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[CPAP] How often is sleep study required?
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retired_guy Offline

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Post: #21
RE: How often is sleep study required?
Shoot, Doc. I can't add anything more than what Paula and the others suggest. But I do think your best option is to write yourself a prescription for a nice S9 Autoset, and a nice new mask, etc, and shop the suppliers above. New or used, you should be able to get good deal. I would not be hesitant to buy a used autoset if the hour meter on it was low. Say a couple hundred hours or less? Those are usually machines that were used on trial, or for whatever reason were turned back in. If that would save me a few hundred bucks, I'd do that all day long.

But even if you want a new machine you should be able to score one at a good price.

As to settings? I'd set that sucker up at minimum 6, maximum 12, with and EPR of 2. I'd turn "ramp" to the "off" position. I'd get me a nice, no frills P10 pillows mask, a neat new teddy bear and climb in bed.

In the morning I'd input the SDCard into the computer, into Sleephead or Rescan software and see where I'm at.
05-20-2015 09:56 PM
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trailrider Offline

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Post: #22
RE: How often is sleep study required?
Well, I think it should an A10 autoset. Takes up less real estate on the night table. Might as well get the shiny newest toy!
05-21-2015 11:07 PM
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SlightlySleepy Offline

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Post: #23
RE: How often is sleep study required?
How time flies! First of all, apologies to everyone for not following up with the rest of the story. I'll do my best to remember the events back in 2012 as best I can.

First of all, I want to correct any misconception by newcomers to this thread that might have lead them to believe I am not in favor of getting a doctor's prescription before using CPAP. Nothing could be further from the truth. As an earlier poster commented, a doc who treats himself has a fool for a doctor and a fool for a patient. That said, we all do treat ourselves to some degree, and even non-physicians are encouraged, even expected to take a much larger part in their care. This forum is part of a much larger e-patient movement that acknowledges the wisdom that can be gained online from 'micro-experts' in various disciplines. I am heartily in favor of this. But I digress (happy to discuss that in another thread).

My 2012 original post in this thread was fueled mainly by frustration with my (new) insurance utilization review process in which I as a long time CPAP user was being treated as a 'brand new' patient, something many of you probably remember vividly.

I eventually was able to find a reasonably local sleep physician who would see on fairly short notice, and after I declined UVP wrote a prescription for CPAP machine. Thanks to this board I was able to request the AutoSet S9 and that was one of the best medical device choices I have ever made.

I eventually returned to the world class sleep clinic in which I was originally diagnosed over a decade ago, and would you believe (drum roll) they told me I did NOT need a new sleep study. They had money to gain from ordering one, but with the new machines they felt confident enough that I was being properly treated that they were able to renew my prescription with only a slight tweak to the numbers (raised the top number of the two settings between which the AutoSet automatically adjusts itself).

Because I am so stable, I was told an annual visit is sufficient unless I start having problems (excessive sleepiness, etc). So I've been back twice since, last time was this March. I asked my physicians directly (it is a teaching hospital) whether anyone is ever 'cured' of sleep apnea, and the overall consensus seems to be a resounding "NO". The exception might be someone whose apnea is due only to obesity and they lose weight. This seems to be the rare exception (if that).

So essentially, insurance companies are simply making things difficult for patients by creating unnecessary hurdles with fancy names like "compliance". The whole authorization process was so distasteful that I have suppressed my memory of most of the details. I did keep pretty careful and detailed notes about the process that I can refer to should the need ever arise, but I will add that the subsequent insurance company experience was even worse and involved several weeks of phone calls and emails to non-customer-service-oriented humanoids who really seemed more interested in denying care than making it easy to obtain durable medical equipment.

I am embarrassed for the medical profession because of these experiences. Or the financial aspect of the US medical health care system. I don't know that other medical care financing arrangements are any better, but certainly they can not be much worse.

Meanwhile, I'm on my second AutoSet S9...which is great little machine. The old S9 is too, but the insurance company could not promise to replace it if it broke down out of warranty (without going through a lengthy utilization review process) so instead they offered me a brand new machine which I accepted. The logic behind this made no sense to me ("we can't promise to buy you one in the future if you need it, but we can promise to give you one right now even though you don't need one yet!" I took it).

I still watch my numbers (which are great -- AHI less than 1.5 usually. I am getting some centrals which I secure-emailed my physician about and we basically decided they were not worth changing any settings for (6-10). Partly because I have had a recent cold which reduced the effectiveness of my nasal pillows so I'm ordering a backup full face mask.

SUMMARY: SleepApnea does not go away, is not really curable, but is a chronic condition with CPAP as the gold standard of treatment. An overnight sleep study is important for initial diagnosis (preferably in clinic so you can have electroencephalographic monitoring) but routine retests are not necessary once CPAP has been titrated. Physicians appear to be placing significant trust in the AHI readings of the new sophisticated machines such as the ResMed AutoSet S9.

PS The nocturnal palpitations have disappeared. Not sure if we'll ever know why, although temporally the change correlated with slight increase in top pressure and possibly partially due to an adjustment to my B vitamins(?) including B2.

