Newbie/ST/autoSV

[krb39]

Greetings from a newbie,

Five weeks ago I started on my CPAP and my ahi went down from fifty something to around eight or ten. Those remainng are, for the most part, central apneas. Last Friday I had my 30 day check-up and we set up a new sleep study for the CAs. The doc emphasized we would be going with the auto SV. Monday night I went in and they set me up for an ST study. I explained about how the doc had said autoSV, but the tech said that the order was for ST/autoSV meaning we try ST first and move to autoSV if I can't handle ST. He's a tech, he does what the order says. So I slept with the ST and had no problems. The tech doesn't do reports but he unofficially said the results looked good.

Well, I'm glad the ST seems to be working but my wife was with me last Friday and assures me that I wasn't hallucinating, the doc said autoSV. So yesterday I called the doc's office. They told me that he is gone until mid January. Now I am not happy that when I saw him last Friday he didn't mention this and say who would be handling my case, but the forum cannot help me there and I will stay focused on my questions. The office gave me the voice mail of one of the staff, not a doc, he called me back and said that the ST first approach is required by medicare (I'm 73 and have medicare plus supplemental insurance). I talked to the guy from Respironics who will be setting me up with whatever new device I get, and he says the cost for the ST and for the autoSV is the same. He is also guessing that when it all gets written up, the order will come through for an autoSV. Perhaps, but sounds a little weird to me.

Anyway, this is all new to me. I am busy learning all this new vocabulary and I have no idea whether I really need an autoSV, or if an ST would be fine, or whether I need to make a fuss, or whatever. I have done a bit of internet searching and can find nothing regarding the quoted medicare policy. I want the one that's right for me, I have no great interest in which it is.

Any thoughts would be appreciated.

And yes, I have already made my displeasure about the doc disappearing on Monday without mentioning it on Friday known to them. Not the office staff's fault, I didn't shout, but I did say that I had never encountered that style before.

Thanks,
Ken

[johnthomasmacdonald]

what's ST?

[Xney]

STs used to be less pricey than the ASVs, from my understanding (ASVs are newer tech). Now, there's not a lot of difference. Maybe the procedure is simply out of date to the costs.

[krb39]

Perhaps my words are off, there have been many.

As I understand it there is a model that sets a constant bi-pressure, say 12/7 for pressure breathing in and pressure breathing out. The autoSV varies the bi-pressure, maybe 9/5 or maybe 16/12, according to the needs of the moment. I think that is the distinction. I think the first is called an ST, the second is called an autoSV.

But if I am unclear in my statement, it reflects some lack of clarity in my understanding

[krb39]

At http://bipap.respironics.com/ I found the following. Actually, it sounds like a good gadget. But still, the doc said autoSV.

BiPAP® S/T System with Encore® Pro Smart Card®
Is the newest addition to Respironics home noninvasive ventilator fleet. The compact and lightweight unit is simple to operate offering a straightforward user interface and an integrated heated humidifier for easier set-up and management. The unit also is the first noninvasive device to combine Respironics’proven BiPAP®technology with Smart Card®for use with Encore®Pro and is rich with features such as Digital Auto-Trak™Sensitivity,adjustable Rise Time, and

[Xney]

ST is a bipap with a backup timer. The backup timer will increase pressure to trigger a breath (hopefully) if it notices you having a central apnea. Like any BiPAP, even an auto, the pressure is determined manually (standard bipap) or automatically, but is adjusted over time.

The ASV determines the pressure on each breath, and will also trigger a breath with a pressure change if you stop breathing. Because it is watching every breath, it tends to work better, and is also more complex (expensive). The price difference is coming down, or has come down, between the two. An ASV is always "matching" your breathing, and will aggressively trigger a breath if needed. How aggressive depends on which type you have.

An ST BiPAP can help some cases of central/mixed apnea, whereas an ASV usually helps all of them.

[krb39]

Thanks Xney. I was thinking it was like this, but you confirm it and with more details. I appreciate it.

Since I have to deal with this problem I want to deal with it as effectively as possible. It seems to me that the asv is the way to go if indeed it can be written up that way. The simple solution would be for me to pay for any difference in price but nothing is ever simple like that in the bureaucratic world.

Sometimes I get worked up over things that I needn't. The Phillips rep is going to call me when the order comes in. Maybe it will be asv. So far I have had almost no difficulty adjusting to these machines, so I imagine I can do an asv.

Thanks again.

[Xney]

Inurances can require you to "fail" ST BiPAP before shelling out for an ASV. They are different insurance codes, so there may not be an option to pay the difference because you can't get an ASV at all.

