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Getting a CPAP without a sleep study
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SuperSleeper Offline

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Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
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CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

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Location: Illinois, USA

Post: #1
Getting a CPAP without a sleep study
[parts of this thread were copied from our old forum in 2010]




chillywig Wrote:I'm a 36 year old male with self diagonsed sleep apnea. A couple years ago my girl friend told me I stopped breathing and would keep waking me up staying "breathe!" I started to do the sleep study. My family doc had me wear a blood o2 meter home and I dropped into the 70's. Scheduled the sleep lab but had to go out of town for work rescheduled and something else happened and never went. Had a doc apt hear recently and discussed the apnea again. He talked me into going to the lab and I have made an apt. A co-worker has just gone through the lab himself and after talking about his experience I wonder if I should just buy an auto cpap offline. He had the sleep study where they hook up monitors for the first apt, then another apt where they looked and the results, then another apt where he actually got the where the machine, then two follow ups after he took the machine home for pressure adjustments. I guess I know I have a problems but just don't know if it is worth the extra bucks and time to go to all the doc apts instead of just doing it myself. After looking at some of the auto cpap's and the software they come with it seems silly to get a fixed pressure machine from the sleep lab so I'll have to go back for adjustments. I do have insurance but will have to pay 20% of the bill myself. After all the apts and getting a retail priced machine I am starting to think it would be cheaper to buy one from [URL removed by Admin] and I would not have to fool with all the doc apts. Has anyone ever went this route before? I did have my doc write the scrip for the cpap, he is the one that told me I could just buy one offline if I wanted. Before then I thought it had to come from a lab. Any thoughts???

Thanks
03-20-2012 10:47 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #2
RE: Getting a CPAP without a sleep study
Hi chillywig, welcome to Apnea Board!

If you are seriously considering doing this, Auto-CPAP is really the only way to go, and preferably a data-capable machine that has available software to monitor and analyze your treatment as you proceed.

HOWEVER, I would not advise, nor have we here on Apnea Board ever advised that a patient start themselves on CPAP therapy without at least first consulting with a qualified sleep doctor. We advocate patient empowerment and patient involvement, but we do not advocate that patients avoid professional medical help. We simply believe in keeping it all in perspective, where you thoughtfully consider what a doctor tells you and weigh that advice against what you can learn for yourself in places like this on the Web using common sense to mitigate risk if you choose to self-treat.

Most sleep doctors will insist you get a proper sleep study and titration prior to them issuing you a prescription for CPAP. This is really the only prudent way to proceed. Even if you want to buy accessories online, like a CPAP mask, the federal government now has made it so you need a prescription for CPAP first before such accessories can be legally sold directly to you (assuming you're in the U.S.)

Getting that first sleep study will make your life easier when it comes to dealing with your insurance company, online CPAP sellers, your doctor and the government as we move towards socialized medicine (as much as I hate socialized medicine). Also, a sleep study will help determine if you have any other sleep-related issues that need to be addressed. In addition, you'll feel a lot more confident in your self-treatment if you have a baseline pressure that was suggested by the sleep lab.

I think you should go for the full sleep study - especially if your insurance will pay for 80% of the costs; that's not bad at all.

If you're concerned about multiple sleep lab visits, try to find a lab that will do both the Polysomnography (sleep study) and titration (procedure that determines your optimum CPAP pressure) in the same overnight visit. This is called a "split night" study.

The split-night study has the advantage of having to come to the lab once, so it is less disruptive to your schedule, plus it's cheaper overall. Disadvantages of a split study is that there is less time to make a diagnosis of sleep apnea (Medicare requires a minimum of 2 hours of diagnosis time before the mask can be applied, (most insurance companies use Medicare guidelines) and there is less time to assure an adequate CPAP titration. If the titration is begun with only a few hours of sleep left, the remaining time may not assure a proper CPAP titration, and you may still have to return to the lab.

