10-31-2019, 03:50 PM
(This post was last modified: 10-31-2019, 03:55 PM by jtech1.)
RE: Bi-Level, S, ST, ASV??
(10-31-2019, 03:13 PM)jtech1 Wrote: OK. So... script says only BiPAP 16/7. So if I am understanding this correctly, I should be making sure he gets the ResMed AirCurve 10 S or VAuto unit... along with ClimaLineAir Oxy, Air10 oximeter adapter, and third party oximeter (ResMed does not make one, right?).
Just to confirm... the VAuto does everything the S model does and adds the auto feature, right? VAuto will do fixed 16/7 mode, right? But will have the additional flexibility for the Dr to use Auto mode later if they want to... am I correct in this? Anyone using the VAuto in fixed mode?
Thanks!
Adding on to my thoughts above... please correct me if I am wrong, but the titration study seems to be an archaid way of doing this and just a money maker for the sleep lab... they try different pressures and spend so LITTLE time at each pressure that the AHI numbers are completely invalid... ie AHI of 120 since ONE apnea occurred and he was alseep for 30 seconds... that is ridiculous! WHY wouldn't the Dr just use an auto machine, let it vary things as needed, and adjust it weekly based on the reported results, and possibly get to a fixed pressure in the end that is the lowest possible that produces the best results? That seems like a MUCH better way to find the correct pressure.. but, oh.. it would mean less revenue for the sleep center, and more time for the dr to spend without billable hours... am I wrong? The sleep stud says that 16/07 is the right level. but lower levels had less than 5 minutes at each level... and some less than 1 minute... statistically those results are invalid and a waste of time. So, 16/07 may be higher than he needs... and without an Auto unit, he will never know. Should I push for the VAuto or accept the S model? The S and the VAuto are the same price on most sites... WHY would anyone not get the VAuto??? Am I missing something????
I reread the ResMed guide.. and after I called them and they tell me the VAuto does everything the S does and more... I see in the guide that the S has a greater pressure range than the VAuto... what the heck else is different that they did not tell me about... 
RE: Bi-Level, S, ST, ASV??
(10-31-2019, 03:13 PM)jtech1 Wrote: OK. So... script says only BiPAP 16/7. So if I am understanding this correctly, I should be making sure he gets the ResMed AirCurve 10 S or VAuto unit... along with ClimaLineAir Oxy, Air10 oximeter adapter, and third party oximeter (ResMed does not make one, right?).
Just to confirm... the VAuto does everything the S model does and adds the auto feature, right? VAuto will do fixed 16/7 mode, right? But will have the additional flexibility for the Dr to use Auto mode later if they want to... am I correct in this? Anyone using the VAuto in fixed mode?
Thanks!
This is correct. The Vauto will be setup with pressure support at 9.0 cm which is a lot! (16-7=9). I would really like to see the diagnostic or titration report because that much pressure support sounds like it is intended to cause a breath to be taken during central or hypopnea events, and that much pressure support will almost always cause hypocapnia (CO2 washout) which will diminish respiratory drive. If you can get the reports, please post them because I think an ST or ASV may be the next machine when this one fails. I would be very reluctant to recommend a pressure support of 9.0 without a backup rate. Perhaps you should ask the doctor? Specifically, call the doctor's office and ask, "Is it your opinion that he needs a bilevel with a pressure of 16/7 (PS 9.0) without a backup rate, or should we get the ST or ASV?"
RE: Bi-Level, S, ST, ASV??
The Dr specifically does not want him on ASV because of his heart failure... and I asked if he wanted regular Bilevel or T/ST machine and he said he did not see a need for that based on his results.
He had 174 minutes of sleep at Bilevel 16/07 with only two centrals, one hypopnea and 1 RERA during that entire time (AHI 1.0), and very few drops in O2 level during that time. Untreated, he was at AHI of 67.9 (76% OA, 12% CA, 5% mixed, 7% Hyp).
They did do the untreated entirely on his back... and the treated was about 50/50 back and sides... I think it is BS that they do the initial entirely on the back. When I had mine they told me the same thing... stay on your back. I am guessing to skew the results and make money on treatment... but I would prefer to identify differences in position and apneas so it can be treated properly.
RE: Bi-Level, S, ST, ASV??
(10-31-2019, 03:50 PM)jtech1 Wrote: (10-31-2019, 03:13 PM)jtech1 Wrote: OK. So... script says only BiPAP 16/7. So if I am understanding this correctly, I should be making sure he gets the ResMed AirCurve 10 S or VAuto unit... along with ClimaLineAir Oxy, Air10 oximeter adapter, and third party oximeter (ResMed does not make one, right?).
Just to confirm... the VAuto does everything the S model does and adds the auto feature, right? VAuto will do fixed 16/7 mode, right? But will have the additional flexibility for the Dr to use Auto mode later if they want to... am I correct in this? Anyone using the VAuto in fixed mode?
Thanks!