I think the ASV is a better option if you can get it, but an ST bipap could work. If you fail it, you usually get a new insurance code for the ASV and they should pay for it. (I would check with your insurance so you're not stuck with an ST bipap instead of an ASV) I'm just going by my understand of how it usually works.

An ASV can be.... rather weird to get used to.

Edit: to clarify, the scenario you want to avoid is: insurance gets you an ST bipap to try - it doesn't work, but you can't get the insurance to now pay for an ASV despite the ST bipap not working. With some insurances, your doctor could maybe argue for the ASV right away and justify it medically - then the insurance might get you the ASV right away instead.

[archangle]

Inurances can require you to "fail" ST BiPAP before shelling out for an ASV. They are different insurance codes, so there may not be an option to pay the difference because you can't get an ASV at all.

I think the ASV is a better option if you can get it, but an ST bipap could work. If you fail it, you usually get a new insurance code for the ASV and they should pay for it. (I would check with your insurance so you're not stuck with an ST bipap instead of an ASV) I'm just going by my understand of how it usually works.

An ASV can be.... rather weird to get used to.

I believe this is a little different from the Auto/manual CPAP difference. I think an ASV will not usually have an option to work in ST modes, and it is more difficult to adjust to. However, the ASV is more likely to cure central apnea. i.e. an ASV isn't a clear choice over ST bilevel in all cases.

[Xney]

I have a hard time imagining an ST doing a better job than an ASV for central/mixed/complex sleep apnea. But I guess for some people that could be true.

I could definitely see it being better for people who also have lung issues, etc.

[archangle]

I have a hard time imagining an ST doing a better job than an ASV for central/mixed/complex sleep apnea. But I guess for some people that could be true.

I could definitely see it being better for people who also have lung issues, etc.

Isn't that sort of the purpose of the timed mode?

However, I expect the ASV will be better, but there may be more "dropouts" who can't/won't adjust to the ASV.

I wish the manufacturers would stop all this nonsense and just put the full software capabilities in all their CPAP machines. The hardware is mostly the same going from the manual CPAP with data all the way up to ASV.

[krb39]

I'm sorry to hear that the ASV may be more difficult to adapt to than the S/T, but I was thinking that might be the case. Which seems to mean that it would not be practical to assign me to an SV after I spent the sleep study night attached to an S/T.

I guess my plan is to give the doc's office a call. He's gone for a month, but there are other docs there to, I hope, speak with and I want to do it. I want to see a full report on how my S/T study went. The staff person I talked with Tuesday said he would call me back after the evaluation was done, but he hasn't yet done so. If the S/T solves my problem, then I guess that's fine. I think it is safe to say that I will not be recommending this particular office to any friends who ask about my experience.

Thanks for all of your comments.

[Xney]

Don't worry about what's the most difficult to adjust to. Some people adjust to ASV just fine. It just takes a bit of time if it's kicking in a lot. The ST will also do some of that, I think. (I've never used an ST, myself)

You want a machine that fixes your problem. That's all that counts.

[wilsonintexas]

I like you had a problem getting rid if lingering centrals on bipat. It was a long process (over 9 months) and i had to Fail on bipAP before I could get a ASV machine.

It had to be a sleep study that showed an AHI above 5 with more than 50% being centrals, while on the bipap. I was able to do my 4th sleep study as a home study, it was a little cheaper and easier. I arranged it so it was over a weekend. Since I was using my own bipap machine, I could look at the data the next morning.

With my sleep patterns, I had some good noghts and some bad nights. The first night of the sleep study was a "GOOD": night, and my AHI did not hit 5.

The sedond night it hit 10, and 75% were centrals....

RECOMENDATION:
See if they will let you do a home study over the weekend.. That way you have a better chance of having data that they will need to get you what you need.

Good luck.

ASV does take a while to get use to it...... but my results have been worth it.

On BIPAP my ahi was 4-15... SPO2 topped out 93, usually 85-90 dropping on deep centrals to 83 needed naps in the evening. Afraid to use my power tools except on weekends.

on ASV AHI of 0.0 to 0.3 (mostly 0.0) and the .3 are hypos, probably when I am turing over..... SPO2 90 - 94 topping out a few times at 97.... dropping to lows of 86 or no naps...

Still getting use to sleeping with it, but getting there.

[krb39]

Thanks again for the thoughts. I have now heard from them and they say the S/T went well. They are sending me the report, they are sending off a prescription to the DME (of that's the right name) for an S/T. I hope it works as well as they describe. From reading the replies here and on other threads, I am learning that this may take a while. I need to educate myself some on all of this.

The home test sounds like a fine idea. My experience with the CPAP is that some nights have a lot lower index than other nights, in fact it varies from a low of 3 point something up to a high of 12 or more. So one night in a lab is useful but hardly conclusive. We shall see.

Thanks,
Ken