AHI Too Low For Treatment -- Where To?

[heavyduty]

Hey all,

After many days of being tired and complaints from the wife, I recently had an at home sleep study performed. The at home study came back borderline, so the sleep specialist recommended an in-lab study. I finally got my results from the in-lab study -- my AHI did not qualify for treatment under my insurance. The results from the technologist are as follows:

"The total study time was 390 minutes and the patient slept for 352 minutes, for a good sleep efficiency of 93% (normal > 85%). Sleep latency was slightly early (8 minutes). Latency to Stage REM sleep was slightly delayed (130 minutes). Sleep staging was notable for normal amounts of sleep stage N3. Stage REM sleep was seen but was decreased by approximately 35% during the baseline study. The sleep technologist noted mild-to-occassionally moderate snoring.

The patient demonstrated an Apnea + Hypopnea Index (AHI) of 9 events per hour (normal < 10). Medicare AHI=3.1 (All apneas, plus hypopneas with 4% or greater oxygen desaturations). This included 51 hypopneas. REM AHI = 0. Supine AHI=12. In addition, there were increased spontaneous arousals (12 per hour), associated with subtle respiratory efforts, suggesting increased upper airway resistance. Oxygen saturations were typically in the 92-94% range, with cyclical desaturations to 89-90%. The lowest oxygen saturation was 87%. Because the patient did not meet Aetna criteria for CPAP therapy (Medicare AHI=<5), a CPAP titration was not performed."

So with all that in mind, where do I go from here? I am still fatigued during the day, but I seem to be left with no treatment option. It appears my Supine AHI is considerably higher, so do I simply need to make efforts to not sleep in the supine position?

Thanks for any help!

[Pugsy]

You might read up on UARS Upper Airway Resistance Syndrome.
Lazer is a forum member who like you didn't initially make criteria for official diagnosis.

Where's Lazer? Haven't seen him post for a while.

Anyway, you might read some of his earlier posts. Go back to his older posts.
search.php?author_id=61881&sr=posts

You can of course try sleeping on your side to see if it helps. Sometimes easier said than done though.

[Todzo]

Hey all,

After many days of being tired and complaints from the wife, I recently had an at home sleep study performed. The at home study came back borderline, so the sleep specialist recommended an in-lab study. I finally got my results from the in-lab study -- my AHI did not qualify for treatment under my insurance. The results from the technologist are as follows:

"The total study time was 390 minutes and the patient slept for 352 minutes, for a good sleep efficiency of 93% (normal > 85%). Sleep latency was slightly early (8 minutes). Latency to Stage REM sleep was slightly delayed (130 minutes). Sleep staging was notable for normal amounts of sleep stage N3. Stage REM sleep was seen but was decreased by approximately 35% during the baseline study. The sleep technologist noted mild-to-occassionally moderate snoring.

The patient demonstrated an Apnea + Hypopnea Index (AHI) of 9 events per hour (normal < 10). Medicare AHI=3.1 (All apneas, plus hypopneas with 4% or greater oxygen desaturations). This included 51 hypopneas. REM AHI = 0. Supine AHI=12. In addition, there were increased spontaneous arousals (12 per hour), associated with subtle respiratory efforts, suggesting increased upper airway resistance. Oxygen saturations were typically in the 92-94% range, with cyclical desaturations to 89-90%. The lowest oxygen saturation was 87%. Because the patient did not meet Aetna criteria for CPAP therapy (Medicare AHI=<5), a CPAP titration was not performed."

So with all that in mind, where do I go from here? I am still fatigued during the day, but I seem to be left with no treatment option. It appears my Supine AHI is considerably higher, so do I simply need to make efforts to not sleep in the supine position?

Thanks for any help!

Hi heavyduty,

First of all do not be disappointed that you do not qualify. The truth is that over fifty percent of those medically commended to xPAP therapy are not using it a year later. Most fail.

So what else can you do? --

--Raise the head of your bed a couple of inches.
--Purchase a good pedometer and start the long process of moving toward 10,000 steps a day (made 90% of that for a time last summer - just replaced my old pedometer with a new one).
--Start a long term relationship with a dietitian. Move toward getting the nutrients you need. Eat more toward anti-inflammatory.
--Seek out and make use of some Traditional Chinese Medicine (they do have a track record - many claim healing from OSA and you do not have it too bad yet).

Modern medicine does not have any good answers to OSA yet. The track record long term is just to bad to say that they do.

Work on taking care of your body and it can take better care of you.

