False Start

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Mad Scientist
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False Start

Post by Mad Scientist » Mon Mar 20, 2023 5:57 am

So this past Friday I had an appointment at my DME to get my machine and get started with CPAP. He asks me if I had an at-home or in-lab sleep study, and I tell him I had one at home, and was scheduled for an in-lab study in a couple weeks. This stopped him dead in his tracks. He asks me to clarify...

I tell him I was scheduled to get my machine that day (March 17), and I was told to use it until my in-lab study on April 7. Then I was told to bring my machine to my in-lab study, and they would do a titration test and adjust the pressure to the best level for me during the study. Then I would go to a follow-up appointment on April 12 to make sure my numbers were good.

None of this made sense to him. He told me if I was already prescribed a machine, there was no need for an in-lab study for titration, and if they DID feel it necessary to do the second study, then I really shouldn't be committing to a machine beforehand because the study might show I actually need a BiPAP or something other than the machine I'd have already been committed to paying for.

Ultimately we decided it would be best to wait until he could get a hold of the sleep lab to figure things out (it was at the end of the day on a Friday and the lab staff were already gone).

I'm glad my DME person helped me avoid what could have possibly been an expensive error, but I'm frustrated that I have to wait even longer for my machine. Anyone else ever hear of this kind of issue?

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Rubicon
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Re: False Start

Post by Rubicon » Mon Mar 20, 2023 6:27 am

Frequently.

In the case of severe OSA, patients were often started ASAP to get them out of of immediate danger.

What constitutes "immediate danger" discussion to follow...
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

Mad Scientist
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Re: False Start

Post by Mad Scientist » Mon Mar 20, 2023 8:44 am

Interesting.

I mean, the way it was explained to me at the sleep lab made sense. Like you said, I feel like the plan was to get me on a machine ASAP and then tweak the details later.

But my DME person AND his sales rep said they had NEVER heard of this kind of scenario. It's honestly made me feel uneasy about this whole situation.

Why not have accomodations for this kind of scenario? My at-home sleep study was done on Feb. 22, and my appointment with my DME was over three weeks later - so it would seem like they didn't feel it was THAT urgent. But then why would they expect me to start payment on a machine that may or may not be the one I need, and expect me to eat the cost if it isn't AND pay for a different one?? I have insurance and I'm willing to invest in equipment I need to stay healthy - but this is not an arbitrary amount of money for me. It seems like there should be some sort of loaner or temporary rental service in place for people who need treatment immediately yet haven't had the details of their diagnosis completely worked out.

I know folks here aren't involved in my situation directly and can't really provide a definite answer, but it's a very frustrating situation to be in.

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ozij
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Re: False Start

Post by ozij » Mon Mar 20, 2023 9:36 am

Why did you have a sleep study at all?
Who ordered it?
Did you get its results? Do you know what they were?
Mad Scientist wrote:
Mon Mar 20, 2023 5:57 am
I tell him I was scheduled to get my machine that day (March 17), and I was told to use it until my in-lab study on April 7
You "were told"? Who told you?
Who is (or are) "they" in the following:
Mad Scientist wrote:
Mon Mar 20, 2023 5:57 am
Then I was told to bring my machine to my in-lab study, and they would do a titration test and adjust the pressure to the best level for me during the study.
Mad Scientist wrote:
Mon Mar 20, 2023 5:57 am
He told me if I was already prescribed a machine, there was no need for an in-lab study for titration, and if they DID feel it necessary to do the second study,
Mad Scientist wrote:
Mon Mar 20, 2023 8:44 am
I mean, the way it was explained to me at the sleep lab made sense.
Who did the explaining?
Mad Scientist wrote:
Mon Mar 20, 2023 8:44 am
so it would seem like they didn't feel it was THAT urgent. But then why would they expect me to start payment on a machine that may or may not be the one I need,
They? Who is the "they" who expected you to "start payment on a machine that may or may not be the one I need".

People on this forum have been prescribed different machines from the ones they started out with, when doctors realized the first machine couldn't do the job.
If "they"" scheduled you for a sleep lab study, based on your at home results, what did "they" see that caused it?

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Rubicon
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Re: False Start

Post by Rubicon » Mon Mar 20, 2023 10:16 am

Rubicon wrote:
Mon Mar 20, 2023 6:27 am

What constitutes "immediate danger" discussion to follow...
And as foretold by the prophet...
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

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chunkyfrog
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Re: False Start

Post by chunkyfrog » Mon Mar 20, 2023 10:29 am

You are correct that urgency arose for unknown reasons.
I can imagine a yacht payment coming due.
Their emergency is just theirs.
Do not panic--and hold on to your towel.

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Miss Emerita
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Re: False Start

Post by Miss Emerita » Mon Mar 20, 2023 10:40 am

I'd like to underline this question: what were the results of your at-home sleep study? It would be especially useful to know your AHI and the breakdown of it into obstructive apnea, central apnea, and hypopnea.

It would also be very helpful to know what the sleep report said about follow-up treatment. Please be aware that if you live in the United States, you are entitled to receive a copy of your sleep report. I recommend that you get one asap if you don't already have one.

