APAP and central apnea

[CynthiaMueller]

Ghandi,
I have both central and obstructive events without therapy. The CPAP made the central worse, and didn't fix the obstructive enough. I switched to regular BiPAP and the obstructive got better but the central got even worse. I've had a prescription for a BiPAP ASV since the beginning of May but I haven't been able to get a DME to actually get a hold of one in order to sell one to me. (I have been through a few. I think that they have to get someone to invent it or refine the plastic used in it or something. ) Insurance has said "no problem" to coverage - they have the documentation.
It's amazing what the DME will try to tell us. BiPAP isn't used for apnea? You are lucky enough to have been treated successfully with the equipment they issued you. Next time you'll be more confident in dealing with the DME.
Cindy

[vsheline]

I've had a prescription for a BiPAP ASV since the beginning of May but I haven't been able to get a DME to actually get a hold of one in order to sell one to me. (I have been through a few. I think that they have to get someone to invent it or refine the plastic used in it or something. ) Insurance has said "no problem" to coverage - they have the documentation.

Hi Cindy,

That's amazing. Maybe you can call your insurance company and ask them to identify a DME who can dispense the unit to you. Or ask if you can buy on line and be reimbursed at same rate as if using an in-network DME because you have been unable to locate a DME in your area which will supply the machine.

Hurry, or you may need to start all over again because pre-authorizations are only good for a few months, and then another ASV titration may be required or something like that.

Make sure you get either the newer S9 VPAP Adapt REF# 36037 (NOT older S9 VPAP Adapt REF# 36007 or 36017 if including Humidifier or 36027 if including Humidifier and heated hose, which had ASV mode but did not have the new ASVauto mode), or the PRS1 DS960 with heated humidifier AND HEATED HOSE).

Best of luck,
--- Vaughn

[vsheline]

BiPAP with ASV (auto servo ventilation) seems to be marvellous. I'm just a little more irritated that it wasnt suggested to me at all.

Hi Ghandi,

In USA most insurance companies will not pay for the (much more expensive) ASV type of bi-level machine unless the patient is already being treated with CPAP or APAP or ordinary bi-level machine AND the nightly Central Apnea Index is both above 5 AND is higher than the Obstructive Apnea Index, AND a special ASV titration is done and shows ASV treatment works well for the patient. AND some US insurance companies require AHI to be greater than 5.0, others greater than 10.0, others greater than 15.0 when patient is using their present (non-ASV) machine.

Congratulations on your good success with CPAP + C-Flex.

[Sleepster]

Oh god, i regret not paying that extra 150$ for the apap option. That way i could have asked to try apap at some point. Now it's too late . At least for the next 5 years.

Not really. You can shop around for a good used machine, for example on craigslist. You'll find that a back up machine is a must-have because any machine can fail at any time and leave you stranded.

For example, that's how I found my VPAP Auto, and it's much better than the fixed pressure BiPAP prescribed by my doctor.

Just keep your eye on the advertisements, keep some cash on hand, and be ready to act fast. When a good deal comes up on craigslist it goes fast. On a Friday night I saw an ad that had been posted that afternoon. I called the seller and the next morning, after a 45-minute drive, I was at his house. As I was leaving he was texting someone else to tell him not to bother coming because he had sold both machines to me. An Autoset and the VPAP Auto. It was too good of a deal to pass up!

[archangle]

When i asked for bipap the DME told me they did't used it for sleep apnea. They reacted so strongly, like i was out of my mind to even mention the word bipap. So i backed off.

Your DME is trying to protect his profit margins.

Bilevel is mostly for people who have trouble exhaling against the CPAP pressure.

Bilevel may improve or worsen central apnea. It's cheaper than an ASV unit. ASV is also uncomfortable for many people to get used to. It's worth trying bilevel as long as you monitor the results and see whether centrals go up or go down.

Some people definitely need the ASV, though.

Ghandi, how high are your AHI and CAI numbers?

[Ghandi]

CynthiaMueller well i hope you can get your asv machine and find a proper DME if that exists. I would call the insurrance like vsheline proposed

vsheline There is the medical mafia and the insurance is not any better . my therapy is succefull but i wish i could eliminate the couple of long events that are probably causing desaturation.

