Will an ASV hurt or help me?

[wking]

Short version.... Sleep doc says I have mixed sleep apnea. When I asked why I am using an AirCurve 10 ST and not an ASV she did not have a good answer other than to recommend another sleep study.  Don’t have a lot of faith in this clinic and am not going to the hospital during Covid.   From readings here I know that ASV’s are often, but perhaps not exclusively, a choice for treating mixed and/or central sleep apnea.  Other than cost, would purchasing an ASV out of pocket be a reasonable choice to consider?  What would be the pitfalls or advantages of this option.  I believe knowledgeable people on this forum have helped individuals set up their ASV’s to successful treatment parameters. As I said, short version. But would moving ahead on my own be a detrimental option.

[Gideon]

It is normal to have an ASV titration sleep study to prove efficacy. That is the proof your insurance would need.

Tell your doc you will do the sleep study if and only if it is an ASV study.

When you get the machine, based on feedback of many users here, accept only the ResMed.

Doing it on your own, we've got your back and have helped many.

[SarcasticDave94]

Agreed with bonjour. Tell the doc unless ASV is part of the test you won't do it. State you know about the use for ASV, Central, and Mixed, Complex Apnea. And that this info comes from manufacturers like ResMed.

ResMed states this:

AirCurveTM 10 ASV

"The AirCurve 10 ASV offers truly personalized therapy for obstructive sleep apnea (OSA), central and/or mixed apneas, or periodic breathing. By treating central breathing disorders with auto-adjusting pressure support – and upper airway obstruction with auto-adjusting EPAP – the device works to rapidly stabilize respiration.1 (footnote)

As the only one of its kind to target the patient’s own recent minute ventilation, ResMed’s ASV is the most clinically studied adaptive servo-ventilation therapy."

I added bold to treating central breathing disorders. ResMed knows the ASV is to TREAT CA. Anything other than an ASV is to avoid not treat CA. Admitted, some here on AB can do OK with machines that need to avoid or minimize making CA worse. You must demand you want CA treated. This comes from me, a guy with high CA on CPAP and drastically higher still on BPAP. Say NO to anything that is not ASV. I'll ratchet it up even more, do not accept anything but ResMed AirCurve 10 ASV. Do not sign or accept any other.

I own the ASV, so I have used it, and it is great at combatting CA and anything else. Disclaimer, I cannot use mine anymore as I have COPD that's ticked up a bit stronger than from a year ago when ASV was doing excellent. I had tested as having 124 CA to 24 OA...that's what my ASV had to fight against, and win every time.

You'd be subject to a diagnostic test called echocardiogram, an ultrasound of the heart. It is a simple test of 30 or so minutes to gauge the hearts Left Ventricle Ejection Fraction -LVEF for short. A cardiac doc will do a quick summary along with LVEF is x%. You are looking for 45% or higher. You'd know if you were going to get a low percentage as 45% LVEF is congestive heart failure and trust me if your LVEF were near that YOU'D KNOW and your cardiac doc would have talked with you. I tested at 55% in 2017 and I have heart troubles of high BP at times and had palpitations now linked to a condition called PVC, that is Premature Ventricular Contractions. This test is just a loophole jumped through to stave off medical liability, it's basis is from a questionably accurate study called SERVE-HF.

PS do not accept an ST, it may stand for Spontaneous Timed, but it probably should stand for Stupid Thing.

[Sleeprider]

In working with your doctor you have a couple choices how to approach the problem. If you are willing to pay out of pocket for the ASV, ask your doctor for a prescription. You can stipulate you will accept all responsibility for setting it up correctly based on the Resmed Titration Protocol below. A sleep clinic doesn't do anything more that put you on the automatic mode of ASV, and there is absolutely no benefit to a titration test other than making them about $3000 richer. You can do the same thing at home and demonstrate efficacy with the data for the cost of the machine ($1349 from Supplier #2). If the cost of a titration test is unacceptable, just get the prescription for ASV. You can use the information contained in the Resmed Sleep Lab Titration Guide to justify the use of ASV. Note that ST is not intended for complex sleep apnea. https://www.resmed.com/us/dam/documents/...er_eng.pdf

The second approach is more conventional as suggested above. Request your doctor order a titration test with ASV. If you have significant deductibles or copay this is expensive. If your insurance offers full coverage, this is a good approach.

The Resmed Aircurve 10 ASV seems to produce the best results using automatic default settings, and we will normally optimize the settings based on the data to increase the minimum EPAP pressure or limit the maximum pressure support setting. Note there are only 4 settings that can be made, and the default for you in ASVauto mode is:
EPAP min 4.0
EPAP max 15.0
PS min 3.0
PS max 15.0

[RayBee]

I agree. All great info above. I'm totally out of pocket. Went through numerous studies with many machines and masks through Kaiser over 9 months. Finally got to the ASV for mixed diagnosis and 39 AHI. Got a script and made the purchase from Supplier #2 . They were very nice, very helpful and acceptable price. I bought new for $2100, but would have no issues recommending saving a bunch of dollars on a lightly used one from Supplier #2 too.  The "very nice" part - they price matched a ridiculously low price on a complete mask and threw in a 90 deg elbow for free (I wanted to buy it, but they said they would toss it in for free).

