10 years with a CPAP, just had another sleep study done.

TomDac · Post by **TomDac** » Tue Feb 06, 2007 2:14 pm

Hi all,

New to the forum. I was diagnosed with apnea about 10 years ago and have been using a CPAP machine every night since. My job has changed numerous times and I still have the same machine (HealthDyne Tranquility Quest) which was originally set on 7. I manually adjusted the pressure over the years and unfortunately I don't know what it's set on now, but it's still tickin' and things are good.

So, we got new insurance at work and I got a new Primary Care Physician, so I went in for a checkup and mentioned that I use a CPAP and she asked me all sorts of questions regarding my use of it, etc. and that led us to get me back into a sleep study, etc. so I can get a new machine since my present one is 10 years old.

Last night was my sleep study, and the sleep lab knew all about my history. I could NOT go to sleep without my CPAP on! It was a horrible night and finally at 1:30 this morning after several hours of trying to sleep all wired up and without any CPAP, I rang the tech and told her that I have to work in the morning and I can't just stay up all night because I'll be a zombie, so get your butt in here and hook me up!!

She explained that the insurance companies want the data from 2 hours of sleep without the CPAP and that I was just approaching the 2 hour mark after 6 hours of laying in bed trying to sleep! ARRRGGGHHH!! So she put a mask on me and put my pressure on 10 and I went right to sleep. Unfortunatley it was too little too late and I'm totally wiped out today. She said she bumped it up to 13 by the end of the night (5:30AM).

Sorry for the long rant but my question is this: They know I have been sleeping with a CPAP for 10 years and I told them that I can't sleep without it... Why can't they just put a mask on me right away and then ramp it up until I'm in uber REM state instead of putting me thru this torturous ordeal? This should definitely change! Have any of you ever experienced this or had a followup test where they put a mask on you right away? Should I have insisted on it?

Any advice would be greatly appreciated

Thanks!

Tom.

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oldgearhead · Post by **oldgearhead** » Tue Feb 06, 2007 2:32 pm

I'm surprised they didn't do a split-night study. That's 3-4 hours at 4 CM/H2O, then the APAP takes over. I would ask my primary care doctor
to write you a script for an APAP.

Sleepy Dog Lover · Post by **Sleepy Dog Lover** » Tue Feb 06, 2007 2:33 pm

Because if they kill you during the sleep study they won't have to buy you a new machine? Sorry, just a little bad cpap humor.

The new insurance co probably wanted to document medical necessity, although IMHO that could provide a danger to somebody with severe OSA. Make sure you get a copy of your sleep study, such as it was to get your AHI info.

Congratulations on being a faithful cpaper for 10 years.

Wulfman · Post by **Wulfman** » Tue Feb 06, 2007 2:39 pm

Tom,

Sorry to hear about your ordeal.
Do you have your ORIGINAL prescription?
Sounds to me like somebody was out to make some money.
I can relate to your not being able to fall asleep.....and I've only been on the hose for about 2 years. I would think that they would have just done the titration part of the study with the mask you normally wear. (if it was entirely necessary at all)
If you have a prescription, you could purchase an "Auto" machine and software from CPAP.COM and check your therapy yourself.

Best wishes,

Den

nosbig-nosbig · Post by **nosbig-nosbig** » Tue Feb 06, 2007 3:04 pm

Hey! Tom:

My experience is similar to yours. Got my Tranquility in 96, also set at 7cm. After about 6 years I increased the pressure every couple of weeks and ended up at 9cm.The therapy was a God send, haven't slept one night without it either. Even though my first masks (Healthdynes) were torture to use.

Anyway, my new insurance wouldn't recognize or support my therapy without a more recent sleep study. The Sleep Doctor told me that they would do a split study, I told him that I didn't think it would work. He seemed to feel that it would. It seems that they have to confirm that OSA is present, before titration is done. (this seems to be the answer to your question)

So they wire me up and I try to sleep, they ended up with about 40min. of data and then had me to put my mask on, the tech reached for the straps of my Active, before I could grab his hand he cinched it down. I told him that it was too tight. He said that it had to be tight otherwise it would leak. I couldn't get to sleep and finally loosened the straps and went to sleep.

Suprise, surprise: My new proscribed pressure is 9cm.

Lyza · Post by **Lyza** » Tue Feb 06, 2007 4:12 pm

new insurance with a new primary care physician reads HMO insurance to me. HMO won't do crap the intelligent, logistical way. Yes I'm on HMO insurance myself.

CollegeGirl · Post by **CollegeGirl** » Tue Feb 06, 2007 4:31 pm

Oldgearhead, to do a split night study they need 3-4 hours of sleep data first. If he's not sleeping (and really, after getting used to it, who COULD sleep without it?!) they're not getting 3-4 hours of data.

TomDac · Post by **TomDac** » Tue Feb 06, 2007 5:38 pm

Thanks for all the replies folks...

I do NOT have the original sleep study results.. I had Kaiser Permanente back then and shortly after I got my CPAP, my employer ditched Kaiser and went with another insurance company. Seeing how I didn't really use Kaiser except to get my CPAP, I didn't get my records transferred to my new Dr, who I didn't even go see for a few years (my bad).

Over the years, I've never used any insurance to purchase accessories for my CPAP - thought it was too much trouble, so I just bought new masks, headgear, hoses, etc. on my own on the internet (Montage Medical - they're great btw)

You're correct, I'm now on another HMO (Great West Healthcare).

So these "Auto" CPAP machines I've seen on cpap.com can be connected and set thru my computer with software??? WOW. That's cool and of course totally new to me.

