Upcoming Sleep Study (ASV related) Opinions Wanted

[Spy Car]

I've been on APAP (AirSence 10 Auto) for over a year now. At times I've gotten decent therapy, but in recent months my condition and my numbers have generally gone south. 

I'm having a fair portion of CA events. Sometimes more than half CAs, but probably averaging about 40%. 

I've become very wiped out. Although I'm enjoying the best day I've had in a while today.

I recently went to my sleep doc who ordered a trial of a Bi-level (AirCurve) which was a disaster. I started pushing for a trial with ASV when I got the "looks like APAP is better for you" response and there was no alternative offered. I asked for an in-house study with an ASV.

I've never had an in-house sleep study. Just a home study. As a compromise, of sorts, the sleep doctor ordered an in-house sleep study that would split the night between APAP and ASV.

I'm starting to wonder if--with over a year of use and all the data and mixed results--whether this half-a-night on ASV is a reasonable approach or not? Is +/- 4 hours on ASV a fair test? And what will the same hours prove for APAP?

Maybe there are good arguments for this approach that I'm not considering?

I appreciate input. I don't know if I should question this, or go along? 

Bill

[Walla Walla]

Usually a Sleep Study is done without any PAP machine. I'm guessing your Doctor is just trying to document that you require an ASV by comparing the results. He must think he needs to do that for insurance reasons.

[Spy Car]

Usually a Sleep Study is done without any PAP machine.  I'm guessing your Doctor is just trying to document that you require an ASV by comparing the results. He must think he needs to do that for insurance reasons.

I hope you're correct. I've been uncertain if this was to help approve an ASV or help with a denial. There definitely seem to be cost-containment and insurance issues in the background of all this. I'd be more confident if the ASV trial was his idea and not mine.

Bill

[SarcasticDave94]

My FWIW: this would give a direct comparison/contrast for APAP vs ASV results. Same place, night, technician doing tests, etc. I think it will help. And you only have to study for the sleep study one time to get this one out of the way.

[Sleeprider]

Bill, be sure to read up on the ASV titration protocols. The results you get will depend on how the machine is setup. You need to ensure the EPAP min is sufficient to control most OA events, it does not have to control H or FL. Go back through your APAP use and decide what that needs to be. The EPAP max should control nearly all OA events. Pressure support in the titration protocol generally ranges from 3-15. You can vary that based on your results. If you are normally comfortable at 3 and it doesn't make CA worse, then that should be fine. Keep a relatively high PS max so there is support there for hypopnea and flow limitation. You already know of my strong preference for the Aircurve 10 ASV in ASVauto mode. Don't get tested on something not set to auto mode.

[Walla Walla]

I saw on a earlier thread that your with Kaiser. Now I understand why you're worried about what the Doctors intentions are.
If after the Sleep Study the Doctor say's you don't need ASV make sure you get copies of all records from your sleep study. Not just a summary. By Law they have to give you copies. Than take those records to a lawyer!

[Spy Car]

Bill, be sure to read up on the ASV titration protocols.  The results you get will depend on how the machine is setup.  You need to ensure the EPAP min is sufficient to control most OA events, it does not have to control H or FL.  Go back through your APAP use and decide what that needs to be.  The EPAP max should control nearly all OA events.  Pressure support in the titration protocol generally ranges from 3-15.  You can vary that based on your results.  If you are normally comfortable at 3 and it doesn't make CA worse, then that should be fine.  Keep a relatively high PS max so there is support there for hypopnea and flow limitation.  You already know of my strong preference for the Aircurve 10 ASV in ASVauto mode. Don't get tested on something not set to auto mode.

Titration protocols? 

Most of my time on APAP I've been around 7 min/11 max with an EPR of 3. At the least, these setting have been very comfortable for me. I've had some good therapy around this range, and some not so good.

I will ask for AutoASV. Any more thoughts? I feel a little bit out of my league here, and concerned about having one night (or 4 hours) to "do or die."

Bill

[SarcasticDave94]

Spy Car / Bill

All sarcasm aside, wishing the best results for your upcoming PSG / sleep study. FWIW after I finally got my ASV, my AHI has gone WAY down. I can't remember the exact original CPAP AHI on the PSG in 2015, but I am thinking around 70 +- 10. I have only had my ASV not yet 1 month, and with current settings I am averaging 1.7 over the past 19 days of use! I am on the ResMed AirCurve 10 ASV.

Dave

[Spy Car]

I  saw on a earlier thread that your with Kaiser. Now I understand why you're worried about what the Doctors intentions are.
If after the Sleep Study the Doctor say's you don't need ASV make sure you get copies of all records from your sleep study.  Not just a summary.  By Law they have to give you copies. Than take those records to a lawyer!

Yep. He doesn't like that I have the data (via Sleepyhead). And I've felt painted into a binary choice between APAP (mixed) and Bi-level (terrible). And he didn't act supportive of news that I'm aware of ASV.

I don't like ascribing others will false motives, and I just don't know what's happening here. I do sense that cost-containment pressures are a factor.

On the other hand, he did order the in-house sleep labs that include ASV. But due to a push.

This guy has a pretty good reputation. I'd like for him to be an ally. Intelligent self-advocacy seems critical here. I will get a full sleep report. 

I don't know if ASV is my answer (or not). But high CA nights track perfectly with low energy days. So I have hope.

Bill

[Spy Car]

Spy Car / Bill

All sarcasm aside, wishing the best results for your upcoming PSG / sleep study. FWIW after I finally got my ASV, my AHI has gone WAY down. I can't remember the exact original CPAP AHI on the PSG in 2015, but I am thinking around 70 +- 10. I have only had my ASV not yet 1 month, and with current settings I am averaging 1.7 over the past 19 days of use! I am on the ResMed AirCurve 10 ASV.

Dave

Wow!

IMS I was about 15 on my sleep study. Lately, I've had a few nights higher than that. But periods under 2 or under 3 as well. It has been a highly-mixed journey. When I started (and dialed in and acclimated) I thought APAP would be the thing.

I haven't missed a single night. I hope they at least see that I'm trying.

Congratulations to you Dave!

Inspiring results.

Bill