Two sleep studies and now questions...

So I had my first sleep study about three weeks ago and it came back with an AHI of around 120. After that I needed to be scheduled for a CPAP titration sleep study, which I completed last night.

First let me say, I am on a high-deductible health plan. I don't want this next part to sound condescending, etc but most people don't get it... My health plan is probably different than a lot of peoples health plans. I will pay for 100% of my actual medical expenses (insurance negotiated rates) up until I reach my deductible of almost 4000. So my first sleep study was ~400 and the one last night was ~500. That said, I have no issues planing this because plan premiums are low, and I will but whatever is best for my issues. However, I need/like to understand what value I am getting for my money and evaluate medical purchases just the same as all other (if that makes sense).

That said, I think I finally have some good news with my sleep issues over the last year or so. I had my CPAP Titration Sleep Study last night. It'll be a few days until I get my results but I slept great. The office had me try on all three type of masks and I decided on the nasal pillows. The tech said I could try it as long as I didn't open my mouth. If I opened my mouth I'd need to do the full face mask. Well I fell asleep within about 10 minutes and only remember waking up one short time (feeling my nose wondering what was in there) and then quickly fell back asleep. 6h15m later I was awoken by the tech at the end of the study time. All day I have felt way more refreshed than normal. I can't wait until I get the results and can start this at home. My AHI is almost 120, and while they couldn't tell me the results last night, they said I was so much better. To help in the end, when I told my tech I was on a high-deductible HP, so everything will be out of pocket, she gave me the exact mask I used for the evening (ResMed AirFit P10). I hope all goes smooth from here.

That said, I do have some questions:
1) I passively asked about the APAP machines vs CPAP and the tech said she hated APAP machines and CPAPs were much better. I really didn't get a good explanation why, but I'm curious here, if anyone here had thoughts?

2) I asked at the end of the night what pressure I was on and they said 15. From what I'm reading "pressure" doesn't really matter as long as the machine can deliver it. Is that correct?

3) After I get the report, I'm assuming it'll have a Rx for a machine, etc. I'm guessing I have to wait until then to get the stuff from cpap.com or whatever site I want to use? I have attached a picture of the machine that I was hooked up to last night. The tech said that was a professional machine.

Anything else I need to know in the next few days as I prepare for my final CPAP titration report and choose the machine, etc to buy?

Sorry for the long post, thanks for reading. I will continue to update this post as I get my results from the titration study. If anyone has questions about my initial study (other than the 120 AHI) I have the complete report and should be able to answer whatever.

Welcome to the forum.

Get an APAP capable machine if at all possible...they are simply cpap machines with additional modes of operation or functions available.
A fixed cpap pressure machine has one mode of operation...a fixed single pressure.
an APAP capable machine will have 2 (sometimes 3 depending on brand and model) modes of operation available so like getting 2 machines in one package. You may or may not need or want the apap (auto adjusting pressure) mode but it's always better to have something and not need it than to need it and not have it.

There are times when having a machine be able to auto adjust the pressure can come in real handy.
I like to use myself as an example....my OSA is worse in REM stage sleep...REM makes up about 20 % of the total night's sleep. In REM I might need 6 to 8 cm more pressure than I might need in non REM sleep. It's so much more comfortable using the higher pressures only when needed instead of having to use it all night.
Same thing can be said about pressure needs and sleeping on one's back....sometimes we need more pressure when on our backs.
Both are common...it's not something that is a rarity.

Target the ResMed auto adjusting model machine and in the latest model that would be either the AirSense 10 AutoSet or the AirSense 10 AutoSet for Her.
See this manual for explanations of what it can do
https://sleep.tnet.com/home/files/resme ... -guide.pdf

The reason I suggest ResMed over Respironics for you...mainly the higher pressure needs that you might have if you end up needing that 15 cm pressure all night.
Should you maybe need a little more at times or you end up having trouble exhaling at those higher pressures I think that the ResMed's exhale relief at the higher pressures is a better option.
I have used both brands...and in some situations I say it probably doesn't matter which brand but in some situations I go directly to recommending the ResMed. Also the machine's auto adjusting algorithm (should you end up wanting to use apap mode) responds faster than Respironics and often this ends up meaning that a person can get by with a little less pressure when the machine can respond faster.
Another example...with the Respironics in APAP mode I need a minimum of 10 to get the same results as I can get with a minimum of 7 on the ResMed apap machine. Might not sound like much but sometimes 2 or 3 cm difference can end up being big in terms of comfort.

