newbie needs help

[tiredNorlando]

Good morning all, just a quick background on me.. I am 42 year old male, 5'11 200 pounds . I have always snored since I was a kid, once I got married back in 2011 my wife convinced me to go to a sleep doctor and get checked out.. so I did all the tests and then did a sleep study. the doctor said I had very mild apnea and he would not prescribe me a cpap, but prescribed me provent therapy. the provent seems to work sometimes, but if I end up rolling over on my back during my sleep I start to breath through my mouth which renders the provent useless. I ran out of my provent a few days ago and am still waiting on my package to arrive..

the past few days without using the provent I can hardly stay focused at work, I even fell asleep on my break in my office! I am so tired it is miserable! I fell asleep watching tv last night... my eyes are heavy and even people at work say I look like I haven't slept in days, which is what I feel like!

So I got to researching how I can get a cpap without a prescription.. I cant afford to go back for more sleep studies ( I have insurance but my deductibles are so high it will break the bank)


so my questions to you folks are

should I do an at home sleep study? I found one that is 175$ but is this company just doing sleep studies so they can sell me equipment? do I even need another sleep study?

cpap or apap? I've found an apap on amazon that has great reviews that does not need a prescription (Apex Medical iCH II Auto machine with PVA and Built-In Heated Humidifier (Second Generation)
would that be a waste of money?


basically I am just so confused right now and don't know what to do next! with all the information and different products out there its overwhelming to say the least..

I am leaning towards the home sleep study and then going with what they suggest after the study, but I am afraid they just want to sell me something..

ANY help of advice would be wonderful!

thank you all so much in advance
madison

[Cardsfan]

Get a copy of your 2011 sleep study results report. It is part of your medical records and you have a right to have it. If your report shows you have sleep apnea, no matter how mild it is, get a Dr to rewrite your prescription from that.

[robysue]

Welcome to the forum tiredNorlando.

You asked a few questions that I'd like to address specifically.

should I do an at home sleep study? I found one that is 175$ but is this company just doing sleep studies so they can sell me equipment? do I even need another sleep study?

It may be worth getting the home sleep study done. Or not. Your choice. If you are going to want your insurance to pay for some of the cost of the machine or supplies, then you need to contact the insurance company and find out from them if they're willing to accept the sleep study from 2011. If so, then it's just a matter of getting a doctor (*any* doctor) to write the script ....

If your insurance does require a new sleep study, you'll want to make sure they accept the home study you are thinking about.

If you decide that you want to avoid the cost of a sleep study and/or you want to self-treat without a prescription, then the important thing is going to be to find a quality machine that records full efficacy data that you can read using software that you can get your hands on and install on your computer.

Which brings us to:

cpap or apap? I've found an apap on amazon that has great reviews that does not need a prescription (Apex Medical iCH II Auto machine with PVA and Built-In Heated Humidifier (Second Generation)
would that be a waste of money?

The Apex machines are not mentioned very frequently on this forum, and it's not clear to me whether they would work with the SleepyHead software that so many of us use to monitor the efficacy of our therapy. According to an old CPAPtalk thread at viewtopic/t90932/Apex-software.html the Apex software was available back in 2013. I have no idea if it still can be obtained from the links in that thread or not. I also have no idea what data is actually recorded by the machine you are thinking about.

In terms of machines, there are two very commonly used brands around here: Resmed and PR.

In the Resmed line, look for a Resmed AutoSet. Either an older S9 or the current AirSense 10 would work. And either the AutoSet or AutoSet for Her model is a great machine.

In the PR line, look for a PR System One Auto CPAP (either model 550 or model 560) or the current DreamStation Auto CPAP would work.

SleepyHead is also compatible with some F&P Icons and DeVilbiss Intellipap CPAP/Autos. There are some bugs with the SleepyHead/F&P stuff and the DeVilbiss machines do not record the wave flow data---i.e. the data that shows every breath you take all night long.

Finally, you write:

I am leaning towards the home sleep study and then going with what they suggest after the study, but I am afraid they just want to sell me something..

I'd check with the insurance company to see if they would recognize the results of a home sleep study for justifying coverage of CPAP equipment. If the insurance company insists on an in-lab sleep study, the home study may be a waste of time and money. If the insurance company is happy to use the results of a home study, then the cost is well worth it.