Sleepster This is super idea and i have been thinking about it for an auto-pap. i cant get myself to sleep with used medical equipment. I may be a chicken but i'm really scared something bad could happen if the item is not working properply(and this could be the reason of the sale). The cpap shop is still a security blanket at this point for me. Maybe i will get more confident but for now i cant do it. Thx for the advice though. How is your Vpap therapy going? Do you have chronic obstructive pulmonary disease or just osa?

[Ghandi]

When i asked for bipap the DME told me they did't used it for sleep apnea. They reacted so strongly, like i was out of my mind to even mention the word bipap. So i backed off.

Your DME is trying to protect his profit margins.

Bilevel is mostly for people who have trouble exhaling against the CPAP pressure.

Bilevel may improve or worsen central apnea. It's cheaper than an ASV unit. ASV is also uncomfortable for many people to get used to. It's worth trying bilevel as long as you monitor the results and see whether centrals go up or go down.

Some people definitely need the ASV, though.

Ghandi, how high are your AHI and CAI numbers?

Therapy Efficiacy
AHI 1.33
Obstructive Apnea Index 0.49
Hypopnea Index 0.68
Clear Airway Apnea Index 0.16

But when i sleep on with a backpack to prevent sleeping on my back it lowers AHI to .7 .8. I have more obstructive than central apneas.

i suffer from chronic rhinitis. So i have 20mg zyrtec and nasonex daily to be able to use the cpap.

[archangle]

Therapy Efficiacy
AHI 1.33
Obstructive Apnea Index 0.49
Hypopnea Index 0.68
Clear Airway Apnea Index 0.16

But when i sleep on with a backpack to prevent sleeping on my back it lowers AHI to .7 .8. I have more obstructive than central apneas.

i suffer from chronic rhinitis. So i have 20mg zyrtec and nasonex daily to be able to use the cpap.

1.33 AHI is just fine as numbers go. Unless you're having other problems, be happy.

Centrals are not necessarily more harmful than obstructives, just harder to eliminate. Look at your data, and see what the apneas look like. Unless they're really long, be happy.

[Ghandi]

Therapy Efficiacy
AHI 1.33
Obstructive Apnea Index 0.49
Hypopnea Index 0.68
Clear Airway Apnea Index 0.16

But when i sleep on with a backpack to prevent sleeping on my back it lowers AHI to .7 .8. I have more obstructive than central apneas.

i suffer from chronic rhinitis. So i have 20mg zyrtec and nasonex daily to be able to use the cpap.

1.33 AHI is just fine as numbers go. Unless you're having other problems, be happy.

Centrals are not necessarily more harmful than obstructives, just harder to eliminate. Look at your data, and see what the apneas look like. Unless they're really long, be happy.

What do you consider really long ?
I may buy an oxineter to check desaturation.

Yesterday i had 1.78

Hypopnea 0.89
Obstructive Apnea 0.51
Clear Airway Apnea 0.38

The longest event was 26 seconds. But some nights i have 40 and 45 seconds apnea. so would that be too long?

My theory is that when i'm sleeping on my back the pressure is not high enough to treat some of the OAs.

I have ben using the cpap for over 3 months now. Overtime will it(number of envents and lenght)decreae with me getting used to get therapy?

The thing i'm happy about i that i have no problem sleeping with the machine. As a matter of fact i like it.

[archangle]

What do you consider really long ?
I may buy an oxineter to check desaturation.

Yesterday i had 1.78

Hypopnea 0.89
Obstructive Apnea 0.51
Clear Airway Apnea 0.38

The longest event was 26 seconds. But some nights i have 40 and 45 seconds apnea. so would that be too long?

My theory is that when i'm sleeping on my back the pressure is not high enough to treat some of the OAs.

I have ben using the cpap for over 3 months now. Overtime will it(number of envents and lenght)decreae with me getting used to get therapy?

The thing i'm happy about i that i have no problem sleeping with the machine. As a matter of fact i like it.

30 or 40 is relatively long, but not enormously long. Some people go 120 seconds or longer. Do you stop breathing entirely or do you breathe a little?

Sit down, preferably in a recliner, or lay down. Get calm, relax, inhale and exhale regularly for a while. Take a normal breath in and hold it for that number of seconds if you can. See how hard it is to hold it for that long. Remember that it will be less stressful to do this in your sleep. Consider how many times a night you do this in various lengths of time.

I think most doctors will look at AHI<5 and say you're OK. I"m not sure I'd disagree unless your apneas were a lot longer.