Juniper's questions

[stevew168]

Details regarding Medicare qualification for various types of CPAPS/BIPAPS (ASV is E071, as well as other BIPAPS with a backup rate):

https://www.cms.gov/medicare-coverage-da...CDId=33800

Other providers are somewhat similar.

[juniper]

Looks like I'm going to need an in-lab study. Yuck.

Anyway, I don't get Medicare until August. My current insurance does seem to follow their rules.

[juniper]

If I had no centrals in my sleep study and majority centrals using CPAP, do I really have complex apnea and need an ASV? I didn't have complex apnea before. Maybe I just need to get the settings right on the CPAP or maybe the CPAP is false flagging things that aren't centrals at all. Wishful thinking, maybe.

Anyway, as I look back at overall trends, I think I see the higher the pressure, the higher the AHI. Not perfectly. The AHI sometimes drops for no apparent reason. But, overall, raising the pressure does not seem to be helping.

[stevew168]

If you have treatment emergent central apnea, you have several months to see if it goes away. Higher pressure would make it worse. It did not go away for me, but I had to have a wide range of pressure to control obstructive apneas. Other than lower your pressure, there's not much I know of that will stop them with your apap.

If I'm not mistaken, you had a home sleep study. Most of these kind of tests do not differentiate between central and obstructive apneas.

[juniper]

Yes, it was a home study. This is what it said:

Obstructive apneas/hypopneas: 65
Central appearing apneas: 0
Apnea-hypopnea index: 14.2 events per hour.
Central apnea-hypopnea index: 0.0 central events per hour.

Oxyhemoglobin saturation range: 99% to 94%
Oxygen desaturation index: 11.3 desaturations per hour.
Time oxygen saturation < 88%: 0.8 minutes (.02%) of sleep time.

IMPRESSION: Mild obstructive sleep apnea syndrome. Obstructive
sleep apnea is associated with oxyhemoglobin desaturation to a
low of 83%.

It seems to be claiming it measures centrals.

I guess I should try a lower pressure. Weirdly, my sleep doc told me to raise my pressure to 10 when I messaged about the centrals. Honestly, I don't even know if he looked at my pressures. He may have assumed I was following the original generic script of 5-16 auto-titrating. Or maybe his generic response to problems is to try a constant pressure of 10 for 3 weeks and get back to him. (Like, "Take 2 aspirin and call me in the morning.") His answer came back so fast I couldn't believe he had spent any time looking at my numbers. I'm thinking of switching to one of the nurse practitioners. They seem to be allowed more time with patients than doctors are.

[UnicornRider]

Juniper, we have to travel out of town for medical services, so I have not been able to respond earlier. I will try to play catch-up.

Thank you. So, an airsense 11 is an APA, not a CPAP.  (See how little I know!) Or wait, an APAP is a kind of CPAP. I think that's it, right?

  I prefer to think of APAP and CPAP  as "Mode" of operation as there are several machines that have Both APAP and CPAP Modes of operation. APAP machines can easily emulated CPAP Mode with pressure settings.

 I suggest you request a copy of your AirSense 11's Clinicians Manual from the ApneaBoard.

 Top center of this page, in the Black Bar running across the page, click on "CPAP Setup Manuals"

Thanks, I've seen that article. I have an ergonomic pillow with a deep spot for back sleeping and high edges for side sleeping. I tried a cervical collar once. I could not imagine how someone could sleep with one. Perhaps the pillow and the collar interfered with each other in some way. So, what I am using is my pillow and tape.

It is possible for the pillow and collar combination, to be excessive or conflicting for your purposes. It may take time to learn how to use your pillow, I have a similar pillow from your description, Pillow and tape are a good combination.

Since I had no centrals in my sleep study, isn't it likely I will eventually be able to figure out the right settings to get rid of them and not need an ASV? My AHI hovers above and below 5. My insurance/provider will probably not think I need an ASV. People have much worse numbers than I have.

With no Centrals in your sleep study, it would be a little premature to declare that ASV is your only solution. There are other machines and features that could possibly resolve any CA events you are encountering at this time. It is possible with additional trialing of various pressure settings this machine will eliminate many if not most of your CA events. Meanwhile you have a couple of months before you qualify for Medicare, therefore I suggest we utilize that time to try to provide as much comfort and relief as possible, while at the same time exhausting all possible modes and pressures of operation your current machine has. Your ResMed AirSense 11 is documenting everything, so when it comes time for you to see your doctor you will have justification documented on the ResMed SD memory card.
 

Very helpful, thanks. So I need to contact my provider and document these problems in case I ever need an ASV. Will do. 

My centrals are way more than 50%. I move from around 3 to 8 for AHI in what looks to me a random manner. 

