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BiPAP ST to ASV - Optimizing - Printable Version

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RE: BiPAP ST - almost there - please help - Gideon - 07-23-2021

PS is the difference between EPAP and IPAP. Increase that difference from 4 to 5 by increasing IPAP.

Ask the RT if that sounds right. Until you get an ASV I don't want to upset them


RE: BiPAP ST - almost there - please help - Sleeprider - 07-23-2021

I just want to say the ST machine was never intended to treat your problem. Please read the Resmed Titration Guide https://document.resmed.com/en-us/documents/products/titration/s9-vpap-tx/user-guide/1013904_Sleep_Lab_Titration_Guide_amer_eng.pdf Pay attention to the conditions the ST and ASV are intended to treat. Your current therapy is a complete joke and will be immediately resolved with ASV.


RE: BiPAP ST - almost there - please help - fikus56 - 07-23-2021

(07-23-2021, 06:57 PM)Sleeprider Wrote: I just want to say the ST machine was never intended to treat your problem.  Please read the Resmed Titration Guide https://document.resmed.com/en-us/documents/products/titration/s9-vpap-tx/user-guide/1013904_Sleep_Lab_Titration_Guide_amer_eng.pdf  Pay attention to the conditions the ST and ASV are intended to treat.  Your current therapy is a complete joke and will be immediately resolved with ASV.

I've gathered that from the recommendations on this forum and from reddit. 

Having said that, after getting them to lower the settings it is working a bit better than the cpap. 

Also, they seem fairly adamant that I need to try the BiPAP and fail prior to trying out the ASV.  I already got in an argument with them about this so it seems like all I can really do right now is stay the course and keep pressing them.

my IPAP is 16 and EPAP is 10.


RE: BiPAP ST - almost there - please help - Gideon - 07-23-2021

PS=6, sorry I got it wrong.

Show 5hem those screenshots, email them to them and tell them it isn't working. Include a list of your symptoms. The. Repeat often. That is a press. Ask " how long do I have to put up with this before I can try an ASV?


RE: BiPAP ST - almost there - please help - Sleeprider - 07-23-2021

Quote:Also, they seem fairly adamant that I need to try the BiPAP and fail prior to trying out the ASV.  I already got in an argument with them about this so it seems like all I can really do right now is stay the course and keep pressing them.

Sadly, the sleep medicine practice is not practicing medicine or good judgement, but trying to satisfy insurance as defined by Medicare.  It is a Medicare requirement that moving beyond CPAP requires failure of CPAP, and moving to advanced PAP requires failing Bilevel.  You are already using an advanced PAP HCPCS Code #E0471, but it is an ST.  Your doctor just does not know that the ASV is also HCPCS #E0571 (bilevel with backup rate).  You are one of many "lucky" patients to be working with a duck, and his first language is "quack".  Sorry, but this was avoidable. You have already been approved for ASV and even your doctor doesn't know it. My post is not intended to be critical of you, but after seeing hundreds of people prescribed the dumb and outdated ST machine when they needed an ASV, I just get frustrated that these guys are allowed to collect fees for this malpractice. It's all about keeping patients in the mill and churning the sleep test money generator.

Wiki article: http://www.apneaboard.com/wiki/index.php/Special:Search?search=justifying+advanced+PAP&go=Go


RE: BiPAP ST - almost there - please help - SarcasticDave94 - 07-23-2021

OK, fikus56, you're among friends, and asking friends for opinions. Myself, I've been exactly where you are now, except I didn't get an ST. I did my diagnostic sleep study in lab for BPAP because I couldn't tolerate straight CPAP. Test date was early 2017, just about the time I joined Apnea Board.

Sleeprider and Gideon walked me through the steps of getting my hard copies of the diagnostic test and helped with the Respironics Auto BPAP as best as they could. Sleeprider had to interpret my test results. Short highlight was 24 Obstructive to 124 Centrals and I forget the other stuff, except one Central was 90 seconds long. The pulmonary sleep medicine doctor decided I needed the BPAP aforementioned, not telling me of the extreme CA on the lab report. WRONG WRONG WRONG ANSWER for a guy (me) with predominantly Central Apnea. I ad-libbed my way through the dance the rest of the way with them as cheerleaders.

How long did Dave use the BPAP Auto? I think it was a very long 4 nights, period. Not months. I called my pulmonary office and requested to be scheduled for an urgent need office visit the following Monday. I got that visit scheduled mid-morning the prior Friday. I took a 7 AM opening. Yeah ok pre-COVID. Do you best to emulate.

I took my diagnosic printout that was highlighted with what was discussed here on AB in my thread HERE (Dave's thread).

Friend, take my advice, call them soon and tell them the ST machine isn't going to work successfully in treating your CA (Clear Airway to the ResMed/Central Apnea to people) over the long haul consistently. Because your Central Apnea are consistently inconsistent, meaning up and down frequently without setting changes.

Best to you on this, and we will help you. We advise, you do the work.

PS: you can fail the ST machine later if the doc decided you failed or fail it now. There's compliance remember? Failed compliance for medical cause. That was my insurance ruling if I recall it rightly. Demand the ASV, politely yet firmly. No, or later, isn't the accepted answer.

Yes maybe the ST machine is doing fair for you now. How about this? Put up your OSCAR summary that shows the rolling tally of events in therapy. CA going up sometimes, and other nights pretty quiet? Ah, yep, that's CA for you.

Dave Coffee


RE: BiPAP ST - almost there - please help - fikus56 - 07-24-2021

Forgot to put the card back in the unit last night. 

However I slept from about 9:30 to 7:00 - AHI of 3.5.  (Modified the backup rate to 10 instead of 9) We can safely assume that there was still some lingering centrals. 

ok so the first picture is my overview of the BiPAP - I suppose those Unclassified Apneas are presumably Centrals.  

Also pictured is how I performed on the CPAP - which is pretty bad. 

Regarding the ASV - I will keep pressing the doctor / RT on it.


RE: BiPAP ST - almost there - please help - SarcasticDave94 - 07-24-2021

OK thanks. I think I saw the trend I was more or less expecting. Keep up the fight, and don't quit.

If you have questions or need prep for some ASV request steps, ask.


RE: BiPAP ST - almost there - please help - fikus56 - 07-26-2021

Thanks - I’ll be reaching back out to the respiratory therapists this week.

Any tips for things I can say that I haven’t already ? They shot down the ASV request previously , said I needed to try Bipap and fail first.


RE: BiPAP ST - almost there - please help - Gideon - 07-26-2021

"I failed BiLevel, and here is why!"
"When can we look at ASV?"