If there's no reason to suspect you might need a different kind of machine, then there's really no need for an in-lab titration. Your settings can be fine-tuned using the data recorded by the SD card that will be in your machine. If there's reason to suspect you might need a different kind of machine, then I believe ideally you'd be titrated in the sleep lab using a special titration machine that can emulate the different kinds of machines you might wind up needing.
Oscar software is available at https://www.sleepfiles.com/OSCAR/

Mad Scientist
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Re: False Start

Post by Mad Scientist » Mon Mar 20, 2023 12:56 pm

Okay, to clarify things a bit...

I've snored for a long time. I knew it, and when I got married it became an issue for my wife's quality of sleep. Over the past few years I've gained a little weight, and of course that didn't help. So with the encouragement of my wife, I bit the bullet and talked to my primary care physician. He recommended a sleep study.

I had one appointment at the sleep lab, and was prescribed an at-home sleep test. I did the rest, the machine said it was "successful" (I got the green light), and returned the device. A couple days later I went back to the sleep lab and got my results. (I did NOT get a copy of anything). I believe it was a nurse practitioner that gave me my results, it was not the doctor who prescribed the test. She said my AHI was 70 and explained that my blood-oxygen level got low for a certain amount of time. She is the one who explained to me the process of getting the machine, using it for a while, bringing it to the in-lab test for titration, continuing to use it, and then having another follow-up appointment to verify it's effectiveness. The administrative assistant placed an order to the DME, and scheduled me for both the in-lab study and follow-up appointment.

I got a call from the DME's head office. She set me up with an appointment at a local store and explained the payment process. I had to give her a credit card number, and she explained I'd have one large initial payment that covered my deductible and a portion of the machine's cost. For me that would be about $382, then I'd have an automatic monthly payment of $24.50 for the remaining eleven months.

When I got to the DME he asked me what tests I had done, and that is when the confusion started. The DME explained that this is not the usual process, and that if I walked out of there with a machine the initial $382 charge would be processed and non-refundable. If the results of the in-lab test showed I require a different machine, I would have to turn the unit I just paid on back in and start payment again on the new one. We rescheduled until he can verify the process with the sleep lab.

Mad Scientist
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Re: False Start

Post by Mad Scientist » Mon Mar 20, 2023 1:25 pm

ozij wrote:
Mon Mar 20, 2023 9:36 am
...If "they"" scheduled you for a sleep lab study, based on your at home results, what did "they" see that caused it?
To answer this specifically, the PA didn't tell me the in-lab study was because of anything specific that was found during the at-home test. She told me that when I got my machine it would be set for an "approximate range" of pressure, and that the purpose of the in-lab test was to do a titration test, which she explained meant they would monitor me during the night and adjust the pressure accordingly to a range more suitable for me specifically.

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chunkyfrog
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Re: False Start

Post by chunkyfrog » Mon Mar 20, 2023 1:38 pm

Yep--yacht payment.
Do you have insurance?
I, and many others, have self-titrated with an APAP--
far more accurately than all those $leep $tudies.

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Miss Emerita
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Re: False Start

Post by Miss Emerita » Mon Mar 20, 2023 1:50 pm

I'd still like to know the breakdown of your AHI. Unless you had a lot of central apneas, I don't see a need for you to have an in-lab titration. But if you DID have a lot of centrals, then yeah, might be a good idea (though with other types of machines available to be trialed as well).
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Mad Scientist
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Re: False Start

Post by Mad Scientist » Mon Mar 20, 2023 1:57 pm

I do have insurance.

And I'm feeling now like I got the quick-and-dirty diagnosis. The PA literally only told me I stop breathing 70 times an hour, and my blood oxygen dropped too low for a certain amount of time. I wasn't given a report or explained what central apneas are or told about different machines or anything.

I know I'm responsible to advocate for myself and ask questions, but outside of what research I did online I didn't know what I should ask about or have explained to me.

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Julie
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Re: False Start

Post by Julie » Mon Mar 20, 2023 2:09 pm

As was said above, your results must be available to you by law - get them and come back to this thread. You can screen shot them, post to Imgur.com and leave that link here for experts to look at and if necessary make suggestions to tweak whatever might be a good idea (pressures, etc). Posting directly here is difficult now because the forum's too full of attachments, so e.g. Imgur has to be used 'until'.

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Rubicon
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Re: False Start

Post by Rubicon » Mon Mar 20, 2023 2:20 pm

Mad Scientist wrote:
Mon Mar 20, 2023 1:57 pm
The PA literally only told me I stop breathing 70 times an hour....
AAAAAHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

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Rubicon
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Re: False Start

Post by Rubicon » Mon Mar 20, 2023 2:28 pm

Mad Scientist wrote:
Mon Mar 20, 2023 1:57 pm
...my blood oxygen dropped too low for a certain amount of time.
Need to know the real numbers.

BTW how old are you?

From the practical point of view, you've probably been doing this for a long time, so a little while longer won't make much difference.

That said, now they KNOW you're bad, so if an event does happen (and the likelihood is more like it would be something that would happen as a result of falling asleep at an inopportune time, resulting in an automobile or industrial accident or the like) now they have a monster liability.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.