Do these settings make sense on an ASV and is it even worth trying a BiPAP?

[erouting]

Hi All,

I'm using an old Resmed S9 VPAP ADAPT. I set it up back when I couldn't think and just messed with it until I could sleep incorporating advice from this board.

EPAP: 8.4
Min Pressure: 6.0 (won't go higher)
Max Pressure: 15.4

Last night it recorded an AHI of 1.1.

I have central sleep apnea, not obstructive, hence the ASV/VPAP ADAPT system rather than a conventional CPAP. I just don't breath until my O2 concentration hits about 84-88%, then I gasp in air. 

Does my EPAP setting seem reasonable? I did a home study, they found I was about 97% central apnea events, tried a CPAP at home with my own pulse oximeter and found that it did absolutely nothing, then tried ASV and it worked, I could have told that even without the oximeter as I wasn't waking up exhausted every day. Tried to do a sleep study and couldn't fall asleep on a CPAP, they refused to switch me to an ASV during the study until I fell asleep with the CPAP and that wasn't something I could do, nor could I safely get to the sleep lab with as tired as I have to be to fall asleep when I'm not breathing. So flipped them off and continued to do my own thing. I'm not putting someone else's life in danger on the road for paperwork and have no other way to get there. As such I've never tried a BiPAP. Worth buying a used one to try out on the basis that replacement is cheaper than an ASV or not because they just won't work for CSA?

Thank you.

[Jay51]

Thanks erouting.  The question about your EPAP being correct:  If you download OSCAR and upload some charts it would be easier to tell.  Usually, if you are having some OA's (and possibly even some H's), EPAP should be raised.  

The max pressure support needs to be high enough to trigger you to breathe.  Normal respiratory rate during sleep is approximately 12-20 or so, but can vary from that normally also. 

I have an S9 Adapt ASV also.  

Hopefully the ASV is the right move for you here.  Good job.

[erouting]

Thanks erouting.  The question about your EPAP being correct:  If you download OSCAR and upload some charts it would be easier to tell.  Usually, if you are having some OA's (and possibly even some H's), EPAP should be raised.  

The max pressure support needs to be high enough to trigger you to breathe.  Normal respiratory rate during sleep is approximately 12-20 or so, but can vary from that normally also. 

I have an S9 Adapt ASV also.  

Hopefully the ASV is the right move for you here.  Good job.

Thank you. Once I have an SD card in my unit I'll upload some charts. 

I'll try raising EPAP a bit to see how that does me in the mean time. I used to have an AHI on the machine of 0 and now it's 1.1, which is less good, replacing my filters that may be clogged but I could also have adapted to the machine. I'll know once I have data to share.

[SarcasticDave94]

When I was on the ResMed AirCurve 10 ASV, I ran ASV Auto mode, EPAP 7-12, PS 3-15, giving IPAP 10-27.

A standard BPAP that doesn't have a breath backup rate will not go well for you.

Your old study results should help you get a new ASV if that's what you're after.

[erouting]

When I was on the ResMed AirCurve 10 ASV, I ran ASV Auto mode, EPAP 7-12, PS 3-15, giving IPAP 10-27.

A standard BPAP that doesn't have a breath backup rate will not go well for you.

Your old study results should help you get a new ASV if that's what you're after.

Thank you for the numbers and advice.

I want a new ASV but I'm on medicare and my understanding of their rules per CMS is they require an in-lab study for CSA/ASV. Since I can't safely do given that I need to drive to and from the lab (and the lab had a car accident when they tried medicating someone in my exact situation) I don't know how to get that covered. 

Maybe if there was some way to just get a doctor to diagnose me with OSA, but I don't have any doctors I have a good relationship with, which is common when you're disabled. We usually have to brow beat them into following the standard of care and they tend not to be willing to help us after that. Absolutely open to any ideas that don't put me or others at risk. Getting a ride from anyone else is impossible due to my mental issues.

[Deborah K.]

I don't think Medicare requires a new sleep study.  I think that is just DMEs and Doctors, both of which make money by pushing you to have more tests that they can charge for.  I have a Medicare Advantage plan and got my recent new ResMed AirCurve 10 Vauto free, but that's the Advantage part making it free.  And I did not need a new sleep study.  Still, I bet Medicare would pay most, maybe all of your bill for the machine since you are disabled.  Plus, if they prescribe your machine, Medicare should also pay for new masks and all the other paraphernalia required. This would help you with the mask issue you brought up in another thread.

Don't give up!  

[SarcasticDave94]

I'd attempt to get whichever doctor you have the best relationship with and ask for the ASV script. Make it the ResMed ASV, you can go default settings, and dispense as written.

Medicare Advantage follows regular Medicare rules, and they do not require a new test for the same device, at least. This is not info from the insurance.