How do I do this?

napanap · Post by **napanap** » Thu Apr 30, 2015 10:58 am

I'm tired all the time, I feel mentally "dull" quite often, and my wife complains that I snore loudly every night. I went to my regular doctor, who did blood tests (no problems were found), than gave me a prescription for a sleep study. The results were that I had apnea but it was borderline. There were a large number of "minor sleep events" per hour, but few "major sleep events". (Not sure that terminology is right; I can probably get a copy of the results from my doctor to get the exact results).

The sleep study consisted of taking home a CPAP machine and using it for two nights. Then the sleep study people looked at the recorded data. I did feel somewhat better those two days of using the CPAP.

But my doctor said, according to the insurance guidelines, I don't quite qualify for a CPAP machine. She said if I really think I need one I can buy one myself.

So I'm planning to buy one. I'm planning to get a Resmed Airsense 10 Autoset. But I'm not sure what issues I'll run into, doing this myself. What kind of mask should I get? Are there other accessories I need? Do I need some special knowledge to set up the machine? Any other advice?

Thanks in advance.

palerider · Post by **palerider** » Thu Apr 30, 2015 12:06 pm

napanap wrote:So I'm planning to buy one. I'm planning to get a Resmed Airsense 10 Autoset. But I'm not sure what issues I'll run into, doing this myself. What kind of mask should I get? Are there other accessories I need? Do I need some special knowledge to set up the machine? Any other advice?

one of our forum members, stlmark, has one available at the moment, scroll down the front page. there are also a few other members that may have similar, or better machines available for various prices, you might get a PM or two.

picking the right mask is one of the toughest jobs in the whole cpap thing. if you normally breath through your nose, you might try the resmed P10 nasal pillow mask... I picked up my last one for 40$ on ebay, it was advertised as "pillows and headgear+bonus" the 'bonus' was that it was a complete, unopened package with everything needed.

the minimum for getting started is machine, hose, mask, and software to monitor what's happening and fine tune it.

I slapped a cpap on my bedmate, because the snoring was causing us to have to sleep in separate rooms... ("here, wear this and you don't have to live in the spare room" "ok") a little pressure, and life's good again

Janknitz · Post by **Janknitz** » Thu Apr 30, 2015 12:07 pm

You didn't have a proper diagnostic sleep test. Regardless of results, your sleep test with a CPAP machine won't meet any insurer's criteria. There are proper sleep tests that can be done at home, but that's not what you had. Go back to your doctor and insist on a proper POLYSOMNOGRAPH test at home or to a sleep lab. If your doctor won't refer you get a better doctor.

You probably DO qualify for insurance covered machine, but the test you had was inadequate.

SleepDisturbed · Post by **SleepDisturbed** » Thu Apr 30, 2015 12:13 pm

What Janknitz said in spades.

Julie · Post by **Julie** » Thu Apr 30, 2015 12:20 pm

But regardless of what else happens, if you've been sleeping on your back, do whatever you can not to, because it causes lots of events that otherwise probably wouldn't happen... and may be the culprit in your results. In other words, you may have at most what's called 'positional apnea', only registers on your back, but not otherwise.

QualityDMEGuy · Post by **QualityDMEGuy** » Thu Apr 30, 2015 12:28 pm

To address the study - was it actually a CPAP that you took home? Or another home unit? If it didnt have a mask interface delivering air pressure, it may have been an HST (Home Sleep Test) device. They CAN be accurate, but usually don't tell the whole story. I'd consider seeing a sleep specialist and seeing if you can have an AST (attended sleep test) in a sleep lab - it may yield different results that will qualify you for a study. I wouldn't jump to say your doctor is a bad one, but if he's not a board certified sleep physician, you may not be getting the whole story.

Regarding getting the machine - if you go through retesting through a sleep doctor and can get a machine through your insurance, it will resolve most of the concerns you have. A DME (durable medical equipment) provider will get you the machine and educate you on it (you can request a certain one, still) but more importantly can work with you on mask options. A good provider will let you try different tester masks to see what works best for you. And then if you choose and don't like it, they can replace it under a warranty within the first 30 days.

Ultimately, I wouldn't go buy a machine right now. I think you can be better prepared by taking a couple of extra steps. It'll save you money and also make you much more educated about the process.

napanap · Post by **napanap** » Thu Apr 30, 2015 12:29 pm

Janknitz wrote:You didn't have a proper diagnostic sleep test. Regardless of results, your sleep test with a CPAP machine won't meet any insurer's criteria. There are proper sleep tests that can be done at home, but that's not what you had. Go back to your doctor and insist on a proper POLYSOMNOGRAPH test at home or to a sleep lab. If your doctor won't refer you get a better doctor.

Sorry, my mistake for saying it was just a CPAP. My doctor did send me to a sleep lab called SleepQuest. They sent me home with a machine, which to me looked like a CPAP but it had additional stuff like sensors on my head and on my finger, and a band around my chest and stomach. It probably was a polysomnograph, I'm not sure, like I said I'm pretty dull lately

CanadaVoice · Post by **CanadaVoice** » Thu Apr 30, 2015 12:41 pm

Julie is spot on, IF your apnea is positional in nature, i.e. snoring more on your back than on your side, you might be able to ease the mild OSA a bit with side-sleeping.
A pillow between the knees and a good neck supporting pillow can prevent throat closure and ease snoring.

Once those proper sleep tests are done, the AIrsense 10 is a remarkable unit to work with. I know many who have one and love it.

There's mention of a proper mask and this is 95% of success.

This IS true.

Comfort drives the whole CPAP experience. And you say you trialed a CPAP and felt better. That's a great indicator that CPAP will work for you on some level.

Here in Canada, there's a more generous trial program that monitors success before you purchase, assuring the mask you choose works and your comfort with the CPAP is optimal.

Maybe you have the same opportunity?

Cheers!

napanap · Post by **napanap** » Thu Apr 30, 2015 12:45 pm

Julie wrote:But regardless of what else happens, if you've been sleeping on your back, do whatever you can not to, because it causes lots of events that otherwise probably wouldn't happen... and may be the culprit in your results. In other words, you may have at most what's called 'positional apnea', only registers on your back, but not otherwise.

Thanks Julie for your reply. I don't ever sleep on my back, so it must not be positional apnea.

palerider · Post by **palerider** » Thu Apr 30, 2015 1:09 pm

napanap wrote:Thanks Julie for your reply. I don't ever sleep on my back, so it must not be positional apnea.

apnea tends to be positional, if you did sleep on your back, it would likely be worse than what you have now.

sleepydc · Post by **sleepydc** » Thu Apr 30, 2015 1:43 pm

I'm no doctor, and others on this forum undoubtedly know more, but my understanding is that the "home" test you took is hardly dispositive. Instead, it's often used as an "intermediary" test to give some comfort to an insurance company that the much more expensive "sleep study" is worth the money. But at least in my case, the home test results were not enough for a cpap machine; I still had to get the sleep study (which also involved titration) anyway.

I don't know your insurance or financial situation, and perhaps that's completely and utterly controlling what your doctor can do here. But it would seem to me that, medicine being an art and not a science, you need a doctor who pays attention to your symptoms and does what they can to get you to the sleep test.

palerider · Post by **palerider** » Thu Apr 30, 2015 1:58 pm

sleepydc wrote:I'm no doctor, and others on this forum undoubtedly know more, but my understanding is that the "home" test you took is hardly dispositive. Instead, it's often used as an "intermediary" test to give some comfort to an insurance company that the much more expensive "sleep study" is worth the money.

were you going for 'definitive'?

home studies are typically pretty accurate, enough to diagnose many people, and at least one insurance company is relying on that, home study, then an apap for extended titration.

robysue · Post by **robysue** » Thu Apr 30, 2015 5:01 pm

palerider wrote:
sleepydc wrote:I'm no doctor, and others on this forum undoubtedly know more, but my understanding is that the "home" test you took is hardly dispositive. Instead, it's often used as an "intermediary" test to give some comfort to an insurance company that the much more expensive "sleep study" is worth the money.
were you going for 'definitive'?

home studies are typically pretty accurate, enough to diagnose many people, and at least one insurance company is relying on that, home study, then an apap for extended titration.

If the home sleep study clearly shows moderate OSA, there's no problem in obtaining coverage.

The problem is that if the home study shows very mild/borderline numbers, then you might not be able to get insurance coverage, but at the same time, the test itself is borderline and that may indicate the need for a full-blown in-lab attended sleep study where there's no second guessing whether the patient is awake or asleep when the events start.

It's worth the OP's time to see if the doc would be willing to refer him/her for an in-lab sleep test and whether his/her insurance would pay for the in-lab sleep test since the home test was inconclusive.

SleepDisturbed · Post by **SleepDisturbed** » Thu Apr 30, 2015 5:11 pm

napanap wrote:
Janknitz wrote:You didn't have a proper diagnostic sleep test. Regardless of results, your sleep test with a CPAP machine won't meet any insurer's criteria. There are proper sleep tests that can be done at home, but that's not what you had. Go back to your doctor and insist on a proper POLYSOMNOGRAPH test at home or to a sleep lab. If your doctor won't refer you get a better doctor.
Sorry, my mistake for saying it was just a CPAP. My doctor did send me to a sleep lab called SleepQuest. They sent me home with a machine, which to me looked like a CPAP but it had additional stuff like sensors on my head and on my finger, and a band around my chest and stomach. It probably was a polysomnograph, I'm not sure, like I said I'm pretty dull lately

Then I withdraw my "ditto"

From what I understand SleepQuest has a decent service.

Have you thought about buying used? Check out http://www.secondwindcpap.com -- I have purchased from them with excellent results.

I would think the ResMed S9 Autoset (what I use) would be an excellent choice and would save you some money.

Jay Aitchsee · Post by **Jay Aitchsee** » Thu Apr 30, 2015 5:40 pm

napanap wrote:But my doctor said, according to the insurance guidelines, I don't quite qualify for a CPAP machine. She said if I really think I need one I can buy one myself.

Why don't you get a copy of the test results ( they're yours for the asking)? Post them here and I'm sure folks would be happy to give you their opinions and advice.

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