You are close to maybe even needing a bilevel machine. ResMed's EPR exhale relief will come closer to mimicking a bilevel machine than the Respironics can.

The For Her AirSense 10 Autoset...had 3 modes of operation.
CPAP fixed mode
the regular auto adjusting (apap) mode that the other AutoSet has
plus an additional different auto adjusting mode (explained in the manual).

If you were a family member of mine...you would be getting at least the AirSense 10 AutoSet.

Do get your sleep study results from the titration study...before actually trying to buy one though. We don't want any hidden surprises in that study pointing to maybe a different model machine like a bilevel.

Always get auto adjusting capable if you can because it might come in handy to have that extra mode.
The tech who says cpap is best...I would have to strongly disagree with that person. I have personal experience to the contrary. 9 years worth of experience with various machines over the years.
You can always use the apap capable machine in cpap mode if you wish but you can't ever make a cpap only mode machine do anything other than fixed cpap.

1) Ignorance on her part... maybe they're too complicated for her to understand (they're really not).
2) I don't understand the question. whatever pressure you need to alleviate events is what you need.
3) yeah, you usually need a prescription. I don't see any pics.

palerider wrote: ↑

Fri Jul 13, 2018 10:52 pm

1) Ignorance on her part... maybe they're too complicated for her to understand (they're really not).
2) I don't understand the question. whatever pressure you need to alleviate events is what you need.
3) yeah, you usually need a prescription. I don't see any pics.

Sorry didn't attach them... It is just a picture of a Phillips Resptronics Omni Lab Advanced system one type machine.

Side thing. At first when the slightly warm wet air was blowning in my nose I thought it was too hot, however, I fell asleep fine. I'm reading other posts here and it seems that temp and humidity percentage is set. Will that be in my titration report or do I have to call the lab to see the setting?

I don't ever remember seeing a humidity and hose air temp setting as part of any titration sleep study. Normally it's just the recommended pressure setting along with any exhale relief.

Humidity and hose air temp are considered comfort features and can vary a lot and not something the titration study really works at.
Besides the humidity setting needed for optimal comfort can vary if the ambient humidity varies and the same with the hose air temp.
It's usually something that the patient gets to figure out at home what he/she ends up liking the best.

When in doubt...go with the factory defaults for humidity setting and hose air temp as a starting point. The reason they are the default settings is because that's what most people do well with.

trekwars2000 wrote: ↑

Fri Jul 13, 2018 11:09 pm

palerider wrote: ↑

Fri Jul 13, 2018 10:52 pm

1) Ignorance on her part... maybe they're too complicated for her to understand (they're really not).
2) I don't understand the question. whatever pressure you need to alleviate events is what you need.
3) yeah, you usually need a prescription. I don't see any pics.

Sorry didn't attach them... It is just a picture of a Phillips Resptronics Omni Lab Advanced system one type machine.

Ah, yeah, I've seen those funny lookin things... I've got one of the Resmed S9 lab systems here... it's interesting to tinker with.

trekwars2000 wrote: ↑

Fri Jul 13, 2018 11:09 pm

Side thing. At first when the slightly warm wet air was blowning in my nose I thought it was too hot, however, I fell asleep fine. I'm reading other posts here and it seems that temp and humidity percentage is set. Will that be in my titration report or do I have to call the lab to see the setting?

You woudn't want to get any info like that... humidity settings are *VERY* individualized... you'll just have to tinker with them to see what YOUR nose and sinuses like.

palerider wrote: ↑

Sat Jul 14, 2018 12:01 am

trekwars2000 wrote: ↑

Fri Jul 13, 2018 11:09 pm

palerider wrote: ↑

Fri Jul 13, 2018 10:52 pm

1) Ignorance on her part... maybe they're too complicated for her to understand (they're really not).
2) I don't understand the question. whatever pressure you need to alleviate events is what you need.
3) yeah, you usually need a prescription. I don't see any pics.