PPS If stuck on a deserted island without access to medical facilities and specialists (but having access to a good CPAP machine with good AHI monitoring technology) I would definitely risk a low level unprescribed CPAP vs. the dangers of untreated sleep apnea given the low risk/benefit profile. But given my current situation with access to world class sleep specialists, I am fortunate not to have to take even that low risk with my life.
(This post was last modified: 05-22-2015 12:59 AM by SlightlySleepy.)
05-22-2015 12:35 AM
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Terry Offline

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Post: #24
RE: How often is sleep study required?
(05-22-2015 12:35 AM)SlightlySleepy Wrote:  I am embarrassed for the medical profession because of these experiences. Or the financial aspect of the US medical health care system. I don't know that other medical care financing arrangements are any better, but certainly they can not be much worse.

That's pretty much it. It's so difficult to get though the process that I'll never do it again.

The machines are cheap enough and there are any number of online vendors I can use, and with intelligent machines, great software, and a not-very-exotic breathing problem at night, I see no reason spend another $2,000+ night in a sleep lab or deal with my local crime syndicate (oops, I mean equipment provider) to buy a nice $800 machine for $2,000 ever again.

My sleep doc is a very nice person and a very good doctor, but he's stuck in the middle this horrible process. I actually feel bad for him.

While the sleep labs are a god-send for people with uncommon or strange or hard to diagnose problems, I'm pretty sure that right now, they're being used to discourage the vast majority of people who could benefit from an auto CPAP, but would cost the insurance company money. If a patient complained that they snored all night and scored terribly on something like the Epworth Sleepiness Scale, most could easily and safely be given an auto machine to try for a week, and that would be all the testing necessary.

Terry
(This post was last modified: 05-22-2015 08:34 AM by Terry.)
05-22-2015 08:30 AM
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Mosquitobait Offline

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Post: #25
RE: How often is sleep study required?
Medicare doesn't require a sleep study every 4 years. Medicare just covered my brother's bipap using his old sleep study (8 years ago) and that was two weeks ago. They only care that your sleep study showed an AHI of 5 or more using only desaturations greater than 4.

I couldn't wait and bought a used S9. All the stuff arrived the day before titration. I feel much better now. I have a script, but no machine yet from Medicare.

I'd say raise your pressure one cm until your appointment. I've read a few places that you need to discontinue you cpap use 3-7 days before a study or you won't get accurate results of your current condition without therapy. Ask you insurance what they require to pay for the thing. Most insurances accept home studies as valid.

Can you cure sleep apnea? A lot of YOUNG obese people do cure their sleep apnea with weight loss. Apparently, using a didgeridoo (sp) an Australian wind instrument and certain vocal exercises can also cure mild sleep apnea. Once you get older, I don't suppose you do. I lost 30 pounds last year and it made getting a machine a medical necessity whereas before, I slept on my side with no problems. YMMV.
(This post was last modified: 06-08-2015 08:30 AM by Mosquitobait.)
06-08-2015 08:29 AM
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rhandel Offline

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Post: #26
RE: How often is sleep study required?
(05-03-2012 01:04 PM)SlightlySleepy Wrote:  I also bought supplies to build my own simple home manometer out of tubing from a design on the internet. Seems like a fool-proof method to calibrate my current and new cpap machine (if and when I ever get one!)

Oh? I would be interested in a manometer. I have a little (VERY little) time to play around with my CPAP machine (and my spare). I am looking to perfect this science. Since the Dr.'s don't seem to have any desire to do better. Home brew stuff REALLY drives this area of medicine.

RAH
06-08-2015 11:47 AM
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SlightlySleepy Offline

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Post: #27
RE: How often is sleep study required?
(06-08-2015 08:29 AM)Mosquitobait Wrote:  I couldn't wait and bought a used S9.

You could not wait for what? A re-titration or an original, new, diagnosis? I know used machines are deemed safe, but personally I would hesitate to buy (or even rent) one because it is too easy for me to imagine the home of the previous tuberculosis-ridden, chronic bronchitis, COPD-ridden former user in a moldy house. All that stuff goes through the machine and I seriously doubt it can be thoroghly sterilized.

Quote:I'd say raise your pressure one cm until your appointment.

Not sure who this was directed to, why, or how safe this advice is. I don't think you intended it for me.

Quote:Can you cure sleep apnea? A lot of YOUNG obese people do cure their sleep apnea with weight loss. Apparently, using a didgeridoo (sp) an Australian wind instrument and certain vocal exercises can also cure mild sleep apnea. Once you get older, I don't suppose you do. I lost 30 pounds last year and it made getting a machine a medical necessity whereas before, I slept on my side with no problems. YMMV.

As noted in my OP, I am not obese. Nor do I have a large neck. I have not found any documentation anywhere that my apnea can be cured without surgery. Even surgery seems to have mixed results and high recidivism. I do find the research on orchestral instrument players and didgeridoo (see http://www.sleepapnea.org/treat/treatment-options/digeridoo.html ) fascinating, but I have yet to meet anyone who plays the didgeridoo regularly.