By the way, I had to remove the web address of that commercial web site, since we can't post commercial links here in the main Apnea Board forum. I also use that web seller and they have great prices and super customer service, so I hate to remove it, but we have to enforce the rules.

Hope others can chime in on this also... if you have further questions or comments, please let us know.

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

03-20-2012 10:47 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #3
RE: Getting a CPAP without a sleep study
chillywig Wrote:Yesterday I talked with the lab about doing the split study and they said they had a protocol for it and just could not schedule it that way. I would have to be asleep for more than two hours by 1am and have had 20 episodes each hours to be determined sever and then they would start me on a cpap. I asked about why they don't use the apap instead and was told it is hard to get a doctor to diagnose that I need it and hard for insurance to pay for it. As far as cost it is $2150 for the first night and $2520 for the triation night. Plus I would have to see the doc about results and getting the machine prescribed. May family doc already gave me a prescription for the apap after what we have discussed during the last visit so I could get one from the afore mentioned online supplier. I am going to have another talk with my insurance to see how much this is actually going to cost me.

I am sold on the idea of the auto adjusting machine so I feel like the only thing I would gain from the study is my initial pressure setting on the cpap. I have all the classic symptoms of apnea and likely all the classic causes: overweight, drink too much, smoke occasionally. Probably what I should do is focus on loosing weight and cleaning up my lifestyles - but what fun would that be?
03-20-2012 10:49 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #4
RE: Getting a CPAP without a sleep study
Rustydad Wrote:Do you snore? Snoring is a good sign of obstructive sleep apnea. There is a possibility that you have central apnea. If so, buying a cpap or an apap could be a waste of money. I believe central apnea is more rare though, so you probably have obstructive. The only way to be sure though is with a sleep test.



Breathe Jimbo Wrote:Find a sleep lab that will do a split study in one night, then take a sleeping pill to make sure you fall asleep.
03-20-2012 10:50 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #5
RE: Getting a CPAP without a sleep study
chillywig Wrote:I have been thinking about this and I have decided to go to the lab and have the sleep study done. After getting the results I may not go back for the titration. I kept thinking how it would be to my advantage to see where a tech would set a cpap but right now my sinuses are totally plugged. What ever number I may have needed last week, this week I would need more power. An auto cpap seems like the only way to go.

If you that have the auto adjusting machines, do you run them wide open or narrow the range? I would think if you were sleeping fine you would want the pressure reduced and if you needed more why limit the machines output?

chillywig Wrote:I've been told like a buzz saw. Often times when riding in the car with co workers I'll wake myself up snoring and they'll make some comment about not being able to hear the radio over me.
03-20-2012 10:51 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #6
RE: Getting a CPAP without a sleep study
Ltmedic66 Wrote:I think it would be to your advantage to have the titration done, though I think you should do it when you are healthy. The titration would measure much more than just your leak rate and AHI. For example, it would also determine if you are achieving the proper stages of sleep and if your heart rate is normal throughout the titration. You might have problems other than (or in addition to) OSA that are causing problems, and home titration on an Auto-PAP will not detect these.

As one example, you might have a sleep disorder other than OSA. Perhaps you would correct your OSA through CPAP, but some other sleep disorder (such as restless leg syndrome) might keep you from entering stage 3 or stage 4 sleep for the proper amount of time. Trying to self-treat yourself without a lab titration will not detect this.

In my own example, my first sleep study showed that I was only spending about 5% of my sleep time in Stage 4 (the most restful sleep stage) due to OSA. During the titration, it was proven that the OSA was completely eliminated at certain pressures (11 is my magic number), my leg movements were virtually eliminated (I was moving my legs due to airway obstructions), my blood oxygen levels were normal (went down to 70% without CPAP), and I was in Stage 4 sleep for about 25% of the night (a normal range), and my heart rate was normal while on CPAP. If I had only used an auto-PAP at home, about the only thing I would have known from this list was that my AHI were eliminated, the pressures the machine used, and my leak rate- I would have not ruled out all of the other possible problems that were monitored during the sleep study.

