ResMed AirCurve 10 VAuto vs ASV to Treat Central Apnea

[waldo1945]

Thank you for your continued thoughtful support Dave.  I could not help noticing that you and my wife share common CPAP therapy.  You both have an underlying medical condition.  In my wife's case it is Pulmonary Fibrosis.  You are both using the Resmed Aircurve 10 ASV machine and F20/Airtouch full face mask.  And my wife just decided to try the medium Amara View mask while reading which I think you are doing also.  Small world!  I bought the full Amara View (head straps, base with 90 degree connector, medium cushion and short quick release hose) new off Ebay for $95 and will let you know how my wife likes this mask for reading after it arrives and she uses it for a week or so.

Now back to my cost discussion.  Our medical insurance agreed to pay 85% ($1,734) of their agreed upon total ASV cost of $2,040.  That made my 15% copay $306.  But I also had to pay two $35 copays (one to get the sleep study prescription and then another for the ASV prescription) plus an $85 copay for the sleep study.  This added $155 brought my total ASV cost to $461 plus about a three month process.  This compares favorably to my recent Craigslist purchase of a new Resmed Aircurve 10 ASV for $450 for my wife and I did not have to wait the three months. She has not had any apneas (especially the cluster central apneas)  since upgrading from a CPAP to the ASV machine two weeks ago and using the Auto mode algorithm with no restrictions. To me it was also worth the additional $70 gasoline and 600 mile round trip to pick up the ASV machine so that my wife did not have to wait the additional three months as I did.  This brought her ASV machine total cost to $450+$70= $520.  Paul T.

[SarcasticDave94]

You are welcome Paul.

FWIW I liked the Amara View mask because I could read, even with glasses on, in prep for sleeping. But, when I got the ASV, I just couldn't get it to stop leaking after about a week's worth of trying to adjust it. Since I had been given the F20 with the ASV, I'm guessing my motivation to keep trying the Amara View was close to MIA as I was able to dial in the F20 much easier. My biggest irritation on the Amara View I think is that short heavy hose that is attached to it.

[Sleeprider]

Paul, have you had any feedback from your wife's doctor regarding the therapy change? It seems it is working exceptionally well, and hopefully her comfort and sense of well-being follows that.

[waldo1945]

Hi Tom, our monthly appointment with our General Practitioner is August 31st this month (the end of each month).  Since my wife has only been on the ASV for about two weeks, he does not yet know that we made the switch from CPAP to ASV.  We plan to bring the three Sleepyhead charts that I previously posted for my wife to show him that the cluster central apneas have now been eliminated by the ASV machine.  I think that he will agree that the move from CPAP to ASV was a good thing to do. 

 It will not be until next month that we share the same information with our pulmonary specialist.  I take full responsibility for making the switch without prior doctor approval.  Granted we do not know if my wife's heart ejection fraction is over 45% but my wife has never had any heart problems.  Frankly ejection fraction is the least of our concerns since she has pulmonary fibrosis and only been given a few more years to live.  My concern has been to minimize the load on her lungs to try and extend her time.  The ASV has increased her tidal volume at night and thus given the opportunity for more oxygen to circulate throughout her body to aid repairs.  She is also taking additional doctor ordered oxygen through the special Climateline CPAP hose port while sleeping and reading in bed.  We will see if either of the doctors ask the ejection fraction question.  Thank you again for your continued support.  Paul T.

[Sleeprider]

With the complication of PF, I think you did a great thing for her, and it certainly can unload much of the effort of respiration at night.  In her case watch whether higher minimum PS is in order by periodically reviewing her results and seeing if the ASV is routinely adding PS min most of the time. This would be an indication the machine is working to maintain flow even when there are no events.  It's easily possible as her condition progresses a higher minimum will improve comfort.  She is fortunate to have you watching out for her best interests. It will be interesting to hear how the pulmonologist reacts, however I think you have already reached your own conclusions that the therapy is beneficial and working well.

