Newbie with Questions

sleepergal · Post by **sleepergal** » Mon Nov 20, 2006 1:42 pm

Hi Everyone,

I was diagnosed with moderate sleep apnea a few weeks ago. My AHI was 29 with increase to 68 in REM. Average Sa02 was 96 with drops in REM to 85. When I met with the sleep doctor last week, he didn't say too much about what all those numbers meant - just told me I have moderate sleep apnea and needed a cpap machine (I had no apnea events on a cpap in my second sleep study). When I asked him about oral devices, he said I have two options. One is to meet with a dentist to check out an oral device and do another sleep study to see if it works and the other is to get a prescription from him for a cpap. The doctor said that he was "cutting me loose" at the end of our brief appointment and that my next step with his office to either request a sleep study for the oral device or a cpap prescription.

The next day, I met with my regular dentist who didn't know much. So I called the sleep doc's office for a referral to a more informed dentist. The office assistant expressed great surprise that I was calling for a dentist referral and told me she'd have to check with the doctor. She did get back to me with a referral. I meet with this dentist tomorrow.

Is it typical for doctors to recommend this approach? The doctor seemed to think that my insurance would cover the dental device and third sleep study but I have my doubts.

At this point, this forum is my best source of information. I have learned a lot from all of you since my diagnosis and really appreciate your generosity in sharing all of your hard-earned information.

I would appreciate any advice you have on questions I should ask the sleep dentist and this approach in general.

amos · Post by **amos** » Mon Nov 20, 2006 2:01 pm

Sleepergal,

I have read your post several times, and I am not sure that I understand your visit with the sleep doc. I am not sure if he misunderstood you or you of him.

First, of all an AHI of 29 is technically in the moderate range, but an AHI of 30 is considered serious. Also doctors become concerned anything you o2 saturation gets below 90. I believe you are a prime candidate for cpap.

I would suggest that before you do anything else, you check on your insurance program and see what it does pay for. Then determine what you can pay.

Hope your dentist appointment goes well. Please let us know how your visit with the dentist goes.

Amos

oldgearhead · Post by **oldgearhead** » Mon Nov 20, 2006 2:18 pm

next step with his office to either request a sleep study for the oral device or a cpap prescription.

I think the sleep doctor gave you good advice. He already knows that xPAP works from the PSG with CPAP. Furthermore, he knows the chances of a dental device halting your OSA is slim. Therefore, he wants to see another PSG after you get the dental device. Of course there is a third option, surgery. But surgery doesn't have the success rate of xPAP.

When you talk to the dentist, get the names of real people he has helped, and call them.

Your SAO2 level indicates a need for treatment, sooner rather than later.

I am not a medical professional and what I say here is only a reflection of my own experience..I would bet on the xPAP..

SelfSeeker · Post by **SelfSeeker** » Mon Nov 20, 2006 2:24 pm

Hi sleepergal

May I agree with amos, contact the insurance.

In the mean time.

Get a Rx for a CPAP or an APAP.

Get a copy of your Sleep study and your second study which is the titration.

Ask the Dr or his office why he is cutting you lose, is it insurace related or that you aske to many questions.

I agree with oldgearhead, if you go the dental route, get another study done.

Snoredog · Post by **Snoredog** » Mon Nov 20, 2006 2:25 pm

[quote="sleepergal"]Hi Everyone,

I was diagnosed with moderate sleep apnea a few weeks ago. My AHI was 29 with increase to 68 in REM. Average Sa02 was 96 with drops in REM to 85. When I met with the sleep doctor last week, he didn't say too much about what all those numbers meant - just told me I have moderate sleep apnea and needed a cpap machine (I had no apnea events on a cpap in my second sleep study). When I asked him about oral devices, he said I have two options. One is to meet with a dentist to check out an oral device and do another sleep study to see if it works and the other is to get a prescription from him for a cpap. The doctor said that he was "cutting me loose" at the end of our brief appointment and that my next step with his office to either request a sleep study for the oral device or a cpap prescription.

The next day, I met with my regular dentist who didn't know much. So I called the sleep doc's office for a referral to a more informed dentist. The office assistant expressed great surprise that I was calling for a dentist referral and told me she'd have to check with the doctor. She did get back to me with a referral. I meet with this dentist tomorrow.

Is it typical for doctors to recommend this approach? The doctor seemed to think that my insurance would cover the dental device and third sleep study but I have my doubts.

At this point, this forum is my best source of information. I have learned a lot from all of you since my diagnosis and really appreciate your generosity in sharing all of your hard-earned information.

I would appreciate any advice you have on questions I should ask the sleep dentist and this approach in general.

Goofproof · Post by **Goofproof** » Mon Nov 20, 2006 2:48 pm

[quote="Snoredog If a dental device is truly the therapy you want, then I suggest going over to TAS Dental Sleep Medicine forum and asking questions there. they can recommend the best device and if you then contact that device mfg, they can suggest a Dentist in your area that is experienced with fitting the device. My understanding from reading many posts over the years is the dental device is no cake walk either, they can have just as many problems as cpap therapy does. With whatever treatment you choose it is only effective if you stick with it. Stop for one night and your OSA is back.

