Future BiPAP user.. Which machine to ask for?

[Sleeprider]

Good move. The crap they were telling you was a bold faced lie. Another doctor may be in order. If you have a way of communicating with him like messaging or email, you should ask what problem he has with the better technology and efficacy of ASV. The functionality is the same, just much better implemented in ASV.

[Herb]

Good move.  The crap they were telling you was a bold faced lie.  Another doctor may be in order.  If you have a way of communicating with him like messaging or email, you should ask what problem he has with the better technology and efficacy of ASV.  The functionality is the same, just much better implemented in ASV.

I'm pretty sure it's because of the SERVE-HF trial bombshell, and the warning from ResMed about prescribing ASV for certain heart patients.

It's a third rail thing with these guys. They won't touch ASV.

Due to sheer ignorance, arrogance, and a give-a-sh*t attitude, I know attempting to enter into an intelligent discussion these Docs is a futile exercise.

I'd be really surprised if they even answered an email.


The sleep center manager, along with the sleep techs seem sympathetic to my cause.

That, and the support from everyone I met on the forum has kept my spirits up.


BTW, a friend gave me a CPAP machine and mask they weren't using.

I got a little congested, and kept locking up my airway just as I was drifting off to sleep.

Had a heck of a time falling asleep, so out of desperation I used it. 

I set it to 5 based on my titration study, just to clear my obstructives, and it's worked pretty well.

Once I installed the nose piece on the Opus 360 right-side-up that is, lol.

Two nights with air leaking like crazy till I got a clue.

Now that I've corrected the OSA, gotta say I'm more alert.
Feel pretty good actually with only a few days under my belt.

I know 5 cm is baby stuff, but I've grown to like the feeling of falling asleep more comfortably.

Still have to catch my breath when hypopnea happens when I'm drifting off.


My wrist oximeter shows I'm not dropping below 90% much at all, so there's that.

Still nowhere stable except in rem, constantly cycling between 97-90. Better than 97-77 like before.

Half the problem solved, now on to centrals.

[SarcasticDave94]

Stay with the fight Herb. I thought you were too nice on "Getting dizzy watching him paddle with one oar" thing. Twas an lol moment BTW. Me, I'd say up the creek with NO paddle, if it were your DUCK doctor, QUACK

Roving reporter Dave

PS I've got face to face with Doc 1 may 3rd instead of May 24th. AND this Friday, April 28th is second opinion consult with my SLEEP STUDY report and some cool info from Sleepyhead from the SD card. Going to WellSpan Pulmonary in Gettysburg, which is an hour away. While in Gettysburg, I may have Civil War flashbacks, PTSD or some other thing I've gotta get a doc or a pill for. Oh and I'm in something called Aqua Therapy sessions for my back injuries, AKA physical therapy but I'm in a 91° pool for the back exercises.


    

[SarcasticDave94]

Hey, if this doctor asks you how much postage is necessary for Gmail, you best look elsewhere. Just saying.  

[Herb]

That pretty much sums these guys up, lol

[SarcasticDave94]

Have a great week. I'm going to get ASV either by the first place because the second doctor is questioning settings and why I'm not in ASV already or by way of second opinion method. Don't matter to me how I get there as long as I get there...

[Herb]

Looks like my ASV QUEST has detoured through BiPAP-ST-ville.

Thought I was cleared with Medicare, but the DME said there was a problem with the sleep center PSG data complying with Medicare medical necessity criteria.

I fit the criteria, but the sleep center has to spell it out, breaking out the central hyponeas, and apneas.

They have to go through the PSG waveforms, and generate the numbers.



The only way to keep the ball rolling is by going through with the ResMed S9 VPAP ST order, so I told them to go ahead.

Maybe I can delay picking up the machine after I'm approved,  I dunno.

Playing with fire though, have to prove I'm going to use the machine faithfully or its game over.

So now, looks like it's BIPAP ST and go from there.

All this grief for naught. 

Well not quite actually, made some friends and learned a LOT!

[Sleeprider]

Get the ST. It will backup your breathing with pressure support so you won't have CA, but I think you will end up with nearly every breath being timed rather than spontaneous. That is the advantage of the low minimum PS on ASV. With ST you get PS all the time and we know that causes the CA. Document your experience and keep some stats like B.P. heart rate etc. If you tolerate it and it works, that's great. If not then you need to backup why you are "intolerant".

A couple Philips SV units on SecondWindCPAP for $1300 FYI.

[SarcasticDave94]

Sorry to hear that. Kinda like a Hoover vacuum...it sucks. Seriously though, best wishes this gets DONE ASAP! Just seems like these people want to go lawyerly on you. No negatives towards you whatsoever Herb. We're right behind you all the way here FWIW. I'll have something new after my Friday appointment with new pulmonary group. This is same group handling my back injury but obviously in another specialty division. Very pleased with this WellSpan so far. Great     week to y'all. Roving reporter Dave signing off...no FAKE NEWS here.

[Herb]

Get the ST.  It will backup your breathing with pressure support so you won't have CA, but I think you will end up with nearly every breath being timed rather than spontaneous.  That is the advantage of the low minimum PS on ASV.  With ST you get PS all the time and we know that causes the CA.  Document your experience and keep some stats like B.P. heart rate etc.  If you tolerate it and it works, that's great. If not then you need to backup why you are "intolerant".  

A couple Philips SV units on SecondWindCPAP for $1300 FYI.

You know, after using the CPAP, and looking at the differences in the SpO2 chart from my wrist oximeter, I can see why I was feeling so tired. 

I would go through 20 min. periods where my saturation was dropping from 90s into the low 70s. Sometimes two or three a night.

Not so with the CPAP. Just a couple spikes into the high 80s, and I feel the difference with just a few days under my belt.


Point is, it's kind of a window into what's going on through the night.

I'm hoping I can use this SpO2 information and adjust the ST to minimum pressures. That, along with the data from the machine.

Although the ST will mask centrals, it does indicate spontaneous vs timed, so maybe I can use that to judge things.

So I'm going to add this to the record keeping you mentioned and see how it goes.

I'm really looking forward to ANY machine with backup.

I still experience events where I have to catch my breath just as I'm drifting off to sleep.

Jars me awake, and repeats for a while.

And even though the CPAP is only 5 cm, it does take some effort to exhale, so the ST being a respiratory assist device rather than PAP, it should be even more comfortable falling asleep.

I know I'll probably need to tweak the settings a bit to get the IPAP and EPAP timing just right.

I remember during the PSG the IPAP time was too short and I couldn't get a full breath.

Had to lift the mask off and get a nice long breath.

I couldn't fall asleep until I found a way to trick the machine with a short exhale to get another IPAP cycle.


Thanks for the SecondWindCPAP tip.

I had contacted them about purchasing a AirCurve 10 ASV, but they needed a prescription.

I should be getting approval from Medicare soon, and once my co-insurance deductible is met, everything is covered 100% till next year.

It's been over two months, tilting at windmills it seems, since my initial appointment.

Now I'm getting anxious.