How to get ASV machine for Central apnea?

Orig. study showed all apneas to be central, AHI was 58 an hour.

Discharged from hospital 10 months ago using the Remstar Plus One with either swift nasal pillows or Quattro FX mask depending on nose at night. Bleeding in 2L of O2.

Last night was one of the best nights using cms 50D+ , 1 hr adjusted index AHI is 12.2 and pulse is 10.2, average spo2 is 93.3 avg. low is 86.5 with two events going below 88% in 9 hours. Looking over last 2 weeks AHI's average 16 an hour. Is this considered successful treatment?

In talking with the insurance-yes I've been reading all the dealing with insurance and DME info here - they will cover purchase of another machine if it's "medically necessary" without requiring a "failure". So I want to see what leads a Dr to order an ASV machine? and am I correct in thinking that we should be pushing for one? Part of the issue is we have already meet our $5000.00 a year deductible and insurance will be changing next year to medicare .

ejackson1200 wrote:Orig. study showed all apneas to be central, AHI was 58 an hour.

Discharged from hospital 10 months ago using the Remstar Plus One with either swift nasal pillows or Quattro FX mask depending on nose at night. Bleeding in 2L of O2.

Last night was one of the best nights using cms 50D+ , 1 hr adjusted index AHI is 12.2 and pulse is 10.2, average spo2 is 93.3 avg. low is 86.5 with two events going below 88% in 9 hours. Looking over last 2 weeks AHI's average 16 an hour. Is this considered successful treatment?

How did you decide you have an AHI of 12.2? The REMstar Plus doesn't give AHI numbers.

Is it possible you have a REMstar PRO? Look next to the display.

What's your pressure?

The AHI is from the cms 50D+pusle oximeter , been using it most nights since it arrived. Actually bought it as the cpap isn't as effective as hoped in getting a good night's sleep, nor the daytime tiredness.

Pressure was set at 7 per the sleep study. O2 is 2 Liters constant bleed in as a result of the follow-up pulse oximeter study the Dr did in early spring.

When the Dr reviewed the data compliance he did say that there were lots of air leakage issues-I'm not sure how he could tell-he did show me the report with bars that had breaks of white in them most nights.

Within a week of that apt. the machine started shutting itself off over and over again at night.

ejackson1200 wrote:..Within a week of that apt. the machine started shutting itself off over and over again at night.

Howdy, A brief observation by a newby. If your machine -which ever model it happens to be- is set for "Auto On/Off", could it be that the machine thinks you've disconnected; hence it would shut down until it thinks you have reconnected.?

The way to get an ASV is to ask a doctor to order a sleep study to be titrated for it. They are complicated little buggers and you don't want to get one as a do it yourself project; bipaps and cpaps are one thing, but ASV screw-ups can cause problems. If your AHI is that high, it should be no problem getting a script for the titration.

Of course, having said that I must admit that I have changed the settings on my machine myself, but that's tweaking from the original settings, after consulting the therapist and finding out that the person who titrated me goofed up.....

Original machine and settings were on auto shut off -then we suspect it got zapped by the lightening hit that took out all our power for 5-6 hours as the following night the machine was shutting itself off multiple times an hour. We took it in and the DME reset it to constant blow and the AHI's got some better-still in the 20's an hour but we pushed for a replacement as the not having auto off was a pain. DME replaced it as it was still under warranty and now things appear to work properly, but I think the AHI's are still too high.

The nasal pillows fit well and we don't hear much leakage, and the replacement machine doesn't appear to be shutting itself off during the night. So the system set up seems to be working fine now but I suspect it's not the right system for him as he's still tired much of the time, falls asleep within 2-3 minutes, needs afternoon naps, and is dragging much of the time. He's also waking up 8-12 times a night. (Thanks to the person who suggested cotton balls to be tossed-that was a great cheap idea.)

ejackson1200 wrote:So I want to see what leads a Dr to order an ASV machine? and am I correct in thinking that we should be pushing for one?

I'm not the most knowledgable on this, but since I've got centrals, my experience is on my first titration I was put on a regular CPAP machine and it did next to nothing for my breathing. So they ordered a second study which was to be on an ASV since the ASV would handle the centrals and other breathing problems I was having.

So I would think yes, push for an ASV however as has been mentioned, another study/titration is likely going to be necessary.

ejackson1200 wrote:The AHI is from the cms 50D+pusle oximeter , been using it most nights since it arrived. Actually bought it as the cpap isn't as effective as hoped in getting a good night's sleep, nor the daytime tiredness.

The "Adjusted Index" on the SPO2 report has nothing to do with AHI.

My "adjusted index" shows 9 and 19 from the SPO2 report on a night when my CPAP AHI was 2.

What was your minimum SPO2?

This shows you why the insurance companies are idiots for allowing DMEs to dispense non-data machines. Now you need an in-lab PSG to look for what a data-capable CPAP would have been able to tell you.

