Insurance Management

[impatient]

I find myself intimidated by the process of getting equipment to try. I had my study 3.5 years ago, tried and failed at cpap.
My quality of life was not that bad that I would be willing to use cpap. After spending some time reading here and watching how well I sleep. I think it might be worth the trouble to at least try a dental device. Most of the time I am OK. Some weeks I notice that I can't remember passwords and become really sleepy about 3 in the afternoon.

I just got off the phone with my insurance company to see if they would cover the $1500 cost. They sent me back to my dentist to get a procedure code and a diagnosis code. I think that I have just been blown off. Then again how on earth would a customer service rep at an insurance company stand a chance at knowing all the various medical procedures.

I kinda had this same problem with my DME when I started. Is my insurance company really ready for me to piddle my way through thousands of dollars in equipment to find something that I like. I am certainly not ready to do that with my own money so why would I ask them to do that.

If I knew something would work and I could tolerate it then the money is not a problem. It is this whole trial and error process that creates a disconnect for me. I have given up on my sleep doctor and DME provider.(they are the same company) I kept getting pat advice and treated like I wasn't taking my pills for being non-compliant and wanting to adjust my pressure setting.

The info in this board is has been real helpful in understanding my troubles.

I have Blue Cross insurance. Sorry for the rambling post but it captures unfocused condition of my feelings and treatment.

[Muse-Inc]

Welcome aboard!

This ain't no easy journey for most of us, that's for sure. This condition mangles our lives, each of us a bit differently. Coming here to rant at times, to share what works at other times, and just plain self-educate about our variant is a God-send because we've all been there to one extent or another so we understand and cut each other lot of slack, this condition affects our thinking and our moods and lously sleep just makes us a bit nuts. Some come and go quickly, some hang around, some become our resident user experts. Too, we have visits from the pros in the sleep industry who come by and share -- we're mostly nice, sometimes we bite

Do you have the results of the sleep study? Please post details.

[impatient]

I did not push the issue of getting a copy until my dentist encouraged me to do so. I called the sleep study company and they pushed me off into voicemail. I think that I had asked for it before. So I called the Dentists office and asked them to do it. They got a copy in just a few hours. They made another copy that I am supposed to go pickup today.

I have not read it yet. I will have to get back to you with the results. 3 years ago I could not have made heads or tails of the thing anyway. Now that I have studied sleep apnea here and elsewhere I might be able to read the thing.

I also picked up an oximeter so I should be able to compare to the study and get a clue if my poor sleep is caused by apnea, stress, bad habits or a bad bed.

Thanks

[impatient]

I have reviewed my sleep study. They report that I am waking up every minute or so for 9 to 25 seconds. Had 2 central apneas and they consider me to have severe sleep apnea. The study was a split night. And during the titration part I rolled to my side. Looks like I sleep pretty well on my side. You can see where they cranked up the pressure until the arousals stopped. The arousals started up again some minutes later but the study ended without any further pressure adjustments. The arousals seem to start and stop in a pattern largely unrelated to the pressure adjustments. There is a graph of something called Resp that I don't really understand.I am guessing respiration. It has little spikes that seem to loosly relate to the Arou graph. The oxygen graph bounces up and down whenever I am sleeping on my back regardless of the cpap pressure.

It all seems to be rather little clear information to work from. I don't understand what they consider an arousal. I am thinking that I will need to do another sleep study. My dentist suggested I should get some therapy in place before doing so.

Thanks

[Hawthorne]

I don't know but it sure seems to me that you should be on cpap! You say you were diagnosed with "severe sleep apnea" adn had a split night study. Dental appliances tend to work better for mild to maybe moderate sleep apnea but not "severe", as I understand what I have read.

After 3 1/2 years, if it were me, I'd have another sleep study before I spent any money!

[cinco777]

Impatient wrote

The oxygen graph bounces up and down whenever I am sleeping on my back regardless of the cpap pressure.

Until you get your own CPAP, train yourself to sleep on your side and NOT on your back. Many members of this forum, me included, have Positional Sleep Apnea (PSA). Trying to sleep on my back guarantees that I will be a full-fledged Zombie the next day. Even with CPAP and higher pressures, I experience 20X the number of Apneas/time period compared to my sleeping on my side (I also have discovered that I sleep better on my left side rather than my right). There are many postings on CPAPTalk that describe the methods members have used to keep themselves from sleeping on their back. A tennis ball and three firm pillows used as wedges worked for me.

Additionally, refuse to accept a compliance-only CPAP. Fight for and get a full data capable unit (preferably an APAP), one that records/reports Apnea, Hypopnea, System Leak, Pressure, etc. events. Then purchase with your $$$ the associated reporting software. With a data capable CPAP, software, and the advice and recommendations you will find on this forum, you can be successful. Do it!