Sorry didn't attach them... It is just a picture of a Phillips Resptronics Omni Lab Advanced system one type machine.

Ah, yeah, I've seen those funny lookin things... I've got one of the Resmed S9 lab systems here... it's interesting to tinker with.

trekwars2000 wrote: ↑

Fri Jul 13, 2018 11:09 pm

Side thing. At first when the slightly warm wet air was blowning in my nose I thought it was too hot, however, I fell asleep fine. I'm reading other posts here and it seems that temp and humidity percentage is set. Will that be in my titration report or do I have to call the lab to see the setting?

You woudn't want to get any info like that... humidity settings are *VERY* individualized... you'll just have to tinker with them to see what YOUR nose and sinuses like.

LOL. I guess my point was, I did like the settings, so I'd be curious what they were if they were not the defaults.

Anyway, off to bed. This is the first day in a long time I've been up since this morning with no want for a nap and not even close to falling asleep when we were watching TV tonight. It's almost midnight. I'm bummed I won't have a machine right now and how the results come back quick so I can get this solved.

If anything matters, I do travel a lot for work, the machines seem somewhat portable but perhaps a little big for rollerboards?

Even if you knew the humidity and hose air temp settings in the lab...remember that the lab might have started with different ambient room humidity and temps than you will be using at home. So the same settings might not give you the same results at home. Might not feel the same.

[quote=trekwars2000 post_id=1258145 time=1531550960 user_id=875

If anything matters, I do travel a lot for work, the machines seem somewhat portable but perhaps a little big for rollerboards?
[/quote]

there ARE travel specific cpap machines. do a google search and have a look. or our site sponsor has an extensive array of machines (all sorts) and masks and so forth. find them at-

https://www.cpap.com/

good luck!

trekwars2000 wrote: ↑

Sat Jul 14, 2018 12:49 am

If anything matters, I do travel a lot for work, the machines seem somewhat portable but perhaps a little big for rollerboards?

The Resmed's smaller than the Respironics, and has a much better travel bag included. CPAPs don't count against your carryon allowance since they're medical equipment. The resmed bag also has a strap on back to slip over the handle of your luggage case.

To reinforce Pugsy's point about the humidity, the machines react to your room temp and humidity, so, even if you used the same settings (which are different between the respironics lab machine and the Resmed you'll hopefully get), unless your bedroom temp and humidity are the same, even the same settings on the same machine won't necessarily feel the same.

Worry about getting a different (smaller) machine for travel later after you have traveled with your machine.
Those tiny machines come with some baggage that you might not like and you might find that traveling with your forever machine isn't that big of a deal.
Cross that bridge later if you want to.

The biggest drawback for me...humidification...most of those tiny machines got tiny by eliminating humidification and my nose wants/needs its moisture. To do without it would mean having some really ugly nasal symptoms which would make me feel like crap during my trip.
The machines that are tiny that do offer more humidity...by the time you add the humidifier to the tiny machine you are back up to just about the size of your at home regular machine. Don't really gain that much.
Now if a person doesn't need or want the added moisture...and they are okay with more noise from the machine...might be worth it to someone.

Increased machine/motor noise and lack of adequate humidification are the 2 main drawbacks that keep me from wanting a tiny machine.

If the had had today's machines 20 years ago, I would not have had the surgery I did. The machines back then we're much bigger than today's machines. My job required a lot of travel and l was already carrying a nebulizer because of my asthma. It was small enough to fit in my briefcase.

Okay got my titration sleep study report. They wrote a script for a CPAP machine with a pressure of 15. Also a heated humidifier, nasal pillow mask and all the assessories. I called the sleep center and they told me I could change it to an APAP and put in pressure of 10-17. I still need to get my doctor to sign the prescription. He is out of town for a week- I've got a call into the clinic to see if someone else will sign it.... needless to say I'm a bit frustrated about this process.

