Intro and beginner's questions...

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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stienman
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Intro and beginner's questions...

Post by stienman » Thu Feb 04, 2016 1:17 pm

I took a home sleep test and got some interesting results back which concern me. Immediately after that my insurance situation became murky, then changed altogether to a lower insurance package which doesn't cover DME until after the $2k deductable.

The AHI was 10, putting me in the mild sleep apnea category. However my lowest O2 desaturation was 56%, and I spent 69 minutes (out of 7h 40m sleep period) below 90%, 4 minutes below 80%.

The sleep test was administered by a doctor who never sees their patients - a tech brings the equipment, instructs you, then picks it up the next day, then a nurse calls later for a phone appointment (ie, billed as a medical appointment) to discuss the results. So I'm having some confidence issues with this specialist. Further, it was a dentist that recommended the sleep test, and did a lot of legwork to make sure it went through this particular specialist.

The specialist recommended oral appliance therapy (OAT, which I suspect is just going to be a mandibular advancement device) to treat the AHI and daytime sleepiness, and pulse oximetry to see if it also solved the O2 issue.

I probably would have followed that recommendation if I still had the old insurance, but now that I have to pay 100% for everything, I need to figure out my best course of action.

It appears that the OAT would start at $800 and could go as high as $2,300.

Meanwhile i'm alerted that resmed is firesaling all their "for her" S9 autoset machines and I'm tempted to just get the specialist to write a script for one and go straight to the "gold standard" therapy for apnea.

On top of this, I've also decided to lose weight to see if that helps, but it's taken me a month to get from 190 to 180, and by the time I reach 140 I'll have wasted another 6 months or more being sleepy and possibly hurting my heart and brain.

Which leads me to here - after doing some research I still have questions, and I'm hoping that you can help.

1. Assuming I can get the specialist to simply write a script for the S9, is that a reasonable path or am I jumping the gun here and this case is mild enough that I really don't need to go this far?
2. I've seen a few posts on here that the S9 autoset isn't great because it's discontinued, but as far as I can tell if I'm diligent it can give me enough feedback that I can probably successfully determine my own therapy, and it's still significantly cheaper than the newer machines. What's the downside of starting out with this machine?
3. Is there anything other than a cosmetic difference between the S9 autoset for her and the S9 autoset?
4. The sleep study was one of the worst night's sleep I've had in a long time, and that was with the simple at-home testing (chest strap, nose cannula, pulse ox). Is it reasonable to ask for an apap prescription without doing a more complete sleep test or cpap titration (which would just add to the total cost and increase the time to receiving therapy)?
5. Anyone want to sell me your S9 autoset machine (come on, you know you want to upgrade...) and is it illegal to buy/sell cpap/apap machines, or is there a way to do this sort of thing in a completely legal manner? (I expect not since it's prescribed, but what do I know?)

I'm a nose breather, so I'll probably try nasal pillows first. I'm also a data geek, so I'm getting a CMS50F tomorrow and will start noodling with sleepyhead. I'd love to have the data right on my iphone, though, so I don't have to fiddle with the memory card and computer, thus:

6. If I miss the S9 sale (say my doctor won't write one without another sleep study or cpap titration), or find out that machine won't do what I need, what machines are available that do wireless data (and perhaps configuration?) that I have access to (ie, not just the DME or doctor), whether bluetooth or wifi?

Anyway, thanks for listening to my rambling, I don't have a feel for this community so it feels rude to just jump in like this, but I'm anxious about the whole situation, so I hope you forgive me for my impatience...

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
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Cardsfan
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Re: Intro and beginner's questions...

Post by Cardsfan » Thu Feb 04, 2016 1:24 pm

Were you diagnosed with central sleep apnea? Do you have your results, it will be on there. The reaason you need to know this, is if you have central apnea, you need a specialized machine to treat it.

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stienman
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Re: Intro and beginner's questions...

Post by stienman » Thu Feb 04, 2016 1:35 pm

No, I was not diagnosed with central sleep apnea. I'll see about sanitizing the report and posting it here. Severe snoring, and no cheyanne strokes breathing.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: CMS50F PulseOx, Sleepyhead

Cardsfan
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Re: Intro and beginner's questions...

