And so it begins...

[jumpinminnow]

Like most I was falling asleep about an hour after lunch and on some days barely making it home driving after work. I am also fat (>300lbs). My first sleep study didn't really hit me until I saw the results. I had 90 events per sleep hour. The average duration of an apnea event was 28 seconds or as long as 69 seconds. 51% of the time my O2 was below 89% with a low of 60%. N1=9.1%, N2=83.1%, N3=0% & REM=7.8%.

48 hours ago I did the follow up with different masks and pressures. The first was a Wisp nasal mask, but when I slept on my back I would start to mouth breath. He tried various straps that did not work. We then went to a full mask that was very uncomfortable and had difficulty sealing. I found out the next morning it sealed well enough to function, but the reason it was uncomfortable was that they were out of XL units.

So I asked the tech about the next step and he said they would create a prescription and work with my insurance to secure a machine from their supplier. While I'm still learning a lot I'm leary of a physician referring me to a study group who will work with my insurance to secure a unit through their supplier. If I'm going to make an investment 1) I'd like to have a say in the matter 2) I'd like the option of getting a premium unit (Resmed S9 autoset for example) even if I pay the difference.
I'd like to know what the board thinks about this.

I'm hoping that among the other issues I'm experiencing now my morning blood pressure will reduce and that I'll have more energy to get me back exercising instead of being spent at the end of the day. Thanks for reading.

Jumpinminnow

[OpalRose]

Hi jumpinminnow,
The first thing you should do is call your insurance to see what exactly they cover, and what your share of the cost will be, then find out from your insurance the names of the in-network providers they work with.
Do your research on the newest machines, and ask for a fully data capable auto machine.
Make sure you get a thirty day trial on a mask.

[surferdude2]

Hi jumpinminnow and welcome!

Four main points strike me from your post.

1. You are overweight and you have been diagnosed with apnea. You accept that. So far so good.

2. You had a problem with various masks. Stick with the full face mask since it's the best all around for beginners. You can try others after you get more comfortable with the therapy.

3. You are disappointed with the way your doctor and DMV are offering to help you with your insurance coverage. That's too bad but that's the way the system currently works. The alternative is to buy and pay for your equipment out of pocket and not let the insurance company get involved.

4. You hope for a measure of improvement in some areas of your health that pap therapy may provide. That's quite possible but don't expect miracles and be patient. This therapy may very well allow you to sleep well again but it isn't a panacea. It may eventually help you in certain areas but you must take an active part in the process and work on others area as necessary.

I think you have a very good chance that pap therapy will change your life for the better. I applaud you for being concerned with how the system is treating you. At this point, I'd say just be sure you are provided with a data capable machine and that it has auto pressure capability. The mask selection is a problem that we all have and will take some trial and error time. Your DME will work with you on that and get you some free trial masks. That's the normal standard of care.

[jumpinminnow]

Thanks for the responses. Pardon my ignorance, but if I'm diagnosed positive (and given the numbers I should meet the criteria) and the insurance will pay up to x dollars for a unit, then why would it matter what I bought or where I bought it if I pay the difference? What if the recommendation doesn't have auto or data recording? I guess I'm putting the cart in front of the horse, but I don't want to invest any money in something substandard - especially with the rate of people that don't stick with the therapy.

I know I have life changes to make - obesity is a snowball rolling downhill. The heavier you get the harder it is to do something about it. Not being exhausted all the time would help.

[DariaVader]

Totally depends on who is covering you and how. My insurance rents the machine. Probably for 12 months - it has been almost 6 mo, and they are paying $190 every month just for the blower + humidifier. They will only pay providers who they have a contract with. They pay 100%, so the details are less problematic for me than if I had to pony up 20% or more. If I go out of network, they will pay 80% of the amount which cannot exceed whatever they set as "reasonable and customary" - these amounts are never on your policy

The DME that I got setup with has S9 Autoset as the standard machine. They issued it in a group "class" so there were 6 of us who got them all at the same time along with the instruction on use, cleaning, and a mask fitting party. Out of 6 only 2 of us had an rx for an auto, me and another; the other 4 were on fixed pressures but the DME still issued the autoset. I have no idea how hard it would have been to get them to issue anything different. especially in that classroom setting they had going. I am lucky I got the data capable machine, since I didn't find all this information on this forum until after the fact. I could have waited another 6 weeks and had a 1:1 session, and in hindsight I should have, because that would have been closer to home, and now my "case" is stuck at this office that is farther away. I just wanted to get things started!

[trish6hundred]

Hi jumpinminnow,
WELCOME! to the forum.!
CPAP therapy can take some getting used to but just hang with it.
Much success to you as you start your journey.

