[Diagnosis] When should ASV be considered

[mmdupas]

I've been on CPAP for a year. My AHI has varied from 26 to under 1. In the last few months my AHI is varying from 10 to 3.5. My OAs are controlled and not a problem with CPAP therapy. What concerns me is My CAs.

When my AHI is above 5 my CA component is what's increased. To illustrate: A recent night was AHI 7.44 OA .77 H 3.19 CA 3.48. The next was AHI 3.32 OA .32 H 2.25 CA .75.

I'm wondering when the CAs warrant considering therapy using an ASV?

Thanks

[Peter_C]

I've been on my machine for many, many years. Had both nose and throat surgery. It's only been since my join date that I have actively been watching my numbers. Due to being in pain MGNT and on opiate meds, my CAs have become the largest number every single night. My sleep doc (whom I like) decided once my AHI stayed over 10 for a month (due to CAs), to put me on an ASV machine.

I am now at zero to perhaps an AHI of 1.0 all the time.

You would need a new titration study to prove the value of an ASV machine as well.

[mmdupas]

Thanks Peter. I'm not staying over 10 for a month so maybe I'm not a candidate? I will be discussing all this with my sleep doc. It's good to hear that with ASV therapy your CAs eventually became manageable.

[Sleeprider]

Are you aware of a lack of effort to initiate breaths? I know I arouse and am aware that I need to breath. This usually corresponds with a CA, often following periodic breathing. It's kind of a manual restart with recovery breathing. My problem is not nearly enough to justify ASV therapy, but I was curious if you had that sensation at times.

[Crimson Nape]

Seeing that you have a 9 to 14 setting, does Sleepyhead show any correlation with an increase in pressure and the CA's? If so, you could adjust the pressure down to avoid any pressure CA's.

[vsheline]

Thanks Peter. I'm not staying over 10 for a month so maybe I'm not a candidate? I will be discussing all this with my sleep doc. It's good to hear that with ASV therapy your CAs eventually became manageable.

Hi mmdupas,

In the USA, insurance companies differ in how high the Central Apnea Index (CAI, which is the average number of central apneas per hour) would need to be (while being treated with a standard, non-ASV machine), before they would approve coverage for an ASV machine.

USA Medicare requires a CAI of at least 5. I think many private insurance companies require the same as Medicare, but others require the CAI to be higher, at least 10 or 15 before they would approve an ASV machine.

Also, I think the CAI may need to be larger than the average number of obstructive apneas per hour, and an ASV titration may be required to show whether ASV therapy is effective.

Take care,
--- Vaughn