Thing is, I didn't get the centrals until I was on the CPAP. I had none in my study.

Some of your CA may resolve themselves as TECSA in the next couple of months, I suspect that has a lot to do with the requirement for a three month follow up when on Medicare, in order to give time for TECSA to start to resolve.  It took me about 9 months from this last major equipment upgrade for my TECSA to finally resolve themselves this last December.
  I still get a few CA events that are suspicious looking in nature.

Looks like I'm going to need an in-lab study. Yuck.

Anyway, I don't get Medicare until August. My current insurance does seem to follow their rules.

Most insurance companies do follow Medicare requirements for PAP Therapy. You will have approximately 3 months to prove that the machine prescribed to you is not meeting your needs to qualify for a different machine that would better suit your needs.

If your insurance is provided to you through employment, they will be designated as primary payee for insurance purposes, medicare will be secondary payee. I have had people I have helped with CPAP have problems when they qualified for medicare, as their insurance company insisted that Medicare be listed as primary payee. Meanwhile Medicare was not paying because the employer provided insurance was supposed to be primary payee. Try to get that resolved before you get to that point.

Yes, it was a home study. This is what it said:

Obstructive apneas/hypopneas: 65
Central appearing apneas: 0
Apnea-hypopnea index: 14.2 events per hour.
Central apnea-hypopnea index: 0.0 central events per hour.

Oxyhemoglobin saturation range: 99% to 94%
Oxygen desaturation index: 11.3 desaturations per hour.
Time oxygen saturation < 88%: 0.8 minutes (.02%) of sleep time.

IMPRESSION: Mild obstructive sleep apnea syndrome. Obstructive
sleep apnea is associated with oxyhemoglobin desaturation to a
low of 83%.

It seems to be claiming it measures centrals.

I guess I should try a lower pressure. Weirdly, my sleep doc told me to raise my pressure to 10 when I messaged about the centrals. Honestly, I don't even know if he looked at my pressures. He may have assumed I was following the original generic script of 5-16 auto-titrating. Or maybe his generic response to problems is to try a constant pressure of 10 for 3 weeks and get back to him. (Like, "Take 2 aspirin and call me in the morning.") His answer came back so fast I couldn't believe he had spent any time looking at my numbers. I'm thinking of switching to one of the nurse practitioners. They seem to be allowed more time with patients than doctors are.

It does to appear as though the sleep study did not find any Central Apneas., I am going to invite some forum members who are highly respected on this board and much more experienced than I, to review your thread and provide input for working with you.

   Meanwhile try to provide OSCAR Reports and be prepared to provide zoomed views of flagged Events.

  If it helps, from your "Events" Tab, you can open event categories and select the time of an event to provide a zoomed view that will provide enough information for most reviews.

  Do post back.

 

[juniper]

   Meanwhile try to provide OSCAR Reports and be prepared to provide zoomed views of flagged Events.

  If it helps, from your "Events" Tab, you can open event categories and select the time of an event to provide a zoomed view that will provide enough information for most reviews.

  Do post back.

 

Thanks. I have a short free trial of SleepHQ. I think it will let me post a link to the data without needing a screen shot. Will that be helpful? My main question is, "Are these really centrals?"

[SarcasticDave94]

I'm not attempting to add to the confusion, but I do wonder if a different machine would be more helpful. No, not ASV, but VAuto, which is an auto BPAP or bilevel. Not trying to make your therapy even more complicated, however the VAuto has more PS than EPR 3 and timing controls including trigger.

Just my 2 cents for the time being.

Are they real Centrals? I don't think they're the Centrals in a pre-dominant fashion or they'd be on the study. In part, I'm thinking there's some Treatment Emergent Central Apnea, and at worst they're mixed with false CA flags.

Stick with us, we'll get your needs figured out.

[juniper]

I'm not attempting to add to the confusion, but I do wonder if a different machine would be more helpful. No, not ASV, but VAuto, which is an auto BPAP or bilevel. Not trying to make your therapy even more complicated, however the VAuto has more PS than EPR 3 and timing controls including trigger.

Problem is, I'm not eligible for anything new. I'm hoping what Uni said above about getting my apap set to a single pressure will be the answer. Only, so far, haven't had luck with finding a better pressure. 

Just hanging out where I am for a bit. All the changes were making my brain mad at me and not wanting to sleep at all with the alien on my face. Or, it might be when I added the tape that it got mad. Whichever, I'm going to stay put for  week or so. Meanwhile, I think I've got this SleepHQ thing figured out. Will post a link.

[juniper]

Well, let's see if this works.

https://sleephq.com/public/c564b7d0-b92e...85b680a82b