Have a great week!

Todzo

[49er]

Hi Heavyduty,

I am perplexed as to why didn't qualify since you slept for 352 minutes and had 51 hypopneas which would mean you had an AHI of 6.x. Mild apnea runs from 5 - 15.

Could it be because your insurance company is claiming normal apnea is less than 10 events per hour which just isn't true?

49er

Hey all,

After many days of being tired and complaints from the wife, I recently had an at home sleep study performed. The at home study came back borderline, so the sleep specialist recommended an in-lab study. I finally got my results from the in-lab study -- my AHI did not qualify for treatment under my insurance. The results from the technologist are as follows:

"The total study time was 390 minutes and the patient slept for 352 minutes, for a good sleep efficiency of 93% (normal > 85%). Sleep latency was slightly early (8 minutes). Latency to Stage REM sleep was slightly delayed (130 minutes). Sleep staging was notable for normal amounts of sleep stage N3. Stage REM sleep was seen but was decreased by approximately 35% during the baseline study. The sleep technologist noted mild-to-occassionally moderate snoring.

The patient demonstrated an Apnea + Hypopnea Index (AHI) of 9 events per hour (normal < 10). Medicare AHI=3.1 (All apneas, plus hypopneas with 4% or greater oxygen desaturations). This included 51 hypopneas. REM AHI = 0. Supine AHI=12. In addition, there were increased spontaneous arousals (12 per hour), associated with subtle respiratory efforts, suggesting increased upper airway resistance. Oxygen saturations were typically in the 92-94% range, with cyclical desaturations to 89-90%. The lowest oxygen saturation was 87%. Because the patient did not meet Aetna criteria for CPAP therapy (Medicare AHI=<5), a CPAP titration was not performed."

So with all that in mind, where do I go from here? I am still fatigued during the day, but I seem to be left with no treatment option. It appears my Supine AHI is considerably higher, so do I simply need to make efforts to not sleep in the supine position?

Thanks for any help!

[sleepstar]

Wow.
The American medicare system really frustrates me. I can't believe they say an AHI of 9 is not enough for CPAP. And then they have their own little "alternative AHI" which is even lower.
Over here, if you're willing to have a trial of CPAP and your AHI is under 5, no worries. The doctor will organise one for you.
And strangely enough, people with technically "no sleep apnea" often find remarkable benefits.

If your AHI is 9 you have mild sleep apnea - and you can still be bloody tired. Hell, people with an AHI above 30 sometimes aren't tired.

Ugh... Medicare. The article I read about how the American scoring rules are "designed for medicare" really annoys me.

[heavyduty]

The strange thing about this is that I do not even have Medicare. As it says in the quote, it did not meet the requirements for Aetna, which is my insurance company. It appears, based on generic policy information I can find for them, that an AHI between 5-15 is only considered treatable if other issues exist, such as history of hypertension, stroke, etc. Otherwise, the AHI or RDI must be above 15 to consider treatment. (I'm going off the document found here: http://www.aetna.com/cpb/medical/data/1_99/0004.html) One thing I am not clear on here is that my AHI falls between 5-15 AND my Epworth Sleep Score (in another part of the document) is 14. These two combined should be sufficient for treatment, according to that document.

[stage0]

I suggest you get with your ordering doctor, be honest with them and see if he will write you a script for a machine...you can usually find a DME that will rent one to you for a month. See how you do. I suggest some nasal pillow mask due to your low AHI.

Another alternative is to find what I use. a NeckLine Slimmer... this device will strenthen your neck muscles and muscle tone.

[heavyduty]

I am going to contact my doctor as soon as I get back in town. If my insurance refuses to pay for it, I may pay for it out of pocket at least temporarily to see if it makes a difference for me. Quality of sleep is worth the investment as far as I am concerned, and issues like poor memory are really getting to me. How much should I expect to pay out of pocket for a reasonable APAP and all the needed accessories? If I rented it and if I bought it?

Thanks!

[SleepingUgly]

It sounds like maybe for your insurance (what they are calling "Medicare AHI") they are only scoring hypopneas according to the AASM Recommended criteria, which entails a desaturation, whereas you probably had mostly hypopneas with arousals. I would have your doctor fight this by appealing the decision. You seem to me to be a candidate for CPAP, which very well might help you.

In the meantime, yes, minimize supine sleep. Put "tennis balls" into the search box above for ideas of how to stay off your back. When I tried this, I basically just put a couple tennis balls in a fanny pack and put the fanny pack on my back.

If you want to buy one out of pocket, read about data capable machines. Without a titration, your best chance of titrating yourself at home is with a data-capable Auto-PAP. But if I were you, I'd fight it and try to get it through insurance. What if it turns out you need bilevel? Then you've spent $ on an Auto-PAP and now need to buy a bilevel. Also, IMO, a titration is a very useful starting point from which to tweak pressures with an Auto-PAP, but without a titration, and without significant oxygen desaturations, it is not that easy to find the ideal pressure. Not impossible, but not easy. That's my experience anyway.

[49er]

I totally agree with SU about having your doctor fight the decision. It sounds like the insurance company is cheating you big time out of paying for something that should be covered.

49er

It sounds like maybe for your insurance (what they are calling "Medicare AHI") they are only scoring hypopneas according to the AASM Recommended criteria, which entails a desaturation, whereas you probably had mostly hypopneas with arousals. I would have your doctor fight this by appealing the decision. You seem to me to be a candidate for CPAP, which very well might help you.

In the meantime, yes, minimize supine sleep. Put "tennis balls" into the search box above for ideas of how to stay off your back. When I tried this, I basically just put a couple tennis balls in a fanny pack and put the fanny pack on my back.

If you want to buy one out of pocket, read about data capable machines. Without a titration, your best chance of titrating yourself at home is with a data-capable Auto-PAP. But if I were you, I'd fight it and try to get it through insurance. What if it turns out you need bilevel? Then you've spent $ on an Auto-PAP and now need to buy a bilevel. Also, IMO, a titration is a very useful starting point from which to tweak pressures with an Auto-PAP, but without a titration, and without significant oxygen desaturations, it is not that easy to find the ideal pressure. Not impossible, but not easy. That's my experience anyway.

[kteague]

Often with insurances the first answer is no because they want the doctor to confirm treatment is really a medical necessity. That's in general. You've got their criteria, now ask your doctor to document the reasons for your eligibility according to their stated criteria. Sometimes that's all it takes for an insurance to authorize payment.

[jencat824]

If you have to go out of pocket, try cpap.com or secondwind.com to get one at a better price. There are some people here who will occasionally sell a unit for various reasons so watch here too if you have time for that. I agree your Dr needs to fight the insurance. My hubby has United Health Care, his AHI was around 10 & they approved his with no problems whatsoever (and treatment is really helping him). It could be that one # is making the difference, but talk to your dr & try to get him to override the insurance or I think you can file for an appeal with your insurance, the process to do so if different with each insurance company, but if it were me, I'd try that first.

Good luck,
Jen

[ems]

Another alternative is to find what I use. a NeckLine Slimmer... this device will strenthen your neck muscles and muscle tone.

I just googled the NeckLine Slimmer. This looks to be strictly cosmetic. How long have you used it and do you think it's doing what you suggest? Do you use it with the mask?

[Woody]

Learning to play the didgerido may help some. I haven't tried it and am in no hurry to.
I will just keep my CPAP, my backup machine, spair mask and battery backup power supply.
But this is something you could look at .


http://www.laoutback.com/Didgeridoo_and ... a_s/42.htm

[NotLazyJustTired]

I am going to contact my doctor as soon as I get back in town. If my insurance refuses to pay for it, I may pay for it out of pocket at least temporarily to see if it makes a difference for me. Quality of sleep is worth the investment as far as I am concerned, and issues like poor memory are really getting to me. How much should I expect to pay out of pocket for a reasonable APAP and all the needed accessories? If I rented it and if I bought it?

Thanks!

I ran into a similar situation. I also have Aetna and they originally refused to cover treatment. My doctor appealed (twice actually) and eventually they covered it. There are different scoring methods for hypopneas. So, your AHI of 9 is probably using a more lenient scoring method. The "Medicare" AHI uses a stricter scoring method and will almost always lower your AHI. Aetna follows the Medicare policy pretty closely from what I have read.

Based on the info you posted, I would suggest getting the script and getting a machine; it will help you. I actually got my best price from Lincare, if you can believe that. They didn't bill me until the insurance situation was settled, and as a result I didn't have to pay anything (but it did wipe out my HRA).

Do you have any other comorbidities like high blood pressure, fibromyalgia, or acid reflux? I have all those symptoms along with hypothyroidism and I think that and an RDI of 40 convinced the insurance to pay; although I was ready to go out of pocket if needed. Please try; I really believe CPAP will make a huge difference in your life. Please keep us posted.