[/quote]

Then when you get through with all that, come back here, get your XPAP treatment started, monitor your own treatment, and get better. Jim

Xpap treatment gives you a much better chance for success, if you make up your mind for it to suceed.

snoregirl · Post by **snoregirl** » Mon Nov 20, 2006 5:37 pm

Whatever you decide (and I vote for CPAP), get the prescription and copies of your sleep studies. You paid for your doc's evaluation, take the prescription. Why pay for another visit to get this later? Especially if you decide that the doc thinks you ask too many questions. May want to find another doc in the future,, but you don't need one now other than for the prescription.

Hold it and use it when you want to. It won't expire and you won't need to tell the doc if you are using it or not yet. Only issue is insurance may need a new Sleep study ($$$$$) if you want them to pay for CPAP and wait over a year from now. All depends on your insurance. If insurance is good get the PAP and give it a try.

ColoradoDreamer · Post by **ColoradoDreamer** » Mon Nov 20, 2006 10:35 pm

I discussed the four options I could take with my ENT when he went over the sleep study results with me. He said that I could do nothing, use CPAP, use a dental appliance or surgery. I told him surgery was out because surgery is hard to undo if it doesn't work. I would like to do something. I had looked into the dental appliance about a year ago and asked the ENT what the success rate was . His response was that it was not as good as CPAP. He felt CPAP showed the best results.

One can buy a cheap mouth piece you boil and bite for about $50 on the internet (I have not used it). The dental appliance, I too asked my dentist about it, will cost around $1K which is about what one would spend on a CPAP set up. The dental appliances are adjustable to achieve optimal performance. I can see why another sleep study would be necessary to make adjustments. Wonder how many times they they have to wake one up to make adjustments to the mouth piece during the study. Having to put on the mask at 2AM was bad enough.

Hope this helps. Do your research, prepare your questions and then ASK, check your insurance coverage, consider what you can sleep with...something in your mouth all night or something covering your face all night.

Snoredog · Post by **Snoredog** » Mon Nov 20, 2006 10:39 pm

[quote="snoregirl"]Whatever you decide (and I vote for CPAP), get the prescription and copies of your sleep studies. You paid for your doc's evaluation, take the prescription. Why pay for another visit to get this later? Especially if you decide that the doc thinks you ask too many questions. May want to find another doc in the future,, but you don't need one now other than for the prescription.

Hold it and use it when you want to. It won't expire and you won't need to tell the doc if you are using it or not yet. Only issue is insurance may need a new Sleep study ($$$$$) if you want them to pay for CPAP and wait over a year from now. All depends on your insurance. If insurance is good get the PAP and give it a try.

tomjax · Post by **tomjax** » Mon Nov 20, 2006 11:49 pm

I will be the contrarian here and will note that your doc is unfortunately like too many are.
He may be a brilliant doc with a head full of knowledge, but his bedside manner stinks.
He sounds condensending to moi and seems to be lacking in the art, not the science of his craft.

relating to a patient is a decreasing skill today and the cause of many confused patients.

The days of Dr Kildare and Marcus Welby may be in the past. This is indeed unfortunate.

Do yourself a favor and go back and read lots of threads to get up to speed on your condition.

But you must also consider your own role in his attitude. After the study, you told him about the dental approach and this may have insulted his fragile ego.
He could have been more diplomatic in explaining your options though. I do not know how he took your dental suggestions.
It may be a failure to communicate.

rested gal · Post by **rested gal** » Tue Nov 21, 2006 5:08 am

sleepergal, along with the good advice you are getting from the other posters in this thread, here's a link that might help:

http://www.smart-sleep-apnea.blogspot.com
Mile High Sleeper's great information resource for cpap users.

Guest · Post by **Guest** » Tue Nov 21, 2006 5:06 pm

Hi Everyone,

Thanks to all of you for the wonderful advice. As suggested, I did contact my insurance company and found out they would pay for a dental device.

I went to the dentist this morning and he was terrific. He listened to me, talked to me, had me do a quick test to see if jaw advancement would work, then looked in my mouth. He immediately said that I had one of the longest soft palates he'd ever seen. He kindly but firmly advised me that a dental device would probably be a waste of money and do nothing for me. He suggested that I go see several ENTs and to try to find the very best one I can. He clearly thought I was a prime candidate for some type of surgery that fixes your palate. He didn't charge me anything and told me that he'd be happy to talk his diagnosis over with my future doctor if he/she has questions. He was very encouraging and very clear about what he thought. What a great experience.

I already have an appointment with an ENT in a few weeks because I need to deal with my chronic congestion. In the meantime, I'm taking the advice from this forum to get my prescription, get my CPAP, and get on with treatment. I desperately need some decent sleep, and I need to get on with my life.

Thanks again to all of you for the help.

Sleepergal

KimberlyinMN · Post by **KimberlyinMN** » Tue Nov 21, 2006 6:09 pm

Wow! It sounds like you had some pretty good experiences with the sleep doctor and the dentist!

Kimberly

bdp522 · Post by **bdp522** » Tue Nov 21, 2006 6:19 pm

I hope all your good experiences continue. Good luck with the ENT. Keep us posted!

Brenda

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