[CPAP] Cheyne Stokes Respiration

[stevew168]

At the very least, a CPAP or APAP can cause treatment emergent central apneas (TECA) due to the higher-than-ambient pressure reducing CO2 buildup.

[TALBERTC]

Thanks to everyone who has responded to my post. I Got a script for an ASV machine but Medicare wanted another sleep study. I didn't want to wait so I found a Resmed Aircurve ASV on Craigslist. My doctor said he felt I needed to see a neurologist/sleep specialist. Waiting for a call with an appointment. It will more than likely be July before I can see him.

I changed my setting on Resmed air to auto with default low and high of 4 & 20 2 nights ago. I don't think it got more than 4. I felt worse the next day. Slept without the CPAP last night and had a restless night and feel even worse.

I saw my cardiologist in January. Had an echo and everything is good. My Resmed Aircurve ASV will be here Wednesday. I sure hope this new machine will help me get a better night of rest.

I looked through my data from 2020 until today and the CSR's have gradually gotten more frequesnt and lasted longer. I sure hope that will explain the way I have been feeling for the past 2 years. It appears from visually checking the data that moving to a higher elevation may be contributing to the CSR's.

[Sleeprider]

Sleep studies and titrations are futile for ASV. This is a fully automated device that provides the pressure support needed to resolve events, in the amount needed to do so. In a Titration the technician sits there and lets the machine do the work in ASVauto mode, or in ASV mode, the tech actually changes the EPAP to resolve obstruction. It's dead simple to do this titration  yourself, and then optimize it.  It really comes down to the fact that a doctor that wants to see an ASV titration, doesn't  understand the device.  Medicare can ask for evidence that ASV is medically necessary and that it is effective. This is actually two different questions. If you doctor says it is medically necessary, Medicare must provide the prescribed device. At that point they may make final purchase contingent on demonstration of therapy benefit and device compliance by the user.  Depending on how, or whether Medicare actually denied this device, it can be appealed. My best guess is that either the DME or doctor invented the denial, because that's not how it works. Medicare is rarely the problem, and lots of DMEs use them as an excuse to say you have not demonstrated a need for this advanced device.  That's my rant and I'm sticking to it.  Here is the actual titration protocol.  Note it can be done in ASV or Auto mode.  In my experience, ASV is amazing in what it can do with only 4-settings, and I have seen it produce miracles hundreds of times.

[stevew168]

Right on, Sleeprider.

TALBERTC, looking forward to seeing how well you do with the ASV. I think you'll really like it. We're here to help you with optimizing the pressures.

[TALBERTC]

Again, thanks to everyone that have helped me determine that I need an ASV machine.  I received my aircurve 10 ASV today that I found on Craigslist. I cleaned the machine, using my tube and tank from my airsense 10, erased the data from the previous owner and set to the manufacturer defaults settings. Should I be concerned about the firmware/software? Mine version is SW sx567-0306. If so, where do I find the latest firmware and how would I install manually?

[SarcasticDave94]

I'd not be too hung up on firmware on the ResMed. It's very rare for them to update it.

Setting used machines to default is a great idea.

Skipping over heated hose, humidity, and basic start-up, you'll want to access your clinical menu and give yourself a good start point for therapy. You'll likely want this:

Mode ASV Auto which gives EPAP a range vs ASV no EPAP range, CPAP is static single pressure.

So ASV Auto mode then you might want default Titration, which will probably already be in place with the reset it seems you've done. You should see EPAP Min 4 Max 15, PS Min 3 Max 15. Note that IPAP is invisible, not directly user adjustable. However it's indirectly editable via manipulation of EPAP and PS.

[TALBERTC]

Here are my results from using my new Resmed Aircurve ASV for the first night. Can this be accurate? If so, that's amazing. 2 night's ago my AHI was 39.58.

[Sleeprider]

That is completely normal. The ASV stops all obstructive and central events, and events out any periodic breathing. Always amazing to new users that need it. Congrats! Looks like you might change EPAP min to 5.0, but other than that it looks exactly right.

I'm going to suggest that once you have some time and experience on this ASV that you contact your doctor and report the results. By getting this efficacy into your medical records, a prescription should be easy, and Medicare will have the proof of benefit needed to contribute to your next ASV. Ironically, you probably saved them the cost of a $4000 titration test.

[SarcasticDave94]

Great results, congrats. Yes, do keep a record of how well your therapy has become with ASV. Doctor needs to be shown and ask to enter into your record. Then request reimbursement.

[Jay51]

Congratulations also.  This is what a back up rate can do to stop CA's (all long as the person can tolerate it).