Post by Cardsfan » Thu Feb 04, 2016 1:48 pm

1. AHI of 10 is sleep apnea. You need treatment.
Any Dr or Dentist can write your prescription.
2. The resmed S9 Autoset for her is a good machine. The only downside is you have an older model". Like buying a new car that is the older model.
3. No, just pink.
4. (My prescription says CPAP, but I have an APAP. APAP machines can function in CPAP mode.
5. Machines get sold on Craigslist and here without prescriptions.

You can also look at http://www.secondwindcpap.com. For used and new machines.

If you buy the S9Autoset, while it is on sale, the bonus is you get the warranty. (Warranties are not transferrable)

I suggest you contact our host https://www.cpap.com and ask them to match that sale price.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments:  CPAP 10 cmH20., User since 1/1/15.
Last edited by Cardsfan on Thu Feb 04, 2016 2:01 pm, edited 1 time in total.

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stienman
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Re: Intro and beginner's questions...

Post by stienman » Thu Feb 04, 2016 1:49 pm

Here are the test results. As you can see the test was limited (just the chest strap, nasal cannula, and pulse/ox) so it doesn't appear to differentiate between central sleep apnea and obstructive. However, if I allow my throat muscles to completely relax I can feel my throat closing up, completely in some positions, and the snoring seems to strongly suggest obstructive.

Image

Image

If I'm misinterpretting the data, though, or if a full test is needed, then please correct me!

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: CMS50F PulseOx, Sleepyhead

HoseCrusher
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Re: Intro and beginner's questions...

Post by HoseCrusher » Thu Feb 04, 2016 2:11 pm

What caught my eye is that for 29 minutes your blood oxygen levels were low...

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SpO2 96+% and holding...

Sleeprider
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Re: Intro and beginner's questions...

Post by Sleeprider » Thu Feb 04, 2016 2:13 pm

You should be able to get the sleep doctor to provide you with a prescription for "auto CPAP, mask and supplies patient choice", which would allow you to self-titrate. If he won't do it, take your study to your regular family physician and tell him what you need. You do not need to specify the manufacturer or model, and the prescription will be good anywhere you want to spend your money.

The Philips Respironics 60 Series Auto CPAP is also on fire sale prices on Amazon ($400), and you probably don't even need the prescription.

Many online DMEs like CPAP.com will provide you or your doctor a form to provide prescription information. That would work too. I get the impression your sleep specialist is looking out more for your dentist than for you.

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OkyDoky
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Re: Intro and beginner's questions...

Post by OkyDoky » Thu Feb 04, 2016 2:19 pm

My concern with your sleep study is that the AHI is made up of 7 Unidentified apneas + 3 hypopneas = 10 AHI. The unidentified could be obstructive or central. I do think you would benefit from an in lab sleep study.
ResMed Aircurve 10 VAUTO EPAP 11 IPAP 15 / P10 pillows mask / Sleepyhead Software / Back up & travel machine Respironics 760

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stienman
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Re: Intro and beginner's questions...

Post by stienman » Thu Feb 04, 2016 2:29 pm

OkyDoky wrote:I do think you would benefit from an in lab sleep study.
That's probably true, but it will probably cost more than a cpap machine out of pocket. While a an apap wouldn't replace a full sleep test, can they tell the difference between OA and CA and help me understand how to proceed?

I'll find out the cost for a full sleep test and add it as an option to my plan.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: CMS50F PulseOx, Sleepyhead

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LSAT
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Re: Intro and beginner's questions...

Post by LSAT » Thu Feb 04, 2016 2:37 pm

stienman wrote:
OkyDoky wrote:I do think you would benefit from an in lab sleep study.
That's probably true, but it will probably cost more than a cpap machine out of pocket. While a an apap wouldn't replace a full sleep test, can they tell the difference between OA and CA and help me understand how to proceed?

I'll find out the cost for a full sleep test and add it as an option to my plan.
Sleep tests in a lab are $2000++ per night. Often you need 2 nights.

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OkyDoky
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Re: Intro and beginner's questions...

Post by OkyDoky » Thu Feb 04, 2016 2:43 pm

stienman wrote:
OkyDoky wrote:I do think you would benefit from an in lab sleep study.
That's probably true, but it will probably cost more than a cpap machine out of pocket. While a an apap wouldn't replace a full sleep test, can they tell the difference between OA and CA and help me understand how to proceed?