That having been said, with the titration done, I now think it is critical to monitor things at home to make sure that the therapy is effective every night. Unfortunately, I got a CPAP without data capability, so I am now in the process of getting an S9...lesson learned.
03-20-2012 10:51 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #7
RE: Getting a CPAP without a sleep study
chillywig,(time=1286237149) Wrote:I have been thinking about this and I have decided to go to the lab and have the sleep study done. After getting the results I may not go back for the titration. I kept thinking how it would be to my advantage to see where a tech would set a cpap but right now my sinuses are totally plugged. What ever number I may have needed last week, this week I would need more power. An auto cpap seems like the only way to go.

If you that have the auto adjusting machines, do you run them wide open or narrow the range? I would think if you were sleeping fine you would want the pressure reduced and if you needed more why limit the machines output?
Glad to hear you're going to have the sleep study done. That's really the best route. Be sure to get the full and complete copy of your study results and diagnosis. I do agree with Ltmedic66 that it's best to get the titration also, for the reasons stated above.

It's best to have the sleep study done when your sinus are not blocked and you have no illness to complicate the sleep study and possibly skew the results. I'd consult with the sleep lab prior to your appointment to get their input also - might be best to wait until your sinuses are completely clear.

There are two main camps when it comes to operating auto-CPAP machines:

First, is the "wide-open" camp - these auto-CPAP users believe that it's best to let the machine "do it's thing" and adjust within the widest possible range of pressures (4-20 cm/H20), and the result will be the best possible outcome for most patients. The only exception for most would be to start the lower pressure a bit higher, since pressures less than 7 or so seem to make many people feel "suffocated". My titrated pressure was 14, and I start my auto-CPAP at the lower pressure of 9.6 and high pressure of 20.

Second, is the camp of auto-CPAP users who insist that the "wide-open" method is flawed, and will result in a higher overall average AHI. Their method includes scientifically analyzing each and every change, and operating their auto-CPAP in the tightest possible range of pressures that will give them an optimized, lower overall AHI. For instance, their average pressure is around 12, so they set their CPAP for a range of between 10-14. Granted, they "mess around" with the ranges over time to arrive at this optimum range of pressure and are more involved with using software like ResScan for their daily analysis.

I'm sort of somewhere between each of these two camps - I realize and respect the fact that much analytical work with experimentation of pressure ranges can result in a lower overall AHI, but I also realize that (for me anyway), my physical situation changes from time to time, and if I were to "lock in" my machine to a tight range of pressures, I might eliminate the possibility for my machine to compensate for any physical changes I might have (such as whether I had a cold, not enough rest the night before, not enough exercise, too much or the wrong types of food, not staying hydrated properly, not sleeping in the same position, the temperature and humidity, etc., etc... So for me, I tend towards the wide open method.

I have found out using ResScan that while my average pressure is around 12.5 now, at times, my S9 AutoSet has found it necessary to "punch through" a series of apnea events, raising the pressure to as high as 18. Had I limited my machine to 15 or 16, I have to believe I would have not been getting enough pressure to eliminate these events.

The argument from the anti-wide-open people is that auto-CPAPs respond much better and react quicker to events when they are limited to a smaller range of pressures. They say that the machines can't handle it well when they are set to wide-open, which results in higher overall AHI numbers. My thought is that this used to be generally true with older auto-CPAP machines; however, the newer machines have vastly improved algorithms to quickly adapt to ongoing patient needs, and operating wide open is not as much a concern today.

I think the jury is still out - there are good arguments and adequate evidence on both sides, and one method or the other may be best for you based upon your individual situation, health and physical needs. I think patients can use their own logic and come to one side or the other, or even end up with a compromise of both, tightening up their pressure ranges a bit from the wide-open 4-20 range if they are unsure.

Hope others will post their experience and thoughts on this also.