How are you feeling? Other than the SPO2, what makes you think it's not working?

It might be worth watching Craigslist for a PRS1 Pro or Auto machine. Or an S9 Elite or AutoSet. I've gotten lucky doing this, but I had to watch for months. It might be cheaper than a sleep study.

ejackson1200 wrote:... Orig. study showed all apneas to be central, AHI was 58 an hour. ...

Yup. That would make you a good candidate for an ASV unit. A regular xPAP device would do nothing for you.

ejackson1200 wrote:... Bleeding in 2L of O2. ...

O2 helps with central apneas, but is not as effective as an ASV unit.

ejackson1200 wrote:... am I correct in thinking that we should be pushing for one? Part of the issue is we have already meet our $5000.00 a year deductible and insurance will be changing next year to medicare. ...

Yes, an ASV unit is the gold standard. Find a board certified sleep doctor and explain the O2 therapy does not seem to be putting a dent in the daytime sleepiness. Then ask if an ASV unit might be an option.

Not sure best approach on insurance vs. Medicare.

Hope that helps.

My baseline sleep study showed CA-98, OA- 21, Mixed-4, hyponeas-17 said I had a RDI of 103.1 per hour. "very severe CENTRAL SLEEP APNEA GREATER THAN OBSTUCTIVE. HYPOXIA AS LOW AS 80%. THE PATIENT DOES HAVE SLEEP APNEA IN A RANGE LINKED WITH INCREASED RISH OF POTENTIAL CARDIOVASCULAR & CEREBRALVASICULAR EVENTS & COULD EXPLAIN NEUROCOGNITIVE SYMPTOMS IF PRESENT. I HIGHLY RECOMMEND TREATMENT"

I HAVE A HX OF HIGH BLOOD PRESSURE, CONGESTIVE HEART FAILURE, MOD AORTIC STENOSIS, 3 STROKES, ATRIAL FIB, VENTRICULAR ARRHYTHMIA, & NOW I'M GETTING SEVERE SHORTNESS OF BREATH WITH INCREASED HEART RATE TO 116 IT THEN DROPS TO 84 & MY O2 SAT ON RA DROPS TO 70. HAPPENING 3-4 TIMES A DAY SINCE 12/25/2013 .I AM GETTING WORSE.

I DID BEST ON THE ASV ADVANCED MACHINE. A RX WAS WRITTEN. I HAVE MEDICARE. O2 COMPANY REFUSING TO GIVE US THE MACHINE. CALLED MEDICARE TOLD THE O2 COMPANY SHOULD HAVE BROUGHT THE MACHINE WHEN THEY RECEIVED THE RX, THEN FILED A CLAIM. THERE IS A 30 DAY WINDOW TO OBTAIN THE MACHINE OR ELSE WE HAVE TO START OVER.

NOW THE O2 COMPANY IS TELLING ME I HAVE TO TITRATED ON A REGULAR BIPAP MACHINE BEFORE THEY CAN BRING OUT THE ASV ADVANCED MACHINE. MEDICARE IS NOT REQUIRING THAT. WHAT IF WE BOUGHT THE MACHINE OFF THE NET & THE TUBING FROM THE MEDICARE 02 COMPANY? DOES ANYONE KNOW OR HAVE ANY SUGGESTIONS ON THE BEST WAY TO GET THE O2 COMPANY TO BRING OUT THE MACHINE?

Hi,

Please start a new thread because otherwise, I fear your post will get lost in a thread that is pretty old. Also, please do not use "all caps" as it is very hard to read. And as FYI, you may not be aware but when you do that, that is considered shouting which I am sure you didn't intend.

Welcome to the forum by the way.

49er

creekredman wrote:My baseline sleep study showed CA-98, OA- 21, Mixed-4, hyponeas-17 said I had a RDI of 103.1 per hour. "very severe CENTRAL SLEEP APNEA GREATER THAN OBSTUCTIVE. HYPOXIA AS LOW AS 80%. THE PATIENT DOES HAVE SLEEP APNEA IN A RANGE LINKED WITH INCREASED RISH OF POTENTIAL CARDIOVASCULAR & CEREBRALVASICULAR EVENTS & COULD EXPLAIN NEUROCOGNITIVE SYMPTOMS IF PRESENT. I HIGHLY RECOMMEND TREATMENT"

I HAVE A HX OF HIGH BLOOD PRESSURE, CONGESTIVE HEART FAILURE, MOD AORTIC STENOSIS, 3 STROKES, ATRIAL FIB, VENTRICULAR ARRHYTHMIA, & NOW I'M GETTING SEVERE SHORTNESS OF BREATH WITH INCREASED HEART RATE TO 116 IT THEN DROPS TO 84 & MY O2 SAT ON RA DROPS TO 70. HAPPENING 3-4 TIMES A DAY SINCE 12/25/2013 .I AM GETTING WORSE.

