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tj123
Unread post  Post subject: Home test done, what's next.  |  Posted: Thu Apr 07, 2016 10:49 am

Joined: Thu Apr 07, 2016 10:19 am
Posts: 8

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My ENT requested a sleep study for me. My insurance denied a lab sleep study, but approved a home sleep study. The test was done by a sleep study lab. I believe it was a type 3 test. Philips device with a belt, air hose and finger sensor. I met with the lab for ~15 minutes to review how the system worked and then took it home for the weekend. I did the test and dropped it off Monday morning. The sleep lab is part of my medical group. I received an message in my online chart from my primary doctor that he recommends CPAP. It didn't have a sleep study report or any scores, just a statement that CPAP should be ordered. I wasn't aware he would be reviewing\ evaluating my report but I guess they sent everything through my primary??

So what now? I'm under the impression that I am done with the sleep lab. I assume the sleep lab will forward the results to my ENT so that I can move forward? I have a follow up set with the ENT in 2 weeks. From here, what happens? How is my pressure determined? Is a second test done with a CPAP to confirm it corrects the issue? How do I get equipment? Am I able to have a voice in which equipment I get? I have high deductible Anthem Blue Cross insurance, so I suppose I'll end up paying for the equipment and put it against my deductible? Does insurance stipulate how much I'm charged for the equipment or what models I'm allowed to use?

Just curious how all this works. Been reading the forum and watching the videos, learning a ton. Semi anxious to get started and see the results.


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arty
Unread post  Post subject: Re: Home test done, what's next.  |  Posted: Thu Apr 07, 2016 6:47 pm

Joined: Mon Jan 18, 2016 6:17 pm
Posts: 114

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First thing to do is call your insurance support line. I have primary/secondary coverage and the CPAP policies were very different. My primary required 12 weeks of rental (with the 4 hours/night average use compliance) THEN they would cover a purchase. My secondary covered a machine purchase after the sleep study prescription. Before you get to the equipment selection, you would be well served to know what your coverage is.

NICE thing about going with a DME instead of the internet "Pick it out yourself" is you will most likely be able to try several masks on? Very common posts here about how hard it is for some of us to find a good mask (that fits our shape of face).

I chose the Phillips Respironics Dreamstation ACAP with humidifier and heated tube ($870) internet purchase. Seems like the Resmed Airsense 10 is the other pack leader. I can't speak to either being better, but based on what I read in this forum would expect either PR or ReMed (any data capable model) would be ok for you?

(IF) you do choose to buy your own on-line. Don't bypass the insurance rules. For my purchase to qualify the company that sold it to me: 1. HAD to have a NPI (National Provider Identifier) and 2. HAD to be licensed as a DME in the state they did business from. ALSO, many online sellers WILL submit the claim to your insurance company. Many online sellers are very vague about the fact that you are totally out of pocket if you buy from them. For me the Online company I went with was Out-Of-Network so the coverage was only 65% instead of 85% (65 is better than zero).

Hopefully you will be given a prescription for an ACAP machine and not just a CPAP machine.

Good luck.

Let us know how it goes for you.

Art


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tj123
Unread post  Post subject: Re: Home test done, what's next.  |  Posted: Sun Apr 10, 2016 7:37 am

Joined: Thu Apr 07, 2016 10:19 am
Posts: 8

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I haven't seen my doctor yet, but got the results. Some interpretation would appreciated. My limited knowledge doesn't really see the need for cpap. AHI of 5.5-9.7 seems to be just above normal. Why go through the expense and hassle of cpap at this level? Maybe there is something I'm not seeing. I do have daytime drowsiness, but I also have chronic kidney disease with 18% kidney function, so that doesn't help.

Impressions

1. This Type 3 Portable Sleep Test demonstrates mild apnea with
AHI of 7.9 for total sleep time (9.5 when supine) with O2 nadir
of 86%.

Recommendations:

1. Nasal CPAP is indicated.
2. Avoidance of alcohol and sedatives is recommended.
3. Persons with excessive daytime sleepiness may be at an
increased risk for motor vehicle and occupation-related
accidents. This should be explained to the patient and treatment
of underlying sleep disorder should be addressed.


Sleep Data
The study began at 9:14:55 PM and ended at 6:07:43 AM for a total
recording time (TRT) of 532.8 minutes. The patient's time in bed
(TIB) was 532.8 minutes with a monitoring time (MT) of 526.8
minutes.

Respiratory Data
A total of 69 events were observed during the analysis period as
follows, 18 obstructive apneas (2.1/hr), 24 central apneas
(2.7/hr), 0 mixed apneas (0.0/hr) and 27 hypopneas (3.1/hr) for a
total apnea-hypopnea index/respiratory event index (AHI/REI) of
7.9 /hour of sleep. The supine AHI/REI was 9.5/hr. AHI/REI in
non-supine positions were as follows: Prone /hr, Left 5.5/hr,
Right 9.7/hr and up 0.0/hr.

