New to CPAP- Questions for someone who wants to take charge of his health.

[Hermanoscott]

I have completed an overnight sleep study and got the results.
The sleep center called and wants me to buy a CPAP and the price point up front, plus the monthly fee (10 months of payment to own) seems ridiculous, even with insurance.
So I know, or at least seriously feel, that's waaaay too high.

I'm still not up to speed, beyond the basics that I have a sleep disorder, and knowing a CPAP will help, I've looked at a few sites with the CPAPS looking at the features etc, and I have the faxed sleep study results (below).

What do I need to get and why?
What do I need to look for when buying online?
Is there a thread that explains the different machines?
Nose thingy? Full nose/mouth thingy like at the sleep study (I snore loudly) and had no problem with the overnight study sleeping with the CPAP nose/mouth thingy?
Whats up with software? Does it come with the units? What's it for, etc.

If I get my own CPAP, what do I need to have to follow up with the sleep clinic? Or do I even need to and why or why not? Is it just to make money for the clinic/Dr?

Is there a wiz bang pop CPAP that will auto adjust as I change/improve?
Basically do I need the sleep Dr for anything in the next year(s) or so or can I self diagnose with the CPAP going forward, maybe that's what the software and groups like this is for, like taking blood glucose readings as a diabetic to make insulin adjustments, consulting with others having similar health issues?

I beat diabetes in 5 months (between HA1C tests). So now I'm diagnosed as a diet controlled diabetic (7.4%HA1C to 5.4%HA1C), looking to lose more weight and I'm working out, with the goal of health and minimal body fat, so things will change for the better, as I understand, as I continue to lose weight.... and this will help with that.
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Looking to slay sleep apnea next, or at least have a non-drug fix and go forward plan.

Thanks in advance!
Scott

Here's some info from the sleep study....
SLEEP ARCHITECTURE: The total time in bed 481 minutes, total sleep time was
401 minutes and the total wake time was 80.0. Sleep efficiency was 83.4%.
Sleep onset was 11 minutes with a REM onset of 91 minutes. While asleep, the
patient spent 6.1% of time in stage 1 sleep, 60.5% of time in stage 2 sleep,
0.0% of time in stage 3-4 sleep, and 33.4% of time in REM sleep.
The patient had 12.0 arousals. 2.0 associated with respiratory events, 0
associated with PLMS and 9 were spontaneous arousals. Overall arousal index
was 1.0/hour.
RESPIRATORY SUMMARY: The patients baseline O2 saturation was 95.0% and the
lowest O2 saturation observed was 87.0%. The patient had a total of 46.0
respiratory events with an AHIof 6.9/hour. The maximum event duration was 28
seconds. There were 5 Obstructive, 7 Central, and 18 Mixed Apneas. There
were 16 Obstructive Hypopneas.
ADDITIONAL SUMMARY: The average EKG rate was 66.5.
IMPRESSION:
1. Previously diagnosed obstructive sleep apnea syndrome, with overall good
response to PAP therapy with REM Supine sleep noted.
2. Significant Periodic Limb Movements were not observed with index of
12.4/hour.
3. Mild sleep fragmentation
4. Normal Sinus Rhythm noted.
RECOMMENDATIONS:
1. CPAP pressure of 10cm H2O with heated humidity.
2. Follow up in sleep clinic in 4-6 weeks.

[DariaVader]

First.. Here is a breakdown on what machine and why
http://www.apneaboard.com/wiki/index.php...ne_Choices

If you have a deductible and a 20% copay, you will probably find it more economical to buy from an online vendor


You have predominately OSA with some Central and Mixed Apnea, but your total AHI of 7 put you in a mild category , so CPAP or APAP should suffice. You may end up on a straight CPAP if centrals increase with pressure, but I would buy APAP because it is more comfortable. In any case, get a data capable machine, and why don't they give you software? ha! good question... but they seem to think that you wouldnt be interested

[Hermanoscott]

So what's up with the compliance stuff? Something to do with insurance (Blue Cross/Anthem)?
I want to get better, so besides fooling around or forgetting, I'll be wearing and using the system.
From what I can see, it's cheaper to buy your own even without insurance.
This looks like a lucrative business for the practices.... where else can you go for relief?

They want about$1300 ish over the 10 months, with a 70something% compliance requirement. I can't imagine what it costs fully billed to insurance ($2k+ maybe).
I just want to know I'm getting results, and not getting ripped off by the medical practice system.

Thanks for the info. So I'm looking for a data capable machine.
What exactly is the difference in the data? Wifi/bluetooth/usb/sdcard for me to review or for the Dr that I'm trying to avoid going forward?

[justMongo]

Typically SD data card such as those used in cameras. Most computers have a reader built in.

Stick around and learn how to interpret leak, flow, pressure waveforms; and you could easily avoid having frequent meetings with the doc.
I only see mine so that Medicare will pay for expendable supplies. Even those can be bought online. A mask requires an Rx in the US.
Get a copy of the Rx your doc writes. It will likely say: "Mask of choice."

Compliance makes the difference between the insurance paying or not. There are a % of people who get the equipment and don't use it. Insurance companies don;t like to keep paying for unused equipment. So, they want compliance reports.

If you buy online (You still need a prescription in the US,) then compliance is not an issue -- unless you are in a safety related job such as commercial driver.

Up at the top of the page is a link to the supplier list. I bought my present machine as a zero-hour open box special from Supplier #2 on the list.

Overall, your sleep study isn't bad.

[trish6hundred]

Hi Hermanoscott,
WELCOME! to the forum.!
Hang in there for more answers to your questions and much success to you as you start your CPAP journey.

[DeepBreathing]

What do I need to get and why?

