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Ordered a Auto CPAP / Was diagnosed with Sleep Apnea
#1
Hi guys,

I was diagnosed with Moderate Non-Positional Obstructive Sleep Apnea, however my doctor refused to prescribe me a CPAP Machine. Instead he wants me to do yet another sleep study. Since he owns the Sleep Center, I am under the impression that he is just trying to milk my insurance for more money.

My AHI was 3 and my RDI was 21 (the AASM standards state that a RDI of 15 and above should be treated with CPAP) I stressed this fact to my doctor's office assitant but he wouldn't budge.

I am tired of dealing with the broken medical system. I decided to just buy a Auto CPAP to finally get my Sleep Apnea under control.

I ordered a DreamStation Auto CPAP DSX500T11 brand new with a Respironics Nuance Pro Mask. I really need all the help I can get. I am expecting the CPAP to be delivered early next week.

Thanks,
Catherine
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#2
When you had the sleep study, did they do a titration? Meaning did they put a mask on you?
PaulaO2
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#3
(10-15-2016, 01:05 AM)PaulaO2 Wrote: When you had the sleep study, did they do a titration? Meaning did they put a mask on you?

I had an at-home sleep study. They didn't do a Titration.
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#4
The value of a titration study would depend on what method the doctor proposes to use. Conventional titration would only try to minimize apnea, which is not a problem for you, however they "could" also evaluate bilevel in case your RDI is not responsive to CPAP alone. I doubt that is what is proposed. Another value for titration is to screen for complex apnea from CPAP pressure. Fewer than 15% of people develop this, so it's not a very high risk. Just giving the doc the benefit of the doubt here, his business model is probably to increase the sleep study business which actually pays more per test than the whole cost of equipment. With or without titration, you should get a copy of your test results, and hopefully a prescription for CPAP.

I think you will find adjusting to CPAP very easy. The Dreamstation Auto will give you very good data in auto mode on relavent events like flow limitation, snores and RERA in addition to any obstructive or clear apnea. Your pressure needs to overcome the RDI will be somewhat trial and error. A good starting point would be with the machine in auto mode at minimum 6.0 CM, and you can leave the max pressure at 20. The machine will only increase pressure as long as you have flow limits and snores, so don't worry about maximum pressure. That machine uses Aflex to drop pressure a bit during exhale, with a user-settable range of 1-3. Flex is flow based, so the numbers do not correspond to pressure so much as response to your exhalation flow. My preference was always for 1, but you will just have to wing it on that setting.

Keep in touch as you get started, and we'll try to coach you through the process so you under stand the charts. Be sure to have SleepyHead installed on your computer.
______________________________________________
Organize your SleepyHead Data
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#5
(10-15-2016, 09:45 AM)Sleeprider Wrote: The value of a titration study would depend on what method the doctor proposes to use. Conventional titration would only try to minimize apnea, which is not a problem for you, however they "could" also evaluate bilevel in case your RDI is not responsive to CPAP alone. I doubt that is what is proposed. Another value for titration is to screen for complex apnea from CPAP pressure. Fewer than 15% of people develop this, so it's not a very high risk. Just giving the doc the benefit of the doubt here, his business model is probably to increase the sleep study business which actually pays more per test than the whole cost of equipment. With or without titration, you should get a copy of your test results, and hopefully a prescription for CPAP.

I think you will find adjusting to CPAP very easy. The Dreamstation Auto will give you very good data in auto mode on relavent events like flow limitation, snores and RERA in addition to any obstructive or clear apnea. Your pressure needs to overcome the RDI will be somewhat trial and error. A good starting point would be with the machine in auto mode at minimum 6.0 CM, and you can leave the max pressure at 20. The machine will only increase pressure as long as you have flow limits and snores, so don't worry about maximum pressure. That machine uses Aflex to drop pressure a bit during exhale, with a user-settable range of 1-3. Flex is flow based, so the numbers do not correspond to pressure so much as response to your exhalation flow. My preference was always for 1, but you will just have to wing it on that setting.

Keep in touch as you get started, and we'll try to coach you through the process so you under stand the charts. Be sure to have SleepyHead installed on your computer.

Thanks for the advice!

I have my results and they are clearly stating that I have an RDI of 21. My doctor is a pulmonologist who owns his own sleep center. I am sure it is a cash cow for him. It really sucks that I had to spend over $500 to override his gatekeeping. I am reporting him to my Insurance and filing a grief report.

Here is a imgur of my Sleep Study Results I blacked out any personal info.

I am reading up that people recommend starting the Range from 5-20 for the first week or two, then adjusting it afterwards.

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#6
You seem to be on top of it. When using flex or EPR I usually suggest 6-20 because it keeps the pressure at 6/4 accounting for exhalation pressure. Either way, you will know what works best in short order. I was given a clinical sleep study, then prescribed an APAP way back in 2008. It worked for me, and with so many people having large deductibles these days, I don't see much value in second, third etc sleep studies unless there are complications.
______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
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#7
I had another thought on the sleep study thing. It is becoming common and accepted practice for insurance to simply approve home diagnostic studies and to issue an APAP for self titration. It seems to be within patient rights to choose whether to submit to any test, or procedure, so it seems you could insist on a prescription for APAP and then work with an in-network DME of your choice to be issued a machine under whatever insurance you have. I don't know if you could insist on a prescription in your circumstances, or if you have to shop the doctor first, but I think I would avoid a practice with the inherent conflict of interest your doctor has.
______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
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#8
(10-15-2016, 11:37 AM)Sleeprider Wrote: I had another thought on the sleep study thing. It is becoming common and accepted practice for insurance to simply approve home diagnostic studies and to issue an APAP for self titration. It seems to be within patient rights to choose whether to submit to any test, or procedure, so it seems you could insist on a prescription for APAP and then work with an in-network DME of your choice to be issued a machine under whatever insurance you have. I don't know if you could insist on a prescription in your circumstances, or if you have to shop the doctor first, but I think I would avoid a practice with the inherent conflict of interest your doctor has.

I haven't had much luck with doctors. Most of the ones in Las Vegas have 3 week to 2 month wait times. I really don't want to go another week suffering.
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#9
An advantage of buying your own equipment is that you don't have to worry about minimum compliance hours. That said, obviously the goal is to sleep much more than the compliance minimum of 4 hours. I bought my own equipment, I found this forum, I make all of my own adjustments, I ask questions here and read a lot, and I don't see a doctor although I do leave my machine cellular modem on so my doctor could read my data should the spirit ever move him. You can do this!
Coffee
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#10
A titration test, and ongoing compliance monitoring may actually be a requirement of retaining your driving licence.

And some companies require full testing and compliance if you job involves high risk activities that may put you or other employees in physical jeopardy.

If ultimately the insurance company is paying for it, then why not do it? [though I agree with the moral aspect of it not being right for doctors/providers to just "milk" the insurance cash cow]
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