Does my data qualify me to get cpap treatment?

[222844]

Untreated apnea has made my life difficult. After a severe foot injury I returned to school, I was formerly a chemist and am working on getting my license to work in a hospital lab. In the last 6 months I have gone from being a straight A student to flunking 2 finals in classes I had As in before the finals but I didn't have the energy to stay up and cram the extra hours. I flunked the last badly, the teacher gave me an incomplete or I would have flunked out of the program and it's the last class I need to finish the program. This teacher gets horribly behind and we had to do 19 new chapters of micro in 2 weeks. I get sick from any virus going around and it takes weeks for me to recover. In the last 6 months I have been sick 4 times. I also started sleep walking and fallen twice, once falling and hitting my cheek on the edge of my desk and once falling backwards and clunking my head on the floor. I worry that I have dementia sometimes I forget weird things, like what day it is. I work part-time as a cashier and I can barely handle the rules. Previously I've always been rated an excellent employee in much more demanding jobs. My access to physicans is poor because my insurance doesn't cover much. I had 2 appointments about these issues with drs last week, neither showed up. Does it seem these things are related sleep apnea?

I read through the DME it says they hypoapneas of 30 or more are covered. I'll list the data here and was hoping someone can tell me if I qualify to get cpap equipment covered.

Overall AHI 7.2 per hour
REM AHI 50
sleep efficiency 61%
sleep onset 12 min
latency to REM sleep 143 min
absence of sleep stages 3 and 4
REM sleep decreased by 40%

I appreciate your help in advance!

[Pugsy]

Welcome to the forum.

How old are you? Male or female?

We have no way to know what requirements might be for your insurance to pay for cpap equipment.
Some might use the over 5.0 AHI rule or some might use a different rule. You need to be asking the insurance company.

Not sure what the DME means with the "30 or more hyponeas"...is that per hour or over the entire night and if the entire night how long does that night have to be. That's an odd requirement to be mentioned in that manner.

What symptoms caused you to get a sleep study in the first place?

[Okie bipap]

Did the sleep report say what your oxygen levels were? With your AHI of 7.2 and REM AHI of 50, I think you are a good candidate for a machine. Some insurance companies will authorize machines for people with mild apnea if their blood oxygen levels drop below a certain level (usually 90%).

[Julie]

There are a couple of other sleep disorders that result in falling and similar symptoms... you may or may not have those and I'm purposely NOT naming them here because I believe you need to see some doctor asap (before you kill yourself) to be looked at, rather than Googling and asking a bunch of forum members out here about it. Apnea is just one among quite a few sleep problems and you may in fact have something else (not even sleep related) going on. Don't wait and if you have to talk to your insce. co. or an ER, or whoever, I think you shouldn't wait.

[D.H.]

AHI of >5 alone is enough! You qualify (according to most U.S. insurance). You should be titrated in a sleep lab if possible.

If that's not possible, you can get an automatic (that is data capable), set the range from 4 to 20, and self-titrate using SleepyHead. This is not ideal, but some don't really have a better alternative.

I suggest getting an automatic that is data capable, even if you are titrated in a sleep lab. You can always use an automatic as a fixed pressure machine (but not the other way around).

[nawchem]

Welcome to the forum.

How old are you? Male or female?

We have no way to know what requirements might be for your insurance to pay for cpap equipment.
Some might use the over 5.0 AHI rule or some might use a different rule. You need to be asking the insurance company.

Not sure what the DME means with the "30 or more hyponeas"...is that per hour or over the entire night and if the entire night how long does that night have to be. That's an odd requirement to be mentioned in that manner.

What symptoms caused you to get a sleep study in the first place?

44yo female, I was sent to an ENT with difficult sinus infection. I was telling the doctor about how I fall asleep everywhere and he recommended the study. The insurance has been difficult to move on things. I used to sleep walk as a kid, when in college the first time, it seemed to flare up again when I developed thyroid disease. I had thought the extreme fatigue was thyroid disease and the thyroid treatment helped with the brain fog, but I am so sleepy tired. I once crashed my car at 5pm when I dozed off driving a long time ago and often fall asleep in the car when I get home from work. My oxygen sat in the 95% range, 91% in rem sleep. During thyroid issue I was very obese but I lost all but 18lbs from normal weight now.

