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Chip McDonald
Unread post  Post subject: What To Ask After the Titration/ Sleep Study?  |  Posted: Thu Aug 09, 2018 2:55 pm

Joined: Sat Jul 28, 2018 3:32 pm
Posts: 13

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(apologies if this has been gone over elsewhere, I've been ardently reading through the forum and haven't found a sticky regarding this, or specifically someone asking "what do I ask?"..)


I've had a study done a few weeks ago, but I'm having to wait to do another study for titration. I'm male, 51 slim non-smoker and was told I have "moderate apnea, 20 events per hour, 25 events occurred during REM, O2 went down to 87% at one point", and that it wasn't anything than a "boring" result (which is fine by me).

I wish I had asked for a report, but I was not aware of the protocol at the time.

1) what IS the protocol? I think I've gleaned the info that there is a "sleep study report" and a "titration report"?

2) should I ask for said reports from the first sleep study when I go back?

3) if I am having "events" during REM does that tend to be central? Is that more/less/average relative to "moderate apnea", 20 events an hour?

4) does "evens" during REM indicate I should ask for APAP?

5) I am a very restless sleeper - again, should I ask for APAP?

6) Do I indicate this to the sleep tech the morning after?

7) What happens after the titration - do I go home with a machine, how long should it be before I get a script, how long before I should expect the DME to respond/deliver etc?

8) The Resmed S9 Autoset seems to be a de facto go-to for APAP - do I request this specifically when the doctor gives me the script, or do I request that from the DME, or... "?"

9) Am I going to have to make yet another appointment for for the doctor (no doubt another 3 week wait) to get the script, results?

10) Should the tech, the doctor, or the DME have an issue with me requesting a machine that does full data, presuming I can't just ask for a specific machine? (BCBS)

The ... alarming nature of this, coupled with recent experiences with the medical industry regarding my elderly parents - seems like it's going to be "awhile" before I have a CPAP/APAP at home from this experience? I go back for titration in 10 days (it's been a few weeks..), and it seems like it's going to be weeks more after that?

Ahrgh.. I'm impatient to know if "this" is going to work...

Thanks ahead of time...


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Pugsy
Unread post  Post subject: Re: What To Ask After the Titration/ Sleep Study?  |  Posted: Thu Aug 09, 2018 3:25 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 684
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Chip McDonald wrote:
1) what IS the protocol? I think I've gleaned the info that there is a "sleep study report" and a "titration report"?



No special protocol as it can vary between doctors, sleep labs, insurance and such. Not everyone who has a diagnostic sleep study will get an in labe titration sleep study. Some places or insurance just go straight to an APAP machine and do the titration at home.

Chip McDonald wrote:
2) should I ask for said reports from the first sleep study when I go back?


Yes ask for copies of all reports. You never know when they might come in handy or if you have a question about something.

Chip McDonald wrote:
3) if I am having "events" during REM does that tend to be central? Is that more/less/average relative to "moderate apnea", 20 events an hour?


No..actually the opposite. It's rare to have centrals during REM for some reason.

Chip McDonald wrote:
4) does "events" during REM indicate I should ask for APAP?


Maybe. Especially if there's a significant pressure difference between REM and non REM sleep. It's common for our OSA to be worse in REM (and when on our backs) and sometimes there's a significant difference in the pressure need. Not always but fairly common.
My OSA is 5 times worse in REM than in non REM. I can sometimes need pressures 6 to 8 cm more during REM. I might see 16 to 18 cm during probable REM and other times during the night maybe 8 or 9 cm...If I were to have a fixed cpap machine I would have to use 16 to 18 all night instead of part of the night and with REM usually composing 20% of our sleep that would mean the other 80% I would have to use a lot more all night long and 16 isn't nearly as comfortable as maybe 8 cm.

Always get an APAP machine if at all possible. It's better to have something and not need it than need it and not have it.
APAP capable machines are like 2 machines in 1...because they have both cpap fixed mode and apap auto adjusting mode to choose from.
Heck, the ResMed AirSense 10 AutoSet for Her has 3 modes.

Chip McDonald wrote:
5) I am a very restless sleeper - again, should I ask for APAP?


Not really because of the restless thing...but the in general thing as for apap.

Chip McDonald wrote:
6) Do I indicate this to the sleep tech the morning after?


No.. The sleep tech has no control over what machine you get...and he doesn't care anyway. That's not part of his job.

Chip McDonald wrote:
7) What happens after the titration - do I go home with a machine, how long should it be before I get a script, how long before I should expect the DME to respond/deliver etc?


