research project as thanks .

My own CPAP machine (not going so well), some funky monitor overnight one night and a very cool respironics medical watch for ten days.

I'm hoping that something will show up that will be flagged and help me move forward in my quest for something (in my case, I think the aircuve Vauto would be the best bet based on all my trials. ) Sadly, the government won't be willing to pay for it.

I'm glad you are moving forward with your situation though!

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Re: update on the asv saga for the few who have followed it

Post by Pugsy » Wed Jul 19, 2017 4:03 pm

xxyzx wrote:pugsy loves it
depends what your problem is i guess

he claims they can set it in auto mode
dont know cant say but mine was fixed and useless
I am a she not a he (that's what the F means in my profile right under the avatar.... Female).
You don't want to believe me...read for yourself what ResMed says
See the manual ....3 modes ...CPAP, S (that's fixed bilevel), VAuto (that's auto adjusting)
https://www.resmed.com/content/dam/resm ... ow_eng.pdf

How do you know it wasn't in auto mode? Did you use the software to see what it did or didn't do?

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Re: update on the asv saga for the few who have followed it

Post by Pugsy » Wed Jul 19, 2017 4:36 pm

xxyzx wrote:he is the generic pronoun
i have no idea what your gender is
and have not researched it
It takes research? Could have fooled me...clearly shows F by gender on every post I make.
xxyzx wrote: i had no software
i was brand new
read the manual that came with it

i know what it did to me
it was not auto
or if it was it was too damn slow to matter
Well since you didn't have any software you don't really know what the settings were other than what you got when you first started up the machine.
Auto adjusting won't show up while awake.

Good luck on your ASV. Might want to get the provider manual for it.

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Re: update on the asv saga for the few who have followed it

Post by ajack » Wed Jul 19, 2017 4:45 pm

page 41 has the default settings for the resmed asv
https://www.resmed.com/us/dam/documents ... lo_eng.pdf

ASV default settings
Only three therapy parameters to set
EPAP 5 cm H2O
Min PS 3 cm H2O
Max PS 15 cm H2O

ASVAuto default settings
Only four therapy parameters to set
Min EPAP 4 cm H2O
Max EPAP 15 cm H2O
Min PS 3 cm H2O
Max PS 15 cm H2O

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Re: update on the asv saga for the few who have followed it

Post by zoocrewphoto » Wed Jul 19, 2017 5:33 pm

xxyzx wrote: =====

i had no software
i was brand new
read the manual that came with it

i know what it did to me
it was not auto
or if it was it was too damn slow to matter

You probably only had the user manual which is different from the clinician manual. The doctor and/or DME will not tell you that you could have changed the settings yourself. It wasn't locked. You just have to know the secret button sequence to get into the clinician mode. Unfortunately, this is why many people fail. The doctors and DMEs think we are too stupid to handle our machine, so they lie and tell and us we can't make changes. Your machine WAS capable of doing auto. It just wasn't in that mode.

People who find this forum during that stage are able to get the full manual and the free software. They can learn to change their settings and improve their therapy. Unfortunately, many people do not find this forum in time, and do not get help from their doctor or DME.

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Re: update on the asv saga for the few who have followed it

Post by poppi2 » Wed Jul 19, 2017 6:36 pm

xxyzx wrote:....right now i have NO treatment
waiting for another appt will take months more delay....
Wait a second!

Have you ever used an xPAP machine for more than 4 hours a day? How did you acquire your expert level of treating sleep disordered breathing? The value of this forum is the knowledge that actual xPAP users bring to it.

Why do I see you posting advice in thirty threads a day?

You're a con man. Ma'am, have you no shame?

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Re: update on the asv saga for the few who have followed it

Post by robysue » Wed Jul 19, 2017 6:47 pm

xxyzx wrote: the philips manual says otherwise
The APAP manufacturers also claim that no titration study is needed for an APAP. But the fact is that a titration study provides a good first guess on the settings to use. You're free to believe otherwise, and as I said before, my guess is that you're going to be miserable when you first start using the ASV and you won't have any idea which of the multiple therapeutic settings are to blame ...
if tweaks are needed they can be done like so many are doing here for themselves
there is NO reason for an expensive overnight sleep lab titration that only is good for the first 5 seconds after which the ASV titrates itself
Again, you're entitled to your opinion. I know sleep studies are no fun, having had 5 of them myself. But an ASV machine has a lot more settings than a simple APAP or even a simple bi-level auto has. And getting all those extra settings right is going to take time since you'll be flying blind without a titration study to tell you where to start ...
the free market is the best way to do things
it may not be perfect but it beats socialism by a gazillion to none
Free market means things are profit driven. And you keep complaining about the fact that your insurance company wants to make a profit by setting up a procedure that you must follow in order to qualify for an ASV machine.