97 desaturations occurred during the study. Desaturations were
based on 4% or greater drop from baseline. The lowest SaO2 was
86% with an average of 91%. 185.4 minutes were spent below 90%
saturation. The total time spent <89 was 72.4 min.

Cardiac Data
The average heart rate during sleep was 81.6 bpm. The highest
heart rate during sleep was 118 bpm. The highest heart rate
during recording was 118 bpm. The lowest heart rate during sleep
was 63 bpm.


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tj123
Unread post  Post subject: Re: Home test done, what's next.  |  Posted: Wed May 04, 2016 7:58 am

Joined: Thu Apr 07, 2016 10:19 am
Posts: 8

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Quick update. Meeting with DME today. Doctor gave Rx for apap 6-16. Insurance requires rental with 90 day compliance report. Planning to go with Airsence 10 Autoset.


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TheLankyLefty
Unread post  Post subject: Re: Home test done, what's next.  |  Posted: Wed May 04, 2016 12:00 pm
User avatar
Site Admin

Joined: Mon Aug 15, 2011 10:22 am
Posts: 4670
PAP Mask: Practically tried them all.
PAP Machine: Use Phillips Respironics System One APAP with Aflex for mask testing
Humidifier: None
Pressure Setting: When testing, I use APAP with a range of 5-10

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tj123 wrote:
Quick update. Meeting with DME today. Doctor gave Rx for apap 6-16. Insurance requires rental with 90 day compliance report. Planning to go with Airsence 10 Autoset.
Nice! Glad that you're getting treatment for this.

Just out of curiosity, why the AirSense Autoset over the DreamStation Auto CPAP?

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tj123
Unread post  Post subject: Re: Home test done, what's next.  |  Posted: Mon May 09, 2016 7:04 am

Joined: Thu Apr 07, 2016 10:19 am
Posts: 8

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TheLankyLefty wrote:
tj123 wrote:
Quick update. Meeting with DME today. Doctor gave Rx for apap 6-16. Insurance requires rental with 90 day compliance report. Planning to go with Airsence 10 Autoset.
Nice! Glad that you're getting treatment for this.

Just out of curiosity, why the AirSense Autoset over the DreamStation Auto CPAP?

I looked at both of these systems. Pretty much the only ones I really considered. Briefly looked at the s9 as an option if I was buying outside insurance. Reviews on both system were pretty consistent as being very good. Not having used a CPAP previously, I didn't have anything to compare to. I read the main difference was the algorithm used. ResMed being more aggressive. Since I was diagnosed as mild, 8 AHI, I didn't expect my pressure to be very high and felt the algorithm of either would work, if not, I am renting to own through DME \ Insurance, so I can switch. With the systems offering pretty much the same options, it came down to style, appearance, and size. The Airsense doesn't look medical, almost like a clock radio. The DreamStation looks like someone tried to make an iCPAP. Cosmetically and size wise, the Airsence won in my book. I also prefer the integrated humidifier in place of the two part design.

Having used the Airsense a few days now, I am happy with it. It fits nicely on the night stand. It is practically silent. The water container is easy to remove and install. I don't use the menus so much, but know enough to get into the clinical menu and understand what all the settings are. I have autostart set and it works at start, but sometimes does not shut down. I am using a DreamWearer mask and if I have the small pillow, the leak isn't large enough for it to cause the Airsense to shut off if I take the mask off to go to the bathroom. If I use the medium pillow, it will shut off a few seconds after removing the mask. I started off using Auto ramp and found the low pressure unpleasant and shut it down, so it starts at 6. It's still awkward at the beginning, but after few minutes and I'm comfortable. I don't have any leak issues with the small pillow, but I get a slight pain \ bruised feeling under my nose after wearing all night. The pain only last 30 min or so. With the medium pillow, I don't have the pain, but can get some very minor leaking when I sleep on the side or stomach. So far, I'm very happy with the mask and like the hose up top so that I can turn from side to stomach to side and not have an issue with the hose. Oddly, I find them I am sleeping on my back more often. I rarely did before.

I have been looking at my data with Sleepyhead. I don't understand most of it, but it's interesting to look at. My AHI has been 2-4 with about 8 hr use a night. It is set for 6-16 and my avg pressure is around 7, high around 12. Seems to climb toward the middle of the night and then settle back down. From the charts, it looks like I practically don't snore, which is a big change. Well, at least my wife thinks so. My life hasn't changed 180°, but I can definitely tell a difference even after only 5 days. When I get up, I don't immediately start looking forward to bed time or the weekend so I can sleep late. This weekend I didn't get to bed until 1 am and woke up after 7 hours later and was ready to get up. At first, I laid there thinking, I can't get up it's only 7:30, but after laying there not being able to get back to sleep, I got up, had some coffee and then started yard work. Spent 2 hrs on the yard and was done before I would typically even be out of bed. Then was up late again Saturday without feeling completely drained.


First Night Chart
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Second Night Chart
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