New Dx, 4 sleep studies in 3 weeks, feel left hanging with questions

[Sleeprider]

Remember what I said about ST...that's what they gave you. You are using the BiPAP ST with EPAP 14, IPAP 18 and PS 4.0 with a backup rate of 12 breaths per minute (BPM). The black hash marks at the top of your chart are timed triggers for IPAP backup breaths. There are a lot of them. This only happens when you don't take a spontaneous breath within the timing set.

Please read the titration protocol https://www.resmed.com/us/dam/documents/...er_eng.pdf. Read about ST and why it is absolutely the WRONG choice. You were not even told this is not CPAP! The insurance HCPCS code for your ST is E0471, the same one as ASV. You could have been provided the right technology, but these clowns are really messing with you, most likely because they are incompetent to be treating complex sleep apnea. This B.S. should be strongly confronted, and you should be looking for a more competent medical team and supplier. Finally, don't take another Philips machine. The effectiveness and comfort of the Resmed is much greater. With a Resmed Aircurve 10 ASV and very low pressure, compared to this ST, you could achieve less than 1- AHI within two nights of starting therapy. You really do belong on ASV.

[SarcasticDave94]

I think that until you put your foot down this group of incompetent medical hacks are going to push you around and issue the wrong products and give bad advisement until you fire them. You need an ASV to treat CA symptoms not an ST. Go draw a line, tell the incompetent dopes that you demand an ASV. If they refuse to listen, fire them. I'd suggest fire them anyway. Take your medical needs somewhere else today.

[emmylouwho]

I believe what you’re saying but I am so confused as to why medical prof tell me one thing and I read total opposite on forum.
I picked up my mask this afternoon and showed the respiratory therapist my data. She agrees I don’t need the ST. She thought that first visit. She said ASV and BiPAP do the same thing and that’s what they’re called by the 2 different companies. She says I need a AVAPS because it focuses on the tidal volume. I don’t know what any of that means because I am new to all of this. She says hospitals use Respironics because they’re much more adaptable. Then said ResMed ASV maybe? Is useless if the humidifier goes out where you can still use the Respironics.
I did call the doc office back and left message that I want to move to the next machine and that the RT agreed after seeing my data today.

I’m super frustrated and feel like I basically need to research like I am writing a thesis about complex apnea because no one is explaining the nuts and bolts of anything to me.

[Sleeprider]

"that is what they are called by two different companies". That is ignorant! Both companies use the same terms for the same technology. Philips Respironics has both the Dreamstation BiPAP ST and the Dreamstation BiPAP AutoSV. Resmed has the Aircurve 10 ST and ST-A and the Aircurve 10 ASV. The difference between ST and ASV is dramatic.

The ST uses fixed pressures and a timed backup rate. In your case, the EPAP is 14 and the IPAP is 18. If you do not initiate a spontaneous breath in 5 seconds, the machine switches to IPAP. There is no intelligence with this machine, and it is intended to treat pulmonary disease, neurological disorders of the chest and obesity related hypoventilation.

The ASV uses an auto-adjusting EPAP pressure to maintain airway to prevent obstructive apnea. A small amount of pressure support is used for comfort. The machine monitors the last 90 seconds of your breathing to determine your breathing rate and volume, and uses additional "adaptive" pressure support to ensure that rate and volume is maintained on a breath-by-breath basis. Your current machine can only switch to IPAP on a timed basis. The ASV can use anywhere from zero to 20 cm of pressure support to maintain your volume and rate. In addition, the Aircurve 10 ASV delivers pressure in a gradual natural pressure curve. The difference is incredible and solves all apnea. READ the titration protocol I linked to better understand.

I swear these doctors and therapists live on the fact they know something you don't. You can turn the tables by reading and becoming smarter than they are. It doesn't take much. I can't force-feed it to you. This is a self-help forum and I can only give you the tools to solve a difficult problem.

[SarcasticDave94]

It's easy to pass wrong info if some truth is woven in. You don't need ST. That's true. ASV is BPAP, also true as is on the general high level. ASV has more to the story. It has backup rate, it is variable, and it's designed to treat Central Apnea. The ST is to treat COPD, and etc. but not CA. It does not have backup rate. BPAP or BiPAP are the same thing, BiPAP is what Respironics calls a Bilevel, which is any with 2 pressures as in exhale and inhale pressures.

ASV and BiPAP both have 2 pressures, but ASV is a specific type while BiPAP is a generic class or division of the PAP machine lineup. AVAPS is an NIV ventilator therapy mode, again more for COPD patients. Respironics are not more adaptable. And just because hospitals use it is irrelevant.

My ResMed AirCurve 10 ASV is 4 years old, and the humidifier never broke down. I'd rule this irrelevant as well as we've not yet solved getting the right type or therapy device. These CPAP, BPAP, ST, ASV machines have a warranty to protect you if the device breaks.

Complex Apnea is having both Obstructive and Central Apnea. Focus on this: you have Central Apnea events and this must be treated by an ASV. Either ResMed or Respironics make a machine made to treat CA. ResMed calls it ASV short for Adaptive Servo Ventilator. Respironics calls theirs AutoSV, Auto Servo Ventilator. Both are made to treat CA.

You must tell them you do not need ST as it is for a COPD patient. And the flip side is you need ASV as you do have central apnea.

And FWIW, my own RT stated this piece of info, Respironics devices have the same slow adjusting habit from APAP to Trilogy NIV. Ditto for ResMed on being faster from APAP to Astral NIV and all in-between. ResMed and Respironics have their unique way of air delivery, breath patterns, etc.

Bottom line is this:
ST No
AVAPS No
ASV Yes
I would strongly suggest ResMed as it does an excellent job.

[emmylouwho]

Thank you for your response and I was not venting at this forum but rather doctors. I don’t expect you all to lay it out for me. I have been reading as much as I can in the evenings. I also read the protocol you linked. So according to the DME who called me this morning, the doctor’s response to my call stating  I want the ASV & my AHI is still high, is to increase my pressure this week and next. He said as I get used to it and use it more, my AHI will come down (insert eyeroll). From what I’ve learned so far and the titration protocol, increasing my pressure will only make the hypopneas worse during REM sleep especially since that seems to be where the largest clusters are.  I’ll be calling back today.

---

I agree with you and from everything I’ve read online, the ResMed is superior. Yesterday the RT went into, “I’ve been doing this 40 years and Respironics is the go to....yada yada yada.”

[Sleeprider]

Thanks for hanging in there. We all have to deal with the same system. I was looking at the run hours on my machine today and the run hours are up to 16, 300, and I have had the machine over 5 years. I called the DME, and heard her talking about a new test, face-to-face physician encounter, and my machine has to break down before Medicare will approve a new one, but don't worry, they will provide a loaner. I went straight to searching for a replacement on Craigslist.

[emmylouwho]

Uhhhh why must they make this so hard? Thankful for insurance but it could be much smoother. I’m grateful you heard that convo when you called though or else you could be in a mess in the future. I hope you’re able to find what you need on Craigslist.

[emmylouwho]

Thank y’all for your support, provided info and encouragement. 

So I did as y’all suggested and called the DME back and put my foot down in as much as a tactful way as possible.  I provided all the info about the differences between ASV & ST. Plus how terrible my sleep study results were on the ST.  AND to my surprise, he said he agreed with me. He had already thought I should be on an ASV and that increasing my pressure would only make my CAs and hypopneas worse. He even mentioned it’s the same code as the ST, like you all said, so there’s no approval needed by insurance. He just needs a new script. I told him I wanted the ResMed ASV which he wrote down. He said he was calling the doc on her cell to get me what I need and would call me back ASAP.  He said perhaps the doc doesn’t understand how easy it is to switch over from a ST to ASV since they’re the same code. He said he will probably have to order it because they mainly carry Phillips machines. 

Fingers crossed this is resolved today!

[Sleeprider]

Wow! You got a good one.