I'll find out the cost for a full sleep test and add it as an option to my plan.
Yes they do report them separately and as long as you have a data cabable machine and monitor your data to see if you have increasing centrals it would be possible to self titrate. I would go with an APAP rather than the dental device. Financially it makes more sense and it is the better treatment. If you start having more CA events, we all have some reported that are not worrisome, you can always go later for the sleep study if needed.
ResMed Aircurve 10 VAUTO EPAP 11 IPAP 15 / P10 pillows mask / Sleepyhead Software / Back up & travel machine Respironics 760

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stienman
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Re: Intro and beginner's questions...

Post by stienman » Thu Feb 04, 2016 3:00 pm

Trying to get benefit information from my insurance is apparently like pulling teeth. They have a labs section, but only list radiology and mammograms as having coverage (probably the minimum required by the ACA). I'll have to talk to customer service to figure out if they do, but even if they do it would be maximum 80% covered, leaving me with a $400 bill + $40 office visit for the consultation, etc, etc, etc.

Called up the sleep specialist that did my test in December and they didn't even blink - looks like I'll have an apap prescription in my email momentarily.

I do have an appointment with the dentist for a consultation Monday, but I already know it's going to cost more than the cpap - at least twice as much, and it's only going to have a 50% chance of helping at all (according to my reading of the studies, which could be wrong). Big advantage of the OAT treatment is I don't have a tube connected to me, but to lay out $800 on something that has a 50% chance of working vs $400 on something that will almost certainly work seems like a no-brainer.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: CMS50F PulseOx, Sleepyhead

Cardsfan
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Re: Intro and beginner's questions...

Post by Cardsfan » Thu Feb 04, 2016 3:12 pm

My dental device sits in the drawer. It forces the jaw into an unnatural position all night. My jaw hurt for an hour every morning after removing it.-- I bet the dentist didn't tell you that tidbit of info.
They do not treat central apnea, in case you find out you have that. If you do a search on here of dental devices, you will find a lot of info.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments:  CPAP 10 cmH20., User since 1/1/15.

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palerider
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Re: Intro and beginner's questions...

Post by palerider » Thu Feb 04, 2016 3:14 pm

stienman wrote: 1. Assuming I can get the specialist to simply write a script for the S9, is that a reasonable path or am I jumping the gun here and this case is mild enough that I really don't need to go this far?
2. I've seen a few posts on here that the S9 autoset isn't great because it's discontinued, but as far as I can tell if I'm diligent it can give me enough feedback that I can probably successfully determine my own therapy, and it's still significantly cheaper than the newer machines. What's the downside of starting out with this machine?
3. Is there anything other than a cosmetic difference between the S9 autoset for her and the S9 autoset?
4. The sleep study was one of the worst night's sleep I've had in a long time, and that was with the simple at-home testing (chest strap, nose cannula, pulse ox). Is it reasonable to ask for an apap prescription without doing a more complete sleep test or cpap titration (which would just add to the total cost and increase the time to receiving therapy)?
5. Anyone want to sell me your S9 autoset machine (come on, you know you want to upgrade...) and is it illegal to buy/sell cpap/apap machines, or is there a way to do this sort of thing in a completely legal manner? (I expect not since it's prescribed, but what do I know?)
6. If I miss the S9 sale (say my doctor won't write one without another sleep study or cpap titration), or find out that machine won't do what I need, what machines are available that do wireless data (and perhaps configuration?) that I have access to (ie, not just the DME or doctor), whether bluetooth or wifi?
  1. you need it
  2. it's "last years model" but it's almost the same as the new model, there is a new mode optional on the airsense10 autoset for her that is supposed to be nicer for women, and most people say "get that, it has more", but the s9 series of machines are great, I've got a different S9 model, and am perfectly happy with it. there were BIG differences between the S8 and S9 autoset machines, but between the S9 and AS10, the differences are cosmetic, the treatment functions are the same, except for the new mode.
  3. just the color, and if you end up hating that, and wishing you had silver, or something else, you can custom design a skin for it, here's mine:Image
  4. yes, with our help at reading and understanding the data, start by reading the first post in the announcements section.
  5. there are machines available for sale from various members here, and likely on your local craigslist.
  6. no machines have wifi, but you can put a toshiba wifi sd card in them, and wifi your data to your computer.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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chunkyfrog
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Re: Intro and beginner's questions...

Post by chunkyfrog » Thu Feb 04, 2016 6:57 pm

Skinit has "skins" for the S9 series machines; a big assortment, not including custom skins you can design yourself.
The hospital where I had my surgery had skins made up with a photograph of the building.

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