Treatment Resistant Central Sleep Apnea?

[asdz123]

Thank you everyone, it looks like it's time for me to find a doctor that'll let me take the sleep study with the ASV. A bit disappointing that the CPAP didn't work out, but I've been encouraged by everyone's helpful advice. Here's hoping I'll get prescribed soon!

[Gideon]

Print a copy of your sleep study and always show it to your Doc, highlight/circle the Central Diagnosis and the 33/73 counts of Central and obstructive apnea., getting this on a diagnosis is correct, but uncommon. Most often in a case such as yours the diagnosis is purely OSA even with 45% + Central Apnea. You are ahead of the game, use this leverage.

[Sleeprider]

My previous comment is based heavily in your comment that your are self-funding therapy through your HSA. You might be able to get a prescription for ASV to buy from Supplier #2, or just find one online like the one I talked about in Fayetteville, AR for $350. Sometimes it's easier to just do it than to ask permission. Clearly, once you have ASV you can demonstrate efficacy (or not) and that make any sleep study that can cost up to $5000 moot. Take those results to your doctor and get your prescription updated retroactively. The simplicity of ASV belies the difficulty of getting one. Even an expensive clinical test is mostly observation of how you respond to the auto algorithm of ASV. I'm just saying, your money does you more good than spending that much on what you can do for yourself. The machine costs a lot less than the test.

[SarcasticDave94]

I would agree on this. Once you have usage of the ASV, and having proof of effective therapy on it, they cannot suggest stepping down to less effective therapy.

[asdz123]

Noted Sleeprider, I would rather avoid having to pay for any expensive clinical tests on my HDHP if I already know that I can benefit from the ASV.

If I were to somehow get an ASV without the prescription first, would I really need to retroactively change my prescription? It seems like it'd be a moot point once I have the ASV.

[jaswilliams]

The only reason for an updated prescription is to get someone else to by your second ASV in 5 yrs time

[Sleeprider]

I agree with Dave and Jas above, however let's review the facts. Your original sleep study showed a strong tendency for central apnea that your doctor actually was concerned about. Your CPAP therapy revealed the CA clearly. There is exactly one appropriate solution for that, ASV. It works easily and instantly for 95% of the people we have coached in that directions and those that arrive at the forum with ASV. Some additional improvement can sometimes be achieved by tweaking default ASV settings. We have further noted a considerably better result in AHI and comfort among individuals using the Resmed ASV vs the Philips Auto SV, however there are some manual settings on the Philips that are needed for a few. ASV may be contraindicated in individuals with congestive heart failure and a very low left ventricular ejection fraction (LVEF). There is even significant doubt about that risk and an ongoing study, ADVENT HF is showing the risks shown in SERVE HF seem resolved. We have seen dozens if not hundreds of ASV users on this forum, and I cannot recall any serious complications.

ASV is clearly a solution in this case with a younger, fit individual with complex sleep apnea. The fact you are self-funding makes the decision to direct you towards the second-hand market really easy; however the first choice is to request the doctor that reviewed your sleep study, further consider your CPAP results and write a prescription for ASV. Access to ASV therapy is restricted by insurance companies that do not want to pay for it, and have created nearly insurmountable costs and medical proofs that the medical mafia gladly embrace since it pays the bills. You will succeed with ASV and need only to decide you want your life back. Once you use ASV it becomes just as normal as CPAP does to the person with obstructive sleep apnea, and with no greater risks.

[SarcasticDave94]

OK when you have questions, we can help inform about both directions, meaning self funding and getting doc on-board with updating the diagnosis and script. And both need to be acted on and explored, in my opinion.

[asdz123]

Thanks, I tried reaching out to the Lofta sleep team (didn't have a direct line to the doctor unfortunately) with my CPAP results, but they said I'd require an echocardiogram and an in-person lab visit to get the prescription for the ASV. I'm thinking I'll have to schedule an in-person appointment with a local sleep doctor to get the prescription.

I also found a used Resmed Aircurve 10 10 ASV for a great price on the secondhand market that I can probably get without the prescription (not the $350 one in AR unfortunately, haven't been able to get a reply ). Since I'm really eager to get my sleep issues resolved ASAP, I'm thinking I might just pull the trigger on it now and ask for forgiveness later. The only caveat is that the machine has 12,595 run hours. Apparently the average CPAP lifespan is 20k hours and many machines can last well past that if well maintained, but would that be too much?

[SarcasticDave94]

Given about 15-20K hour life, it's half to three quarters done now. How much are they charging? I think at best you'd get 3 years if you're lucky. Regardless of what you choose to buy, ask for an ID photo showing the front ASV panel of the bottom right showing the metallic words AirCurve 10 ASV with ASV in a rectangle. If it doesn't have that, it's not ASV.

Image of my ASV to show front panel nameplate:

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