New on Bipap ASV, have a few questions

[Sleeprider]

I'm fairly certain that it is not the lower Flex that caused your shortness of breath, but the zero minimum PS. You might try taking PS to 2.0 minimum. If you feel timing is still off, then Flex at 2 is preferable to 3 IMO.

Hypopnea events are highly clustered, and I'm thinking a soft cervical collar might clear up a lot of it. Please read these two wiki articles:
http://www.apneaboard.com/wiki/index.php...cal_Collar
http://www.apneaboard.com/wiki/index.php...onal_Apnea

I think if we can avoid the hypopnea clusters, this looks pretty good, and I'm pretty sure you will see a resemblance between your results and the example graphs on ASV near the bottom of the Soft Collar Wiki.

[tcolar]

Interesting, I do have "The Eliminator Series Sleep Aid Cushion" or very similar, gray, might be a different brand, will check tonight.

I tried it a couple times 6 months ago, without any noticeable effect, but it felt much smaller than the picture and didn’t nearly feel the gap between my head and neck, maybe I need a better/larger one. 

I sleep on a pretty steep (high) pillow, I’m guessing that does not help if the goal is to keep the chin away from the neck.

[Sleeprider]

It could be as simple as using a thinner pillow that lets your head drop back a bit. There is no single answer for everyone, but many members that have displayed this pattern resolved a majority of their events by avoiding chin-tucking.

[tcolar]

Ill definitely try that tonight, I even have one of those cpap pillow where you can add or remove layers, I m not using it as did not find it very comfy when I tried it, but if a skinnier pillow can solve the apnea I'll definitely trade comfort for that .

[tcolar]

The equipment provider just called me and told me they gave me the wrong machine and it should have been a bipap and not an ASV , sigh .....

do bipap machines offer a backup rate ?

[SarcasticDave94]

As best as I know, ASV and ST machines have backup rates, the rest of the xPAP do not.

[Sleeprider]

If your doctor prescribed a backup rate, then the choices are ST and ASV. The ASV provides pressure support and a triggered breath when needed and only as much as needed. The ST (spontaneous-timed) is a much less sophisticated machine that provides fixed bilevel pressure and a timed back up breath. It provides the same pressure support all the time. If you have complex apnea (a mixture of central, obstructive and hypopnea), you have the right machine.

Your first post cites "treatment emergent central apnea and aerophagia". In my opinion you have the machine in your hands that properly treats both central apnea and does so with less pressure. I would talk to the doctor and not return this machine. I am almost certain that if you resolve the positional obstructive issue, you are going to achieve efficacy with your current therapy. You may have been titrated on a ST machine, but I think you can already see the advantages of the AUTO-ADAPTIVE BiPAP ventilator, compared to the FIXED PRESSURE BiPAP ventilator.

Let's look closer at bilevels and the billing codes suppliers must use. You can read the Justifying Advanced PAP Wiki http://www.apneaboard.com/wiki/index.php...P_Machines I'm pretty sure your provider wants to sell you a much less advanced and cheaper machine with the ST, than the SV Auto you have. Here are the billing codes for BiPAP

ASV or Adaptive servo-ventilation (ASV) The below is based on Medicare Requirements for procuring

E0470 - RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE) (Similar to ResMed Aircurve 10 VAuto)
E0471 - RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE FEATURE, USED WITH NONINVASIVE INTERFACE, E.G., NASAL OR FACIAL MASK (INTERMITTENT ASSIST DEVICE WITH CONTINUOUS POSITIVE AiRWAY PRESSURE DEVICE) (Similar to ResMed Aircurve 10 ASV or ResMed Aircurve 10 ST/A)

If you need a backup rate you need an E0471 machine. Medicare and most insurnace reimburses the DME at the same rate for either of those machines, but the ST costs about $1000 less. This is why they want to trade.

[SarcasticDave94]

First, Sleeprider's right. You're dealing with central apnea. You have the right machine now. Standard BPAP or ST won't work well to combat centrals. Get this medical staff to prove medical necessity for ASV. Cynical Dave thinks this thing you're facing is a money based decision.

[tcolar]

Yeah I agree that the ASV sounds like the right thing since it specifically mentions "complex apnea"

What really happened is that I told The sleep clinic that the DME had mis-set the machine, asking them for confirmation that I had now had set it correctly (as I asked here), instead they sent a complaint to the manager of the DME, and I'm guessing they are now displeased with me, or they want to swap the machine to pretend they didn't make a mistake, or as you said make some bucks ...

I never liked this DME company, the never sent me the resupplies as they said they would and every-time i went there they seemed pretty clueless and condescending, judging by their reviews online, it's not just me who is not pleased with them (lots of terrible reviews).
https://www.yelp.com/biz/northwest-medical-renton

I'm going to ignore them for a few days so I can try the ASV machine some more, and I'll check with the sleep clinic on what machine they want me to have, I'll try to see if I could switch to another DME, really I wish I could just skip a DME altogether ....

I was wondering why would anyone use a ST given than the ASV gives all the same options plus much more, because online they both seem to cost around the same price (~3.7k), although you mention a 1k difference, but maybe it's different online from what the DME pays.

[Gideon]

Sleeprider has given you good info.

The ST is a good machine if you have serious non-central apnea, breathing issues such as COPD.

from the wiki http://www.apneaboard.com/wiki/index.php...AP_-_BIPAP

Just to clarify The VAUTO, ASV, S, and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable. They are not a choice between them to treat a single condition.
They should be chosen to treat the specific condition that the user has, Here are the various CPAP machines and what they are designed/intended to treat
This info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients