Sleep lab recommendation for Cleveland/Akron/Canton?

[lostinthemidwest]

I had my first sleep study in 2014 (in another state) and I was told to come back for a second study but I didn't go because my insurance sucked back then and the deductible meant I would have paid fully out of pocket which I couldn't afford. 
Fast forward to 2018, I have much better insurance (and a employer funded medical expenses account) and I want to try cpap now.

1) Is it worth getting that report from 2014? Would I be forced to do another diagnostic study or would I go straight to the tritiation study this time?
2)My insurance does cover Cleveland Clinic. Is it worth the drive up there? Would they be significantly better?
3)Does anyone have any recommendation for sleep doctors and labs in the Cleveland/Akron/Canton area?
4)What questions should I ask when choosing a sleep lab?
5)I talked to the DME that I have to use (Cornerstone Medical Services)and it sounds like they want to give me a 'brick' unit unless I push back. Any advice here?
6)Is a lightly used Resmed VPAP Auto for $160 with humidifier a good deal? Would there be any harm in trying it out whilst I wait for an appointment?

Thanks!

[DeepBreathing]

G'day lostinthemidwest. Welcome to Apnea Board.

Obviously I'm not able to answer your more detailed questions, but I'll have a shot at the more general ones.

1. Yes, definitely get hold of the old report. Even if you need a new study, this will provide a baseline to measure how your condition has evolved over the years. As to whether you need a new study, I suspect this will be dictated by what your insurance company requires. However if the old study showed moderate or severe apnea, then it's possible they will save some money by not requiring a new diagnostic study as it's unlikely to get better. My personal view is that a diagnostic titration study is a waste of time and money for all but the most complex cases. You're much better off using an auto machine and titrating based on the results from that, in your own bed over a period of weeks. A diagnostic titration study is just a snapshot in time, in an unfamiliar environment with 19 probes and electrodes attached to your body. Any resemblance between the results and your true requirements are likely to be coincidental.

2. 3. Sorry, can't help.

4. One key issue is that the doctor, lab and DME should all be financially independent of each other. Avoid situations where the guy who prescribes the treatment also dispenses the treatment. This is true in all areas of medicine, not just sleep medicine.

5. Are you sure that's the only DME you can use? Talk to your insurance company and get a list of all in-network DMEs in your area. Talk to them all and select the one you feel will give you helpful, honest service. Do not accept a brick under any circumstances - the are ripping you off by even offering one.

6. The S9 is long superseded but is still a good machine. Mine is coming up for 5 years old and still running perfectly. The VAuto has a mode which automatically adjusts pressure in response to flow limitation, snore and apneas. Pressure support (PS) can be set and is fixed throughout the night. Min EPAP and Max IPAP restricts the delivered pressure range.  If you can get a lightly used, clean example for $160 I'd say that's probably good value.

Edit: Changed "diagnostic study" to "titration study" in papa 1.

[OpalRose]

If you are from the Akron area, Cleveland Clinic has a Sleep Center at Akron General Hospital.
If your insurance covers it, give them a call.

Google for more information.

[gwc2795]

lostinthemidwest welcome to the forum

I don't think you will get a lot of advice until we know more about your condition. That 2014 sleep study will be a good start, it will do as most ins companies will take one up to 10 yrs old. Since you can go the insurance route I would advise that (as posted by deepbreathing) "Talk to your insurance company and get a list of all in-network DMEs in your area. Talk to them all and select the one you feel will give you helpful, honest service." Don't start with an old machine as your first machine, you will need support and you do not want machine issues to complicate your OSA journey. In addition without the sleep study we don't have any idea what type of machine you need. In addition the DME will help with setup and mask. You will read many post of forum members using, buying used machines, they are generally members with many, many years of xpap usage, not newbies.

This link is very valuable to read
http://www.apneaboard.com/forums/Thread-CPAP-Machine-Choices-read-this-before-you-accept-a-new-machine

gwc

[Sleeprider]

You could use your 2014 sleep study and discuss it with your primary care physician, and ask him if he will prescribe an auto CPAP, such as the Resmed Airsense 10 Autoset. If your doctor agrees, then the claim can be submitted by your choice of supplier to your insurance. Most insurance companies don't want to pay for excessive testing, and they may accept the test, or require you to complete another diagnostic test. If so, then a home sleep study is sufficient. A titration study is NOT required for dispensing CPAP. In your case if you have a clinical study done, you should use the previous diagnosis to leverage a "split study", where the diagnosis and titration are all done in one overnight study. This saves time and money, and gets you where you need to be faster.

The Cleveland Clinic has a great reputation, but obstructive sleep apnea is not exactly the kind of condition that requires top-flight talent to diagnose and treat. Much better to have someone that is concerned with your health and a good understanding of how treatment works. For some of us, our main physician can fill this role, write prescriptions and perform the annual review.

[lostinthemidwest]

Thanks for the replies! Already requested my old report. So if I can convince any MD to write a script (no pressures required, right?), then I can at least buy a mask out-of-pocket until I can see a sleep doc? The S9 VPAP Auto should figure it out (I can set the support pressure to zero for now)?

[Sleeprider]

All you have to do is meet with your doctor, or otherwise persuade him that your condition is unchanged or worse. You have a diagnostic test in hand, and the ability to self-titrate with an auto machine, and should be good to go. Any Rx should cover the machine and mask, so what comes out of pocket kind of depends on the cooperation of the supplier and insurance. Sleep doctor specialists are kind of optional. Like you, I have not seen one since 2008 when I had the original sleep study done. Ever since then, my primary doctors have met all my prescription needs.

[mdhampton]

Just one thing. Stay away from main Cleveland clinic campus. I was there (ok, 15+ years ago) and saw 3 different people for my followup. Mostly open time in room waiting for the next person. The last was the Dr. the rest were students or in-training. Spent time and money for "at-a-boy" for using cpap every day and refusing to sleep without it. 

My sleep study was done in a specially set up hotel room at a residence inn with IR cameras and the nice glued on the head probes, finger, leg, chest, and nose probes. Biggest problem was the forced me to sleep on back, not cross arms, and kept yelling at me her intercom. Of course that was sleep study + titration.