[CPAP] How often is sleep study required?

[retired_guy]

I personally have no qualms about buying and using a good, clean, used machine. New hose, new mask and I'm good with it. I just had a breathing function test done at the hospital, and I noticed they did not throw away the machine when they were done using it on me. Maybe they should have, but I'm not going to insist on a new machine every time they decide they want to see if I can breath or not.

[SlightlySleepy]

Looks like I've stirred the pot a little. Let me see if I can add some light from my perspective.

First of all, the spirometry (breathing) machine used to test lung function is a different animal. Very little air reservoir, usually one-way only (exhalation). In fact, the new ones don't use a bellows at all (presumably for sanitary reasons). Instead, they use some kind of pressure transducer that works on the venturi principle and extrapolates volume from velocity. But that probably more than most of you are interested in. I only know because I was certified to use these machines to test patients.

Second, in the past at least, DME providers often rented machines. Whether they were disinfected between use or not I have no idea. My first machine was clearly a rental. It eventually turned into a purchase, and it ran for 7 years before I realized that there was much newer technology on the market. I survived. I think. I can't say for sure I did not catch something but as far as I know I did not.

That said, a CPAP or APAP machine (esp. with a humidifier) is essentially a giant impact air sampler (google impact air sampler and read how they work). I'd provide links but non-commercial rules for the forum prevent it and I could not find a non-commercial link easily.

Presumably they could be ethylene-oxide sterilized, but I doubt most devices are. They certainly cannot be autoclaved.

[SlightlySleepy]

...I could not wait for everybody else to get their ducks in a row so that I could get a machine NOW, not 2 months from now. I went from taking 2 naps a week in January to 2 naps a day by my first appointment with the sleep doc in March. The sleep study was 3 weeks after that. Then the titration weeks after that. I apparently could not get across to him how quickly I was deteriorating or it didn't matter to him. I called repeatedly to move these tests up or give me a loaner - anything. I will return for one more appointment only because Medicare requires that followup to pay for my new machine. That will be the last one. This is a 4 month process that shouldn't be this hard.

I'm still really annoyed that they didn't do a split study. There is just no reason to hold a patient hostage like that. I'll get my GP to give me prescriptions for supplies....

This truly is part of the American Medical Care system tragedy. It should NOT be hard to get to see a doctor. Supposedly we have the 'free market' and the wonders of 'private medicine' here in America. Sometimes I wonder.

I noticed you were from Minnesota, so I picked up the phone and called the Mayo clinic this afternoon in an attempt to find out just how hard it would be to get an appointment to see a sleep specialist. Here's what happened:

I wanted to ask a simple question: What is the wait for a new appointment to the Mayo sleep clinic?

I called the Central Appointment number (507)538-3270, dialed ext 1 'for new appointments'.
~2:40pm - 2:43pm 'on hold'
Then at 2:43pm spoke with "Amy". I asked how long would someone need to wait for a new appointment with the sleep clinic if they wanted one. She said 'it depends' (implied that they would have to see if they could see me)...
I asked "It depends on what?"
She asked "What's your name?"
I said "why do you need to know? To discriminate?" She hung up on me

So I called back, and was on hold from 2:45- after 2:52pm
instead of option 1, waited for the general respond person, "Miranda" who happened to be a lot nicer.
I asked again, and explained I was asking on behalf of someone else I did not know on the internet. I wanted to know if Mayo was exclusive, screening out certain types of people, or why the initial phone person responded so evasively. After a quick apology, she explained:

a) that at least two departments at Mayo require general physician referrals:
The sleep medicine clinic and the rheumatology clinic.

So unless you have a diagnosis of sleep apnea or referral from a general physician, you cannot be seen at the center for sleep medicine. Parenthetical note: This is not unusual in my experience. I had the same problem myself earlier (which was part of the reason for my original post in this thread).

b) she said it can take weeks or months to get any appointment

c) but there is no restriction with regard to patient acceptance of medicare, only certain medicaid (presumably from different states?)

d) You can self refer to one of their general doctors, who would presumably refer you to sleep medicine if necessary, but she could not speculate on how long the referral process would take. She said she had scheduled such an appointment with a generalist earlier today and they were scheduling out to early August

e) Once in the sleep medicine clinic, they try to do everything as soon as possible, preferably within 4-7 days.

So there is my contribution to research in the Rochester, Minnesota area.

Anyone else have better luck? I'm truly disgusted by the attitude of the medical community towards patients. It's as if they are doing you a favor to see you. Is this by design, the wishes of the clinicians, or the outgrowth of management optimizations?

I can see reasons why clinicians my think it ideal, but in the digital age where patients are expected to self-manage, I wonder if the gatekeeper mentality is still appropriate, especially given the apparent scarcity of gatekeepers well informed enough about sleep issues to properly refer when appropriate.

