Titration Study - Poor Results?

[richb]

As Sleeprider says we have to play the game. Then stay in touch so you can get some help from people who have gone through the maze.

Rich

[MeDee]

MeDee, I've been doing more reading about simple vs complex apnea. In an article entitled "Complex Sleep Apnea Syndrome" by a couple researchers at the Medical College of WI, a couple points stuck out. One is their mention of repeated central apnea events (>5/hour) persisting or emerging when obstructive events are extinguished with positive airway pressure "and for which there is not a clear cause for central apneas such as narcotics or systolic heart failure..."
Well, you've got the >5, That's when obstructive events are "extinguished," but your numbers show that was not achieved during titration---not even close to eliminating OSA events. This makes me wonder how your doc (and tech) can dismiss the centrals as passing events rather than the real thing. Sounds to me like the degree of your centrals isn't fully known other than that they're over 5/hour.
The article concludes with the idea that centrals in most pts. are resolved with CPAP. For those with continued centrals, they mention bi-level CPAP, ASV, permissive flow limitation and/or drugs as the best treatment.

David

Thank you this was very helpful in helping me understand what we have - and have not - ruled out. I understand that I may have to jump into the biPap arena and fail first before getting to the next stage. And if I read the article correctly, the biPap machine solved 75% of those with Central Apnea. I will be getting a Resmed Aircurve Vauto - not certain if it will be set to fixed or auto mode yet. Crossing my fingers.

[Sn00zeAlarm]

I have run into the non-communicative sleep tech problem. My sleep Dr is quite open but the tech will tell me nothing. As she was having me sign the HIPAA form (which only mentioned the privacy aspects) I told her the law also said I was entitled to all results. She denied any knowledge of that.

[PaytonA]

I have run into the non-communicative sleep tech problem. My sleep Dr is quite open but the tech will tell me nothing. As she was having me sign the HIPAA form (which only mentioned the privacy aspects) I told her the law also said I was entitled to all results. She denied any knowledge of that.

I went on a rant which I just erased. Make the request of your doctor. He/she will be more aware of the responsibility and probably more open to giving you a copy of your results.

Best Regards

PaytonA

[Sn00zeAlarm]

It wasn't the formal results I wanted from the tech (and I did get those later from the Dr). After the conclusion of the lseep study, as she was removing the wires, I asked "did you see any events?" She answered, "You will have to ask the doctor."

I knew from conversations we had while she was wiring me up that she completely understood all the terminology and could have answered my question.

[Hornnumb2]

The game is what they tried to do to me, I would have had 4 sleep studies done and insurance would have been 16K out of pocket or after the second study they could have just paid for the ASV machine and saved $4000 but lets don't do that...

[ger365]

I was at the DME today picking up a machine, and had a chat with the respiratory therapist. Pretty much, this is the game that must be played because insurance won't authorize the ASV until the bilevel is proven ineffective. Nice how they call that "patient failure". Anyway, the trick is to minimize your risk exposure if there is a question whether the machine will work or not. So the idea of getting the machine on a rental basis is not bad in this case. In the event a different machine is required, a new rental period will start. People with high deductible policies are at personal financial risk to lose the rental amounts or amount of deductible and copay in a purchase. In the event you are one of the lucky people without a high deductible, you'll be fine financially, although it might take longer to get the treatment you need. Most new users are required to meet with their doctor in the first 90 days to discuss whether the machine is working or not.

Play the game, and be patient...that's why they call us patients.

But, then what they do is called a "practice" because they are guessing...

[Sleeprider]

Actually Ger, the suppliers, and event the doctors have limited options due to the procedures required by insurance. Insurance wants proof a less expensive machine is not effective, before they will authorize the next level. In the case of ASV a patient must fail CPAP and then Bilevel before the ASV will be authorized. This can easily result in 12-18 months in which the patient is not treated, and many drop out because CPAP does not work. It's hard enough when it does work but to be required to submit to ineffective treatment and multiple studies is a recipe for quitting. I really think many therapists, and most doctors know what is going to work for patients that show complex, and central apnea, but it's pointless to prescribe ASV or try to get approval for insurance reimbursement, when you know it will be denied until the game is played.

[Rob S]

i don't know why, but i wasn't subjected to "the game" 1 night sleep study, 1 night titration from cpap to asv with a prescription for ASV coming just a few days later. wish i knew what i did to disqualify myself from the game, i would gladly pass the info on.

[trish6hundred]

Hi MeDee,
, (I wish you good luck as you play the game, it’s a shame it has to be this way, (It shouldn’t,) but just keep on persevering.