ASV and LVEF<45%

[zzzZorro]

The Sleep Doctor's assistant called today with a prescription for AUTO BiPAP IPAP-15/Epap-7.  Not receptive to conversation apparently unable/unwilling to go beyond data dissemination.  Wanted to know which DME to send the prescription to?  Told I would call back at a later date.

I have not been privvy to viewing the Second Sleep Test yet.  But the Tech who administered it said, "Heavy Centrals initially on going to sleep/ mixed apneas- The BiPAP isn't helping".

Can anyone explain 'how' a BiPAP is going to function to improve a condition like this when an APAP will not?
Why will setting the APAP I have to 15/7 not create a similar result..

Thanks

[Spy Car]

The Sleep Doctor's assistant called today with a prescription for AUTO BiPAP IPAP-15/Epap-7.  Not receptive to conversation apparently unable/unwilling to go beyond data dissemination.  Wanted to know which DME to send the prescription to?  Told I would call back at a later date.

I have not been privvy to viewing the Second Sleep Test yet.  But the Tech who administered it said, "Heavy Centrals initially on going to sleep/ mixed apneas- The BiPAP isn't helping".

Can anyone explain 'how' a BiPAP is going to function to improve a condition like this when an APAP will not?
Why will setting the APAP I have to 15/7 not create a similar result..

Thanks

As I understand is common, I had to "fail" with Bi-Level to advance to ASV. But I got to borrow a machine for 5 nights (not purchase one), and it was horrible for me. Is this what you doctor is going for? 

Any way to trial a bi-level to show failure?

I hope senior members have better ideas for you, but I'm with you in the "huh?" response (unless this is just a hurdle you need to jump). That might be it. 

Bill

[Sleeprider]

We have seen this many times on the forum. Bilevel pressure, in your case at PS of 8, causes severe central apnea. The reason for using PS 8 is that it is a minimum pressure that actually can cause you to take a breath, however, without a backup rate like in ST and ASV, that won't happen. You will find yourself barely breathing...sorry for the rather dark prognosis, but if you could do this with a loaner machine for a few nights, that should adequately prove this won't work. It's a lot better than investing in a bilevel that is sure to fail.

If you were close to me, I would loan you my backup. This is a waste of time and money, but is the normal protocol required by insurance. You have to demonstrate you don't tolerate or benefit from bilevel before a unit with a backup rate will be authorized. Your doctor or DME may have a rental unit. This is exactly the case where a rental is best. Trust me, this won't take long. You will quickly find you are better off with CPAP, than a bilevel with no backup.

[SarcasticDave94]

If your path is to head onto an ASV, this makes a lot of sense. Insurance typically requires a Fail on CPAP and BiPAP first.

The beginning of this year, I demanded to get a BiPAP skipping over an Auto CPAP which may have worked as well. For me though, getting the BiPAP revealed in my PSG for BiPAP lots of Centrals which started my ASV path.

[Spy Car]

We have seen this many times on the forum.  Bilevel pressure, in your case at PS of 8, causes severe central apnea.  The reason for using PS 8 is that it is a minimum pressure that actually can cause you to take a breath, however, without a backup rate like in ST and ASV, that won't happen. You will find yourself barely breathing...sorry for the rather dark prognosis, but if  you could do this with a loaner machine for a few nights, that should adequately prove this won't work.  It's a lot better than investing in a bilevel that is sure to fail.

If you were close to me, I would loan you my backup.  This is a waste of time and money, but is the normal protocol required by insurance. You have to demonstrate you don't tolerate or benefit from bilevel before a unit with a backup rate will be authorized.  Your doctor or DME may have a rental unit.  This is exactly the case where a rental is best.  Trust me, this won't take long.  You will quickly find you are better off with CPAP, than a bilevel with no backup.

You told me pretty much the same thing prior to my Bi-level trial, and boy were you right.

Being simple, I hoped Bi-level would have to be better than APAP, and I felt awfully smart getting the machine on a Wednesday (so I could have 5 nights with a loaner instead of the usual 3). That was a big mistake. I felt tortured with Bi-Level. 

If I'd needed to purchase one it would have been a supreme waste (or someone for whom Bi-level was appropriate would have been gifted a very lightly used machine).

zzzZoro, talk to the office. See what they have in mind. Try to do a rental/loaner as what Sleeprider is saying matches my own experience. This machine is unlikely to be your answer.

Bill

[zzzZorro]

I was dead serious when I said I was P*ssed at myself for ever getting involved with this particular SleepDoctor's office.  I had to see his PA to avoid a long wait but their procedure is that he apparently calls the shots.  Ever go to a quickie gas stop in a rough part of town where you deal with some dude through a crack in a bullet proof partition? That's about the air of the encounters there.
Primary Doc wants to set up tests with a pulmonologist to be sure the lungs are OK. [never smoked] Waiting on that to be scheduled as it is probably the best chance to get a second opinion on his AUTO BiPAP recommendation and could possibly circumvent the SERVE-HF stumbling block.  In the meantime I'm going to hang with the APAP. 
If  I fail to return at some point the 'hang' was literal      

[Sleeprider]

If it is possible to directly communicate with the sleep doc, please ask him why he would prescribe something he knows, and his own clinical tests prove will fail. I'd love to know the answer.