Just to clarify - the results you gave above look like a titration study, where they tried you out with the machine. If you're still getting an AHI of 6.9 with the machine, that's not optimised. What it doesn't tell us is whether the central and mixed apneas were pressure-induced or whether you had them beforehand. This is important to know as it will affect the optimal choice of machine. You have a fairly high percentage of central and mixed (central and obstructive) apnea. You should be able to get away with a standard CPAP or autoset (APAP) type machine if these are pressure-induced. However, if the centrals don't resolve, or get worse under therapy (which happens sometimes) then you will need a much more sophisticated (and expensive) ASV type machine. For this reason, I'd suggest great caution before jumping in and buying a machine. The two main manufacturers are Resmed and Philips Respironics, who control the great majority of the market. Other reputable makers are Fisher & Paykel and De Vilbis.

What do I need to look for when buying online?

What is the return policy? If the machine doesn't work out, can you return it and get credit towards a more sophisticated unit if necessary? Or can you get a month's trial?

Is there a thread that explains the different machines?

http://www.apneaboard.com/wiki/index.php...ne_Choices

Nose thingy? Full nose/mouth thingy like at the sleep study (I snore loudly) and had no problem with the overnight study sleeping with the CPAP nose/mouth thingy?

It's called a mask They come in several types:

Nasal pillows: where the only contact is via a soft prong against each nostril - very popular but can be difficult to use if you're a mouth-breather.

Nasal mask: What it says - the mask just covers your nose but does not directly contact your nostrils.

Full face mask: Covers both mouth and nose. This sounds like what you had. A lot of people find them claustrophobic and they can leak air which is annoying and detracts from the therapy. I have a Simplus fill face which I find pretty good.

Find a mask which fits snugly, is comfortable and doesn't leak. There are hundreds of different types out there and getting the perfect mask can be the hardest part of PAP treatment.

Whats up with software? Does it come with the units? What's it for, etc.

There are two basic types - web-based summary services, like Resmed's "MyAir" or fully detailed analysis software like SleepyHead or ResScan. MyAir uses the cellphone chip in your machine to upload each day, and gives you a basic summary of how you're going. For many people that is enough. SleepyHead and ResScan give extremely detailed analysis on a breath-by-breath basis. They really let you see in great detail exactly what's happening, and allow you to fine tune your treatment. SleepyHead is a free download from this site (see the link at the top of the page) and covers a wide range of machines, but not the most recent Respironics Dreamstation. ResScan is Resmed's proprietary software, only for their machines, and Encore is Respironic's software. You can also download them from this site.

If I get my own CPAP, what do I need to have to follow up with the sleep clinic? Or do I even need to and why or why not? Is it just to make money for the clinic/Dr?

A lot of people never see their sleep doc again, and live to tell about it. While I'd never give that as a recommendation, I haven't seen mine in a couple of years and probably never will. On the other hand, if you are a professional driver, pilot or machine operator then there may be laws or regulations in your locality which require you to have medical supervision of your treatment.

Is there a wiz bang pop CPAP that will auto adjust as I change/improve?

Yes, the Resmed AutoSet machines and equivalents from other manufacturers will do this for you. You do need to provide some basic parameters (such as minimum and maximum pressure limits) and the machine will operate within those limits.

Basically do I need the sleep Dr for anything in the next year(s) or so or can I self diagnose with the CPAP going forward, maybe that's what the software and groups like this is for, like taking blood glucose readings as a diabetic to make insulin adjustments, consulting with others having similar health issues?

As said above, many (most?) people never see a sleep doc once they're set up. However if you have difficulty with the treatment, or if there is a regulatory requirement, then you may need to see the doctor.

[justMongo]

Time for sleep. Mongo wrong.

[Diane1048]

from a newbie to CPAP therapy - just my thoughts on your thread Hermanoscott to give another perspective.

I just bought my machine yesterday: ResMed Airsense 10 with Built-in Wireless Connectivity and settled on an AirFit P10 Nasal Pillow CPAP Mask with Headgear. For my setup it probably cost me between $250 - $350 more than if I had bought on Online not knowing what I needed to know upfront.

I didn't buy Online because I am no expert on sleep science and I was scared to invest so much money when I did not know what was the right machine for me and if I made a mistake it would cost me dearly.

I went through a sleep physician and sleep clinic who lent me a machine for 5 weeks to trial before I committed to buying. If I decided that I did not want to buy then they would only charge me $80 for the hire of the mask after I returned all their gear.

For the extra money I got at no extra charge from the sleep clinic: (it all works at out in the end )

*1 hour consultation about the trial machine before they sent me home with it.

*1 hour consultation two weeks later to see how I was doing and to make modifications to my prescription which they did. They also gave me a full face mask to trial to compare with the nasal pillow mask. (I chose the nasal pillow after my comparison)

*1 hour consultation to send me home with Oximeter that plugs into my CPAP machine to measure my 02 Saturation which was 73% nadir before CPAP therapy. I have severe OSA as diagnosed from my first Sleep Study.

*1 hour consultation next day to check my results from the Oximeter to see if my CPAP therapy was working and it is working- I am now WITH CPAP therapy at 97-98% all night

So 4 hours consultation to make sure that I had the best machine for me. The extra cost seems like insurance to me to make sure you are getting the best bang for bucks.

OnLine buying can be so good in so many ways - but if there is a no return policy then you are screwed. You really really need to know that what you are buying is the BEST possible product for you

I know for the extra money - if something goes wrong I will get better results from a health practitioner than an online vendor. However, I know that some people have had terrible experiences with health clinics ):

Just my thoughts Hermanoscott - I hope you find all the right answers in your Sleep Apnea journey.