How difficult to adapt to asv

sawinglogz wrote:

JohnBFisher wrote:

sawinglogz wrote:How do you know when a cushion is dying and needs to be replaced (especially with mask liners)?

It starts to leak more .. When that means it awakens me more than I like, I switch to a new mask cushion.

How do you tell the difference between that and the headgear stretching out and needing to be tightened?

The mask cushion starts to feel stiff (when compared to a new cushion). It leaks more because of that stiffness. So, a monthly change seems to keep things in check. When the headgear stretches, it ends up allowing the mask to move about a bit more .. again, a different feel than just a stiff mask. I also change the headgear along with the mask shell annually (at least) to keep it from becoming a problem.

Hope that helps.

Thanks for the recommendations on the mask leaks John. I tried a different mask for part of the night during the titration, one of the full face respironics devices rather than the Quattro full face I currently use. I swapped masks halfway through the night because it was seriously trashing my nose. I've got a big bruise/sore on it now so I'll be using moleskin again for a few nights

JohnBFisher wrote:…you will find that the mask cushion dies a LOT faster with ASV therapy due to the constant flexing with the change in pressure. I personally use a Resmed Quattro FX full face mask. I find I have to change the mask cushion on a monthly basis. When I had CPAP and BiPAP therapy the mask cushions would often last three to six months. Not with ASV therapy.

Thanks for pointing this out, John.

I have been thinking about this lately, as I think I have been noticing an upward curve in my leaks as the weeks roll by after installing each new one. It always starts out great, and then gradually goes downhill (actually, uphill ).

Also, as someone else just mentioned, I think the straps seem to stretch and need to be made a teeny bit tighter, but this goes on over months rather than weeks.

Best wishes, Nate

I think I'm headed for an ASV myself. I'm meeting with the Dr. on Friday to discuss. Since I started APAP about 2 weeks ago, my OSAs are way down but my Centrals are going crazy. They come in clusters throughout the night and last around an hour at a time, with individual Centrals coming consistently around once a minute. I feel like "Old Faithful!"

Although after just 2 weeks I'm certainly no expert, I'm sure getting the impression that this whole process is at least as much art as science.

rd1978 wrote:... I'm sure getting the impression that this whole process is at least as much art as science. ...

You are definitely correct on that. While a sleep study is necessary, there's no doubt that it records the data from just one night that may or may not be representative of a "normal" night. That's where the "art" comes into play.

Let me provide a personal example. I have a LOT of problems with sleep onset central apneas. They are normally scored out of the sleep study. But in my case, I stop breathing so long that my blood oxygen levels drop below 70%. Yikes!! .. As I went through the sleep study cycle to get some relief, I finally complained about this (very clearly) to my sleep doctor. I had mentioned it before, but it was in with everything else. This time, I made it exceptionally clear. (Breaking down in tears when he wanted to repeat a BiPAP study makes it clear that something is wrong! ). So, he went back and looked at the data that was excluded (since it was sleep onset) and decided that I definitely qualify for ASV therapy.

Why did the system not catch it initially? Well, by default sleep onset centrals are normal and not a problem .. when the last a few seconds. But it's NOT normal and MUST be addressed when the last for more than a minute!! So, while the normal "rules/science" is pretty good, the process still requires some good "judgement/art" on the part of the doctor.

Well, I heard from the sleep doctors nurse today, and she said that they liked what they saw on the vpap/asv titration and that they would send an updated prescription to my DME if it was okay with me. Luckily, I learned enough from what I've read on here to understand there was a problem when the DME called to say the doctor had sent them a prescription for a VPAP, which was basically just a brand name difference from a BIPAP, which is what I'm on, and that the settings didn't look right. I explained the complex sleep apnea, let her know they did my last titration with a resmed vpap adapt asv in order to see if they could get my AHI which was primarily now composed of centrals down lower by using the asv, and she informed me that made sense and that she would get with my doctor to take care of the prescription, then start working with the insurance companies to get pre approval. Again, the Bipap machine was recommended as a home trial since the best they got in the lab was a little over AHI of 10 composed of central apneas. The hope was that the centrals would resolve over time, and it was mentioned you had to fail on BIPAP prior to moving to asv.

Now I guess it's wait and see how things go with the insurance companies. Since they pre-approved the third titration, I assume they knew the new machine would probably be the result.

SeekSleep wrote:... Now I guess it's wait and see how things go with the insurance companies. Since they pre-approved the third titration, I assume they knew the new machine would probably be the result. ...

It's a sad and unacceptable thing that such communication problems are the norm. But you are correct. You should get approval without too many problems. If you jumped to the ASV unit, they would be well within their right to ask "Isn't a cheaper alternative effective?". But you and your doctor has shown the answer is a clear "No!". Documentation and process do matter. Now if they can only figure out how to do a better job of communicating ...

Note that Respironics' ASV unit is called the "BiPAP Auto SV Advanced", which doesn't contribute to clarity.

The terminology definitely doesn't help when each company calls it something different. Unfortunately, it appears my doctors office isn't very up to date either. For the last sleep study, my doctor referred me back to the sleep doctor for my last sleep study, but I actually saw his PA who set me up for titration study. My DME called me again today to let me know they were still not understanding what I was requiring, as the prescription was pretty much for the Bipap I was already on. I got ahold of the doctors nurse again, and she said I needed a trial on a VPAP. I asked if that wasn't primarily just a brand name difference from Bipap, and she said no, they are totally different machines. I then asked her to get with the doctor, find out for sure if there shouldn't be something name wise following the "VPAP", and then get with the DME again to clarify things. This is going to end up giving me a worse headache than the sleep apnea did. I didn't see the machine they hooked me up to as it was in a cabinet, but I do know it didn't behave at all like my BIPAP. If I didn't breath, it would start blowing at me with increasing pressure until I took a breath whereas if I don't start taking a breath with my Bipap it doesn't ramp up to the higher setting let alone ramp up to the point of blowing out the seal on my mask.