You can't have it both ways: Our current medical system is a profit-driven, that is far closer to free market than it is socialized medicine.

My point is simple: You want to blame "the system" for you're not being "given" an ASV machine, and I'm merely pointing out that your insurance company is behaving exactly the way an insurance company in a free market system should behave: It's putting it's bottom line first and paying your doctors and DMEs for what it deems an appropriate level of treatment for your condition. Your doctors and the DMEs aren't going to treat you for free---they have to be paid for their services. And you're not paying 100% out of pocket, so the docs and the DMEs have to play by the insurance rules as well, or they don't get paid.
there will be a transition problem if they do it cold turkey
but we must phase all medicrap and socialist programs out over 20 years or the usa will collapse from the deficit spending and hyperinflation it kicks off
So why is EVERY OTHER first world country able to spend a fraction of what the US spends on health care with their socialized medicine?

Seriously---every other major country has some form of socialized medicine and NONE of them have the kind of medical costs that are driving this country's health care system into the ground.

And please tell me: Who pays for Gramma's health care when Medicare goes away in your system? The average 65 year old is a "high risk" customer for any for profit insurance company, and Gramma won't be able to afford the premiums. Gramma's former employer doesn't want to pay for Gramma's health insurance for the next 10-30 years after Gramma retires since that drives up the premiums of the group health insurance the company buys for its *current* employers. And the cost of the health care itself is NOT going to go down: Drugs, surgery, and durable medical equipment are expensive to develop, and will only get more expensive without meaningful governmental regulation. So in a free-market health care system, Gramma won't be able to just pay for her care 100% out-of-pocket.
resmed back up rate is automatic
flawed but automatic uses patients last rate and then moves it to 15 RR when it should have stayed on patients normal RR
Which may or may not work for you since you felt that Resmed's "EasyBreathe" algorithm rushed your inhalations. If your usual resting/sleeping RR is 12-14, like mine is, an automatic back up rate that move to 15 bpm may very well seem way too fast ...
there is no trigger for an ASV
Then how does the ASV know when to switch from EPAP to IPAP when you are breathing normally? Depending on the brand, there may or may not be an actual "trigger setting", but there is a trigger. And if the machine's trigger is too sensitive, it will increase the pressure to IPAP too soon, causing a feeling of "forced inhalations". If the machine's trigger is not sensitive enough, it will keep the pressure at EPAP too long, causing a feeling of "not enough air." In either case, the changes between IPAP and EPAP will feel out of sync---which is one of the things you were complaining about in the Resmed AirCurve 10 VAUTO ...
it has Exhale min exhale max inhale min inhale
resmed will be breathing for you at the wrong rate but as soon as you inhale it changes back to your numbers
These numbers control what happens when the machine is NOT happy with the way you are breathing.

If your exhalations typically last longer than exhale max, then the machine is going to constantly be switching to IPAP before you are ready, and it will feel like the machine is forcing you to breath in an abnormal and uncomfortable way.

If your inhalations typically last longer than inhale max, the the machine is going to constantly be switching to EPAP before you are ready, and it will feel like the machine is cutting off your air supply on every inhalation.

To work well, your average inhalation and exhalation times need to be between the min and max inhalation/exhalation values. But the min and max values also have to be set in such a way that the machine can (instantly) respond as soon as your breathing appears to be in trouble: If your exhalation lasts "too long", that's a sign that there may be a central apnea in progress. So instead of waiting (indefinitely) for you to spontaneously inhale, the machine waits until "max exhale" has elaspsed, and then it increases the pressure from EPAP up to a target IPAP that is based on how much trouble the machine thinks your are in. (The more trouble, the higher the IPAP, in an effort to trigger an inhalation from you.)
max ps min ps mas and maxmax
PS Max is critical in determining how much the pressure is allowed to go up in an effort to get you to inhale. PS Min is critical both in determining your comfort when you are trying to get to sleep AND in helping you to spontaneously maintain the correct CO2 balance. Too much min PS can cause you to have problems with blowing off too much CO2 during the exhalations, which triggers a whole bunch of bad things, including strings of central apnea.

based on the titration manual and my 11/14 cpap rate then 3 6 9 12 15 and 25 would be good numbers to start at
the alternative is i dont get the ASV at all because i just dont have the money for another useless sleep lab session
and i refuse to be tortured where i cannot sleep at all for their convenience instead of when i normally sleep
Sure, go with your gut. But that's not the way the DME is going to set the machine up. Of course, now you know about clinical menus, and so you'll just do it yourself.

