RE: Bi-Level, S, ST, ASV??
Thank you vsheline for your clarifying post. Another member "SarcasticDave" is looking into the ST-A iVAPS as an alternative to his existing ASV, to treat a combination of COPD and complex apnea.
01-21-2020, 11:59 AM
(This post was last modified: 01-21-2020, 12:02 PM by SarcasticDave94.
Edit Reason: PS
)
RE: Bi-Level, S, ST, ASV??
I copy that, vsheline. My research has given me that same conclusion. FWIW for me if I'd stay with the DME Apria they can offer a Respironics Trilogy if I prove need to go above my ResMed AirCurve ASV. If I change to Lincare (which I'm seriously considering), they stay with ResMed and offer the ST-A with iVAPS or the ResMed Astral also in iVAPS mode. My new sleep study is in about a week to see if things changed enough to show medical necessity for insurance. Trilogy and Astral are under a different script HCPCS code E0466 with ST-A VAuto and ASV under E0471.
PS I'll self fund the machine if necessary as I'm going to be getting SSDI and Supplemental deposits shortly.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Bi-Level, S, ST, ASV??
This thread is regarding my fathers therapy. He has heart failure, and the Dr will not prescribe ASV. I know all the ins and outs of the studys and tend to agree ASV would be beneficial, but I also don't believe he needs ST mode at all... I think the titration studies never went far enough to find the right treatment in the first place... that having been said... back to the real question at hand...
Why the nasal mask shows few UAs and quite a few hypopneas but high leaks... and the View mask shows a lot of UAs and much less hypopneas, and no leaks.
The replies before speculate that the nasal mask is not providing proper treatment due to the leaks... and the View mask IS treating, but not effectively due to low PS.
The wrench in that theory is the O2 saturation numbers... with the nasal mask his O2 is near 100% all night. NO drops below 90%. With the View mask, he has frequent drops to low 90's, and a few below 90 and much more variation up and down all night. So, the reality is that with the nasal mask he has GREAT O2 numbers and VERY short, mild hypopneas with continued respiration. But with the View mask he has more drops in O2 and much more frequent obstructive or CA events, longer in duration, therefore more abrupt awakenings and breaths.
If I could figure out HOW to control the hypopneas with the nasal mask and address the leaks, I think it would be even better. I may start with 1 point increase in IPAP to see if it makes a difference... the original levels were 7/16. When dr saw that lower levels during ramp were treating effectively, they reduced to 7/12... which was a bigger jump than I expected. May be need to experiment with 13 or 14... since increasing PS (IPAP only increase) is what the titration guide calls for to treat hypopneas. But that will probably increase leaks also...