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

03-20-2012 10:51 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #8
RE: Getting a CPAP without a sleep study
chillywig Wrote:I spoke with the lab this morning to register for the apt. I did ask about my current sinus situation and they said it didn't matter and the person I was talking with said everyone has sinus probs this time of year and not to worry about it.

We discussed paying for the balance that insurance doesn't pick up. Over the years I have dealt with this hospital before once or twice and somewhere better I don't care if a bill is a little late and like everyone often times I'm a little short on cash, they have threated me with collection before I settle up. They always bring the ballance down to pay cash today. So I assume the grand I'd rack up doing the whole study I may only have to pay a portion of. I'll take this whole thing as a learning experience and not go in with my mind made up about my next move.

On a side note I had to do some driving today. Normally I take a helper along but today it was just me. About a two hour drive up and back with 7 or so hours of work in between. If I have help I drive in the morning and let them drive back. Since it was all up to me about 30 miles out returning home I got the if I don't pull over "right now" I'm gonna fall asleep feeling. I stopped at the next exit pulling off at the bottom of the ramp and leaned the seat back, looked at the clock and slept for exactly 3 mins before waking myself up snoring, then 4 mins, then 3 mins. Put the seat up and drove home refreshed. I wonder if I try sleeping on my back if I can raise my events high enough to get the split study. I normally sleep on my side and find this postion best for a attempting to make it throught the night, but I always wake up.
03-20-2012 10:52 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #9
RE: Getting a CPAP without a sleep study
chillywig Wrote:So I had the study done 10-6-10 which was not much fun. I spent most of the night trying to get comfortable hooked up to all those leads and doing a lot of tossing, turning and cussing. I had not heard back for the results and was starting to worry maybe they didn't see any problems since I only slept about two hours. The tech I spoke with said I did snore and have OSA. Shocker!!! They have a cancelation for tomorrow so I jumped on that apointment because the next opening was in December.

I thought I had to go see a doc but the doc just reads the report and makes the recommendations and writes the scrip for whatever machine, mask and pressure setting. I asked again about the auto and the tech told me that the auto machine didn't always work to get rid of snoring and the OSA and most people had better luck with the strait cpap or bipap. From what I have read here and other places it seems like most that have switched from the constant to the auto machines are pleased with the results. Has anyone ever used the apap and had issues and chose to go back the cpap?

I keep going back to my original thought about just buying the apap. I already have a scrip for that from my family doc and am going to have 1000 bucks tied up in getting my triation number and no equipment yet, which of course is going to cost big bucks from the local medical supplier.
03-20-2012 10:53 AM
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SuperSleeper Offline

Administrators

Posts: 9,974
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #10
RE: Getting a CPAP without a sleep study
Chilly -

An auto CPAP can be set up to run in straight CPAP mode or in auto mode. It's really the best of both worlds - tell your doctor that you've read a lot about auto machines and you INSIST upon getting an auto CPAP. Stand your ground on that. If they've already written a prescription, then tell them you want them to write another one for auto-CPAP. You're the customer, after all. They are the ones providing a service to you.

If he or she needs a reason, tell them that you want ALL options open to you - you want a data-capable auto-CPAP so that you can try both straight CPAP for a while, checking your AHI as you go, then try AutoCPAP for a while, and see which one gives you the lower AHI. There is absolutely no reason (assuming you have simple OSA) that your doctor should not be willing to do this.

Tell them that you are the patient, and you want to have the best treatment, not simply treatment that "is good enough" - and auto-CPAP allows you to test both types of treatment with ONE MACHINE. Don't fall for the "well, let's try straight CPAP first, and then if it doesn't work, we can go to an auto machine". There's no reason why they just can't start off with auto first, since it is both a standard CPAP and auto machine - it's a matter of pushing a couple of buttons in the setup mode to switch modes. If you have insurance, they will pay for either one - but the doc or sleep center has to write the specific script for an auto-CPAP.

Read more about the benefits of Auto CPAPs here:

http://www.apneaboard.com/APAP.htm

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

03-20-2012 10:53 AM
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