I'm assuming I can get the prescription from last night's study from my PCP and then buy something on cpap.com... I guess I'll wait a week or two and then call my PCP and find out what to do... Apria Healthcare is the DME provider, so perhaps they'll just end up calling me.

Anyway, thanks for your comments.. I appreciate them...

BTW, what's the life span on CPAP machines? My current Tranquility is a little beat up, but still goin' strong after all these years.

Tom.

Julie · Post by **Julie** » Tue Feb 06, 2007 5:47 pm

Just to clarify something - you don't hook your machine itself to your computer, but the 'smart card' that sits in the side of the machine all the time. It goes into a little card reader that's hooked to your comp. and then you download the data and read it.

Wulfman · Post by **Wulfman** » Tue Feb 06, 2007 7:50 pm

TomDac wrote:You're correct, I'm now on another HMO (Great West Healthcare).

Tom,

Great West is the manager/processor of our group.....and it's a PPO. If you got a card from them look at it and see if it actually might say PPO.

In OUR case, they're pretty darned good to work with. (although it MIGHT be an apples and oranges situation....depending on your plan) I was able to purchase all of my equipment from CPAP.COM and was reimbursed for 80% of my cost.....once I got my prescription from the doctor. I was in communication with them throughout my process (for approvals).

Best wishes,

Den

rested gal · Post by **rested gal** » Tue Feb 06, 2007 8:31 pm

TomDac wrote:So these "Auto" CPAP machines I've seen on cpap.com can be connected and set thru my computer with software??? WOW. That's cool and of course totally new to me.

TomDac, an old borrowed HealthDyne Tranquillity Quest was the first cpap machine I used, a little over three years ago. To this day, I still don't know what pressure I was using (yeah, I used a little screwdriver to turn it up...lol) for 4 months until I bought myself an autopap online. As loud, ancient, and heavy as the HealthDyne machine was, it hooked me for life on "cpap" treatment, since I felt so refreshed and wide awake each morning from night #1.

Actually, you don't even need software to set up an autopap machine fresh from the box, bought online. Instructions come with it. You can use the buttons on top of the machine itself to adjust all the settings... the pressure range you want to use, ramp time and starting pressure if you want to use "ramp" (I don't) to start at a low pressure and build up to "prescribed" pressure. Set "C-Flex" to give a comfy (for most people) slight reduction in pressure at the beginning of each exhalation.

Sure beats guesstimating with the little screwdriver.

I think you'll also be pleased with how much quieter and lighter in weight the current machines are, compared to the old Tranquillity.

Back to the software -- even though you don't absolutely need it in order to tweak and adjust the machine to your heart's content, it is extremely useful (not to mention interesting) to have the software in order to "see" what went on during the night while you were sleeping blissfully, sucking in that good air. Helps to see the leak rate especially, imho.

If you decide to completely skip insurance hassles and buy an autopap online, like from cpap.com, I think a copy of your old prescription from years ago will suffice. Or just get your PCP to write one word on a prescription. Just the one word "cpap" (doesn't even have to state a pressure, since autopaps come preset for a range of 4 - 20 cm H20) on the Rx will let you order an autopap from cpap.com. After you receive the machine you could set the range how you want it. For example, if a sleep study titration came up with "13", I'd probably use 11 - 16 as the range and would set the C-Flex at 2 or 3 ("3" giving the most pressure drop at the beginning of each exhalation.)

Me...I'd get the Respironics REMstar Auto. Either the previous "tank" (describing the slightly bigger size) or the smaller M series Auto. I'd get the integrated heated humidifier with either one.

Should it turn out that you do better on straight cpap, an autopap can be switched to cpap mode. Two machines in one. If you don't like C-flex, that can be switched off. You can operate the REMstar Auto as a straight CPAP with or without C-Flex, or as an Autopap with or without C-Flex. By golly, now you've got four machines in one!

Go for it, TomDac. After that many years of being such a compliant puppy, you deserve it.

P.S. check your private messages - button at upper right of this page.

TomDac · Post by **TomDac** » Tue Feb 06, 2007 9:09 pm

Thanks for all the info, folks... I appreciate it.

I'm a computer geek, so getting a new unit that can record data and dump it into my computer via a smart card is COOL!

My coverage is DEFINITELY HMO via Great West.....

Anyway, I'm sitting here asking myself, "Why are you still awake? Get to bed"....

Thanks again all...

Tom.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Smart Card

Sadie · Post by **Sadie** » Wed Feb 07, 2007 12:18 pm

rested gal wrote: <snip>... since autopaps come preset for a range of 4 - 20 cm H20) on the Rx will let you order an autopap from cpap.com. After you receive the machine you could set the range how you want it. For example, if a sleep study titration came up with "13", I'd probably use 11 - 16 as the range

Rested Gal: I'm curious...the range really wouldn't NEED to be altered, would it? ...if the preset range includes the titrated range.

...just wondering, and considering NO ramping.

Thanks!

Mile High Sleeper · Post by **Mile High Sleeper** » Wed Feb 07, 2007 12:32 pm

TomDac, if you haven't already read it, see the article under the light bulb above/our collective wisdom on machines. It talks about apap, software, has lots of links.

Be assertive with your DME to get the machine you want. I got an apap w/ software capability from Apria but was luckier than many. You can ask your doctor to prescribe a specific machine and model; then the DME has to give you that one.

Lyza · Post by **Lyza** » Wed Feb 07, 2007 1:48 pm

Mile High Sleeper wrote: You can ask your doctor to prescribe a specific machine and model; then the DME has to give you that one.

NOT always true, especially with HMO! I did the same thing couple weeks back and HMO denied it. "Didn't medically qualify for that type of machine" when standard cpap machine was working just fine.

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