Sleep apnea test (study) help?

[UKwildcatfan]

Hello, this a long story but here goes. My doctor told me I needed a sleep study so I went for the first part of the test the other night. I layed there for 6 hours with my eyes shut and could not sleep a wink. I told my doctor about this and she rescheduled another one I had last night. She said she would write me a prescription for a Xanax 1mg to help me sleep.

           So last night I went for the second part of the study again and took 200mg of Benadryl and the Xanax. I had never taken Xanax before, but it did nothing for me. I laid there 6 hours but somehow managed to sleep an hour and fifteen minutes. I went back to the doctor today and she said I have severe apnea and have to go back for the second part (to sleep with a mask) in a few weeks. Anyways, I cannot get to sleep at all in these studies. Is there any advice you can give me to help me get to sleep in the sleep lab? She said the Benadryl counteracted the Xanax is why I had a difficult time sleeping. Is this true? Anyways, I guess I will just keep going back and trying to sleep until they get tired of me. I'm not giving up on this because I need a CPAP.

[DeepBreathing]

G'day UKwildcatfan. Welcome to Apnea Board.

It's not unusual for people to have a great deal of difficulty sleeping in these circumstances. Having twenty or so probes and electrodes attached to your body is not restful. The fact that they were able to record enough sleep time to diagnose the apnea is good.

As for the second part of the test (the titration test), this will be a repeat of the first one, except you will be provided with a CPAP machine. The techs will adjust your pressures through the night to determine an optimum to control your apnea.

I have real doubts about the value of these titration tests. Firstly, it's hard to sleep (as you have already discovered). Second, it's only one night and in a foreign environment, so even if you do sleep, it's not really a satisfactory way to determine a prescription you will have to live with. In my view (I'm NOT a medical professional) you are much better off skipping the titration test and getting an autoset machine (APAP) which will automatically adjust pressures up and down as required through the night. These don't cost much more than a plain vanilla CPAP and do a MUCH better job of treating the condition for most people.

You may get some push-back from your doctor, especially if she benefits financially from the sleep test. (There is a lot of conflict-of-interest in this business). Also a lot of doctors seem to resist prescribing autosets, preferring to use only a single fixed pressure.

Talk through your situation with your doctor. If she is competent and caring she will see that a third night in the lab isn't going to do you any good, and the autoset will perform a far more satisfactory on-going titration. If she won't come to the party you may need to find a doctor, dentist or nurse practitioner who will prescribe the APAP.

Once you have the machine, you can use #SleepyHead software to monitor your progress and optimise your settings. There are plenty of people on this forum who can help.

[MitchS]

Welcome to the forum, UKwildcatfan.

As DeepBreathing said, the titration test may not do much good. I was diagnosed with mild sleep apnea,  prescribed a fairly low fixed pressure and sold a straight cpap machune. By using the auto trial feature on my machine I have found my apnea is probably more severe than diagnosed and I need higher pressures to address my apnea and snore events. I am looking at buying an auto machine out of pocket in order to be able to continue recieving the better treatment an auto machine provides. My machine will only let me use the auto trial for a limited time. As DeepBreathing has said, it would be to your advantage to refuse to accept anything other than an APAP.

Sleep wll.

[car54]

You could also have a home study. A lot less wires and your in your own bed.

Car54

[UKwildcatfan]

I have medicaid. (I work a low wage job.) Will this pay for the auto APAP machine? So you're saying if I can't sleep well at the titration test they could give me a pointless machine? I'm just doing this because I want to go to truck driving school, but they require a CPAP since I am overweight.

[Wrz77]

I am also on Medicaid in KY - there are different MCOs for Medicaid here and the one I am on is Humana CareSource. Different MCOs have slightly different policies but mine at least did pay for a data capable non-auto CPAP. However, this was before I learned about the exisence of APAP machines and by then it was too late for me to switch my fixed pressure one for an APAP.

Medicaid did pay in full for everything though. Including a replacement mask kit every 6 months, mask cushion every month, pollen and fine filters, water reservoir for the humidier.
EDIT: Actually, no, I DID have to pay $25 for the modem - one time fee. 

Before I received my machine I assumed I would get some crappy refurbished unit from the early 00s.

I would assume they will pay for it if it's prescribed as auto.

Whichever DME you choose can determine what brand of machine you get. Like the one I defaulted to only has DreamStation (Philips) and not ResMed products -- aside from masks. So you should probably make sure to get the Rx in writing if you want to carefully call different DMEs to ask for a specific brand because in my experience they prefer to fax it to a DME.

If your current MCO gives you any trouble, you can switch to another MCO. You need cause to do so outside of the 'open enrollment period' though I think. KY has 4-5 different MCOs to choose from for most counties.

[UKwildcatfan]

I have WellCare medicaid in Kentucky. Do you think it will pay for an Auto? If not, I will just take whatever I can get. I'm not going to switch doctor's this whole process has been too hectic. I mainly just need advice on getting to sleep at the sleep studies, because I struggle to, plus I woke up drenched in sweat. I just need a CPAP and a  readout that shows 90 days so a trucking company will hire me. I just can't get to sleep in the studies.

[MitchS]

I drive under DOT rules. Depending on how oveweight you are and what your neck circumference is, you may fall under DOT's rule for mandatory testing for sleep apnea. The school wants to make sure you won't have a problem meeting DOT medical certification requirements.

It's not so much about not being able to sleep causing you to be diagnosed with sleep apnea you don't have. They have minimum requirements they have to meet to make the diagnosis. It is harder for them to tell the severity of the apnea and figure out your pressure needs. By insisting on an auto cpap, you will have a machine that will be more flexible in meeting you needs.

It is my undersyanding that insurance uses the same billing codes for the straight cpap and the auto cpap, and the price isn't that much different any way. There shouldn't be a problem getting it paid for if you are diagnosed. Just be proactive and be sure the doctor writes the prescription for an APAP, if at all possible.

[Sleeprider]

UKwildcard, there is no need for a titration (follow-up) sleep study.  I also had trouble tolerating the clinical sleep study. As a result the doctor recommended dispensing an auto CPAP machine and self-titration.  That was in 2008, and I have never needed another study.  When you are dispensed a CPAP of any kind, it is done by prescribing HCPCS Code E0601.  That is for a CPAP, and covers all machine types from basic fixed pressure CPAP to Auto CPAP with full data capability.  There is no difference, so you are covered. [link to commercial DME removed, instead go to THIS PAGE to see a list of Insurance Codes].

You should tell your doctor, you do not tolerate the clinical sleep study and would like to self titrate on an Auto CPAP. You should add that the studies are a financial hardship.  This should get you what you need.  Be sure to keep a copy of your study results.  If your doctor won't help you avoid the second study, you can find one that will based on that study.  Don't get ripped off.  You do not have to consent to a titration study, and your diagnostic study is sufficient to demonstrate a medical need for auto CPAP.  Discuss this with your doctor, and if you're getting push-back. let's talk about how to proceed. If you are dealing with a specialist, tell your primary doctor about this problem.  He can prescribe the auto CPAP...you do not need a specialist.

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[UKwildcatfan]

They want me to keep coming back because they said the titration study could get me dialed in precisely. Aka they want more money.