Diagnostic ADVICE...

[2007User]

I have been a PAP user for 14years. I started with a dumb M Series CPap machine and a original diagnostic AHI of 94 and titration record of CA in the form of Cheyne-Stokes respirations. 7 years ago my Dr upgraded me to a System one BiPap Auto just before going onto Medicare. This machine now has significant data collection and has been complaining about Periodic Breathing since day one. Most recently I am noticing occasional "CA storms" where I have up to 60 CA's in an hour interspersed with PB at the min pressure settings of the BiPap Auto (11cm EPap and 4cm PS). These storms have occurred in the past months apart and perhaps 2 weeks apart in the last two months. Before noticing this I have visited two certified sleep specialists. The first after listening to my concerns about PB sent me to the lab for Diagnostic and an ASV titration. The Diagnostic confirmed my excessive AHI from 14 years ago. The ASV titration revealed nothing but excellent sleep but no joy with Medicare acceptance.
My second opinion doctor heard my input about PB and Medicare non-acceptance and scheduled another titration using a ST machine. Neither of the recent titrations goes anywhere near showing to Medicare that I have PB much less Central Apnea. I see in other questions the recommendation is to do 4 different evaluations I assume the same night. How is this possible even if everything is consistent every night? In my case it appears impossible to show my issues sufficient for Medicare?  Is my case so minor compared to others that BiPap Auto is the best treatment? CPap Auto. My current doctor does not appear to believe in auto titration machines being useful, Is there any studies or data one way or the other?

 After 7years I want to replace my Respironics machine with a Resmed that has a larger water tank because I run out of water in the new drier climate where I now reside.  Am I stuck with maybe either a APAP or BiPAP auto or non Auto for another
 5+ years as a result of lack of Medicare justification. Any ideas to go further ?

[Sleeprider]

You clearly need ASV therapy, and you need to appeal to Medicare until they approve it. You have clearly failed CPAP and BiPAP for years. ST is an unacceptable solution, and you will be miserable. There are several options. You can continue to pursue an insurance/Medicare solution, or self-fun ASV therapy buying a lightly used machine, Either way, go to your doctor that found ASV effective and get a prescription in-hand! Have the claim for ASV resubmitted. You have therapy onset central apnea and CPAP and BiPAP will not work. It takes a good doctor and DME to make this happen. Many members have obtained ASV through Medicare, but it rarely happens on the first try.

If you want help sourcing an ASV, we can help you find some deals. We have found the Resmed Aircurve 10 ASV provides reliable comfortable therapy with very high efficacy. Let me know what State you are in, and if you're in a position to fund a new or used unit. I have seen ASV machines come up from $400 to $900 or you can buy used from Supplier #2 with a warranty for $1549. Be sure to get copies of all your sleep studies and especially the successful ASV titration study for you personal records.

[SarcasticDave94]

ASV, specifically ResMed AirCurve 10 ASV, is going to be your best weapon for CA combat. APAP and definitely BPAPs without backup rate will not work well.

[2007User]

Sleeprider

I have received the raw data from both sleep studies with a viewer and as an Engineer, I am surprised at the lack
of sophistication in the titrations. Unusable noisy flow data, No data collected from the Flow Generators, ASV was 
placed on full auto with no data from the Respironics Box,  ST was manual adjust with no feedback from Resmed box
when it timed out or not. Two different labs similar data presentations /software.  No evidence of PB or ST's in either
of the reports.  I don't even understand how they would detect PB or ST's if the machines are supposed to suppress
the events in the first place.

I am frustrated looking for any other tests / evaluations / equipment that the Dr. can do to help in appealing to Medicare? 

Thank you for caring..

[Sleeprider]

Titrations are conducted according to a standard protocol, and ignore a lot of significant information in favor of providing simple answers that meet insurance criteria. Most reports are automatically generated, and it's foolish to think a doctor is involved in any kind of analytical way. Your situation is common, and we can help you understand it, and coach you to work with your doctors to get the appropriate diagnosis to justify advanced PAP. This wiki article on Justifying Advanced PAP Devices describes the typical bureaucracy involved http://www.apneaboard.com/wiki/index.php...P_Machines Medicare is not there to help you, it is a bureaucracy that tightly defines the conditions under which it will cover a condition. It takes knowledge of their criteria and some strategic though to win the game.

You have a successful ASV titration, ask that doctor for a prescription!