But you keep getting on your soapbox and yelling to all who will listen that ASV machines ought to be given to any new CPAPer who is still feeling bad after a couple of weeks of PAPing. And most of those CPAPers don't know about the clinical menu and haven't the foggiest idea of what settings to use ....

Still, be my guest: Turn down a titration study even if your insurance company insists that you must have one before they'll pay for such an expensive piece of equipment.
i dont trust this sleep lab to do a proper study
and whatever they come up with will be OBE once i start using it
Ok. You don't trust real, live people at the sleep lab, but you do trust a large corporation that wants to sell as many xPAP machines as possible to as many people as possible ...
right now i have NO treatment
waiting for another appt will take months more delay
i would rather titrate it myself this week than have perfect next year
You're not going to get it "perfect this week" on your own. As I've said, I think you're going to be just as miserable with the ASV as you were with the AirCurve ...
AHC was using medicrap rules not bcbs rules
bcbs would have paid for it asap if AHC had not been assholes
I doubt it.
i am happy with bcbs rules when i can find out what they are
but they do hide them to block treatment
Blue Cross/Blue Shield is a typical insurance company: They all hide the rules and block treatment when they are trying to save money on a patient. In my case, the problem in getting the insurance company to tell me and my DME what the replacement schedule for supplies was: For the first year, every time I or my DME tried to determine when I was eligible for new pillows or filters, the "rules" changed. And never for the better. After about three years or so, things settled down, but even now, I wish the replacement schedule were as clear and as generous as Medicare's is.
dont give a crap about medicrap rules or what RINO ryan wants to do
You're the one who keeps saying you hope the GOP undoes all of the ACA. Well if you get your way, it will affect Medicare and that will affect you eventually, if not right now.
if they deny treatment that should be in writing in their policy so we can choose someone else
but forcing the WRONG treatment that is not approved is malpractice
like giving aspirin for cancer until you can prove it doesnt work
Once again, you are confusing the insurance company (who PAYS for the care) and the provider (who PERFORMS the care.)

Legally speaking, an insurance company cannot "force" you into the wrong treatment, although they can (and do) balk at paying for an expensive treatment when there is a less expensive treatment that can be tried first .... In other words, if you were willing to pay 100% of your expenses out of pocket, you could have simply ask the doc who diagnosed you with the central sleep apnea to just write the script for an ASV and told the DME not to bill your insurance for the machine. Both the doc and the DME would have been happy to have accomodated your wishes.

In general, if an insurance company denies coverage, they do have to inform you of their decision (because of federal and state regulations), but they don't need to inform you about the particulars of why. You have the right to appeal, and the appeals process must be specified in the policy and available to you. If the insurance company declines paying for a treatment, drug, or piece of equipment that you want, it is under no obligation to help you figure out how to pay for that treatement, drug, or equipment. From your insurance company's point of view, you can just pay for that ASV 100% out of pocket without the need for the CPAP and bilevel trials if you want it that bad ...

Choosing a different insurance company when you're not happy with your current one is a different issue and it's got its own problems. If your insurance is provided by your employer as a fringe benefit, you may not have any option to change insurance when you are deeply unhappy about what your insurance covers or does not cover. But if your insurance is bought on the private market, you can always drop the policy and pick up a different one during the open-enrollment period on the ACA exchanges (now). Before the ACA, you could always drop the policy and try to buy another one, but pre-ACA if you had just been diagnosed with a serious, chronic condition like central sleep apnea, the new carrier would most likely add riders to your policy specifying that the new company would pay $0 for expenses incurred to treat your preexisting condition, perhaps for a year or perhaps for as long as you kept the policy active. Some insurance companies would simply have declined to sell you a policy outright with a preexisting condition like central sleep apnea.


my family doctor is excellent
but the sleep lab he uses is CRAPOLA to the max
and treat patients like nuisances they have to put up with
So tell your excellent family doc that the sleep lab he refers people to sucks and then ask your excellent family doctor to refer you to a different lab for the titration test if one is required in order to get your insurance company to pay for the ASV.
i told him i had had central apnea for decades
i told the sleep lab that i had central apnea for decades
Pardon my saying it, but your excellent family doctor doesn't sound so excellent to me since he ignored your symptoms "for decades" ...
i normally go to bed at 2am
they want me to go to sleep at 10pm
tried taht nonsense
did not get to sleep until 6am
after a night of torture tossing and turning trying to force myself to sleep
then they woke me up at 9am
took me a week to recover from that nonsense
Been there, done that multiple times. The thing is the sleep labs have to work on their schedules, not yours. I know that's not what you want to hear, but it's the unfortunate truth.

