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Australian newbie asking advice!
#1
Hi All and G'day,

I'm hoping I can seek the advice of some of the Aussies on this board regarding the diagnosis procedure and process for sleep apnea.

Background
==========
I arrived here through my dentist. My new dentist here in Sydney, Several months ago he recommended that I undergo small operation on my tongue (tongue tie, nothing serious). During this consultation, he happened to ask me about my quality of sleep. Apparently, this tongue tie thing can be a factor related to poor quality sleep.

I told him frankly, "look, I feel like I haven't slept well since I was a kid - I suppose that is normal and part of being an adult."

He nodded. I realised that nobody had ever asked me about the quality of my sleep apart from my employers over the years, to whom I had always said "no problem", but who suspected something from my chronic early morning drowsiness.

This time, an honest question deserved an honest answer.

- People that I know think that I sleep all the time. Personally, I never feel like I have slept and I always feel tired.
- I rarely have dreams while I sleep, if at all - it is only in the last hour of sleep on my regular 12hr sleep marathons on the weekend - if that. I just "blackout".
- Apparently, I snore like a chainsaw that has an occasional clogged fuel line. (Update: I checked with my iPhone app, "Snore Lab" which rates my snore as "Epic", and calculates my snore level as being worse than 96% of its users. Consistently)
- I wake up each morning feeling like I have a hangover. As if in a physical stupor - I have to just sit down in a chair and try and remember what and where I am.
- I can easily "sleep" 11 hours - known as the 'sleepyhead' of my family, but I myself rarely feel rested.
- I drink coffee regularly to 'perk me up'. By this, I mean I am a serious coffee hound with a daily habit, grinder, machine etc. Funny thing is that I don't particularly mind coffee, I just seem to need it to be at a level with everyone else.
- My "sleep" problem has caused me problems with school, university and work my whole life.

After saying all of this - it dawned on me that I actually had a huge problem that was continuing to negatively affect my life. I couldn't believe it.

My dentist obviously agreed, since he:

1) referred me to a sleep doctor in the city, and (2) called me the next month, checking up on me to make sure I booked a diagnosis with a sleep doctor.

So, I have booked to see a renown Sleep Dr at a 'Sleep Centre in Sydney' - and this impending appointment has prompted me to research sleep problems - which made me wonder if I have sleep apnea. Now, I am thinking that it is somewhat likely ... with the obvious caveat that this is just a strong hunch.

At this point I agree that only a proper medical practitioner can (or is allowed to) accurately diagnose and prescribe sleep apnea but ...

I have a sinking feeling that I have sleep apnea and that I am going to need a CPAP machine. So ... Could I ask the more experienced Aussies here?

1) I have to wait almost a month to see my sleep specialist Dr, in the city (Sydney). Is this too long to wait? - Am I doing the right thing by seeing a "high street Doctor"? or should I just find a local sleep centre affiliated with one of those medical companies?

2)  I am concerned this will be very very expensive. I have Medicare and a Private Health fund and I will research more, but it seems that these only cover the initial visit. Does this mean that I have to pay for my entire sleep study, and then I have to see my doctor again and pay for him to look at the chart?

3) I am concerned that this Specialist has a company that sells machines as well - I would rather order from overseas - would I be obligated to buy a machine from this Doctor as well? 

4) Even if I wait a month for this appointment, it might take me another month to get a Sleep Lab Appointment (I'm just guessing here), then I might have to wait a month for my Doctor to see me to discuss my results, then I will have to hire a machine for a month from the sleep centre, after which I am obligated to buy from them.

Put another way, I am really am concerned that from right now - I will have to wait an entire month to see a Doctor to tell me that I have an obvious sleep problem, so effectively two months from now to get physically tested in a study, then effectively three months from now for that Doctor to look at the graph and give me a PAP machine prescription.

... Can I fast-track this somehow by just going to one of those all-in-one retailer/clinic/franchise mobs? Or am I just being impatient? Is this a normal thing?

-Sigh-

I am so frustrated that I have finally found a possible solution to my sleep problem but restful sleep must follow a process that will take months to resolve. 