I DID BEST ON THE ASV ADVANCED MACHINE. A RX WAS WRITTEN. I HAVE MEDICARE. O2 COMPANY REFUSING TO GIVE US THE MACHINE. CALLED MEDICARE TOLD THE O2 COMPANY SHOULD HAVE BROUGHT THE MACHINE WHEN THEY RECEIVED THE RX, THEN FILED A CLAIM. THERE IS A 30 DAY WINDOW TO OBTAIN THE MACHINE OR ELSE WE HAVE TO START OVER.

NOW THE O2 COMPANY IS TELLING ME I HAVE TO TITRATED ON A REGULAR BIPAP MACHINE BEFORE THEY CAN BRING OUT THE ASV ADVANCED MACHINE. MEDICARE IS NOT REQUIRING THAT. WHAT IF WE BOUGHT THE MACHINE OFF THE NET & THE TUBING FROM THE MEDICARE 02 COMPANY? DOES ANYONE KNOW OR HAVE ANY SUGGESTIONS ON THE BEST WAY TO GET THE O2 COMPANY TO BRING OUT THE MACHINE?

I don't know anything about Medicare, but I am a cash patient with severe central apnea. I tried to get a s9 VPAP adapt (as prescribed) machine off the net. I was told those machines could not be sold over the internet, only from a DME. So I ended buying from a DME. The best price I could get was $4000. For the machine only. I had to buy the humidifier, hose and mask in addition to the machine. Good luck trying to get the right machine. As you can see, the o2 company might be reluctant to give you such an expensive machine. Educate yourself on the forums. My DME first delivered a s9 auto and tried to deny they gave me the wrong machine. Then they tried to give me an adapt with over 300 hours, and the outdated model to boot. Finally I got the right machine. The whole DME process took a month to get straitened out. I learned to educated and stand up for yourself. Good luck.

CreekRedMan, here are some quick answers:

1. In the future, you should post this as a new topic.

2. Medicare probably won't do anything. But they might intervene if a DME (the O2 company) does not follow a doctor's order.

3. The DME (the O2 company) would rather not sell you the ASV unit because they don't get reimbursed as much and they probably have no experience with it.

4. You should contact your doctor immediately if the DME (the O2 company) is not bringing the unit. There are other companies that will do so.

5. If you have a lawyer you use, have him write a letter of complaint to the DME (the O2 company). That will get their attention.

6. You can certainly purchase an ASV unit either form our host (CPAP.com) or from others on their forum, who occassionally sell such unit. Sometimes you can find them on CraigsList.

Hope that helps.

creekredman wrote:My baseline sleep study showed CA-98, OA- 21, Mixed-4, hyponeas-17 said I had a RDI of 103.1 per hour. "very severe CENTRAL SLEEP APNEA GREATER THAN OBSTUCTIVE. HYPOXIA AS LOW AS 80%. THE PATIENT DOES HAVE SLEEP APNEA IN A RANGE LINKED WITH INCREASED RISH OF POTENTIAL CARDIOVASCULAR & CEREBRALVASICULAR EVENTS & COULD EXPLAIN NEUROCOGNITIVE SYMPTOMS IF PRESENT. I HIGHLY RECOMMEND TREATMENT"

I HAVE A HX OF HIGH BLOOD PRESSURE, CONGESTIVE HEART FAILURE, MOD AORTIC STENOSIS, 3 STROKES, ATRIAL FIB, VENTRICULAR ARRHYTHMIA, & NOW I'M GETTING SEVERE SHORTNESS OF BREATH WITH INCREASED HEART RATE TO 116 IT THEN DROPS TO 84 & MY O2 SAT ON RA DROPS TO 70. HAPPENING 3-4 TIMES A DAY SINCE 12/25/2013 .I AM GETTING WORSE.

I DID BEST ON THE ASV ADVANCED MACHINE. A RX WAS WRITTEN. I HAVE MEDICARE. O2 COMPANY REFUSING TO GIVE US THE MACHINE. CALLED MEDICARE TOLD THE O2 COMPANY SHOULD HAVE BROUGHT THE MACHINE WHEN THEY RECEIVED THE RX, THEN FILED A CLAIM. THERE IS A 30 DAY WINDOW TO OBTAIN THE MACHINE OR ELSE WE HAVE TO START OVER.

NOW THE O2 COMPANY IS TELLING ME I HAVE TO TITRATED ON A REGULAR BIPAP MACHINE BEFORE THEY CAN BRING OUT THE ASV ADVANCED MACHINE. MEDICARE IS NOT REQUIRING THAT. WHAT IF WE BOUGHT THE MACHINE OFF THE NET & THE TUBING FROM THE MEDICARE 02 COMPANY? DOES ANYONE KNOW OR HAVE ANY SUGGESTIONS ON THE BEST WAY TO GET THE O2 COMPANY TO BRING OUT THE MACHINE?