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Straight to CPAP without a sleep test?
#1
Straight to CPAP without a sleep test?
Hello folks, 1st post here.

The short of it is my pulmonologist suggests a lab sleep study to diagnose sleep apnea, thinks the home tests are not accurate enough for mild/moderate conditions. Even with insurance, my out-of-pocket would be $3,000 for the test. I could just buy a refub cpap machine for far, far less and see if it helps.

Thoughts?

Background: I'm 63 y/o, overweight (6' 250lbs), snore, am fatigued, and have a high red blood cell count that leads physicians to believe I may not be getting enough sleep and/or oxygen at night. To confound matters of restful sleep, I also have frequent night time urination.

All responses are appreciated.
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#2
RE: Straight to CPAP without a sleep test?
3k is outrageous... but it's a pretty "inconvenient" therapy so it's also good to be sure you actually need it. once you get a machine you can't tell if you still need it without a sleep study. i say inconvenient because some people have a tough time adapting but once you get used to it i think it's not bad. 

my personal opinion, for 3k i'd probably trust the at home sleep study. people say they are pretty accurate but who knows.
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#3
RE: Straight to CPAP without a sleep test?
You can do an at-home study for far less. Supplier #41 is someone I have used and can recommend. Worth talking to Jason to get a professional opinion. He charges around $100 USD for an hour consult.

You can buy a used CPAP from Facebook marketplace or Craigslist for a few hundred dollars, try it out, get some help from the folks here, and if it does not work for you donate it for a tax write-off or simply resell it. If you do buy from either always use a payment service like PayPal that will refund your money if the seller fails to deliver.
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#4
RE: Straight to CPAP without a sleep test?
It sounds as though you haven't had any kind of sleep study; is that right?

You could certainly try finding a refurbished machine and see whether it helps. I strongly recommend that you hold out for a ResMed Airsense 10 Autoset. (Every word there counts.) Be sure to ask for the number of hours already on the machine.

I'd also suggest that you use a recording O2 monitor during the day and at night to see how you're doing. This would provide an additional way to assess the extent to which PAP treatment was helping you. (The others are: reduction in fatigue and in the need to pee frequently at night, plus maybe improvement in your RBC.)
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#5
RE: Straight to CPAP without a sleep test?
Thanks for all your answers so far.

I did have a HST in 2018. The results I was provided with are attached. In 6 years things may have changed. Dunno.


Attached Files Thumbnail(s)
       
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#6
RE: Straight to CPAP without a sleep test?
One disadvantage of a home sleep study is that you don't get a measure for RERAs (respiratory effort related arousals). More helpful information here:

https://www.sleepfoundation.org/sleep-re...ep-arousal

As far as home sleep studies go, I'd say the only potentially significant finding in yours was the O2 level below 90 for 11 minutes.

What you need to weigh up is both financial and medical. This isn't easy, and in the end only you can decide whether to risk investing $3K in a sleep study or $?? in a refurbished machine that might or might not hel

Have you been evaluated for other potential causes of the high RBC? And have you been tested for other possible causes of your daytime fatigue? Those tests might include testosterone, iron, B vitamins, vitamin D, thyroid, autoimmune disease (especially in the connective-tissue-disease family), and Lyme disease.
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#7
RE: Straight to CPAP without a sleep test?
When I had my in-lab sleep test back in July of 2018, my insurance covered 100% of it. I had no idea at the time what it cost to have one done. I never thought to ask.  Eat-popcorn
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#8
RE: Straight to CPAP without a sleep test?
(05-22-2024, 08:34 PM)Big Guy Wrote: When I had my in-lab sleep test back in July of 2018, my insurance covered 100% of it. I had no idea at the time what it cost to have one done. I never thought to ask.  Eat-popcorn

Insurance can be funny (and by funny, I mean a sick sense of humor). Mine says they approved the test. But what that means is that without insurance the sleep lab would bill me over $5K, but because of my insurance they give me the "contract rate" of $3K, which goes toward my $5K annual deductible. IOW, insurance pays none of it, but I get a discount. And if I were already over $5K out-of-pocket for 2024, insurance would pay the $3K for me.

What's strange is that I get full coverage for all kinds of other tests. It seems to be a crap shoot as to what they will pay for and what goes toward my deductible. The lesson is to always check with insurance before the procedure. Fortunately the sleep lab alerted me this time.

The last surprise was my colonoscopy. They covered the anesthesia and getting scoped part, but hit me months later with a $1,200 charge for having polyps removed. So they'd pay in full if nothing was amiss, but I pay when something bad is found. Nice system they got there.
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#9
RE: Straight to CPAP without a sleep test?
Yeah, insurance can be very frustrating at times. My wife and I both have Medicare A&B as our primary coverage and with Blue Cross / Blue Shield (Fed. Employee Plan) as our secondary. 

Whatever Medicare doesn't cover, BC/BS will 100%. We don't have any deductibles or co-pays at all. Early morning of May 3, I had to be helicoptered to Phoenix from where we live. It was about a 100 mile flight, give or take. It was an emergency situation. 

I was assured that our coverage would cover the cost of the transport and any and all related associated medical costs. 

We pay a pretty penny each & every month in premiums. But, it covers all of our medical costs.  Cool
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