I Left My Sleep Study -- Undone.

[Nooblakahn]

If I understood it correctly the insurance wont pay for an aborted study. Then the sleep lab can charge you for the aborted study... that's his it was described to me by my sleep lab. Hope they don't do this to you as well. It was a hefty fee...

[BlackSpinner]

I believe insurance may require that a formal cpap test be taken. I know that Medicare requires it and most insurers follow -suit. In my case I had the sleep study at $3,000 a pop (found osa, csa & complex), went back for the titration for cpap (another $3,000) and finally a 3rd visit ($3,000 again!) for the vpap asv titration. I was confused and thought the provider had billed Medicare an extra time so I called Medicare. They investigated and found out that indeed the whole thing cost $9K. Incredible!

The OP had one when he started cpap. He has been on cpap and it has not been working. Why would he have to do a cpap test AGAIN?

[chunkyfrog]

If this happens, Papit may need to hire a (shudder) lawyer.

[Papit]

Oh, wow. I'm rather moved by so many quick replies here all trying to help. Thank you, guys. I'd like to respond to some on this page and PM's to others.

I believe insurance may require that a formal cpap test be taken. I know that Medicare requires it and most insurers follow -suit. In my case I had the sleep study at $3,000 a pop (found osa, csa & complex), went back for the titration for cpap (another $3,000) and finally a 3rd visit ($3,000 again!) for the vpap asv titration. I was confused and thought the provider had billed Medicare an extra time so I called Medicare. They investigated and found out that indeed the whole thing cost $9K. Incredible!

The OP had one when he started cpap. He has been on cpap and it has not been working. Why would he have to do a cpap test AGAIN?

Indeed, why a cpap test again? If really needed, for whatever reason, then why not also allow for the technician to also move on to bi-level and ASV instead of limiting him/her to use the entire night's session to cpap? That's what had me hung up. It didn't make sense. And made me quickly anticipate exactly what happened in MagsterMile's experience, three studies instead of two. I do think this new doc is a very good one. She may be hamstrung by policies beyond her control. At least she get's a chance to review the situation before we proceed.
______________

Insurance may be working against their own best interests, but . . . whatever.
Hope you don't get stung for the aborted sleep study--I know some insurance companies will do that.

I believe (or would like to believe) that this medical practice is a very high-quality center that gives priority to patient care first rather than highest profit margins attainable. That said, given all the horror story experiences we've all read at this Forum, I would not fall off my chair if their "bean counter" decides to go after me for the aborted session.
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It's sounds from your text, that your doc is prepared to write you a script for a BiPAP/ASV. However, if you are looking for insurance coverage, it is doubtful they will comply without a PSG in a certified lab. While data from PAP machine is certainly indicative of symptoms of CSA, it is likely not something the insurance company will embrace unless your doc can write a really good appeal.

This could be a valid insurance point, NotLazy. It could very well be that my doc simply wants to touch all the "bases" to make sure her patient's medical insurance claims will be covered. I guess that would explain a lot. If so, what a tragedy that our system places doctors and patients in this dilemma.

More to come. Thanks again teammates!

[Papit]

Hi Pugsy,
Thanks for your post today (see below). Your thoughts in second paragraph were mine exactly while talking with the technician and her supervisor. The big question is, 'Will the doc and the sleep study department in her practice be sufficiently flexible,' now that the issue has been raised, or does the patient come in second to profit margin. Honestly, I'm not too optimistic mainly because medical practices today seem too bureaucratic. And there's also the real chance that insurance company policy has her hamstrung. 'Twill be facinating to see how this unrolls.

I suspect that an in lab confirmation of the presence of too many centrals (per their criteria) was the object of the plain cpap sleep study.
I don't know how much weight the presence of centrals reported by a home cpap machine would carry with anyone. It does have some limitations.

That said, I feel they should have had ASV available "just in case" and have a tech doing the test that was certified to do ASV titration also "just in case".
They should have been prepared to proceed with the Bilevel machine and/or ASV type of machine.

[avi123]

Papit, I have read only your posts. IMO, you knew before the test, or should have known, all the answers but you wanted to do the test your way. So you have been doing kuntzim (fooling around).

Have we not talked before that you might be seeing John Fisher's Doc who is at Duke in Raleigh?

http://www.dukehealth.org/physicians/paul_c_peterson

If you want to be checked by Dr Peterson (who would arrange the sleep study) then you need to send them a referral from your Primary Doc.

[Papit]

Hi Avi. Good to hear from you as always.

. . . Have we not talked before that you might be seeing John Fisher's Doc who is at Duke in Raleigh? . . . If you want to be checked by Dr Peterson (who would arrange the sleep study) then you need to send them a referral from your Primary Doc.

Yes, we have and you make a good point. Had I seen Dr. Peterson, I think he is much more likely to have arranged a sleep study that begins with cpap test verifications and proceeds into bi-level and ASV sleep study segments in the same night's session. Maybe it would even have ended with an ASV titration -- if he's in a position to determine what he wants done by the technicians.
I may yet have to go that route. However, I am not as convinced as you that a top neurologist sleep doctor is needed. He's not exactly around the corner from me. You and I looked at my zoomed-in graphs and we agree that what we saw looks like instances of periodic breathing and what the machine graphs as rather high centrals. But neither of us is a Board-certified sleep apnea doctor. Nor am I sure that sleep apnea patients in general don't commonly have some instances of periodic breathing. And both Bi-pap and ASV machines have shown themselves to be effective even when prescribed by many sleep docs commonly available in local areas. So I have not forgotten about the doc who pulled off a 'miracle' for John, whose condition was very serious and complex, and I have that route safely tucked in my hip pocket in the event it's needed. Thanks for following my posts and graphs so closely and sharing your good insights. I know of your concern and that your head and heart are in the right place. We'll see if and when that route to Raleigh NC is necessary. I hope and trust that your therapy is coming along much better than mine.