Adding on to my thoughts above... please correct me if I am wrong, but the titration study seems to be an archaid way of doing this and just a money maker for the sleep lab... they try different pressures and spend so LITTLE time at each pressure that the AHI numbers are completely invalid... ie AHI of 120 since ONE apnea occurred and he was alseep for 30 seconds... that is ridiculous! WHY wouldn't the Dr just use an auto machine, let it vary things as needed, and adjust it weekly based on the reported results, and possibly get to a fixed pressure in the end that is the lowest possible that produces the best results? That seems like a MUCH better way to find the correct pressure.. but, oh.. it would mean less revenue for the sleep center, and more time for the dr to spend without billable hours... am I wrong? The sleep stud says that 16/07 is the right level. but lower levels had less than 5 minutes at each level... and some less than 1 minute... statistically those results are invalid and a waste of time. So, 16/07 may be higher than he needs... and without an Auto unit, he will never know. Should I push for the VAuto or accept the S model? The S and the VAuto are the same price on most sites... WHY would anyone not get the VAuto??? Am I missing something????
I reread the ResMed guide.. and after I called them and they tell me the VAuto does everything the S does and more... I see in the guide that the S has a greater pressure range than the VAuto... what the heck else is different that they did not tell me about... Wrong, S Mode can provide greater pressure than VAuto mode. Both machines in S mode provide the same pressures. The VAuto provides a auto mode in addition to the S mode.
IMHO between the S and the VAuto get the VAuto, even if you are using it in "S" mode.
RE: Bi-Level, S, ST, ASV??
I will bet that in 3-years your doctor will reverse his opinion on ASV after the results of ADVENT-HF are published and it is finally concluded that modern auto-ASV is effective and safe for CHF with LVEF < 45%. My speculation aside, I agree with Fred that a Vauto is generally better than the VPAP S when obstruction is present. We don't know that, and this prescription is written to provide positive pressure support to spontaneous inspiratory effort. Either the VPAP S or Vauto can accomplish that. Unfortunately, I have no confidence at all in the sleep studies or recommendations you are working from. I'm out. I don't think 16/7 without a backup rate will work, but if that is what you go with, then either the Vauto or S will work.
RE: Bi-Level, S, ST, ASV??
I will post the titration results shortly... more days went buy and Dr finally got script to DME... 4 days after promised... now DME says it will be another 12-16 BUSINESS days to get insurance approval... does that sound right? Medicare. Mine was all out of pocket deductible so i just bought it and had it the next day... and the Dr lost the Oximetry report so they left the O2 off the script... can't tell you how frustrating dealing with this Dr and office has been. This has all been done as STAT... and yet, it will be over 7 weeks from first appt to getting the equipment... ridiculous!
RE: Bi-Level, S, ST, ASV??
Sounds like a slow roll in timing, but it's probably inline with what others like myself have encountered. Me, I'd probably call in a few days to initiate a swift kick. Or at the very least, to get an update.
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??
(10-31-2019, 05:51 PM)bonjour Wrote: S Mode can provide greater pressure than VAuto mode. Both machines in S mode provide the same pressures. The VAuto provides a auto mode in addition to the S mode.
IMHO between the S and the VAuto get the VAuto, even if you are using it in "S" mode.
Also chiming in to support what Fred said. Get the VAuto ... even if you need to pay a wee bit of cash out of pocket to get.
The VAuto is a superset of the S.
WillSleep
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-04-2019, 11:47 PM
(This post was last modified: 11-04-2019, 11:48 PM by WillSleep.)
RE: Bi-Level, S, ST, ASV??
(10-31-2019, 03:50 PM)jtech1 Wrote: ... but the titration study seems to be an archaid way of doing this and just a money maker for the sleep lab... they try different pressures and spend so LITTLE time at each pressure that the AHI numbers are completely invalid... ie AHI of 120 since ONE apnea occurred and he was alseep for 30 seconds... that is ridiculous! WHY wouldn't the Dr just use an auto machine, ...
Hi jtech,
I feel your frustrations here, yes that is a might short-sighted by that Doc. I think your frustrations are valid but with regards to your first point I personally don't want to paint all registered sleep techs with with a broad brush that condemns them this way. I want to make sure they and those that will follow them view becoming a sleep tech as a good and appreciated career .... so that we have some in the years to come 
That being said, the Sleep Techs industry advocates the AASM have set a really bar as a suggested measure for a successful sleep study (SpO2 90% and AHI < 5.0).
So if anyone I love is going fork over a lot of cash out of pocket, time and disruption for a sleep study I will be using Sleep Study example prescription template published deep on the the AASM website to write a draft prescription to share with the Doc on what we hope that sleep study achieves. 
I went down this path. I used this method and found two Sleep Techs that doubted their skillset and were signaling for an escape and three who were solid and really interested in helping the patient.
WillSleep
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Bi-Level, S, ST, ASV??
This Dr has been absolutely terrible to communicate with. Last week he told us directly that only "S" mode was needed. Now the DME tells me the script indicates AirCurve ST. Can the ST function as the S (without Timed mode active) or does ST always use timed mode and cannot be a synchronous only device? ResMed site says ST mode does not have S mode... only T or ST modes... is that true? Now I need to get to the Dr again and see why they told us one thing and wrote another.
Also, this DME says in 10 years they have never used the Air10 oximetry module... not even sure of they can get it. Probably because ResMed charges $1000 for something you can do with separate $100 device... and just not have the data integrated... I will just have him use an O2Ring I guess.
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