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[Diagnosis] Potential apnea. Some questions, frustrations.
#1
Question 
Potential apnea. Some questions, frustrations.
Hello everyone!

I have yet to receive a definitive diagnosis from a Doc, but have had a couple of sleep studies. The first sleep study was a few years ago and was too short, but I never made the appointment for a redo since I moved among other things. The second sleep study last year was a home study and the doctor scheduled an appointment about a month after the study to review the results. Unfortunately I did not have insurance anymore for the time the follow-up appointment was scheduled and did not have the nearly $300 for the appointment at the time. I have contacted the Doc's office and they will not give me the results of the study despite my paying nearly $800 at this point for no information at all. I did get a tech to agree to mail me my medical records, but he could not confirm if this would have the study results. 

My first in-lab, but incomplete study showed a mild to moderate apnea but needed to be repeated since it was too short, the second I have no results for, but between my sleep monitoring with an Apple Watch and using an app to record my breathing I think it's pretty clear my poor sleep quality and constant waking during the night are a result of sleep apnea.

My question is what to do next? I will wait for the records to arrive in the next couple of days and if that's not what I'm looking for I could do a home sleep study and I guess that would confirm what I believe I know. I also have the opportunity to purchase a Resmed Aircurve 10 VAUTO at a very reasonable price.

I have insurance, but the deductible is pretty high and so I'll be paying out of pocket anyways. So my real question is given the home study results from either my doctor or one of the online providers what do I do next? If the mailed records don't have the information I need is there a home study provider you guys recommend?

Thanks
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#2
RE: Potential apnea. Some questions, frustrations.
If you want to just get the Vauto, do so and we can guide you to comfortable effective treatment. Even new the machine can cost under $1K at Supplier #33, and there are some very good deals on Craigslist and other outlets. The cost is easily twice that through usual DME and doctors.
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#3
RE: Potential apnea. Some questions, frustrations.
If you paid for the home sleep study you are entitled to a full report of the results but you may have to find a way to apply some leverage in order to get a copy. Have you contacted the home sleep study provider directly? Meanwhile, if you have enough reason (symptoms etc.) to believe you need therapy and can swing it your best approach might well be to take Sleeprider's suggestion and get help from this forum.

Welcome to the forum,

Stan
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#4
RE: Potential apnea. Some questions, frustrations.
I think I will be buying it this weekend regardless, I'm starting to feel like its a racket and all the extra tests and appointments are usually just billed to insurance so most people don't care. It's like a 4 month wait for an appointment and I'm at my wits’ end trying to get decent sleep. 

How do I determine initial settings? Just use VAUTO with reasonable max pressure settings and go from there?
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#5
RE: Potential apnea. Some questions, frustrations.
(01-18-2019, 03:52 PM)stanleydean Wrote: If you paid for the home sleep study you are entitled to a full report of the results but you may have to find a way to apply some leverage in order to get a copy. Have you contacted the home sleep study provider directly? Meanwhile, if you have enough reason (symptoms etc.) to believe you need therapy and can swing it your best approach might well be to take Sleeprider's suggestion and get help from this forum.

Welcome to the forum,

Stan

The doctors office did the home sleep study themselves, I went to the office late one evening and they hooked me up and I brought the equipment back the next day. 

They are a sleep specialist practice that I was referred to by my primary care and I don’t know what if any leverage I have.  I have twice requested that someone at least call me back and that hasn’t even happened.  I spoke with a sleep lab tech that agreed to mail me my record, but he could not tell me what those would consist of.
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#6
RE: Potential apnea. Some questions, frustrations.
You state that you definitely have mild to moderate apnea.  This means that you need to be treated.  Get the VAuto, with the exception of Central Apnea or COPD it is the best of the general CPAP machines that you can get.

That said.

A very small portion of our getting started link Helpful_tips_to_ensure_success

Obtaining medical records

Obtaining your records can help you greatly. HIPAA (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information. Under HIPAA, patients have certain rights to their own medical records ( HIPPA Privacy Rule & Patients' rights ) These rights include the right to obtain a copy of your Sleep study/studies, titration records and prescription(s). Obtaining a copy of these items can help patients form a greater understanding of their condition and may help avoid a repeat sleep study or titration.

Fred
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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
RE: Potential apnea. Some questions, frustrations.
(01-18-2019, 03:54 PM)c1387 Wrote: I think I will be buying it this weekend regardless, I'm starting to feel like its a racket and all the extra tests and appointments are usually just billed to insurance so most people don't care. It's like a 4 month wait for an appointment and I'm at my wits’ end trying to get decent sleep. 

How do I determine initial settings? Just use VAUTO with reasonable max pressure settings and go from there?

Titration with the Aircurve 10 Vauto is straight-forward and is a modification of the VPAP-S.  My recommendation would be to set it up at a EPAP minimum of 6.0, IPAP Max 14 and PS 4.0 cm. This will provide pressures from 10/6 to 14/10 which should provide a good starting point for optimization. If we see obstructive apnea, the EPAP is raised to where those are extinguished. If hypopnea is present, increase PS. If there is central apnea reduce pressure support.  A titration protocol may start with an EPAP minimum of 4.0 cm for mild apnea, but most people will need a higher exhale pressure to maintain the airway.  We can try either way.

Provided you are dealing with an obstructive problem and not predominantly central apnea, then the Aircurve 10 Vauto is perhaps the best machine available.  Here are a couple images for bilevel titration:

[Image: attachment.php?aid=4203]

[Image: attachment.php?aid=9716]
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#8
RE: Potential apnea. Some questions, frustrations.
Thanks for the help guys. Ill try it tonight with those suggestions.
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