[Drowsy Dancer]

If this happens, Papit may need to hire a (shudder) lawyer.

/s/ JD 1983, admitted to practice, NY 1984, WA 1987

[NateS]

Papit my friend,

All I know is that it took me three studies to get an ASV: 1) Diagnostic 2) Continuous pressure titration; 3) ASV.

In between 2 & 3 they wanted me to try out a CPAP first for a few months, but I refused and instead wrote a letter to the sleep doctor describing how miserable I was the day after the continous pressure and quoting the evidence of centrals from my 2nd report. I pointed out how my symptoms, both observed by me and in the 2nd report, coincided with a diagnosis or central apnea. He called me on the phone, agreed and set up study #3, whose results supported my request for medicare approval to their satisfaction.

Good luck!

Nate

[Papit]

Papit my friend,

All I know is that it took me three studies to get an ASV: 1) Diagnostic 2) Continuous pressure titration; 3) ASV.

In between 2 & 3 they wanted me to try out a CPAP first for a few months, but I refused and instead wrote a letter to the sleep doctor describing how miserable I was the day after the continous pressure and quoting the evidence of centrals from my 2nd report. I pointed out how my symptoms, both observed by me and in the 2nd report, coincided with a diagnosis or central apnea. He called me on the phone, agreed and set up study #3, whose results supported my request for medicare approval to their satisfaction.

Good luck!

Nate

Thanks for the input, Nate. That's amazing. Had you been on cpap therapy for a while and shown them your SD card? Three studies sounds like an overly milked cow.
Did they combine an ASV Study and an ASV Titration in your final study?

[avi123]

Papit, see this in the

http://www.fpnotebook.com/Lung/Apnea/CntrlSlpApn.htm

You can see that plain CPAP should be avoided in CSAS.

Neurologists are those to deal with it.

Excerpt:

Family Practice Notebook

I.See Also

A.Sleep Apnea

B.Obstructive Sleep Apnea

II.Definitions

A.Central Apnea

1.Cessation of air flow and respiratory effort for at least 10 seconds


III.Causes

A.Decreased responsivity of central chemoreceptors

1.Chronic Obstructive Pulmonary Disease
2.Pickwickian syndrome

B.Increased responsivity of chemoreceptors

1.High altitude

C.Delayed transit of information

1.Cerebrovascular Accident
2.Congestive Heart Failure

IV.Symptoms
A.Insomnia
B.Mild and intermittent snoring
C.Major Depression

V.Management
A.Avoid CPAP - it worsens Central Sleep Apnea
B.Tricyclic Antidepressants
C.Progesterone
D.Acetazolamide

[Todzo]

A central apnea is when you SHOULD have taken a breath but didn't.

In fact there are two basic flavors of Central Apnea. Hypercapnic (as you describe) and hypocapnic (breathing control goes out of wack so a time of breathing way too much is followed by a time of not breathing at all).

Hypercapnic central apnea is rare.

The time of not breathing with hypocapnic central apnea allows the body to restore more normal carbon dioxide blood gas levels which enable circulation and metabolism. It is more a time of recovery established by a more awake brain. So in this kind of central apnea the brain realized that too much breathing was going on and decided to stop.

[JohnBFisher]

A central apnea is when you SHOULD have taken a breath but didn't.

In fact there are two basic flavors of Central Apnea. Hypercapnic (as you describe) and hypocapnic (breathing control goes out of wack so a time of breathing way too much is followed by a time of not breathing at all).

Hypercapnic central apnea is rare. ...

Don't I just feel special! Sigh!

Unfortunately, that's my problem. I just periodically stop ... and my poor machine goes nuts trying to keep me on the straight and narrow. It's one of the symptoms of my neurological degeneration of my brain stem and cerebellum. But I agree ... it's pretty rare.

[JohnBFisher]

Papit my friend,

All I know is that it took me three studies to get an ASV: 1) Diagnostic 2) Continuous pressure titration; 3) ASV.

In between 2 & 3 they wanted me to try out a CPAP first for a few months, but I refused and instead wrote a letter to the sleep doctor describing how miserable I was the day after the continous pressure and quoting the evidence of centrals from my 2nd report. I pointed out how my symptoms, both observed by me and in the 2nd report, coincided with a diagnosis or central apnea. He called me on the phone, agreed and set up study #3, whose results supported my request for medicare approval to their satisfaction.

Good luck!

Nate

Nate, you were more collected about it than I was ...

I fear I was SO tired by the time I needed an ASV unit, I literally fell apart, crying when my neurologist recommended another Bi-Level titration. I asked "What will it change? .. My problem is that when I fall asleep I just STOP breathing. No effort. Nothing. And I stop so long that my Bi-Level machine assumes I am no longer wearing my mask ... How will another Bi-Level machine fix this?"

You definitely were more collected and coherent about it than I was. And Papit, I would not recommend taking my approach! Well, at least my doctor knew that my feelings of frustration were heart felt.

Of course, I've been dealing with that and neurological issues. And it just got a bit overwhelming. Shoot, it's still overwhelming at times.

Needless to say, my neurologist did listen at that point and set me up for an ASV titration. It was wonderful. Even though it takes a bit to get used to the ASV therapy, it allowed me to sleep deeply for the first time in months/years.

[Papit]

Now that my new CPAP study and Titration has just been completed, "Chapter 2" of this thread can be found at viewtopic/t89740/New-Sleep-Study-Done-- ... eport.html. I posted the complete report there and the new doc's recommendations.