I got a list of the 7-8 DMEs in network in town. I'm on a high deductible plan so I may just buy online buy I think I'll stop into one or two and see what the costs are there. I'm told by my insurance the only way "they will pay for it" (I have it in quotes like that because I'm under my deductible so I'll be paying for it all) is to have it rented for three months and then purchased the 4th month. Sounds ridiculous to me.

Any inputs or thoughts on next steps for me?

Okay, so I finally have my prescription signed and I stopped by 2 DMEs on the way home today. It was definitely different than I was expecting. I guess I was expecting to see a storefront or demo area for multiple products, instead I saw a medical waiting room.

At the first DME she asked for my prescription and said there may be someone there I could talk to but it would take 7-10 days to verify benefits, get a pre-auth form (which is NOT needed by my insurance) and get my an appointment. However, she did have someone there I could talk to a bit about the process and some costs. They couldn't tell me my actual costs without my insurance info. When I asked about retail costs she did say the machine was like 950, tubing, blah blah.... She said it was a Respironics DreamStation DSX500H11. I am having problems finding that one as the only one on here is the S11 version (For $850). What she did say when I told her my insurance is that she thinks she could get me into that machine with all the stuff to start for about $250 and then about $35/month for whatever 13 months. I'm not sure if it is worth it to wait another week or to settle for this machine when I'm told the ResMed is the best. This DME did say this is the only thing they carry. They also don't seem to carry a lot of options either.

So off to the 2nd DME, a DME for the "huge" medical group in town. After going in I was told pretty much the same thing about the 7-10 day wait. When I asked about prices she said nothing could be discussed until my appointment. I asked how much stuff was retail if I didn't have insurance (which apparently is like me speaking latin) and she snapped back "we are not a retail store, we only deal with insurance"... I retorted, "it doesn't look like walmart...." Anyway, when i asked why then needed a pre-auth when it was less than $500/month to rent and she said that it was "for them" in case I was not complaint. Anyone know what that really means? Basically they won't see me without that, even though my insurance doesn't need it.

So I'm a bit frustrated now. With my prescription now (which took two sleep studies and almost two months to get) no one will talk to me for another week to two. Its ridiculous. I'm told I have severe sleep Apnea, shouldn't even barely drive my car but nah.,... no one can see me for another week... Is there no way to get this NOW? (minus online)....

I guess that does lead me to the last question. Should I just order this online. The first lady at DME I talked to was very nice, even suggesting I basically go to CPAP.com to buy it if I didn't really want to wait and my deductible was high anyway. But she doesn't really have a lot of options. The second DME couldn't have cared less. In both cases they wanted to see my sleep study with my persciption but I didn't give it to them. Why does the sleep study matter? Do they actually use the info in there or is a CYA with the script?

Sorry for the long and disjointed post. Frustrated and hot (only 112 in Vegas today...) I just want to SLEEP well!

Have you tried searching craigslist in your nearby areas for "CPAP"? I tried to schedule an appointment for a sleep study and the wait time was bordering on three weeks. I am incredibly impatient, and I bought one on craigslist a few days later, and am already up and running with a lot of help from the good people here. You are multiple steps ahead of me having already gotten a diagnosis, a pressure setting, etc. For you to still be put through these long waits and hoops just seems absurd to me, especially given that it sounds like you will be paying for it out of pocket anyways.

I got the Dreamstation Auto completely new in box with the humidifier and heated tubing and an Amara View full face mask for $350 on craigslist. That is precisely $1,257 (+ tax?) on cpap.com. The only downside I can really think of is that I can't imagine getting any kind of exchange for mechanical failure would be possible if I got a dud, but I could try again two more times and still come out ahead of paying full price online.

In my area, I would have to drive about an hour, but I can find another one of the same machine for the same $350. https://southjersey.craigslist.org/hab/ ... 10019.html
And it's not just one, there is another person who is even willing to ship it (PayPal buyer protection would be a good idea here) for $500. https://cnj.craigslist.org/hab/d/dreams ... 63121.html

It's worth a shot. In my case, it seems that the person I bought it from had some cadillac insurance plan and got new products from time to time despite being happy with their old setup, so they just sell them for profit.