You won't go home with a machine but you might go home with the mask you used.
How long to get a script...that's up to your doctor. I had mine the next day.
DMEs take as long as they take. Some can get you a machine the same day and some take their own sweet time about it.
Call up your insurance company and ask for a list of DMEs in your area that work with your insurance and then call them up and interview them and tell them you want an apap machine and ask how long before you can get one.

Chip McDonald wrote:
8) The Resmed S9 Autoset seems to be a de facto go-to for APAP - do I request this specifically when the doctor gives me the script, or do I request that from the DME, or... "?"


That's going to depend on what your pressure needs end up being. If your pressure needs are high you might end up needing a bilevel machine but in general....stick with ResMed brand. You won't be sorry.

Chip McDonald wrote:
9) Am I going to have to make yet another appointment for for the doctor (no doubt another 3 week wait) to get the script, results?


That depends on the doctor. Some make you come see him/her first and go over everything and some will just send an order to the DME of your choosing and follow up a month or so after you get your machine. That's what my doctor did.
You need to call up your doctors office nurse...she can tell you what their protocol is.

You can try requesting a specific machine and it's always better if the doctor write the RX specific to the brand and model because then the DME has to follow the RX to the letter. Some docs are easy to work with and some aren't.

Read this
https://maskarrayed.wordpress.com/what- ... me-part-i/

FWIW....I fired my first DME before I even got a machine from them because they refused to give me what I wanted...and they also lied to me about something. I don't take kindly to being lied to.


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diamaunt
Unread post  Post subject: Re: What To Ask After the Titration/ Sleep Study?  |  Posted: Thu Aug 09, 2018 5:28 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 1804
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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[quote="Chip McDonald"
8) The Resmed S9 Autoset seems to be a de facto go-to for APAP - do I request this specifically when the doctor gives me the script, or do I request that from the DME, or... "?"
[/quote]
The S9 Autoset has been superseded by the Airsense 10 Autoset.

Yes, and yes

_________________
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how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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Chip McDonald
Unread post  Post subject: Re: What To Ask After the Titration/ Sleep Study?  |  Posted: Fri Aug 10, 2018 8:02 pm

Joined: Sat Jul 28, 2018 3:32 pm
Posts: 13

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Pugsy wrote:



You can try requesting a specific machine and it's always better if the doctor write the RX specific to the brand and model because then the DME has to follow the RX to the letter. Some docs are easy to work with and some aren't.

Read this
https://maskarrayed.wordpress.com/what- ... me-part-i/

FWIW....I fired my first DME before I even got a machine from them because they refused to give me what I wanted...and they also lied to me about something. I don't take kindly to being lied to.



Thanks Pugsy for the detail! The entire process of a "sleep study" is somewhat... surreal, and combined with the bureaucracy it's challenging to know what is considered "within reason" to ask/inquire about. Thanks again!


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Chip McDonald
Unread post  Post subject: Re: What To Ask After the Titration/ Sleep Study?  |  Posted: Fri Aug 10, 2018 8:06 pm

Joined: Sat Jul 28, 2018 3:32 pm
Posts: 13

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diamaunt wrote:
[quote="Chip McDonald"
8) The Resmed S9 Autoset seems to be a de facto go-to for APAP - do I request this specifically when the doctor gives me the script, or do I request that from the DME, or... "?"

The S9 Autoset has been superseded by the Airsense 10 Autoset.

Yes, and yes[/quote]

Thanks! It was looking like the difference was just the aesthetics/display - my impression was that it was just a "upscale/friendlier" model.


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diamaunt
Unread post  Post subject: Re: What To Ask After the Titration/ Sleep Study?  |  Posted: Fri Aug 10, 2018 9:16 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 1804
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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Mainly, the airsense 10 autoset takes up less space on your side table.

The For Her model, however, adds a new mode that the S9 AutoSet For Her didn't have... and that is something that some people of both sexes do better with... and it doesn't cost any more than the regular AS10 AutoSet... so that's the one that I usually recommend, just because it's better to have something you end up not needing than it is to not have it, and maybe need it.

_________________
https://sleep.tnet.com/resources/sleepyhead
how to post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur


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Chip McDonald
Unread post  Post subject: Re: What To Ask After the Titration/ Sleep Study?  |  Posted: Sat Aug 11, 2018 9:27 am

Joined: Sat Jul 28, 2018 3:32 pm
Posts: 13

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diamaunt wrote:
Mainly, the airsense 10 autoset takes up less space on your side table.

The For Her model, however, adds a new mode that the S9 AutoSet For Her didn't have... and that is something that some people of both sexes do better with...


Thanks again.


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