The gurus here have helped me beyond words. I truly believe that symptoms and health problems are cumulative over years of untreated apneas. And it took me weeks to months to feel consistency of health improvements. And about a year to what I would call stabilizing in better health and the new "feel good" norm.

If you can go through your insurance for equipment purchases, that's great. But be well informed of what out out-of-pocket costs would be. With insurance, look for any hooks, limitations, "your share" based on inflated prices, and lagging subpar support of machine-tuning tweaks. With Kaiser, everything is scheduled on a clock that only ticks in month increments. Here on AB, that is cut down to minutes or hours.

Nothing to fear with a ResMed ASV in ASVAuto Mode.  In fact, all good if you have mixed apneas.  All the best on your journey to better health.

Ray

[SarcasticDave94]

The ASV won't hurt you, nor will knowledgeable therapy suggestions here at AB. What is harmful is being under the care of a DME named Apria that hires RTs that issue an ASV and yet have to guess at programming it.

When that exact thing happened to me, I found out here how to access the clinical menu, and once I had the ResMed 10 ASV, I self titrated here for about a month. I used the ASV, posted the report as an attachment, which is now called OSCAR. Get the program, use the ASV, post data, tell us how you feel during and after therapy, we suggest this or that, and you act on it. Repeat until your therapy is trending good, then you're more or less flying it yourself.

OR you can schedule a consult with Dr. Dolittle next month. He will allow your comments on needing some more of this and/or less of that. (But then again, maybe he doesn't accept your comment on needing more air, and EPAP does not need to be 7 instead of 4. Then you're stuck.) He takes a few days, writes a script after his coffee break, then faxes it over to the DME, who may not always get the pesky fax. OR the coffee stain blurred the numbers. So you may have to call Dr. Dolittle's office again, DME didn't receive a fax or it wasn't legible. Eventually the DME receives the new script and they OTA it to your ASV. And it changes, but it's still not right. Guess what? Repeat all that again to get EPAP Min changed from 7 to 7.6...hmm NO WAY! Now over a week to a month to do what you can do in 5 SECONDS!

Time's running out. Make a choice.

[RayBee]

Yup.
What he said.
Ray

[wking]

Thank you so much for your responses and the offers of future help. One reply, I think quoting ResMed ASV literature, seems to suggest that the ASV is like one stop shopping as the ASV seems to handle all types of sleep Apneas, but with some health related caveats.  Seems like, in most cases, it should be the default recommendation except for cost.  My last echo had a LVEF of 62/65 % but will double check that with the cardio. As mentioned, due to a severely compromised immune system family member, going for a titration study is out of the question at the moment. But I will keep the “ASV titration study only” on the table in the future. I will call and ask about the script.  I’m not sure I scored any points during my last visit so I am not sure how receptive the doc will be. She did not send a glowing report to my primary about my last visit so advocating for yourself comes with its consequences.  What’s a gal to do!  Nearest alternative clinic is about a 250 mile round trip and I would need to get a one-party insurance approval from the hospital which is not likely.   Why do many machines not recognize centrals but seemingly  group them as unclassified or hypopneas?  Or, is it Oscar that cannot translate the data?  Thanks.

[Sleeprider]

Sleep specialists are probably the most worthless doctors on Earth, and most have other specialties and "sleep medicine" is just an easy income producer. Their interests lie in pulmonology, cardiology, neurology, and sleep prescriptions are peripheral to their primary interests and something they can do with minimal time and liability. When patients are more complicated or look for more help, many sleep doctors just don't see that as part of the deal, and blame the patient for doing something wrong. The "profession" is deeply flawed in the kinds of people it has drawn to be sleep specialists. They just aren't interested, and the practice is entirely based on giving patients orders, not solving their problems. Most of the procedures and dispensing of therapy is dictated by insurance. Think about it, and you'll quickly know this is true.

I do not use a sleep specialist. My diagnostic sleep study was transmitted with a a specialist's recommendation to my primary doctor who wrote my prescription and monitored my therapy follow-up. I have always kept my PAP therapy in the realm of my main doctor by learning enough to communicate my needs and documenting my success through software like Oscar. The sooner you realize the sleep specialist is unnecessary, the sooner you will have more responsive care. Your discussion above that talks about LVEF and therapy indications and contraindications already shows you are ready to take the next step. Make your primary doctor your sleep doctor, and only use the specialist as a supporting cast member as-needed.