Mixed apneas and aerophagia - needing new machine

[emery]

Hi,
Its been a while but we have ended our full-time RV lifestyle so I now have a place in our house to put any machine I may need. Sleep study said I was having some mixed apneas but my biggest problem was/is aerophagia so I have been using a DeVilbiss D57HH Autointellipap BIPAP pretty successfully. However, my AHIs are climbing and pressure adjustments are not helping and it seems like this may well be due to CAs.

My last SStudy in 2018 showed some CAs and an ST machine was sort of spec'd. The sleep dr did not seem to know much detailed info on the differences so I really felt like he used a vending machine approach to pick a machine for me. But that machine was too big to fit in the only place in the RV that I could put it so, thus, the DeVilbiss without any ST or ASV capability. Now, I am getting ready to go pursue the best choice for my needs and I think it is the AutoSet 10 ??? ASV versus VAUTO. What I cannot seem to clear up is whether the ASV also does auto titration for Inhalation and Exhalation as the VAUTO does.

My Wife recently started with Autoset 10 and I find it very nice to play with. I am thinking that I need the ASV for the CA (No, I don't have any heart issues) but I think I really need the independent BiLevel and the separate auto titration of the Vauto because my needs seem to change with all sorts of environment things... like the weather, food, excitement, etc.

I have been a devout PAP user since 9/11 (yeah, that one) and just need some deep technical guidance so I can tell the dr what my best chance solution is. My DME is LIncare and if I could switch I would in a hearbeat. The only good thing about them is that they are so screwed up that after losing my paperwork twice in 2018 I got the machine and stuff but was never charged for it. Being medicare, though, I have to use a bidded DME supplier so I have to get it all right the first time.

Thanks for whatever advice you can give, guys.

[Pugsy]

ST models are fixed bilevel machines with a back up rate to force you to breathe and mainly for central apnea.

What you want is the ASV model as it will both do the back up rate for when you don't breathe (those centrals) plus it will auto adjust the pressures as needed for the obstructive apneas. So it will function like the wife's APAP machine and auto adjust and it only breathes for you when you have a central apnea.

The regular VAuto bilevel machine will auto adjust but it can't/won't breathe for you or be able to do anything with the central apneas.

Research the ResMed AirCurve 10 ASV machine. It will do what you need done and it only does it if needed. If you aren't having central apneas it essentially functions like the VAuto.

Be aware that when these machines deal with centrals they will give you a rather big burst of pressure but it doesn't last long...one or two breaths.
If you went with the ST model you will likely be using higher pressures with every breath you take and it most likely will make the aerophagia much worse.

[zonker]

I have been a devout PAP user since 9/11 (yeah, that one)

a brief derailment, then back to your thread.

i had a job interview on 9/11.

all we did was sit and watch television in the lobby.

[emery]

Thank you, Pugsy, for your confirming summary. I just could not find the comparative detailed information for these machines. They seem to give apples to lugnuts type details.

The variability of my nightly needs just keeps it all so interesting. I just cannot trust a one-time meeting with a dr that sets a prescription for anything based on that criteria. It is always an uphill struggle to get exactly what will work best for me and that always can only happen if I do all the legwork.

Thanks, Again,
Emery

[Miss Emerita]

Once again, my wish for all forum members is that their sleep doctors would know even half as much as Pugsy does....

[chunkyfrog]

I have been a devout PAP user since 9/11 (yeah, that one)

a brief derailment, then back to your thread.

i had a job interview on 9/11.

all we did was sit and watch television in the lobby.

My neice gave birth that day.
Her husband watched tv, and kept the nurses informed.
The baby is in her second year of college--sports medicine.
(Hockey when it is finally allowed)

[emery]

So I am getting down to the wire and actually going to get to see my Sleep dr. this week. As a followup question, would the Dreamwear AutoSV be a better choice or better equipment?

[Pugsy]

I have used both the Respironics ASV and the ResMed ASV models.

I think the better choice is the ResMed ASV and the current model is the ResMed AirCurve 10 ASV. I think it has a better algorithm and it is quieter. The Respironics DreamStation (not DreamWear which relates to mask) ASV is an okay machine IMHO but I prefer ResMed myself.

[emery]

Just as a follow-up: My sleep study finally happened but the first night of it, going in, I had not slept much for the 3 previous nights (full moon) so I was pretty much not sleeping during the study period. Came back the next night and they did the titration and though I did show some central apnea events the tech said that I did not have enough of them to justify switching me to AsV testing mode. C'mon people! This is not rocket science! No one sleeps exactly the same all night every night. My previous Sleep study in 2017 showed enough CAs to warrant the pulmonologist to indicate I needed an ST capable machine. How many CAs more do I have to have during a period when I cannot sleep for whatever the reasons that night are, to justify getting an ASV machine?

Honestly, this is such a racket! Pardon me but I have been on APAPs since 2001 and now they want to put me on a CPAP!???? They totally ignored that I am already on an ABIPAP because of my severe aerophagia. I think sometimes these people can only do the math if they have enough fingers!!

Sorry, but going in I knew It was going to come out like this. Every new machine I have had to get has been this same fight and I have not always won. I am getting too old to be dealing with the cretins that hold my well-being in their semi-competent hands.

[Miss Emerita]

Wow, they wouldn't even trial an ASV during titration? That's just maddening. And do they really want to give you a regular PAP machine when you've been using a bi-level machine?

Unfortunately ASV machines are expensive, but if you could afford to buy one, I wonder whether that pulmonologist would give you a prescription to use?

[Pugsy]

Sleep labs are limited to what the doctor has ordered and the criteria established in the lab for the steps past cpap machine only.
It sucks but it is what it is. If the doctor didn't order ASV titration and criteria wasn't met (for whatever reason) then it just won't happen.

[emery]

As the saga unfolds; The dr did not circle the order that would have mandated an ASV titration but instead, circled the one that had a criteria for ASV titration so the Sleep tech did what the order specified. Now, trying to get the Dr to fix his mistake (you know, they never make mistakes, right?). I also found that the Medicare instructions say to use either the correct HCPC code ( E0471) or the full manufacturer's name, make, model for the desired machine. Furthermore, it appears that from what I can find, the reimbursement to the DME is the same for all E0471 devices but the Resmed Autocurve ASV is about double the cost of the auto bilevel VAUTO. So, this makes it clear to me that when a DME is saying insurance won't pay, what they mean is that they won't get any more money if they give me the more expensive machine even if the dr specifically specified it.

I really hate dealing with these channels of incompetence. People that make rules that have no idea what the implications are and people that don't actually represent the patients standing between a patient and an effective solution.