You can always tell the people who run the study that you will talk to your doctor before making any choice about what equipment to buy and where to buy it from. Here in the US, people who do medical testing are not supposed to be involved in selling the equipment that may be needed to treat the medical conditions they're testing for. But in practice, many sleep docs and sleep labs have found ways around that and they sometimes do try to push a newly diagnosed person to use the sleep doc/lab's choice of "DME". In that case, the best thing to do is to politely, but firmly push back and keep telling the people that YOU will make the choice of which DME to use for providing your equipment and that you will let them know where to fax your script once you've made a decision. Also ask for the script in writing. They are supposed to give it to you IF you ask for a written copy of it.

[tiredNorlando]

thanks for the replies! I think I am not going to even bother with going through insurance, my deductible is 1600$ and I am looking at around 800$ for test and machine... the company is http://www.rpmhst.com I dont know if anyone has dealt with them or not, if so any feedback would be great. they offer three machines all around 600$

I'm going to look for my results from my first sleep study and I can post the info here to see what you all think..

I am going to discuss all of this with my wife tonight and hopefully get the at home test done very soon and then go from there.

thanks again

[ajack]

I'd buy a full auto with sd card resmed or respironics, off amazon or low hour secondhand machine from one of the online sellers. secondwind 1800cpap etc.

as has been said, for a new machine, get a copy of your last test and get a doctor to write a script

[Mogy]

Hi tiredNorlando,
You say that the Provent has been working for you except when you are on your back. Have you tried a chin strap?
The reason I ask is because CPAP is not for everybody. If Provent is working, why go to all the expense and trouble only to find out the cure is worse than the problem.
Many people can't tolerate CPAP, and even though they have severe apnea, don't use their machine.
My goal is to improve my apnea so I can get by with Provent.
Maybe rent a machine for a month to see how
well you tolerate it.

[tiredNorlando]

I have the copy of the last sleep study, which doctor would I take it to? I dont have a primary and I had a falling out with the original pulmonologist who did the study..

as far as the chin strap, the provent only allows you to breath in through your nose and not out.. if my mouth is forced shut with a chin strap, how do I exhale? I would much rather keep the provent if it worked like it used to, but lately it just doesnt seem to work. I'm willing to try about anything at this point!

thanks again for the help

[tiredNorlando]

ok here are the results from my sleep study in 2012,, I have no idea what much of this means.. and the doctor didnt really explain anything at the follow up

epworth score 15
sleep efficiency 87%
sleep time 5.9 hours
sleep onset 19 min
rem latency 135 min
total number of sleep apneas 1
obstructive apnea max duration 29.6
mixed apnea 0
central apnea 0
total hypopneas 4
hypopnea max duration 43.5
total ahi 0.8
total rem ahi 5.2
total rdi 10.0
limb movements 84
limb movement index 14
limb mvmnt with arousal 1
arousal index 12.9 hour

[robysue]

I have the copy of the last sleep study, which doctor would I take it to? I dont have a primary and I had a falling out with the original pulmonologist who did the study..

Any doctor can legally write a script for a CPAP machine.

Do you have a medical doctor (for any condition) that you have a good working relationship with? If so, that's who I would suggest asking.

ok here are the results from my sleep study in 2012,, I have no idea what much of this means.. and the doctor didnt really explain anything at the follow up

epworth score 15
sleep efficiency 87%
sleep time 5.9 hours
sleep onset 19 min
rem latency 135 min
total number of sleep apneas 1
obstructive apnea max duration 29.6
mixed apnea 0
central apnea 0
total hypopneas 4
hypopnea max duration 43.5
total ahi 0.8
total rem ahi 5.2
total rdi 10.0
limb movements 84
limb movement index 14
limb mvmnt with arousal 1
arousal index 12.9 hour

See my blog entry, Understanding the data in your sleep test report for a tutorial about what all these numbers mean.

I will add: It's worth asking a doc (most likely a sleep doc or a neurologist) whether that periodic limb movement index of 14 is worth investigating.

