Quitethe1 Therapy Thread from CPAP to ASV

[Sleeprider]

If you have a prescription for any XPAP machine, you can continue to get supplies as long as you need them and are benefiting from the therapy. That is really between you and your doctor, but the DME supplier needs to ask routine questions to continue to send supplies. There is no difference in the filters, tubing, or mask, so just play like you're using the CPAP and bring the use of ASV up with your doctor at some future date. We can talk about that before your next appointment. Try not to get into TMI (too much information) for your secondary caretakers for now.

[Quitethe1]

From my FB seller:

I sorry but I have to make some inquiries today. It has come to my attention that it may be illegal to sell this cpap unless I sell it to a company that can resell them. If I find out that I can sell and then ship it legally I will let you know and see if you are still interested. I should know hopefully later today. I am sorry I just don't want to get into trouble for this so I need to make sure

Ugh.

[Sleeprider]

The FDA does not enforce the requirement to be a DME against individuals, however if your FB seller inquires, they will be told that legally, only an authorized seller that verifies a prescription may sell these medical devices. Most people don't care and of course the authorized resellers of used machines mark them up quite a bit.

[Quitethe1]

I told her she can ‘donate’ it to me and I can pay her ‘shipping’ cost. She works for the post office so I doubt she will do it. Depends on how bad she needs to money. I guess my I start again

[Quitethe1]

I found someone who has an AVS machine. He doesn’t have a power cord so he’s not sure if it works, but can’t I send it in to have somebody make it work? He only wants $100 for it, which is suspicious, because why wouldn’t he get it fixed. Or buy a cord. Thoughts?

[Sleeprider]

Power cords are easy, but verifying that you are dealing with an honest person that actually has the machine is more important. What town is that in?

[Quitethe1]

I don’t remember. Craigslist probably I’ve searched the entire county and parts of Canada. I’m so tired of looking. I will try later tonight.

[Sleeprider]

I took a look at SearchTempest, and was surprised to see so many aspirational prices. Crazy what people think these are worth right now. SecondWindCPAP Supplier #2 is $1900 with warranty, and that is less than many of these private sellers. You should try to lay out your case to your doctor for an ASV prescription. I assume you have no issues with heart failure which the the only risk factor, and your need to resolve the central apnea issue should not be hard to communicate. ASV is the solution for that. Your insurance seems to come up short on picking up the cost, but a prescription, that lets you start the therapy and follow-up with your doctor seems like a low risk approach. Anyway, it can't hurt to ask. If you need some reference material, the ASV is discussed very elegantly in this Resmed Clinical Titration Guide. https://www.resmed.com/us/dam/documents/...er_eng.pdf

[Quitethe1]

        I have been talking to her.  This is her last reply.  No issues with heart stuff.  My insurance will help with the cost of the machine if I want to be tied to them and their hoops for years.  I just want to buy it and be done.  The funny part is that I work for my insurance company.  Still don't like dealing with them.

Also, this is last nights Oscar data.  Just under 2!!  Which was great, but I was exhausted this morning.  I never feel rested.  I changed masks and this data is with the Wisp nose mask.  The tape failed my mouth at the end.

[Sleeprider]

My reply to her concerns are:
ASV in auto mode is a completely automatic, self-titrating positive air pressure device that only has 4 settings, EPAP min, EPAP max, PS min and PS max. the Resmed Clinical Titration Guide (below), recommends an initial starting pressure of EPAP min 4.0, EPAP max 15.0, PS min 3.0 and PS max 15.0. The EPAP automatically titrates to mitigate obstruction, and pressure support is maintained at the minimum setting for comfort, and servo regulated to maintain the target minute vent as-needed, when-needed.  The titration of an auto ASV consists of consideration of CPAP history of obstruction, and minimizing the range of EPAP pressure and pressure support to optimize. A clinical study rarely achieves this as well as a coached home user, using day by day data to quickly narrow the ranges for efficacy and comfort. Clinical studies are affected by the environment in which they are conducted, the short period of time available to observe an often unpredictable central or apneic response, and bias to demonstrate efficacy of the lowest cost, option to meet short-term study endpoints.

Based on your history with CPAP, you normally control obstructive events with EPAP 6.0, and have generally comfortable results with PS min 3 (same as EPR 3). The titration of maximum EPAP and Maximum PS is a simple matter of trial and error and is quickly determined by observation.  The machine maintains an overall safe and efficacious therapy pressure with its automatic algorithm, and this is actually preferable to a clinical titration for many reasons.  You should request that the prescription be written for Resmed Aircurve 10 Vauto (HCPCS #E0471) in ASV Auto mode, with recommended EPAP min 6.0, EPAP max 9.0, PS min 3.0 and PS max 15.0 based on CPAP history and recommended titration guidelines by Resmed. These pressures can be observed for efficacy and comfort, and adjusted as needed with physician supervision.  

I don't want to overstate this, but I have personally revised dozens to hundreds of sub-optimal ASV clinical titrations with better results, simply by observing results in Oscar and making logical changes that consider the individual's needs and response to the device. I can honestly say, most clinical titrations result in prescribing an ASV set to default settings, or using a fixed ASV mode (fixed EPAP) that fails to deliver effective or comfortable results. The best approach to this therapy does not come from a sleep lab. We rarely fail, we have never hurt anyone, and you continue to work with your treating physician...we just make it easier, cheaper (free) and better. Medicare and Insurance actually will cover titration, but neither requires this study that costs more than the device. The determination of your need and benefit of ASV remains in the hands of your doctor (treating physician). Avoid specialists as much as possible.

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