New member post looking for others with same diagnosis

[Dennisl27]

I just finished my sleep study and slept for 14 hours while they tried various apnea machines to treat me. Finally they tried ASV to treat me and it was determined that I have central sleep apnea and they have to order me an ASV machine. First, today, I had to go for an ECG of my heart before they can order it. I was wondering if anyone has had any advice about using this or if they had any luck with their sleep? And if they had any troubles with insurance paying for it since it is so new?
Thank you
Dennis

[Sleeprider]

There are a surprising number of members on this forum using ASV.  Most had to get there the hard way after failing CPAP and bilevel until they finally got the right machine.  If you search the forum for ASV, you will find many of them.  You will basically choose from either a Philips Respironics BiPAP SV Advanced or a Resmed Aircurve 10 ASV.  While both provide the ASV therapy with breath by breath therapy, auto adjusting expiratory pressure (EPAP) and pressure support from 0 to 15 cm, they have very different "feel".  In my experience the easiest transition to therapy and best results in terms of low AHI and just feeling rested, are those who use the Resmed Aircurve 10 ASV.  It's amazing how someone will start that machine and immediately show zero events (apnea or hypopnea), while users of the Philips Respironics flaver have high levels of hypopnea and struggle to get dialed in for months.  

Just read through the apnea forum, you will find many threads on ASV, and draw your own conclusions.  In addition, the Resmed is easier to get detailed efficacy data into #Sleepyhead, which is a software program that is going to be your friend soon.

Insurance has always been a problem with ASV because they require users to fail at CPAP and Bilevel before they will authorize Bilevel ASV. In your case, that proof was met in your extended clinical trial.  You are very fortunate to have had a complete sleep study, and technicians that knew to move from CPAP to bilevel and finally bilevel with a backup rate (ASV).  I think you should have no problem getting approved, but the machines are expensive, and it can take a while to get approval and to fill the order.

Insurance is all about HCPCS codes, and the machine you need is E0471:

E0601 Continuous airway pressure (CPAP/APAP) device
E0470 Respiratory assist device, bi-level pressure (BiPAP) capability, WITHOUT backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0471 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)
E0561 Humidifier, non-heated, used with positive airway pressure (CPAP/BiPAP/APAP) device
E0562 Humidifier, heated, used with positive airway pressure (CPAP/BiPAP/APAP) device

Good luck Dennis.  Please feel free to ask any questions.  We're pretty familiar with complex and central apnea and the use of ASV here.

[richb]

Hi Dennis. Welcome to the Apnea Board. It is rare that a patient is prescribed an ASV machine without failing on a CPAP or APAP machine. One reason is that many insurance companies including Medicare insist that you try the other machines first. ASV machines are prescribed for Central Apnea and Mixed Apnea. You mention that your Dr is sending you for an ECG. Central Apnea is SOMETIMES associated with Heart disease in particular Congestive Heart Failure (CHF). Sleep Drs have been cautioned by the machine manufacturers to confirm that CHF in not associated with a Left Ventricle Ejection Fraction equal to or less than 45%. The usual test for this is an Echo Cardiogram. Another risk factor for Central Apnea is the use of Opioid pain killers. I am not aware that there are additional risks in using ASV machines in that case. Central Apnea can be caused by CPAP and APAP machines in some people. This often shows up after treatment is begun for Obstructive Apnea. In my case my Central Apnea is most likely the result of a faulty feedback loop between sensors for blood CO2 and the brain. This type of faulty feedback loop is also implicated in cases of High Altitude Sickness or sensitivity. You say that your Dr is ordering an ASV machine for you. The preferred machine among Apnea Board Members is the ResMed Aircurve 10 ASV. You will want to research the topics I have mentioned related to Central Apnea. There are plenty of posts here to look at and advice will be free flowing when you start asking more questions. You will most likely need to become seriously involved in your treatment. The ResMed ASV machine works like a charm if ASV is right for you. Once you get a machine you will be able to observe your own breathing statistics using Sleepyhead software. You can share your results with others here and get help with fine tuning your treatment if necessary. Stick with us. There are lots of very helpful people here.

Rich

[trish6hundred]

Hi Dennisl27,
WELCOME! to the forum.!
I wish you good luck as you start your CPAP therapy, feel free to ask as many questions as you need to, , to help you understand sleep apnea.

[Gideon]

Welcome to the forum. You have indeed found a good place to get advice. You were very lucky to have the adv machine chosen for you so quickly.

A suggestion for when you pick up your ASV. Try on multiple masks. Under pressure and lying down. The more the better. Start with the Mask Primer in our wiki or my signature. And please ask any questions you may have.

[DeepBreathing]

G'day Dennis. Welcome to Apnea Board.

Central apnea is reported to affect about 2% of apneacs - but judging from the numbers we see here I think it's really a much higher percentage. In very simple terms, central apnea occurs when your brain doesn't or cant tell the lungs to "breathe now". Basically there is an organ in the brain which monitors the levels of CO2. When this level reaches a threshold the "breathe now" message is sent. Sometimes the CO2 level is mis-read or else the brain for some reason can't send the message, else the message is sent but not received. In all cases you don't make any effort to breathe until some time has gone by. Disclaimer - I'm an engineer and part-time astrophysicist, not a medical doctor. So my explanation is a bit basic, cos i don't understand the details.

I tried both the Respironics and Resmed ASV machines (previous models) and very quickly settled on the Resmed. For me it has a much nicer feel, like it's helping me to breathe rather than forcing me. Having said that, other people prefer the Respironics. If at all possible try both for a couple of weeks and make up your own mind.

[Dennisl27]

Thank you all for such quick advice on the ASV machine and your expertise on the machines that you are using. I did try on a few different masks during the sleep study and the "full" mask seemed to be the one that was most comfortable to use and keep on. I'm hoping that it won't take long to read the ECG and get those results back. They said they could order the machine after that. I do know about the ejection fraction needing to be above 45 for The machine. I do suffer from a great deal of fatigue and limb heaviness. My Doctor seems to think that should improve with the treatment of the sleep apnea. Is fatigue common with untreated apnea?
Dennis

[C0mbe]

Fatigue is incredibly common with untreated Apnea.  A lot people see big improvements with daytime sleepiness once they have their therapy under control.  Not everyone does, but I would venture to guess that most do.  Keep in mind that it can take a considerable amount of time to work off your "sleep debt."

Good luck!  Here's hoping you get that machine asap and can start getting some quality rest!

[Hydrangea]

 Is fatigue common with untreated apnea?

Heck yeah!  I've had chronic fatigue since my late teens, and nothing touched it... until I recently got xPAP!  I'm in love!  And I'm no longer yawning and needing excessively-excessive sleep.

[TPeters]

Hey Dennis,
Fellow newbee here an just starting asv therapy. It's been a life changer for sure. The crew around here will definitely help you get dialed in. Look up my first thread an read it to see my road to getting asv. But is all good now.