Insurance won't authorize CPAP

[bbarrett]

Hello,
I am new to this forum. I was diagnosed with sleep apnea last week. This is after 25 years of migraines and severe fatigue and doctors saying there is nothing that can be done for chronic fatigue. It has not been easy raising 4 boys when I am sick everyday. I have state insurance and they are not authorizing for me to get a CPAP. In my sleep study I only slept a few hours and had 15 apneas in my REM sleep. I was able to get a CPAP machine for free online and figured out how to adjust the pressure and other settings. It makes a loud noise and the mask is really uncomfortable, but I would like to use it while the doctor does an appeal which can take weeks. Any suggestions? I used a setting of 6 the first night, but noticed my throat still closes as I fall asleep. So the next night I used 6.4 and woke up feeling great with a clear head. I have had a horrible time with this insurance (kids had to take med doses higher then the recommended because it was cheaper for them/ also couldn't get help for my 9 year old who tried to jump off a balcony because 15 ft was not high enough to be suicidal...etc.) Is it dangerous to use a CPAP on your own or is something better then nothing? Thanks! Beth

[jamiswolf]

Hi,
Sorry you're having an insurance hassle. Is this Medicaid. I don't understand why they wouldn't.

OK, you had a sleep study...did they put a mask on you during the study? Often times they will do a titration (pressure determination) at the same time. Records of that are available to you...it's your legal right to get a copy. So do that, or check with your Doctor to see where he's like you to start.

What machine did you get? 6 is pretty low so if need by, you could go a little higher. It isn't a major risk going it alone...except you may not be getting optimal therapy. Does the mask fit you OK? Problems with leaks? It's a difficult enough thing to do without any local support.

But there are many good and helpful people here that should be able to help you get through difficulties until your insurance is approved.
Jamis

[jules]

if it is medicaid the coverage varies from state to state - not all states had covered sleep apnea in the past - not sure what the current status is

you had 15 events - was that an AHI of 15 or 15 events over several hours? that will make a difference assuming your insurance does cover CPAP - some insurance wants an index (hourly rate) of 5 and others want 15

[Slinky]

Meanwhile, if you continue to feel great at 6.4 cms of pressure, stay there. If you start to feel tired again for 3-4 nights then try another small raise in pressure.

Actually, what I usually suggest (and I'm JUST a patient) to those w/a fully data capable CPAP is to make ONE change and stay w/that ONE change for a WEEK. IF still not satisfactory then make ONE more change and stay at THAT change for a week. It might be slower w/o the data to help but that is still the better way to go.