Another sleep apnea "victim"

[SuperDave]

Brief update:
18 days on bilevel. ahi ranged from low of 5.6 to high of 31.16
Machine settings: EPAP MIN from 12-14.5; IPAP MAX from 20-25; ps=0

two best nights
1. AHI=5.6 (CA 1.26, OA 2.51, HYP 1.83); EPAP MIN 13.5, IPAP MAX 20, PS MIN 0, PS MAX 0. 95% EXP 17.1, 95% INS 17.1
2. AHI=6.25 (CA 1.86, OA 2.96, HYP 1.42); EPAP MIN 11, IPAP MAX 22.5, PS MIN 2.5, PS MAX 4. 95% EXP 13, 95% INS 15.5

#2 was much more comfortable due to pressure support and lower 95% pressures.

[Pugsy]

You know it appears that you are getting there.

Use PS if it makes you more comfortable and lets you sleep better. I doesn't appear to affect the centrals now...if it ever did.

[SuperDave]

UPDATE- 30-90 Day Follow-up for Medicare. The Sleep Doctor noted that my AHI has stayed in the 10-20 range over the past 60 days, rarely falling below 10 and never below 5. He stated that he would like to know the breakdown of obstructives, hypopneas and centrals. Luckily, I had printed out the prior night's summary and detailed charts from Sleepyhead, and was able to show the pie chart, which displayed the clear airway, obstructive and hypopnea events.

PIE CHART

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Then I showed him the AHI breakdown in detail, the event flags graph for the entire night, and the flow rate graphs for selected slices of the night where I had restful sleep and other periods of the night where numerous events occurred in clusters.

RESTFULL SLEEP GRAPH

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Cheyne Stokes Respiration (CSR) GRAPH

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He immediately recognized all my events occurred during periodic breathing, during certain hours of the night. He confirmed the pattern was CSR. (I had already recognized the CSR pattern from sleepyhead, and had already advised my regular physician. Subsequently, several cardiac tests showed no cardiac abnormalities.)

He concluded that centrals indeed made up 50% of the total events, and will require ASV thereapy (CPAP & BIPAP therapies do not correct Central apnea.) The sleep doctor confirmed changing epap/ipap pressures from the current settings would probably not reduce central events. So he is setting up an ASV titration with the sleep lab, and stated my Sleepyhead documentation should be sufficient to obtain medicare approval.

He was amazed by the amount of detail data available for analysis in Sleepyhead and said he was pleased that a patient would take so much interest in monitoring the therapy.

[zonker]

He was amazed by the amount of detail data available for analysis in Sleepyhead and said he was pleased that a patient would take so much interest in monitoring the therapy.

well, i will be go to hell, as my brother used to say. i'm always astounded and pleased to hear someone's doctor actually doing doctor stuff and willing to learn new stuff.

good job!!

[SuperDave]

**Update**
Although the doctor has acknowledged that my apnea cannot be corrected with cpap or bipap, and although he has prescribed an ASV (based on a recent titration sleep study where the sleep lab successfully eliminated all obstructives and centrals with ASV therapy), the insurance company (Humana/Medicare) has denied coverage. So I am stuck with bipap therapy that has been proven to be unsuccessful. I realize I can purchase an expensive ASV out of pocket, plus continue the monthly rental on the bipap (I don't think Rotech will let me return the leased bipap because Ive had it for 5 months, with 8 more months rental remaining.)

When I started down this trail, I knew I had centrals and needed ASV. the doctor was not convinced so he prescribed bipap. After 3 months on bipap, I was able to show the Sleepyhead/Oscar graphs and convinced him to let me have a titration study with ASV treatment, which proved conclusively my apneas could all be corrected by ASV treatment when cpap/bipap therapy failed. The doctor confirmed this in writing in his analysis of the sleep study.

Rotech told me the insurance will not approve an ASV machine because they are already paying (co-paying) on a bipap machine (which is not successfully treating my centrals) and the doctor's office confirmed this with Rotech, on my behalf. I thought it was common for insurance companies to force you to start with cpap, and if that doesn't successfully treat your apnea, then try apap, and so on, until finding the level of machine that successfully treats you apnea. I was unaware that unsucessful machines could not be returned, in favor of upgrading to the next level of machine. I thought that was the reasoning for 13-month leases vs. outright purchases!

Does anyone have any ideas if and how I can get out of paying for the remainder of the bipap monthly lease/rental before I buy an ASV out of pocket? Or am I stuck paying for the remaing 8 months of the lease and also have to buy an ASV out-of-pocket?

[chunkyfrog]

Get thee to an attorney!
Proven medical necessity will trump economic decisions,
but you may need to push harder.
Courts and the press often provide the necessary leverage to move greedy butts.
The blower is rented--and most definitely CAN be returned.(just not the humidifier)

[SuperDave]

I decided to purchase an ASV machine out-of-pocket, and to return the rented dreamstation bipap to Rotech, thereby removing the DME, and insurance company, from my apnea therapy. I picked up a copy of the ASV prescription with the recommended settings from my pulmonologist, and can make the settings in the new machine myself. No more compliance certification required and, best of all, I don't have to interact with the horrible DME anymore. New ASV machine arrives in 3 days, after which I will post the results/graphs from OSCAR.

[squid13]

If you don't mind, where did you buy your machine. I hope you gave https://www.secondwindcpap.com/ a look, there great people to deal with.