I'm sorry about all these questions - I would be glad for any and all advice here from those wiser, more experienced, and sleeping well. Thank you if you have read all the above. 

Huh
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#2
Hiya... fellow Australian here.

I can relate to many of the things you have stated...

I had many of the "symptoms" of sleep apnea that you mentioned without having any clue. Eventually it reached a point where I knew there was definitely problem, I started doing research and worked out I had sleep apnea. I too was extremely impatient and wanted to get on CPAP straight away.

Now to address some of your specific points...

1) You should definitely see a reputable doctor specialising in sleep disorders. They are usually fairly solidly booked but you can call around to a few and if you find one who will see you sooner just cancel the appointment you have and go with the sooner one.

I went through a sleep centre (no doctor just a "sleep therapist") but had I known what I do now, I would have went to a doctor.

2) Unfortunately... it is expensive. Medicare will cover some and your private health will cover some but you will definitely end up out of pocket numerous times along the way. There is no way around that.

You need hospital coverage for the sleep study...
You need "extras" cover for the sleep machine... check out GMHBA Gold Extras (they will cover a good chunk of the machine and when I joined up a couple of months back they had no waiting period!).

3) You are NOT obligated to buy the machine from the doctor!

There are many machines on the market... the best machine by far is the Resmed AirSense 10. You can buy the machine overseas or, as I mentioned before, if you have good "extras" cover buy it here and claim back what you can.

4) I remember being in your shoes and thinking to myself exactly the same thing (ie. I can't wait!!!!). 

Going the sleep centre route probably won't speed things up. They are just as booked up as the doctors are.

FYI in Australia you don't need any prescription for CPAP. If you want to get started straight away, there are numerous companies that loan the machines short term (no obligation to buy).

I would recommend you go out straight away and borrow the Resmed machine I mentioned before. Come back here to this forum to get advice on how to set it up (very very easy) and see how you go. In all likelihood CPAP is going to make a HUGE difference to your life. 

PS. you probably need to try it for a least a week to feel a major difference...

I'll be happy to answer any other questions you may have.
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#3
Hello and welcome to Apneaboard. Welcome

You'll find many people from Oz on the forum. Even one of our moderators.
They can really help you get started off on the right foot.

Regards,

Mongo

Admin Note:
JustMongo passed away in August 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#4
Hi hatesleepapnea2017,

Thank you! Thank you! Thank you! Thank you for your advice!

I can't really speak with anyone at home about this problem or any of my friends, so I really really and seriously appreciate the kind words and notes from experience.

I feel so impatient to get some proper rest - I don't care if I have to use a machine that makes me look like Hannibal Lector.

I am going to do exactly that ... I am so desperate I will even look into buying a machine (USA) prior to the sleep study (and if I am wrong, just wear the loss).

Thanks again .... relief to find I am not the only one that feels this way. Thank you for the welcome Mongo.
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#5
You're 100% welcome. I know exactly how you feel and where you're coming from.
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#6
G'day WellSlept. Welcome to Apnea Board.

With great respect to ihatesleepapnea2017, I'm not sure that I agree on the absolute necessity of seeing a specialist. My experience was that the sleep doctor was a dud, and it was the therapist who got everything sorted for me (with a lot of advice from the people here).

First thing to do is interrogate your insurance and find out exactly what is covered. In my case I am with Medibank Private with top hospital and 70% ancillaries. I went through Cardio Respiratory Sleep who are part of a big franchise here in Perth - don't know if they operate in Sydney. Anyhow, the sleep study was bulk billed and the night in hospital for the test was covered by MBP with no out of pocket. The deal that CRS have is that if the test shows you have apnea, then you pay a relatively small amount (it was ~$180 three years ago) which covers a month's hire of the machine and four weekly sessions with the therapist. This is not claimable or refundable but will be deducted from the cost of the machine if you buy one from them. In my case it took about seven weeks, but that's another story. The bummer is that MBF only refunded $500 and I needed a $4000 ASV machine.

