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Finished my CPAP Titration Study, next steps?
#1
Hello all thanks for this site. I am fresh off my CPAP Titration Study to find out my settings for a CPAP machine a couple of hours ago. Let me say I hope it gets easier when I get my machine. I had my initial sleep study two weeks ago and the doctor told me I had severe sleep apnea and woke and average of 78.8 times an hour. This was a phone call and he really didn't tell me much more other than I had to come in again and it was a serious problem.

I arrived at the sleep center and the tech told me I might have a problem because of my mustache and goatee. I told her no one told me to shave it off and I really didn't want to anyway. I would anything I had to, even shave, if it made me sleep better, but only as a last case. I would have trimmed/shaved it though if they told me to.

My tech was very nice and we tried two different masks. A Philips Respironics Wisp minimal contact mask that just covered my nose and a ResMed AirFit P10 Nasal Pillow Mask. After trying them both we settled on the Wisp nose covering mask. I think I should have went with the nasal pillow after the fact, but both were a bit uncomfortable (I guess because I was not used to them).

I set off to try and fall asleep just before 11pm with lights/TV off. I am a stomach sleeper and the tech said I needed to sleep on my back to get good readings. I laid there for a while trying to get used to the mask and breath well. I found myself needing to occasionally open my mouth to get a full, deep breath of air. Eventually I guess I got used to it and fell asleep, but it felt like it took a while.

I actually felt like I went into a deep sleep a couple of times during the night and I am not sure how long these periods were, but I think it was the majority of the night. I woke between these periods at one point feeling like I couldn't breath and called for the tech. She said she had increased the pressure because I had a couple of apnea events. I told her it felt like I could breath at all and thought there was no air coming through and it seemed like the mask was blocking my nostrils. She said it was because of the increased pressure, not a lack of air. She lowered the pressure.

After that I went back to sleep and had my second deep sleep period. I woke up again around 4:30am, again feeling like I couldn't breath, not sure if it was increased pressure, but this time there was no falling back asleep. It took me awhile for my eyes to open and my head to clear, but there was no fall back asleep. After what seemed to be about 15 minutes the tech came in and said I know you are wide awake, but I need 15 more minutes to complete the study. So I laid there trying to breath through my nose for the time and she then came in and unhooked me.

She said I did really well and she was able to find the right settings for me. I was surprised because of the way I ended the study. I hope she is right. Now I have to wait for the doctor to contact me and I am not sure how the DME provider is picked or how I select the machine. I am hoping some of you fine folks can give me some pointers on my next steps. What kind of machine should I ask for. I wonder if my nasal pillow will be better than the other mask I used for the test. The nasal pillow felt a little hard against my nose. Would a better one than the sample they gave me be softer?

Sorry for the long post and thanks.
Paul
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#2
pwgphoto,
Welcome to Apnea Board,

The DME provider should be picked by you. The best thing to do is call your insurance and get a list of their participating DME providers, and be sure to find out what your coverage is.

Most on this forum would agree that DME providers will try to give you what we call a "brick". That is a CPAP machine that collects no useful data.

When you see your doctor, tell him/her to write a script for a fully data capable auto CPAP, and write on the scrip, dispense as written. Here is a link to help you with the current machines available and what you may want to avoid.

http://www.apneaboard.com/wiki/index.php...ne_Choices

As far as the mask goes, it will be the hardest thing to find and adjust to. The DME should give you 30 days to try out a mask.

Don't forget to ask for a copy of your sleep study and a copy of your perscription.
Good luck and check back with us.

OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

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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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#3
Thanks for the reply OpalRose. The sleep center gave me a list of local DME providers last week and I called my insurance co. to see which of the seven on the list were in my network, six of the seven were network. Not sure how to go about deciding which one is best.

My experience so far has been somewhat uniformed by my "doctor." I went for my original sleep study and the techs were nice enough. This was on a Sunday night. I have not met the sleep doctor in person, my ENT Doc ordered the sleep study and I picked a local hospital's sleep center for the test. The doctor is affiliated with the center.

