[CPAP] How often is sleep study required?

[SlightlySleepy]

..the first two Respironics machines were so noisy that I sent them back and finally settled on the S9 (which ended up being twice the price of the others). ...

That is consistent with what the Respiratory Therapist at my DME provider described, only she mentioned that the Respironics motors and humidifiers tended to burn out more quickly. This was difficult for me to believe, because my old Remstar LX was built like a tank and is still running after 10 years, yet most machines only have 2 year warrantee at best, and one DME even suggested most insurance companies accept billing as renting a machine at $330/month until 6-12 months purchase (which I politely declined).

Seems as though you will get your money eventually. Learning what is 'normal' for the system is always helpful. Thanks.

[zonk]

IMO sleep study is in order as you,re covered by your insurance and the last one was some 6 years ago. You don,t want to start with the S9 autoset and get yourself worried seeing your AHI for the first time and especially few centrals in the mix. At least you'll be titrated at the sleep study and see if its any different to what you,re on now and also confirm the diagnoses of plain vanilla sleep apnea or something else.

[SlightlySleepy]

IMO sleep study is in order as you,re covered by your insurance and the last one was some 6 years ago. You don,t want to start with the S9 autoset and get yourself worried seeing your AHI for the first time and especially few centrals in the mix. ...

Good point. I'll look into what the wait time is.

By the way, good luck with your surgery (I think I read somewhere it is scheduled for less than a week from now, right?) I hope I didn't scare you too much by my comments above, although the nasal area is very vascular and can bleed considerably. The father of one of my med. school classmates died from elective sinus surgery, so that is one reason I've been been a bit gunshy as they say. That said, in the hands of a good surgeon having the right anatomy can go a long way towards minimizing problems if that is really what is causing them. I'm guessing in Aussie land you have less incentive for surgeons to promote elective procedures than we have here, where surgery time is reimbursed at significantly higher levels than thoughtful diagnostic time.

[SuperSleeper]

Hi Doc... just wanted to welcome you to the forum. Good to hear your perspective on these things.

[SlightlySleepy]

Thanks for the welcome, SuperSleeper! This is a terrific site and a powerful argument for the value of the internet to human health (much to the chagrin of some older doctors). Fortunately the newer generation seems to be embracing it with more gusto.

[PaulaO2]

Thanks Paula02 - I have read many of your other posts and value your always reasonable opinion and experience. This is exactly the kind of feedback I was hoping for.

Sorry, I don't think I've ever been called reasonable before. Opinionated, yeah, many times. Reasonable? That's like responsible, right? Ain't that either.

And yes, welcome to Apnea Board!

[SlightlySleepy]

Sorry, I don't think I've ever been called reasonable before. Opinionated, yeah, many times. Reasonable? That's like responsible, right? Ain't that either.....welcome...

Your posts seem quite reasonable to me. But being responsible is completely different. Responsibility is no fun. Better to have authority without responsibility, that's the best combination really, at least from what I've heard (wouldn't know from personal experience, but one can always dream!)

It is irresponsible to act reasonably in unreasonable situations.

[truckerdad57]

If you sleep terribly in the lab.... why not consider a home sleep study?

A typeIII HST give good information and can be used to collect data for more than one night. You can order them on-line. They will do a phone screening and UPS it out. You sleep with the equipment on and UPS it back. Study results in the mail..... $ 3-500 for decent studies.

[SlightlySleepy]

If you sleep terribly in the lab.... why not consider a home sleep study?
...

Good idea, thanks! I suspect a home sleep study might not provide quite as much information in my case due to the rather mild nature of my condition. I will discuss with sleep specialist tomorrow. I finally found someone I trust will be good-- my original sleep studies were done at a highly respected center but because it was more than 2 years since my last test they consider me a 'new patient' and no new patient appointments were available until mid June in either case. 'Just put your life on hold in th meantime, we'll get to you when it is convenient'.

I don't know if insurance will accept home study tests either. Meanwhile, I'm having fun correlating my symptoms with the CMS-50D+ home oximetry reports. Last night was perfect -- no desaturations like the first night. And I managed (with Paula's help) to figure out how to download the data without erasing it first!

I also bought supplies to build my own simple home manometer out of tubing from a design on the internet. Seems like a fool-proof method to calibrate my current and new cpap machine (if and when I ever get one!)

[docbooks]

You as a doctor should know you can't buy a sleep apnea machine without and RX from your doctor after you havd a sleep study.
I'm fairly new here so please forgive if this has been discussed in depth before. I have read the thread regarding the pro's and con's of self adjusting pressures, but that is not my question. My question is: Does anyone ever get cured of Sleep Apnea? If not, how often is a repeat sleep study really required if one is planning to purchase the Resmed S9 Autoset? The machine your talking about is a whole lot more then you said is was. I use one of these and it's very good. You and everyone else with sleep apnea should know you can't set your own pressures because if you set it to high or to low you can damage your major organs of the body. The old saying goes "he who treats himself has a fool for a doctor" So do like you'd advise your patients to do and go see the specialist and get the sleep study done and the correct machine for your type of Sleep Apnea. That would be the prudent thing to do. Good luck.