[OneCatBelleSundance]

Impatient -- you mention you've given up on your sleep doctor. Where do you live? I've found that in Des Moines, IA a city of around 300,000 peaple we have two large sleep clinics that are run by the two competing hospital systems. You might want to try to find another sleep doctor. I originally went to ENT doctor who referred to me to the sleep doctor so you might want to try an ENT to get access to a sleep doctor.

Unfortunately the insurance company is not likely to give you advice on where to get assistance. Good luck!

[Muse-Inc]

...waking up every minute or so for 9 to 25 seconds.

Meaning you have an AHI of at least 60; anything over 30 is classified as 'severe.'

...they cranked up the pressure until the arousals stopped. The arousals started up again some minutes later

Raising your pressure until events stop is called titration. That pressure is your ideal pressure. If pressure continues to rise, it might create central apneas which you don't want to occur.

...The oxygen graph bounces up and down whenever I am sleeping on my back regardless of the cpap pressure

Sounds like you have hypopneas on your back. Hypopneas are when your airways narrow, sometimes almost to closure (closure is an apnea), causing your blood oxygen levels to fall, sometimes to dangerous levels. Dangerous levels are where oxygen deprivation occurs causing the brain to go into crisis mode raising adrenaline levels to rapidly increase blood pressure creating nightime hypertension and rapid breathing to raise the oxygen levels. Some wake up right away and resume 'normal' breathing averting the crisis right away; if you do not and if the length or frequency of these sessions of hypertension continue long enough the hypertension will continue into the next day. Each session of nightime hypertension if it lasts long enough alarms the brain causing the body to secrete hormones to reduce the blood pressure by reducing the blood volume creating more urine. I was peeing 8-10 times a night which stopped my first night on CPAP (uncommon experience, takes longer for this to occur for most people, my CPAP therapy was successful right from the start). This type of daytime hypertension is effectively treated with an angiotension receptor blocker as shown in the following study and will likely be eliminated following successful CPAP therapy that eliminates the apneas and hypopneas (took me 18 months and it recurs when I have too many overnight events which sometimes still occur even with good therapy...too much stress, poor sleeping position like chin down which that narrows the airways): http://eon.businesswire.com/portal/site ... ewsLang=en

...don't understand what they consider an arousal

Sleep occurs in REM (rapid eye movements when you are dreaming) and non-Rem (NREM or NR on your study report). NREM has Stages: used to be 1-4 now 1-3; 1 is falling asleep, 2 is light sleep, 3 (and 4 in the old system) are considered deep sleep, also known as slow wave sleep (SWS). There are percentages of times for each of these that is considered normal. When you change from one stage to another it is called an arousal; it is noted when you change from a deeper stage to a lighter stage without waking up and these are the ones they report. Some arousals are likely caused by changes in respiration, some might becaused by limb movements, some have no identifiable cause and are called spontaneous.

The patterns of these numbers and their relationships help identify which type of sleep disordered breathing (SDB) you might have, what type of CPAP machine might be appropriate, and what other conditions might be contributing to your unrestful sleep.

I hope this helps.

[impatient]

hawthorn,
Yes, my dentist said I should be on CPAP. He is worried that a dental appliance will not be adequate. He says I should be ready to pay for the dental device without insurance. And he thinks that at the very least I should have a sleep study done while wearing the device to be sure it is working.
cinco777,
I have been working at sleeping on my side ever since I found out I had CPAP. Trouble is that my bed is too firm and puts my arm to sleep quickly. I have used a foam pad on top of the bed and a pillow between my knees with some success. If I am going to start paying for stuff out of pocket then a new mattress will be first. Probably one that lets my wife have a different firmness. So that means one of those sleep number beds.
One cat,
I am considering shopping for another sleep doctor. I was checking on that today. There are about 6 in town from what I can tell. Sleep centers don't seem to mean sleep doctors. And some docs cover a south and a north location.
Muse,
That is the first I heard of blood pressure and adrenaline swings. I think that they had a blood pressure monitor on me during my sleep study. I wonder why that data was not included in the study. It only has morning and evening pressures. 127/82 and 117/82. I worry that my blood pressure is too low at night and that causes my arms to fall asleep easily. My Doc says no. When a nurse checks my blood pressure I like to warn them that it runs low so that they don't spend a long time looking for it with the cuff tight. Sometimes that causes me to get a headache.

Thanks for the stage explanations. Looks like I was up most of the night. 51 minutes to get to sleep and 2 hours to get the cpap on and get back to sleep. Then when the pressure got high It shows me as being awake. That could be why the arousals stopped. I was awake. I only made it to stage 3 for about 5 minutes while I was on my side with the cpap set to about 6. They finished off at 13.

The arousals don't seem to match the sleep stage as you suggest. There are 91 arousals and only 8 transitions from 2 to 1 on the sleep stage before the CPAP.

I think I should go talk to my primary doctor. He is pretty good to work with and I have to have a referral to talk to a new sleep doctor anyway.

Thanks again.