[trailrider]

Hey Jump! Welcome t the club! Don't stress to much over this. It sounds to me like your doc and DME are doing right by you! That last night of study with the mask on and pressures was your titration; where they figure how much pressure is needed to last through the apnea at various sleep stages. If there is a big enough difference then an autoset will definitely be prescribed.

You raise good questions though about insurance and type of machine. Communicate with them. Talk to the doc and the DME and find out what you need fr your apnea. Most will wan data-capable machine anyways. Then talk to your insurer and find out what they will pay for. If you want more than they will pay for,then ask about covering the extra. However, wait until the doc sees the report from the titration study. You could need a bipap or ASV ($$$) for all you know right now.

Talk to your DME and see if you can get loaner trial masks for the first few months to see what works for you. Faces come in different shapes and sizes, and so do the masks. There is a small cult on here of those who like the P10 nasal pillows. (Don't ask R_G, or you will never get a word in edgewise) Seriously though, even nasal masks come in various size ranges to accommodate size of nose and face structure. If the Wisp L didn't work, then try something else. Your DME can help you there with suggestions.

Don't fret about the energy levels. You will feel better, but it will take about 6 weeks at least. Your body has been deprived of good sleep and good O2 for a long time. It will take at least 3 weeks to get used to the machine and hose and mask. This is not a fast fix, but it will help. Your journey is just beginning!

[me50]

Hi jumpinminnow and welcome!

Four main points strike me from your post.

1. You are overweight and you have been diagnosed with apnea. You accept that. So far so good.

2. You had a problem with various masks. Stick with the full face mask since it's the best all around for beginners. You can try others after you get more comfortable with the therapy.

FFM are the hardest mask type for a lot of people to get used to. DME's like to start people out on them so they don't have to stock a lot of masks. For over 2 years, I had issues with the FFM which caused the extra expense of 2 more sleep studies a switch to the wisp nasal mask which I have used for over a year with a lot of success.

3. You are disappointed with the way your doctor and DMV are offering to help you with your insurance coverage. [b]That's too bad but that's the way the system currently works. The alternative is to buy and pay for your equipment out of pocket and not let the insurance company get involved.

this is the way the sleep center tries to get the system to work but we can purchase our equipment anywhere we choose to. The alternative is to get the script and decide where we want to get our machine from and make an appointment with them and get er done! This is just my opinion and it may work for some and not for others. As always, it is an individual situation and some decide to bypass their insurance and buy from one of the online suppliers. It works for them just as my situation works for me. Wishing you much success and an easy decision and don' accept a brick!

When I was told I needed a vpap, they didn't want to give me an auto and I was NOT going there again because I wanted a machine that could adjust to changes that would occur if any thing changed with my health other than being diagnosed with central apnea and I told my doc that and so I got the auto vpap. it was a choice I made because they are expensive machines and I wanted the top of the line vpap just in case and I am glad I got it because I did not do well on a fixed pressure and I would have needed to start the rental period over if I switched machines and I just did not want to throw more money out the window if it wasn't necessary. [/b]

4. You hope for a measure of improvement in some areas of your health that pap therapy may provide. That's quite possible but don't expect miracles and be patient. This therapy may very well allow you to sleep well again but it isn't a panacea. It may eventually help you in certain areas but you must take an active part in the process and work on others area as necessary.

I think you have a very good chance that pap therapy will change your life for the better. I applaud you for being concerned with how the system is treating you. At this point, I'd say just be sure you are provided with a data capable machine and that it has auto pressure capability. The mask selection is a problem that we all have and will take some trial and error time. Your DME will work with you on that and get you some free trial masks. That's the normal standard of care.

[Mark Douglas]

Hi jumpinminnow,
The first thing you should do is call your insurance to see what exactly they cover, and what your share of the cost will be, then find out from your insurance the names of the in-network providers they work with.
Do your research on the newest machines, and ask for a fully data capable auto machine.
Make sure you get a thirty day trial on a mask.

jumpinminnow Hope you have better luck than I on that front. Getting a straight answer from cigna and it's subcontractors as to what is this going to cost me was impossible. Rather than try to repeat myself if you want to see why I gave up and just bought my machine outright you can look at my threads on this subject. Am I advocating my path to you? Absolutely not. We each must walk our own path.

[jumpinminnow]

Thank all of you for taking the time to write. I am having very little luck getting information from my health care provider and I have even asked my company benefits people to get involved.

The doctor will be reviewing my second results tomorrow. I was told by their office today that there standard recommendation is a Respironics System One Pro c-flex, which is not an auto machine. Apparently the Dr. writes the script and then hands it off to their DME who researches the insurance and then calls me to do a deal. Should be an interesting conversation. Stay tuned.