I recently stated, that "I have no medical background and no training that would make me bad at giving CPAP advise". Your doctor on the other hand clearly has set you up to fail....why? Does it not offend him that a hack like me can give better counsel? All he has to do is be honest and tell you he knows BiPAP won't work, but insurance requires this. Yet he owns the error by not doing so.

[SarcasticDave94]

Even though this failure, which I'm certain it will fail on a BiPAP, just like it did for me. I should think patient care should be getting what's really needed, not just follow some standard protocol of fail all these devices when a trained medical tech has stated BiPAP will fail.

Get a clue doctor Duck, and quit wasting time getting this situation moving towards ASV. In my situation, this exact step took about 6 months total. Here's hoping yours doesn't take nearly that long.

Dave B

[zzzZorro]

If it is possible to directly communicate with the sleep doc, please ask him why he would prescribe something he knows, and his own clinical tests prove will fail.  I'd love to know the answer.  

I recently stated, that "I have no medical background and no training that would make me bad at giving CPAP advise".  Your doctor on the other hand clearly has set you up to fail....why?  Does it not offend him that a hack like me can give better counsel?  All he has to do is be honest and tell you he knows BiPAP won't work, but insurance requires this.  Yet he owns the error by not doing so.

We/You will probably never know. If you are a 'hack' I have to wonder where in the pecking order he resides.

Trying to think back, I believe this riff came about when the assistant  to the Doctor's PA realized I had obtained a copy of the first sleep test BEFORE they had received it.  Needless to say I was unable to get the results of the second sleep test until AFTER she got it first.  This is one of those times you can feel the crap being poured on your head but there is nothing you can say definitively as I would seem to be the Adam-Henry [A.H.] here.  Think her ego considerably exceeds her paygrade!  I'm not one to be screwed-with and this is a dead end street so there is no advantage to pursuing it further with them.  If I accept a prescription from their office, it will as a minimum require my crawling back to the assistant for the insurance mandated face-to-face presentation.  Everything seems to go through her first.
I should mention, my wife also has apnea problems and went to the same place.  Her prescription for a CPAP has been called into the DME so she will have to return to them for her review.  I feel sorry for her as she ALSO shares the same feelings over our experiences there.

FWIW: Even though my APAP is not a BiPAP I dialed in the 7/15 pressures ordered for the BiPAP and it produced less Centrals and a slew of Obstructives. https://imgur.com/a/flLA6 Tried to retrieve O-2 with recording oximeter for the lead-in to check on the Centrals but managed to dump the data.    

I'm DISGUSTED and to the point I now feel I'm whining..  And that doesn't set well.  I will get this all worked out, Please excuse me!

[Spy Car]

If it is possible to directly communicate with the sleep doc, please ask him why he would prescribe something he knows, and his own clinical tests prove will fail.  I'd love to know the answer.  

I recently stated, that "I have no medical background and no training that would make me bad at giving CPAP advise".  Your doctor on the other hand clearly has set you up to fail....why?  Does it not offend him that a hack like me can give better counsel?  All he has to do is be honest and tell you he knows BiPAP won't work, but insurance requires this.  Yet he owns the error by not doing so.

We/You will probably never know.  If you are a 'hack' I have to wonder where in the pecking order he resides.

Trying to think back, I believe this riff came about when the assistant  to the Doctor's PA realized I had obtained a copy of the first sleep test BEFORE they had received it.  Needless to say I was unable to get the results of the second sleep test until AFTER she got it first.  This is one of those times you can feel the crap being poured on your head but there is nothing you can say definitively as I would seem to be the Adam-Henry [A.H.] here.  Think her ego considerably exceeds her paygrade!  I'm not one to be screwed-with and this is a dead end street so there is no advantage to pursuing it further with them.  If I accept a prescription from their office, it will as a minimum require my crawling back to the assistant for the insurance mandated face-to-face presentation.  Everything seems to go through her first.
I should mention, my wife also has apnea problems and went to the same place.  Her prescription for a CPAP has been called into the DME so she will have to return to them for her review.  I feel sorry for her as she ALSO shares the same feelings over our experiences there.

FWIW: Even though my APAP is not a BiPAP I dialed in the 7/15 pressures ordered for the BiPAP and it produced less Centrals and a slew of Obstructives. https://imgur.com/a/flLA6 Tried to retrieve O-2 with recording oximeter for the lead-in to check on the Centrals but managed to dump the data.    

I'm DISGUSTED and to the point I now feel I'm whining..  And that doesn't set well.  I will get this all worked out, Please excuse me!

zzzZoro, I'm still a little confused. Is this sleep doc suggesting you purchase a Bi-Level?

Unlike Sleeprider, I really am a hack, so if I alone thought "this clearly won't work" then I'd doubt myself just a bit. I barely survived 5 nights with a loaner. It isn't the fixed of centals/mixed apneas.

Can you get a loaner or short-term rental, since the odds are a Bi-level won't work for you?

Bill