[parkerdt]

Heavy stuff here - in NC, at Duke took me 2 months to get an apt with a sleep doc. And as new CPAP users need a followup in 90 dyas for compliance, they of course, gave me "next available" - 5 months out! As difficult as it is to get appointments, I'd suggest you go with a request for the top of the line machine - ResMed S 10 AutoSense in the ResMed line; and then you won't have to worry about it for a good long time, hopefully.

I don't wish ill upon anyone in the care community - at least not yet. It does make me wonder when I see my insurance billed for $2000 for a machine I can buy out of pocket for $875. However, it is what it is.

Best of luck in your search. were I in your position, I'd write myself a prescription for the machine I wanted, and be done.

Dave

[Mosquitobait]

I can't diss Mayo Rochester. They would have set up an appointment made via my doctor's office within 2 weeks. I simply had no way that I could drive 2 1/2 hours and be gone for a couple of days. I just never expected a 4 month sojourn when going local!

Anyway, now we move on to DME and they've already failed on the very first part: Reading the prescription and ordering the correct machine. (Resmed Airsense 10 for Her). The name of the machine was written in clear letters. I can't see how they missed it. (rolling eyes).

[SlightlySleepy]

...Anyway, now we move on to DME and they've already failed on the very first part: Reading the prescription and ordering the correct machine. (Resmed Airsense 10 for Her). The name of the machine was written in clear letters. I can't see how they missed it. (rolling eyes).

One problem is that DME's employ people that can barely speak English. My spouse had a similar problem. Heavy accent, over the phone said she was changing the mask from a medium to a large! This was ridiculous. Fortunately, we verbally had them confirm what they were sending first and caught this mistake (fitting had already taken place, there was no reason to substitute).

DME's website was non-functional. Submit button was broken.

I use a different DME provider, but have also sent me the wrong nasal pillows multiple times. Then they have the nerve to ask me to ship them back. I simply ask them to send me FedEx pre-paid mailer and I would be happy to do so, meanwhile, don't you dare charge me. They didn't.

Oh, and I consider my DME above average based on multiple years of experience with them. I actually had to get special dispensation to continue using them when insurance changed (new insurance uses coordinator organization with the oxymoronic name with initials C-C (those who have used it know what I'm talking about).

None of this is likely to be accidental. It is probably a result of business practices where the goal is NOT customer satisfaction or free choice by customer. Many vendors only survive because they are beholden primarily to the insurance company, not the customer who is paying the insurance company premiums or taxes (in the case of Medicare).

[tedburnsIII]

Just buy my machine new for $375, or maybe less elsewhere. It's been great and data and iCode capable. Trust me, one doesn't need SleepyHead, the proprietary data is fine on the machine. [commercial DME link to Supplier #10 removed]

-----
Moderator Action: Link Removed

To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites. This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.

-----

[SlightlySleepy]

Synthesis of posts this thread to date (For those who did not read every post above):

This thread originated in 2012 and was a result of my puzzlement at my insurance company's demand that I go through hoops to re-initiate PAP treatment. In the interim I resolved my personal need for a CPAP device using insurance as described earlier in this thread. But to reiterate, my primary question was not expediency, but whether or not moderate sleep apnea ever resolved in a low BMI apnea sufferer without surgery.

With the possible exception of tantalizing research hints about sometimes impractical exercises or musical instruments (such as didgeridoo), the answer appears to be 'no, sleep apnea does not ever just spontaneously disappear', and therefore repeat sleep studies should not be required to authorize machines once a diagnosis has been established, although a repeat titration may be helpful if you are having problems. In many cases however, the sophistication of auto-pap devices is such that the clinician (and arguably a very well-informed and cautious patient) can adjust the settings without a titration. Indeed, that is what my clinician did and it made a significant improvement in my symptoms. It is amazing what a change of 1-2 pressure units (whatever they are!) can make.

It never hurts to try the exercises, but personally I would not rely on them.

Bottom line: Medicare & Insurance companies seem to be backing down from requiring repeat sleep studies due to lack of documented medical necessity for repeat sleep studies.

In the process of discussing this, many unnecessary problems dealing with insurance and DME companies have been reconfirmed. What is too often seen as a 'compliance' issue is instead a failure on the part of the medical care system to make things work for the health care consumer.

Although stop-gap expediencies such as outright cash purchases may be appropriate in certain cases (still requiring a prescription from too often sleep-apnea poorly literate physicians), I wonder if any advocacy group has thought to address this issue more directly via legislation or some other consumer pressure, especially due to the public safety risks involved as well as the general lack of awareness of these topics: Sleep apnea in general and how to obtain PAP treatment more easily.