Here's my story. Keep in mind I am a physician (not sleep specialist and not currently in clinical practice) and I am not obese. I might or might not benefit from nasal or maxillary advancement surgery but after consulting with the best of the best, decided against it. When doctors think of having surgery they run, not walk away. So until and if my CPAP stops being effective, CPAP is for me.

I've been doing OK until recently I have awakened about 2am with palpitations unrelated to any dream activity etc. My current machine is so old it has no logging abilities, so after learning about the newer machines I have done due diligence and decided to go with the Resmed S9 Autoset. Since we pay good money for good insurance (PPO from a major carrier) I thought it would not be a difficult thing to get a new machine (my last machine was purchased in 2006).

After spending over 5 hours spread over two days on the phone with my DME provider, Insurance company, Sleep specialist (whom I have not seen since 2006) and alternate DME providers (including internet providers) I am becoming very frustrated. I am coming close to just plunking down $1200 and being done with it. My time is too valuable to me to waste on this nonsense. But the principle of this bugs me -- I've paid premiums, why can't I get a new machine? Here's the deal as I understand it:

1) My insurance carrier contracts with certain vendors. If I purchase from one of them, they will pay 90% of the contracted rate and I pay 10%. I cannot be billed for any additional cost of the equipment.

2) If I go to a non-contracted DME provider, insurance will only pay 70% of 'reasonable & customary' but no one is able to tell me what that is. Bottom line, it will cost more to go with a non-contracted provider, even if the device is much cheaper (say $853 on the internet vs. $1100 for the identical device from my current DME provider).

3) My DME provider(s) say that they cannot tell me how much their contracted rate with my insurance carrier is without doing a full requisition which takes about one week. And according to my Doctor's office, the insurance companies are now following Medicare guidelines and requiring a sleep study every 4 years.

Calling a new DME provider would require a new prescription within 30 days of the date of purchase of the new equipment. In any case, this would would require many days because they are about a week behind on fulfilling orders. They can't even tell how much the machine would cost even knowing the name of my insurance carrier "because there are 1000 different versions of that carrier"....what? New price for every employee in the company?

In either case, they too are very busy and could not even promise to get a new machine authorized for at least 3 days even though they admit they have them in stock. I will probably need a new sleep study and definitely a new prescription less than 30 days old.

4) A sleep study costs about $4000 according to my doctor's office. I do not know what the contracted rate with the insurance company.

5) I contacted an internet provider from the DME suppliers list and they said that CPAP prescriptions can be good indefinitely, depending on how they are written.

I asked if anyone ever got cured of sleep apnea without surgery and so far no one has been able to say so.

I sleep terribly in those sleep labs. I've had 4 sleep studies. Three of them at a nationally renowned sleep study specialty center which on one occasion even did the esophageal pressure monitoring. They all say the same thing - obstructive sleep apnea or upper airway disease. Old code 780.53 (I understand the new ICD code is 300's something).

The last was in 2006 and lowest O2 sat was 94, Respiratory Disturbance Index was 16.4 (NOTE: Sleep efficiency was low at 36.6%, Total sleep time was only 194 minutes or just over 3 hours due to sleep onset insomnia due to surroundings---I normally sleep like a baby and cannot be awakened). No central apnea but 53 obstructive hypopneas (16.4 index) mean duration 16.2, longest 32.5, 10 in REM, 43 in NREM sleep)

A previous set of two studies over 10 years ago was similar, 94% minimum oxygen sat, max negative Pes was -22cm H20 to -8cm H20, Respiratory Disturbance Index was 6.3 to improved to 2.1 with 6cm H20 CPAP with poor sleep efficiency (40.2) dx Obstructive sleep apnea with poor sleep efficiency. 1 central apnea episode, 3 hypopneas.

My initial (and current) CPAP pressure is low (6 cm H20) and I suspect I may be having some breakthrough obstructive episodes.

Frankly, if the insurance company wants me to have another $4000 sleep study I'm fine with that, but for intellectual curiousity, I'm wondering whether it is really medically necessary and how dangerous it would be for me to just get an S9 first to see what it reads out before doing another study. In other words, does a sleep study really offer all that much benefit that a logging CPAP machine cannot, especially after factoring in how lousy my sleep is in those labs?

Meanwhile, in my early 50's, these palpitation episodes leave me feeling tired in the morning with chest achiness. I don't think it's angina (I don't have any risk factors, excellent cholesterol, vegan, etc, but it does make me think I don't want to wait forever to find out what is going on. Going to the ER would be thousands.