In situations like this I highly recommend asking them specific questions:

"I think the doctor wants me titrated for ASV. The two such machines are the VPAP Adapt SV and the BiPAP AutoSV Advanced. Could you ask him to confirm that and write that on his prescription?"

and also "VPAP is the brand name for the thing I'm already on, and the DME confirmed that. What specific kind of therapy is the doctor prescribing?"

Now it's also possible that all he's thinking of is a bi-level with some kind of back-up timer (Spontaneous, Timed, or ST).

I was lucky that my doctor and sleep lab knew all about ASV, though they're stuck on the Respironics terminology and keep calling it "autoSV".

Good luck!

Fortunately, I learned enough on here that I think I'll be able to resolve it. I explained the situation in a way the DME could understand, and they understood what machine I thought I needed. My PA's nurse didn't seem to understand, but agreed to check with the PA, and I asked her to also have him verify everything with the Doctor, who seemed quite knowledgeable when I talked to him during my first consult. He's the one that actually reviewed my earlier data and recommended the PA set me up for a third titration study.

I must admit through all this, I'm somewhat bothered by the assorted doctors. My GP was quick to set me up with a sleep doctor and understood sleep apnea should be looked into, but other than that, when I tried to discuss treatment with him, all he could recommend was get with the sleep doctor to see what he thinks. The sleep doctor has me check with his PA first, who appears to be in training. Seems if you didn't take the time to see how things are supposed to work you'd end up without the most effective possible treatment more often than not.

As it turns out, all that needed to be done was involve the sleep doctor rather than the PA who is fairly new. The doc filled out the prescription very specific, but unfortunately, didn't consult me as to any preferences I might have. He spelled out ResMed S9 Adapt asv. Right now I have a Respironics 660 Bipap, and bought a DC power cord to run it in my RV. The Phillips machines run off 12vdc and are thus easy to adapt for camping where the ResMeds are 24vdc I believe. The DME offered to get with the doctor and see if he'd change it but that seemed like more trouble than it's worth to me. I'll just run the machine off a small inverter.

Pre approval with the insurance went smooth, and the new machine is on order, now I just have to see how I take to the more annoying devise

SeekSleep wrote:As it turns out, all that needed to be done was involve the sleep doctor rather than the PA who is fairly new. The doc filled out the prescription very specific, but unfortunately, didn't consult me as to any preferences I might have. He spelled out ResMed S9 Adapt asv. Right now I have a Respironics 660 Bipap, and bought a DC power cord to run it in my RV. The Phillips machines run off 12vdc and are thus easy to adapt for camping where the ResMeds are 24vdc I believe. The DME offered to get with the doctor and see if he'd change it but that seemed like more trouble than it's worth to me. I'll just run the machine off a small inverter.

Pre approval with the insurance went smooth, and the new machine is on order, now I just have to see how I take to the more annoying devise

If it's any encouragement to you, I love my S9 Adapt and I "adapted" to it very quickly even though I had never before had any xPAP machine at all except in the last 2 of the 3 sleep studies. The machine and pressure was relatively fine to adapt to right from the beginning. I have never had a Respironics machine, but my ResMed Adapt has always given me the air I need and want, when I need and want it, with no hassle. Except for the time early on when for about three nights I made the mistake of having the minimum pressure set down too far. I thought I wanted less pressure but once I trusted the machine I learned I needed/wanted a tiny bit more, and have been content with its settings ever since. Over 550 nights now.

On the other hand, I fought with masks for awhile, because I was fixated on going "minimalist" and had a big mental resistance against having to breathe through a mask on my face. But cpaptalk members helped me immensely with that aspect and I ended up being an enthusiastic advocate for first my Swift FX, then ditto with the Bella loops, then my Aloha and now I found my WISP to be easiest of all. Head straps never would stay in place for me, and nasal pillows would slip away during the night, but the tiny nasal cushion on the Wisp has me content, and its straps running from front to back seem to be much more stable than over the head straps. At least for me.

Best of luck!

Regards, Nate

Nate, The encouragement of you, John, and the many others that have pointed out their trails, and success are indeed motivating. My personality type is such that I'll stick through it, force the issue if necessary, and make it work. Doesn't mean I'll like it though. To be honest, last night was my first night since I got my Bipap 3 months ago where I had sleep issues primarily caused by my machine. Seems I was having a bad day and somewhat stressed making it difficult to sleep, they the stupid mask just didn't want to seal good for some reason to where I ended up getting up around 1 am to clean it having not fallen asleep yet. Of course that didn't help much, and at 4:15 am the alarm goes off meaning time to get up and head off to work. Oh well, most of the time it's a quality of life enhancer. Guess you just have to suffer a little every now and then to fully appreciate it.

SeekSleep wrote:Nate, The encouragement of you, John, and the many others that have pointed out their trails, and success are indeed motivating. My personality type is such that I'll stick through it, force the issue if necessary, and make it work. Doesn't mean I'll like it though. To be honest, last night was my first night since I got my Bipap 3 months ago where I had sleep issues primarily caused by my machine. Seems I was having a bad day and somewhat stressed making it difficult to sleep, they the stupid mask just didn't want to seal good for some reason to where I ended up getting up around 1 am to clean it having not fallen asleep yet. Of course that didn't help much, and at 4:15 am the alarm goes off meaning time to get up and head off to work. Oh well, most of the time it's a quality of life enhancer. Guess you just have to suffer a little every now and then to fully appreciate it.

Very well put! Your great attitude will serve you well in this new venture into better health and taking good care of yourself.

Best wishes, Nate