The sleep doctor called me five days later on Friday and basically said I have severe sleep apnea, it was very serious and I needed to come in for another night of testing for CPAP treatment. I had to ask him how many times I woke up during the night and he said an average of 78.8 times. Other than that I got no other real info.

I scheduled my CPAP Titration and went last night for the test, as stated by the info above. I was told that the doctor would send my prescription to a DME supplier and they would contact me for set up. I think I need to start calling the sleep center to get more proactive about this process. I also think there should have been a meeting with the actual doctor to discuss all this, after I believe he is charging the insurance about $500 just to read the first study on top of the $1500 study costs and insurance is paying another $1500+500 for the Titration. Insurance pays 80% and I pay the rest. Only good thing is I think I am at the maximum out of pocket after the first sleep study and everything else should be covered 100% until end of year.

I am so confused, not to mention worried I won't be able to deal with the machine and mask to make it worth it.
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#4
your beard and mustache look just like mine, you will be able to get a good seal.
There are some really great people here with lots of experience, they can get you to where you need to be with CPAP treatment as long as you don't give up. Sometimes it takes a while.

There should be no problem getting a copy of your prescription and a copy of your sleep test summary report-get them.

Finding the right DME can be an issue, I was going to say look for reviews on YELP or the like, but then I must admit that they are all about the same for all DME's. Mine had bad reviews and While they are not what I would like, I have found that I can get them to do what I want (don't expect them to be proactive).
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#5
Yes, you have to be proactive about the process.

I would try to see the doctor that is writing the perscription and find out what they are recommending. I would do my best to get an AUTO CPAP. Some docs don't like to prescribe them, so you may have to be persistent. After all, you have to use the machine and pay for 20%.

Keep in mind that insurance will pay for a straight pressure CPAP and auto CPAP at the same rate.
The DME will make a profit by giving you anything less than an Auto CPAP.

As far as DME's, check around, or call the BBB and check their rating for complaints. Don't know what is in your area, but Apria seems to have a bad reputation.

Don't worry about making it work, we are happy to help you.

Here is a link that could give you an idea of the different machines and what to avoid.
http://www.apneaboard.com/wiki/index.php...ne_Choices
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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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#6
Thanks all. I just got off the phone with the sleep center and they told me the doctor picks the DME and usually uses the one that has a local rep in the hospital. This kind of threw me made me think scam or kickback. The one they said the doctor uses is approved by my insurance company and as long as they get me what I need and it's covered, I really don't care. Maybe it is a good thing the doc has a relationship with the DME provider as long as it is on the up and up.

I also told the sleep center rep that I was not too happy about the lack of info coming from the doctor. She got my chart and told me that because I was referred by my ENT, that could be why and that in all likelihood the doctor will be calling me to schedule an appointment and discuss my next steps. I guess this is where I will talk about what machine I hope to get and DMEP to use.

I am now going to call my insurance and see what level of machine they pay for and hope it is an advanced model with the stuff you all say I should get.
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#7
(10-19-2015, 09:39 AM)pwgphoto Wrote: After what seemed to be about 15 minutes the tech came in and said I know you are wide awake, but I need 15 more minutes to complete the study. So I laid there trying to breath through my nose for the time and she then came in and unhooked me.

She said I did really well and she was able to find the right settings for me. I was surprised because of the way I ended the study. I hope she is right.
Make no sense to me, sleep apnea is while you're asleep, not while you're awake
You could have events while awake, but they don't count , hence he name "sleep apnea", not awake apnea

If the diagnoses, plain obstructive apnea like the majority of us, imo you're a candidate for auto-pap since the crucial part of the titration done while you're awake, sleep apnea while you're asleep as the name imply

Auto-PAP is has a dual functions (the doctor should be pleased) can be used as straight pressure mode or auto-adjusting mode, basically two machines in one. Insurance does not care about the type machine, just that you're meeting compliance requirement and they pay for machine by billing code 0E601 which is the same amount for bottom end machine or top end machine, just bottom ends is more profitable for the lousy DME



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#8
Hi pwgphoto,
WELCOME! to the forum.!
Much success to you as you start your CPAP therapy.
trish6hundred
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