With regard to LVEF%, that screening is conditional  upon a known history of cardio problems.  Here is the actual screening decision-making matrix:

[SarcasticDave94]

FWIW Paul, that heart concern regarding ASV usage probably will not be an issue. My understanding is that yes you or your wife may need to be subject to the LVEF% test regardless, but most definitely if either of you show heart related health issues. I had to get the test to qualify due in part to high blood pressure and family history of heart attacks and angina.

The test they did for me was an echocardiogram. I think it's the same as ultrasound. The procedure takes 30-45 minutes to complete. The tech uses the hand held device to push onto your chest, having the control unit take "pictures" and record sounds of the heart in action. Once the tech is done, the info is sent over to a cardiac doctor to review and generate a report. That report goes to whomever is in charge of approving you for the ASV.

None of the above indicates I think you or your wife needs it, just putting out what I experienced to prep you in case it IS needed.

Continued best wishes on successes... SD94

BTW mine came back at LVEF 55%

[Spy Car]

Well done Paul.

If it helps, I expected that I'd need to be tested for low ejection fraction as yet another hoop to jump through before being approved for ASV. 

To my delight, my sleep doctor (a veteran of Stanford's sleep clinic) said it was totally unnecessary as if I had a problem, we'd be aware.

Also, the study that raised a potential problem was very deeply flawed. For instance, the average user in the study was non-compliant in their usage (well under 4 hours a night) using non-optimized machines with an algorithm that's no longer used.

And the alternative devices that work less well for CA (like ST machines) have not been tested for safety.

I realize this not a likely issue for your wife. 

Best,

Bill

[waldo1945]

Tom, thank you for the heart ejection fraction decision matrix.  My wife has had no heart problems so she probably would not need the echocardiogram to make sure her ejection fraction is greater than 45% unless required by our insurance.  She is also well aware of the CPAP benefit for her Pulmonary Fibrosis.  Her use of CPAP for many years now (plus prayer) we believe has allowed her to live as long as she has.  That's why she wanted me to personally thank you for lobbying for the upgrade from CPAP to ASV as her Pulmonary Fibrosis has recently worsened.  I will monitor PS min as you suggested.  It currently is above the minimum at least half the time during a sleep cycle. 

Dave, your description of the echocardiogram was perfect.  Since I have a history of high blood pressure, afibrillation and a leaky mitral valve, I needed to have the echocardiogram to make sure my ejection fraction was above 45% (actual was 63%).  We also received the Amara View mask since my last post.  My wife has used it once so she could read laying in bed while wearing her glasses.  She fell asleep as usual and woke up when she changed position and the mask started to leak.  She then switched to the Resmed F20 with the airtouch foam cushion for the rest of the night.  It looks like the Philips Respironics Amara View will give her both the benefit of oxygen as well as the ASV while reading before falling asleep.  She had been using just the oxygen cannula and only getting the benefit of oxygen while reading in bed.  She tried to use the Amara View throughout the night but as with you, she had trouble getting it to seal while using the ASV.  The Amara View started leaking every time she changed position and it was easier to switch back to the F20 which stays in place for her as well as for me (and you).

Bill, your insight into the ejection fraction study was greatly appreciated.  I have always had trouble with the studies done before something is approved by the FDA.  The studies all seem to be too short, too limited in scope, with a lot fewer of the proper participants than I think should be required.  To me, a detailed review of all the Apnea Board posts would provide more valid insight than most of the FDA studies.  Paul T.

[waldo1945]

Hi Tom, We informed our General Practitioner Friday of switching my wife from CPAP to an ASV machine. I showed him my wife's three Sleepyhead charts (previously posted) showing absolutely no apneas when using the ASV as compared to the central apneas when using just CPAP.  He agreed that the change looked beneficial but wants us to continue working with our Pulmonary Specialist to whom he referred us several months ago.  Our GP did not ask the ejection fraction question as I think we are out of his sleep apnea comfort zone which is why he referred us to a pulmonary specialist.  Will let you know what our specialist says when we visit him September 10th, 2018.  
Paul T.

[SarcasticDave94]

Hi Paul,

Sounds like you both are progressing along nicely with the ASV assignments. Glad my LVEF description helped in prep for expectations; that's why we're here, to pass on things as learning experiences. Best to you both for continued success.