[Mogy]

Hi Madison,
I am not sure you figured out what the sleep study said but I thought I would put in my 2 cents.
Your AHI was very low 0.8.
CPAP is to help reduce AHI, yours is already low.
Your AHI during REM sleep was a bit higher. 5.2
That is very mild apnea.
Based on this study, there are very few doctors that will give a prescription for CPAP.(although your apnea events are a bit long)
Usually you need an AHI of 15 before they will give you the prescription. This is because many people won't see enough of a benefit compared to the problems you may encounter with CPAP.
My AHI is 22 and CPAP treatment helps me a lot, but I can only use it a few hours a night because I wake up and can't get back to sleep while using it.
According to the sleep study, you're not sleeping due to limb movement. CPAP does nothing for that.
Your sleep study was 5 years ago. There is a good chance your situation has changed. It is probably a good idea for a new sleep study. I am not sure that the home study will help. It is more designed for sleep apnea.
About the chin strap to use with Provent. Apparently, you don't want to tighten it too much, is is more to keep your jaw from dropping. If you search Google there is more info.

[Mogy]

If I understand this correctly, snoring is often associated with flow limitations, which are events that are not quite apneas. But they are not part of your AHI. I am just speculating, but it is possible that Provent is helping reduce the flow limitations.

[palerider]

If I understand this correctly, snoring is often associated with flow limitations, which are events that are not quite apneas. But they are not part of your AHI. I am just speculating, but it is possible that Provent is helping reduce the flow limitations.

snoring, flow limitations, hypopneas and apneas are all different things: https://www.youtube.com/watch?v=-gie2dhqP2c

it's physically impossible for provent to help reduce flow limitations.

[tiredNorlando]

Just thought I would check in. I have purchased two different chin straps to try... I tried one week- provent with chin strap- I tossed and turned all night and felt like crap all day, almost worse with the chin strap, plus it hurt my jaw.. week two tried just the chin strap and it actually seemed to help about 50% of the time. BUT the issue is now the chin straps have already lost their elasticity! so both have been returned. back to square one

I had my wife try and watch me sleep the other night,she said I moved from my side to my back to my side to my stomach and stopped breathing a few times, of course snored like awful, she finally woke me up because she was scared.

so here I am again looking at spending 175$ for a home sleep study.. If I am snoring that bad and I am stopping breathing, one would seem to think thats pretty clear I have apnea wouldnt it?

again, I feel like I am so desperate to sleep I will pay whatever it costs to remedy the problem! if this is PLM issue, does anyone have this problem? if so what do you do about it?

thanks

[ajack]

If I understand this correctly, snoring is often associated with flow limitations, which are events that are not quite apneas. But they are not part of your AHI. I am just speculating, but it is possible that Provent is helping reduce the flow limitations.

I'd throw the provent as far as I could. Your lab sleep test would have tested for other stuff too. So getting mild sleep apnea is a good outcome. The sleep test is still valid, get a copy and take it to doctors, or buy a resmed/respironics full auto cpap out of your own pocket and use the forum to set it up.

[Pugsy]

Given what all you have said....if it were me I would just jump right in and get an apap/cpap machine that is a full data machine that has easy to use (and free) software and see if the machine helps your symptoms.

The really good home sleep studies are going to cost more than a good machine would.

This Phillips Respironics DreamStation would do all that you will likely need and it probably costs less than a comprehensive home sleep study.
https://www.amazon.com/DreamStation-Aut ... eamStation
You won't need a RX and if it ends up being that it doesn't help or you have to go a different route you can likely sell it and not lose much money.
The other alternative is to find a gently used similar machine but a full data apap even with some hours on it might not be all that much less costly.
Forum member grayghost4 might have one though...he dabbles a bit in both new and used cpap/apap/bilevel machines.

Your 2011 report showed very mild apnea and I can see why the doctor thought Provent might be enough but that was 6 years ago and there's no telling what might have changed in that time.

We have lots of forum members who have gone down the self diagnose and self treat road. With just a bit of education there's no reason you can't do it too.

I wouldn't go with the Apex....the software is hard to get and I am not sure just how detailed the reports are.
I would stick with the 2 big players in the cpap market...Phillips Respironics or ResMed.
Also stick with a model that has apap (auto adjusting pressure) mode available...while you can self treat with a fixed machine it is much easier with an auto adjusting machine and there's the added benefit of being able to use less pressure when not needed and letting the machine increase only when needed.
ResMed makes a nice auto but they cost more to start with (long story there) and if you could find a cheap S9 AutoSet (discontinued now) it would be worth looking at too.