Interestingly, I did play a brass instrument in high school, so perhaps that is partially to blame for my sleep apnea (see above article), but I suspect my particular issue has more to do with a combination of childhood braces and nasal anatomy venturi effect than choice of instruments. Furthermore, I would need to analyze the instrument/apnea correlation studies more carefully before giving them much weight as there are other risks to playing these instruments such as hypertension or stroke.

BTW, it boggles the mind to think that the dodgeridoo is recommended by some sites (such as this one: http://sleepapneadidgeridoo.com/didgeridoo-for-treatment-of-osa/)as a possible solution to the problem of CPAP compliance! As a somewhat musically experienced person, I have difficulty even imagining the technique required to simultaneously breath in/out on a didgeridoo. If a person is not motivated enough to wear CPAP I question whether he/she would be motivated enough to practice the didgeridoo often enough (at least 20-30 minutes a day, 4-5 days a week) to make any significant effect on apnea! Even if the person enjoys playing it, I wonder about the neighbors! ;-)
06-08-2015 11:55 AM
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Terry Offline

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Post: #28
RE: How often is sleep study required?
(06-08-2015 11:55 AM)SlightlySleepy Wrote:  You could not wait for what? A re-titration or an original, new, diagnosis? I know used machines are deemed safe, but personally I would hesitate to buy (or even rent) one because it is too easy for me to imagine the home of the previous tuberculosis-ridden, chronic bronchitis, COPD-ridden former user in a moldy house. All that stuff goes through the machine and I seriously doubt it can be thoroghly sterilized.

I know the used machines are supposed to be safe, but the hose only holds about 2L of air and lungs can hold 6L, so I have pretty much zero confidence that whatever comes out of the user's lungs won't end up in the machine, and possibly in my lungs.

I've been tempted to buy a used machine as a spare, but just can't get past that.

OTOH, I think it's ridiculous that an APAP machine requires a prescription.

Terry
06-08-2015 03:12 PM
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Terry Offline

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Post: #29
RE: How often is sleep study required?
(04-25-2012 06:35 PM)SlightlySleepy Wrote:  I'm fairly new here so please forgive if this has been discussed in depth before. I have read the thread regarding the pro's and con's of self adjusting pressures, but that is not my question. My question is: Does anyone ever get cured of Sleep Apnea? If not, how often is a repeat sleep study really required if one is planning to purchase the Resmed S9 Autoset?

Since all your problems seem to be obstructive, not central, I'd just go online, buy a nice shiny new auto machine like a Respironics or Resmed, get a copy of SleepyHead software and call it a day.

You'll be out of pocket about $800, which isn't much different from what it would cost you if you went through "the machine" again, and paid all the co-pays.

Terry
(This post was last modified: 06-08-2015 04:39 PM by Terry.)
06-08-2015 03:33 PM
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Mosquitobait Offline

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Post: #30
RE: How often is sleep study required?
Yes, the other answer was to another poster. It's hard to do the quote thing with a tablet. Sorry for the confusion.

Quote:You could not wait for what? A re-titration or an original, new, diagnosis? I know used machines are deemed safe, but personally I would hesitate to buy (or even rent) one because it is too easy for me to imagine the home of the previous tuberculosis-ridden, chronic bronchitis, COPD-ridden former user in a moldy house. All that stuff goes through the machine and I seriously doubt it can be thoroughly sterilized.

I could not wait for everybody else to get their ducks in a row so that I could get a machine NOW, not 2 months from now. I went from taking 2 naps a week in January to 2 naps a day by my first appointment with the sleep doc in March. The sleep study was 3 weeks after that. Then the titration weeks after that. I apparently could not get across to him how quickly I was deteriorating or it didn't matter to him. I called repeatedly to move these tests up or give me a loaner - anything. I will return for one more appointment only because Medicare requires that followup to pay for my new machine. That will be the last one. This is a 4 month process that shouldn't be this hard.

I'm still really annoyed that they didn't do a split study. There is just no reason to hold a patient hostage like that. I'll get my GP to give me prescriptions for supplies.

FWIW, many of the hospitals use these same units for multiple hospital patients. They are cleaned with the same germicide sold by several online cpap stores. They ask that patients bring their own cpap because (a) they don't have enough of them and (b) they are already set to your prescription which minimizes the time the hospital RT has to spend with you making sure your machine is set up properly.

Quote: I know the used machines are supposed to be safe, but the hose only holds about 2L of air and lungs can hold 6L, so I have pretty much zero confidence that whatever comes out of the user's lungs won't end up in the machine, and possibly in my lungs.

I've been tempted to buy a used machine as a spare, but just can't get past that.

For both of you, if it will make you crazy, don't do it. It will make you crazy. I may very well end up throwing this used machine out when I get the new one, but it's been a great bridge to get me to a long term machine. I have no complaints there. You can't buy a new machine without a prescription, so the used market is your only option. The germy thing doesn't bother me.
(This post was last modified: 06-08-2015 04:31 PM by Mosquitobait.)
06-08-2015 04:30 PM
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