Is CPAP titration necessary to prescribe proper machine

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
btwisted
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Is CPAP titration necessary to prescribe proper machine

Post by btwisted » Thu Aug 27, 2015 4:15 pm

I recently had my sleep study completed and was scheduled for the CPAP titration, however I received a call from the sleep center informing me the insurance company rejected the follow up CPAP titration. They said I needed to contact my doctor. I called this morning and she informed me the insurance company rejected the titration because they have an in-house sleep medicine specialist and they were going to authorize an APAP machine.

My question is: can it be determined from just the sleep study results which machine is needed? CPAP, APAP or BPAP

My study results were.
5.5 hours of study time
56 obstructive apneas
45 central apneas
59 hypopneas

apnea-hypopnea index 29 events per hour

any insight while waiting to hear back from insurance company?
Last edited by btwisted on Thu Aug 27, 2015 4:25 pm, edited 1 time in total.

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Julie
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Re: Newly Diagnosed & Insurance refusing titratation

Post by Julie » Thu Aug 27, 2015 4:25 pm

You ALWAYS want an Apap over a Cpap because Apaps can be run in Cpap mode if you end up being more comfortable that way, but plain Cpaps don't 'do' Apap. So you're lucky if in fact an Apap will be authorized... and I think the point they were making was that you can use an Apap to self titrate (done all the time) if necessary, if you have study results available. Your results are fairly standard looking and I see no reason for you to need a bilevel, but that would be determined for sure once you have done some titration nights. In other words the severity of your results, how many events you registered, doesn't equate to whether or not you need higher pressures to keep your particular throat open to a certain degree - e.g. you can have severe apnea but only need low pressures to do the job, or mild apnea, but higher pressures are needed... just a factor of your airway size. IF it turns out that for whatever reason you DO need very high pressures, a bilevel might be in order.
Last edited by Julie on Thu Aug 27, 2015 4:35 pm, edited 1 time in total.

btwisted
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Re: Is CPAP titration necessary to prescribe proper machine

Post by btwisted » Thu Aug 27, 2015 4:31 pm

Thanks Julie,
I was told by a colleague, something similar, but he pointed out the titration may have indicated an APAP may not be the ideal machine considering the severity of my results. His point was that an BPAP or BiPAP machine would be best suited.

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Julie
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Re: Is CPAP titration necessary to prescribe proper machine

Post by Julie » Thu Aug 27, 2015 4:36 pm

Well, for the record, your results may officially fall in the 'severe' category, but in fact many people score far higher (double or more) than you.

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chunkyfrog
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Re: Is CPAP titration necessary to prescribe proper machine

Post by chunkyfrog » Thu Aug 27, 2015 4:47 pm

Part of the wrong-headed claims made by providers (DME's and their lackeys)
is that APAPS are not appropriate for everyday use--
(This generally opens the door for selling bricks at a huge profit or
KICKBACKS from their buddies at the sleep labs for UNNECESSARY repeated laboratory titration studies.)
an APAP can be run on straight cpap mode if the PATIENT needs it, but a CPAP will not self-titrate.

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BlackSpinner
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Re: Is CPAP titration necessary to prescribe proper machine

Post by BlackSpinner » Thu Aug 27, 2015 4:55 pm

btwisted wrote:
My study results were.
5.5 hours of study time
56 obstructive apneas
45 central apneas
59 hypopneas

apnea-hypopnea index 29 events per hour

any insight while waiting to hear back from insurance company?
You have quite a a few centrals there. I would insist on a titration because the plain CPAP an APAP might not work for you.

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SewTired
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Re: Is CPAP titration necessary to prescribe proper machine

Post by SewTired » Thu Aug 27, 2015 5:31 pm

I am concerned about the number of centrals that you have. I would appeal the decision of your insurance company for a titration. Your's is not a simple solution - not with 45 centrals.

Unfortunately, the general rule of thumb is no matter what the results, a trial of cpap (using an auto-cpap counts) is required before another machine can be authorized. However, cpap (auto-pap), does not fix centrals. You can insist for a reasoning as to why the titration was refused given that you have all these centrals which are not typically treated by a cpap machine.

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