DME site has diagnosis of apneas or 30 hypopneas an hour, no mention of RDI.
I've been recommended for titration study. Figured if cpap works and they don't cover it I could buy my own with the prescription.

I usually drink approx 20 coffees a day, but with cashiering I have to monitor my fluids so I'm down to 1-2/day. The lack of caffeine exasperated the fatigue.

[nawchem]

There are a couple of other sleep disorders that result in falling and similar symptoms... you may or may not have those and I'm purposely NOT naming them here because I believe you need to see some doctor asap (before you kill yourself) to be looked at, rather than Googling and asking a bunch of forum members out here about it. Apnea is just one among quite a few sleep problems and you may in fact have something else (not even sleep related) going on. Don't wait and if you have to talk to your insce. co. or an ER, or whoever, I think you shouldn't wait.

I tried going to the urgent care as my insurance said they were behind on approving things, they refused to treat without broken bones or something tangible. I don't have a primary care at the moment, this last one disappeared the day of my appointment Wed and I was told they were gone. The one I was seeing sat morning changed the appointment location the day before and then didn't show up at either location.

[nawchem]

AHI of >5 alone is enough! You qualify (according to most U.S. insurance). You should be titrated in a sleep lab if possible.

If that's not possible, you can get an automatic (that is data capable), set the range from 4 to 20, and self-titrate using SleepyHead. This is not ideal, but some don't really have a better alternative.

I suggest getting an automatic that is data capable, even if you are titrated in a sleep lab. You can always use an automatic as a fixed pressure machine (but not the other way around).

I asked the insurance about doing a home study and they said they had never heard of it. I haven't worked at my job long enough to request days off and I used my whole years worth of sick time in the first month. So it will take a bit of time to even get to the titration. I have a job offer to work in my new field but it's overnight and my internship is overnight and I don't think I can handle weird hours in the state I'm in right now.

[nawchem]

Did the sleep report say what your oxygen levels were? With your AHI of 7.2 and REM AHI of 50, I think you are a good candidate for a machine. Some insurance companies will authorize machines for people with mild apnea if their blood oxygen levels drop below a certain level (usually 90%).

My lowest desat is 91%. Hopefully....

[nawchem]

AHI of >5 alone is enough! You qualify (according to most U.S. insurance). You should be titrated in a sleep lab if possible.

If that's not possible, you can get an automatic (that is data capable), set the range from 4 to 20, and self-titrate using SleepyHead. This is not ideal, but some don't really have a better alternative.

I suggest getting an automatic that is data capable, even if you are titrated in a sleep lab. You can always use an automatic as a fixed pressure machine (but not the other way around).

Is it possible to rent a cpap without a prescription to do a test?

[Julie]

If you're in the UK you'll need to find out the rules... most of us are in N. America.

[nawchem]

I appreciate you all listening to me. I've gone to my medical provider crying so many times, they've given me a case-worker. Hopefully, this is going to be solved soon.

Julie I am in the US.




JULIE[/b is this what you mean?

[Julie]

Great...

I'm wondering if you realize you don't need a new note every time you post... you can go to the previous one, hit 'edit' (the 'pencil' icon on the right above the note) and it will come up in the writing box so you can just add your new thought... and the next one, and the next , then hit submit.

[nawchem]

Julie
I'm confused. I don't have to quote I can use the pencil?

[Julie]

Nothing to do with quoting... if you have a new question or comment following the one you (more or less) just submitted, go back to that note, click on the pencil (which is 'edit') and you'll be brought back to the composing box where you can then start a new para. (as many as you like) below the previous one and then hit submit. Why start a whole new thread (or new note) for every thought?

Now, if you have a new one e.g. tomorrow, you can still (and should) come back to the same thread, but can then begin a new note in it (as you've done a bunch of here), but no need to do separate ones 5-10 mins after your last one just cuz you had a new (or even final) thought in the same vein. Or at least try to collect a few in a row in one note before hitting submit after every sentence.

Just realized you're trying to address each response you got individually... which is nice, but even then you don't necessarily need a new note if they're all shorties in sequence, just start new paras. with each person's name and your comment to them.