The fact that they let you sleep until 9am was actually nice. The latest I was ever allowed to sleep on an in-lab sleep test was 7:30.

If you have to have another sleep test, it would be reasonable to ask the doctor for a script for one Ambien just to make it easier. It also helps to politely inform the sleep tech of your normal sleep schedule. Sometimes they can at least accommodate you a tiny bit by making you the last person they put to bed, which is often as late as 11 or 11:30.

i dont care what bcbs rules are if they tell me
dont like them then i can use aetna or other insurance
or i could keep my money and pay for my own care cheaper if we got insurance and medicrap and DMEs out of the scam to suck money out of the govt while affecting the rest of us
So why don't you change to aetna or some other insurance company instead of repeatedly complaining about bcbs over and over and over, both in your own threads and in the threads that others start?
we all die
not worried about that
just dont want to be suffering until it happens
and if there is no cure then let me end it instead of pushing some pagan religions idea about life being so valuable
it is futile trying to live longer. we should try to live well with whatever years we have.
keeping people alive when they have no chance of functioning independently is a waste of money that would be better used to help the others who could live well and be useful
I have no idea where this stuff is coming from. I've never mentioned what I choose to believe in (or not believe in) in any of my posts to you because, quite frankly, my religious beliefs are not relevant to you and I don't really care what you believe or don't believe.
resources are very limited
we cant do everything for every tear jerking sad case they show on the news
YOU want someone other than yourself to pay for YOUR ASV just because YOU think you need it. Otherwise, you'd quit complaining about bcbs in so many of your posts and you'd just opt to buy the ASV out of pocket.

Resources ARE limited, so why should YOU be entitled to more of them than anybody else?

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Re: update on the asv saga for the few who have followed it

Post by Doublev » Wed Jul 19, 2017 7:17 pm

I am confused how you do not have an xPAP right now...

Where is the aircurve? I dont see how an ASV is going to help if the aircurve made your life so difficult?

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Re: update on the asv saga for the few who have followed it

Post by Doublev » Wed Jul 19, 2017 7:45 pm

Any doctor can write a prescription. Even your dentist. Especially the online doctors for the DME. I dont know if they will prescribe an ASV (I think getting an APAP is pretty much guaranteed.. but they had a license and cant just dole out ASV) but you can certainly try that route?

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Re: update on the asv saga for the few who have followed it

Post by LSAT » Wed Jul 19, 2017 8:05 pm

end of alphabet boy will eventually get his ASV and based upon all his comments and complaints...he will not be happy with it and will find many things more to complain about his own therapy.

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Re: update on the asv saga for the few who have followed it

Post by Guest » Wed Jul 19, 2017 10:01 pm

xxyzx wrote: i will keep complaining about liars and libtards as well as bullies and idiots
smells like a vicious circle.
But why do you bother to go through all this trouble just to get another useless machine?

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Re: update on the asv saga for the few who have followed it

Post by Cpapian » Thu Jul 20, 2017 10:35 am

How much does a sleep study cost?

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robysue
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Re: update on the asv saga for the few who have followed it

Post by robysue » Thu Jul 20, 2017 11:05 am

Cpapian wrote:How much does a sleep study cost?
Here in the US? Or in Canada where you live?

If you are inquiring about the cost of a sleep test for yourself, you might want to start your own thread.

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Cpapian
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Re: update on the asv saga for the few who have followed it

Post by Cpapian » Thu Jul 20, 2017 4:32 pm

Actually, xxyzx, I was asking you this, because I have seen you mention a few times on this forum, that you do not want to pay for another sleep study. So I wondered if the cost was prohibitively expensive or was it a point of honor for you.

I guess I am also wondering why you won't do whatever it takes to get your medical help sorted out.

Your situation reminds me of something my father used to say to my younger sister. He would say, if she could change her won't power to will power, she could accomplish anything.

After having a life threatening illness (in the past) I found medical matters are not about our convenience and enjoyment and we have to put up and yes, shut up, a lot of the time. Fighting the system is stressful and counterproductive. And there is also the idea of picking the fights.

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