Straight CPAP or ASV?

[joesetx]

I tried CPAP on my own a few years ago after a home cpap test.
I lost some weight and thought I was cured.

In the last six months my sleep has been terrible so my family doc sent me to a sleep lab for an overnight polysomnograph.
My AHI was 25 with 19 obstructive apneas, 13 central apneas, and 5 mixed

During the follow up titration study CPAP at 5 cm H2O produced treatment emergent central apnea and periodic breathing. A trial of ASV resulted in no apneas but I did not qualify for an ASV machine.

I was initiated on a straight CPAP pressure of 5 cm H2o and have been using a resmed s10 auto for the last two months.
My results have been good with an average night resulting in an AHI of 6 or 7.
About 2/3rd obstructive apneas and 1/3 clear airway.

Should I be satisfied with this result or persue getting a second hand ASV

[Gideon]

Not doubting what you have said but to help us understand your condition can you attach your typical nightly Sleepyhead charts, see my signature for help especially with chart organization.  Also if you can post a copy of the full sleep study.

Do you know why you did not qualify for ASV?

Now to your question.
How do you feel?  If all or enough of your sleep issues are resolved then the CPAP should be fine.  If they are not it should be possible to justify getting an ASV.  That is done by documenting the failure of CPAP.

I would include a summary page also as it may show issues with your CPAP therapy such as it is consistently over 5 AHI.

Reasons for failing CPAP include the following, do any of these apply to you?

1. not tolerating high pressure settings
   
2. Pulling at mask
   
3. Experiencing arousals or microarousals
   
4. Can’t progress to REM sleep cycle
   
5. Feels bloated or has a sensation of swallowing air
   
6. Saying pressure is too high
   
7. States it’s difficult to exhale despite EPR feature
   
8. Events persist at 15 cm H2O2 
   
9. More than 3 cm H2O is required between IPAP and EPAP. 
   

[Sleeprider]

Insurance drives machine approvals, and insurance requires that all patients must first fail CPAP, before moving to BPAP, and fail BPAP, before being authorized for ASV. Many patients quit because no one explains the rules of the game. You are fortunate to have a diagnosis and test that shows efficacy with ASV. Your role is to complain to your doctor as ofen and as loudly as possible, so he advances you to the next step. Don't lose sight of your finish-line. You need ASV and will eventually get there, but you need to know how the game is played and minimize your costs and time to win the game. Many of our members have already been where you are now, and can offer advise and encouragement.

Hang in there, and start putting pressure on your doctor. He knows the game and should be helpful if you let him k ow this is intolerable.

[Spy Car]

You are getting very good advice joesetx.

Do post your Sleepyhead data as that will allow members here to help you be better informed as you discuss this with your doctor.

Sleeprider is also correct about this being a process and I know those who do not push typically don't get the device that is optimal. I walked this path and with help from forum members had the support to push for ASV. My total AHIs were in about the same territory yours are in. On the low end of who is going to get approved.

However, the efforts involved in pushing for an ASV were well-compensated by having a machine that is purpose-built to deal with CAs and mixed apneas types. ASV made a big difference for me.

Best,

Bill

[SarcasticDave94]

Who are you guys kidding? Getting an ASV is easy-peasy, just add water coffee!

hehehe JK!

Buy some Tylenol stock before starting down this path, joesetx. Although I am not the first ASV patient, I've helped blaze the path to get the ASV, so I did in fact get a T-shirt on this. If you need ASV, and Sleeprider and others believe you do, you will get one as soon as Even-Tully approves it. There IS a process involved and if you the padawan will stay on the path, we (not just me but collective the AB) can get you there.

In all seriousness, you follow the advice from myself and others on the board that have an ASV, and we'll assist however we can to help you get it. It will take determined effort from you, but I am certain you will win in the end. Trust me on this. The number ONE thing is be determined that you will not quit nor back up one step.

Feel free to ask any questions about the ASV, how to get it, what the experience is like, or whatever. I'll do all I can to prep you by supplying brutally honest answers, so you're forewarned.

OK, it's time to fight to get this ASV. Hope you're ready to win, because we don't lose here on the Apnea Board.

[Broomstick]

Feel free to ask any questions about the ASV, how to get it, what the experience is like, or whatever. I'll do all I can to prep you by supplying brutally honest answers, so you're forewarned.

OK, it's time to fight to get this ASV. Hope you're ready to win, because we don't lose here on the Apnea Board.

I'd like to know the answers to all these questions. Please tell us.

Also, what is so hard about getting this machine. Is it getting insurance to pay for it, or getting a doctor to prescribe it in the first place?

[Apnea Infant]

Feel free to ask any questions about the ASV, how to get it, what the experience is like, or whatever. I'll do all I can to prep you by supplying brutally honest answers, so you're forewarned.

OK, it's time to fight to get this ASV. Hope you're ready to win, because we don't lose here on the Apnea Board.

I'd like to know the answers to all these questions. Please tell us.

Also, what is so hard about getting this machine. Is it getting insurance to pay for it, or getting a doctor to prescribe it in the first place?

I believe it is the prohibitive cost compared to the standard CPAP machine.

[mesenteria]

Yes, that is it.  It's a Ferarri that nobody should hope to need, and the insurers work assiduously to ensure they don't have to cover their share of the costs for such a thing.  ASVs are complicated because they deal with complicated apnea ('complex' actually), so the nice people who bring them to market want their money out of their research and development.  Also, it's a relatively small market for these 'Ferarris', and like anything that has a small market, they are somewhat scarce.  Scarce means more costly to the consumer.

[Crimson Nape]

There used to be a "Rule-of-Thumb" that you would take the price of a regular CPAP and double it for the price a Bi-Level machine and double the price of a Bi-Level to obtain the price of an ASV.

[Fats Drywaller]

It seems like in some cases a gofundme campaign might be appropriate. That's sad. "Please help with a donation: My insurer is denying me the $2000 breathing machine that I desperately need, so I'm forced to buy one myself."