BIPAP vs. ASV

Is there really much difference in an ASV device and a BIPAP? My doc has suddenly resurfaced suggesting that ASV might work in terms of tolerating higher pressures as opposed to a BIPAP with backup rate. I thought they were about the same.

An ASV machine is a bilevel pressure machine.

BiPap is a marketing term for a Respironics bilevel machine but has come to be used as generic term.

There are many different types of bilevel machines that will do different things for different reasons.

Your AirCurve 10 ST is a bilevel machine and it will do something special when you don't breathe yourself because of a central apnea.
Some bilevel machines do special stuff and some don't.

So your doc finally mentions ASV...it's about frigging time.
ASV is one of many different types of bilevel machines and it does some extra stuff that your ST can't do.
It can treat both obstructive apnea and central apnea and it auto adjust which is the part that might enable you to get the therapy you need without the aeorophagia issues that happen at the pressures needed to deal with your obstructive apnea.

Right now you are using fixed pressures all night long....with the ASV maybe you could get by with less pressures most of the night and only have the higher pressures when really needed...and maybe that will keep the aerophagia monster aweay.
It auto adjusts so the pressure change all the time and change quickly. That quick response means it doesn't have to stay up high all night long.

Thanks, Pugsy. Is it a lot more expensive?

lwieland11 wrote:Thanks, Pugsy. Is it a lot more expensive?

Of Course! $$$$!

Yes...it is expensive but I don't know how much more than the ST you have and your DME should take the ST back and replace it with the AirCurve 10 ASV (assuming they stick with ResMed). Online the price difference is roughly 2K but that's online and if you have insurance the online price doesn't count.

What insurance do you have and how much is your co pay?
How much were you paying for the ST and for how long?

Pugsy -

Insurance is BCBS. I'm paying $120/month for 10 months for the BIPAP. Assuming I am compliant by Nov. 1st, I'll be done paying for it then. Deductible was met way back in February. Still trying to pay off the sleep study in January.... Would rather not incur any additional medical expense until I get that paid off...

Interesting xx. Doc is currently approaching the DME to see if I "qualify" for an ASV. I would think that would be her call. Not sure what the "qualifications" would be. Being the cynical person I've become, I'd imagine the DME would approach BCBS with the idea if they can make enough money on the deal. If BCBS approves it, I can only imagine how closely I will be watched now.

If you qualified for the ST you qualify for the ASV.
You've got compSA. I have no idea why they opted for the ST machine first instead of ASV.

Don't assume that your BCBS plan is the same as anyone else's. There's lots of different BCBS plans even within the same state.
For specific coverage questions pertaining to you...you need to contact your ins company and not rely on what the DME, doctor or some other forum member who might have BCBS.

Thanks, Pugsy. I will. Probably chose ST over ASV initially because of cost. I am limited in what I can afford.

If you can keep your pressure needs down a bit by trying to stay off your back the ST could very well give you the therapy you need.
It will breathe for you when the centrals hit.
If your pressure needs are that much higher for the obstructive stuff when on your back then staying off your back could make so the obstructive stuff is managed decently with the existing pressures. Staying off your back is easier said than done though and if REM is involved in the higher pressure needs there's not much we can do about reducing REM.

You may just need to have to make some compromises. If you can't afford and don't want the other machine then deal with what you have the best you can.
Your AHI might be a bit higher than you would like but to get it down you need to increase the pressures and that creates a problem with the aerophagia. So pick the one that causes the most distress and try to eliminate that one.

While not ideal...and AHI of 8 or 9 is still an improvement over what you were getting on apap or even without any cpap.
If you think that side sleeping was responsible for the sub 5.0 AHI last night...it's sure worth trying to stay on your side.

Pugsy, agreed. I just roll over on my side and put a pillow behind me to keep me there. I think it must be working.

I was trying these adhesive chin strips that were actually working and keeping my mouth shut. But, discovered I was allergic to the adhesive. Didn't use one last night though. So maybe between my making a conscious effort to keep it shut and being on my side, it's staying shut better than if I were on my back.

My DME billed BCBS 6 times what the BIPAP was worth. BCBS approved. So insane.

lwieland11 wrote:Is there really much difference in an ASV device and a BIPAP? My doc has suddenly resurfaced suggesting that ASV might work in terms of tolerating higher pressures as opposed to a BIPAP with backup rate. I thought they were about the same.

depends why you have the st, an asv can't always replace a ST. I would go by medical advise.

I was told by my doctor after the BIPAP study that a pressure of 17 controlled both the centrals and the OSAs so it was known when I was prescribed a BIPAP that I had complex sleep apnea. An ASV was not prescribed for some reason, probably cost.

Your bilevel pressures of 17 inhale and 13 or 14 exhale took care of the obstructive apnea stuff.
Unfortunately those pressures triggered centrals and going lower wasn't an option because then the obstructive apnea wouldn't be addressed. Unfortunately the aerophagia monster reared his ugly head and really complicated your therapy.
So they gave you a bilevel machine that has a back up rate to breathe for you when the centrals happened. Unfortunately the aerophagia monster didn't go away.
Your ST model machine is not a "plain" bilevel machine and you didn't need a target volume or anything like that. You just needed something to pretty much force an inhale. The ST model does that.
Regular "plain" bilevel machines won't/can't do the breathing for you thing.
Forum member xxyzz was initially given a "plain" bilevel and not a machine that could actually force him to breathe.
ASV is a bilevel machine with the back up rate available if needed but it auto adjusts for the obstructive apnea stuff where your ST model machine is a fixed pressure machine. It will auto adjust as needed instead of doing the fixed pressure stuff.

We don't know for sure that ASV would have enabled you to use lower pressures for part of the night and maybe keep the aerophagia monster away....we just know that it could maybe have done that and still treat both the obstructive stuff and breathe for you when needed.

If you can keep your obstructive apnea pressure needs low enough to keep the aerophagia monster away and still hold the airway open by staying on your side as much as possible...the ST machine will breathe for you with that back up rate when it needs to.
So your OSA and your CompSA can be treated with the ST machine if all the ducks line up in a row.

And that's assuming that it's sleeping on your back that creates the need for the higher pressures and not so much the REM sleep stuff.
Your aerophagia really complicates your therapy.
Staying off your back is sometimes easier said than done but it is sure worth trying.