Member ajack has had good experience doing everything through the public system including arranging the sleep test through his hospital outpatients department. I've never investigated that option, but I suspect the wait times would be pretty long here in WA.

So, check out what your insurance will cover for the test and the night in hospital, whether your preferred provider will bulk bill the test (which is then covered by Medicare) and how much the insurance will cover for the machine. Also, find out what the public system can do for you.

I do agree with ihatesleepapnea2017 that you should get hold of a machine on a loan or rental basis - you can do that immediately without a prescription. There is no shortage of sleep clinics and on-line providers. You might even get one from your local pharmacy. Get a Resmed Airsense 10 AutoSet. Don't let them fob you off with a Fisher & Paykel or DeVilbis - I'm sure they are good machines but the Resmed is best supported with analysis software and by the people on this forum.

Once you have the machine, download and install SleepyHead software, and use it to read the data card from your machine - I'm 90% certain that will give you enough data that you will be able to prescribe your own settings and never need to go near a sleep doctor. There are some very capable people here on Apnea Board who will guide you through the process.

In the meantime, make the appointment with the specialist, in case it's not a straight-forward case of obstructive apnea. You can always cancel. Or else you could still get the sleep study, which will give you a valuable baseline, as well as a whole suite of subsidiary tests such as lung capacity, EEG and ECG. I'm pretty sure your GP could refer you for that, without needing the specialist.

As a professional engineer (retired) I tend to avoid recommending to people that they do not go for proper professional advice for something. However obstructive sleep apnea is really no more complicated than plumbing. I think the whole apnea industry is riven with poor ethics and conflicts of interest, and I believe this is one medical condition where it's reasonably safe for patients to take the initiative and get the process started.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
I'll add that the people on this forum are very good at identifying complex apneas that may or should require a Dr to investigate.
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#8
a bit of a long story but..You can short circuit it by ringing a sleep center and asking if they accept a GP referral to a home sleep test, I had my specialist book this for me, so I'm not sure if GPs can. If not contact your specialist and ask him to refer you to a center before your appointment. medicare pays and there was a $50 gap. it can be done in a week. If you go Private hospital, costs depend on your cover.

My home sleep study came back, garden variety apnea, so an auto cpap worked for me. some people have the apnea where they don't signal to breathe and need another machine. during the titration home/hospital some need high pressures and need another machine.

when I looked at the rental $70 6mth min or the $200 month trial. I got a cpap off gumtree, I picked up a resmart auto for $200, found this forum realised there is a world where you can look at your results nightly and got a s9 auto for $300 with 2,500hrs, thinking, sell resmart and the s9 will do me as a spare. As it turns out I'm happy with the s9 and I'm keeping the resmart as a spare.

My sister went through the zero cost public system, GP referral to outpatients which we all can do, I rang, there was a 3 month wait for the sleep test, I didn't ask if the public system does home sleep tests, but I'm guessing they don't, it makes too much sense. In my sisters case. Having a health care card, she got a free machine. basic fixed pressure.

I continue with my specialist, but I'm happy with the s9 auto. There are other factors, but irrelevant to this present outcome.

In summary, you could get a cheap s9 auto tomorrow and later keep it as a spare. you could rent/trial from a sleep centre.
I would get a home sleep study first, because it's the quickest. Then get a s/h machine or month trial. If the sleep study throws up major problems then do a hospital titration.

The other school of thought is, everyone is in a panic when they first find out. You have probably had sleep apnea for years, another month or 2 probably won't kill you.
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#9
Hi Wellslept,
WELCOME! to the forum.!
I wish you good luck as you start your CPAP journey and also, dealing with insurance.
trish6hundred
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#10
Quote:The other school of thought is, everyone is in a panic when they first find out. You have probably had sleep apnea for years, another month or 2 probably won't kill you.

This is sage advice. Take your time to research your options and don't rush into any hasty decisions. We've given you a number of approaches above - one or a combination will work for you. It depends largely on your private health cover, your personal financial situation, and how much you're prepared to take responsibility for your own treatment. Many of us on the forum have long since dispensed with sleep doctors as we have found there is no real need to use them in the majority of cases.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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