Failed sleep study after 14 years on the hose

tl;dr just your usual angry failed sleep study rant.

It is beyond me how insurance (It's *all* driven by insurance) can demand such torture. I think, in my initial study, the tech was just kind... or perhaps I was able to sleep somewhat... they mentioned something about not quite meeting the full AHI criterium, then slapped the mask on me... REM rebound/recovery ensued of course.

So it's been a decade and a half and I imagine it's time for another one. My original prescription of 10cm I have self-titrated to 15-20 with EPR 2. Getting numbers below 1 AHI, sometimes pop a zero. My doctor tells me that insurance and Medicare want a study every 10 years... so I agree, I'm thinking I want to progress to bi-level and get a clinical titration. Would that it would be so easy.

Here's a recommendation from me... try it at home. Not saying get a Type 2... I'm saying see if you can actually sleep for 2-3 hours without CPAP, without all the wires etc. (and earth-shaking snoring going on next door). Use your O2Ring to see how it goes... you can shake your hand when you wake as a hillbilly EEG. I though maybe with the help of Benadryl I could get through it... so I popped three of them and was connected up.

Thing is, you have to have events *while sleeping*... IOW, you have to *willingly die* over and over until that magical AHI number, so important to Big Insurance, is reached. There's even a blank on the form, 'will you be using drugs to sleep, which one(s)', should have been a trigger warning. They're like Santa Claus in that regard... no fooling an EEG... and they don't care about drifting off, which turns out to be the point you need the most help.

They let me wear my O2Ring... *at first*. That's why I have the record I'm about to show you. As i finally start drifting off, every time I *immediately* wake up gasping... soon my ring is actually vibrating, letting me know I just popped a <90%. After two hours of this I ring the call button and complain 'you are seeing this right?', at which point the (obviously new) tech said 'your O2s look fine'... a ludicrous proposition. After three really deep desats I complain again... this time they *want me to take the ring off* because it's 'waking me up'. Starting to get angry here... I'm *wide awake*, gasping for air (they see the breaths, they see all)... the damn ring is *not* 'waking me up'... it's telling me the truth, that this torture is killing me slowly. It's been years since I've had panic attacks... had a little one *every desat*, even the minor ones.


Here's how you torture someone: So I take the ring off (at this point I don't trust their equipment) and continue to try and please Insurance. Not better... worse... I'm staying awake longer each time before the drift-off... and my brain is associating drifting off to sleep with *torture*... in other words, training myself to not sleep. *This is not good*.

Eventually I just take off the (highly restrictive and painful) finger cot with their O2 sensor and wait... after a few minutes the tech does show up... so at least their equipment is working... they just don't want to tell me *anything* about what's happening. I ask the tech what would happen if I just walk out now... she seems at a loss... I beg for help... she gets her lead tech.

Lead tech is all business... 'you've failed the study, we can't tell you anything except you didn't sleep enough, talk to your doctor... you have to lay in bed for another 15min and we'll let you go'. $600 down, no titration, and a night of torture.

At this point I'm pretty sure that the medical community has failed me. I do manage to get out the door without using much profanity. Went home and got on the machine... it took me up to 20cm, I woke, fighting to exhale, and put on EPR2 without a pressure reset... discovered later I popped the first CA I've ever had. Still, blissful sleep.

Here's the deal with this torture... it *enrages* your apnea... the places in your airway that are restricted? They *hurt*... damages the skin. I'd never thought about it that way, but last night was an eye-opener... the room humidity was probably 15% (they had central AC on) and I'm used to 85% controlled... this contributed greatly to the torture... I tried covering my head with a sheet to retain some moisture... not much help. Hit the Afrin and albuterol during the night... had an extra pillow from home... none of this helped, I had that feeling that the bed was tilted down at the head... both mouth and nose restricted. The snoring next door made me both angry and envious... how can *you* sleep through that racket? Next time bring a) heroin b) earplugs and c) room vaporizer. Oh... and a cup... I had to use my pill bottle as a cup for water.

So *if* I go back, I'll have to have some drug concoction to *make* me tolerate the death torture... we'll see what they're willing to give me. Or... at this point... just chuck the whole system. I have a 'forever' prescription to cpap dot com, I'm paying out-of-pocket for all equipment supplies/machines anyway... 2500$ deductible not worth meeting. I could have taken that 600$ and spent it on a good consultant with known track record... Lanky Jason has given up on insurance too. Just looking for a good bi-level titration... which I was informed by my doctor would be *another* night in the lab anyway.

Did you actually ever talk to your insurance company about the statement from your doc???
Or did you just take his word for it?
Medicare doesn't require a new sleep study....as long as the first sleep study met their diagnostic criteria and I would assume it did if Medicare has been paying for supplies, etc.

vandownbytheriver wrote: ↑

Sat Feb 10, 2024 3:18 pm

My doctor tells me that insurance and Medicare want a study every 10 years.

I'm the opposite. My original sleep study was 15 years ago. I requested another in November and it indsicated that I no longer needed the CPAP. The AHI was 4.8. I told my doctor that I was more comfortable sleeping with the CPAP. Sh said I could do what I wanted. I go back to see her in 2 months to decide if I definitely want to stick with CPAP. If so, she will make sure it is covered by insurance. Meanwhile I am going to try it both ways.

Pugsy wrote: ↑

Sat Feb 10, 2024 3:32 pm

Did you actually ever talk to your insurance company about the statement from your doc???
Or did you just take his word for it?
Medicare doesn't require a new sleep study....as long as the first sleep study met their diagnostic criteria and I would assume it did if Medicare has been paying for supplies, etc.

vandownbytheriver wrote: ↑

Sat Feb 10, 2024 3:18 pm

My doctor tells me that insurance and Medicare want a study every 10 years.

Nope... just took him at his word. I went on Medicare part A in November. I've been paying out of pocket for CPAP stuff... pointless to file with my work insurance, I don't spend enough in a year to satisfy the deductible. I'll check, thanks for the suggestion.

LSAT wrote: ↑

Sat Feb 10, 2024 5:00 pm

I'm the opposite. My original sleep study was 15 years ago. I requested another in November and it indsicated that I no longer needed the CPAP. The AHI was 4.8. I told my doctor that I was more comfortable sleeping with the CPAP. Sh said I could do what I wanted. I go back to see her in 2 months to decide if I definitely want to stick with CPAP. If so, she will make sure it is covered by insurance. Meanwhile I am going to try it both ways.

Congratulations... glad to hear it. What was your original diagnosis AHI? Have you lost weight etc? I.E. is there a reason you got better?

I never knew you could fail a sleep study.
My first one 13 years ago went smooth mild apnoea only 84 AHI.
Second one was only a titration for my Bilevel ASV machine (not even included in Philips recall) also went smooth.
The last 5 years I have been lucky enough to find used ASV machines here and have paid out of pocket. However my newest machine, I mentioned after the fact to my insurance company that if I got a new machine through them, their first 2 monthly payments would be more than covering 80% of what I paid for my lightly used machine. They actually sent me a check for the 80%. I almost didn't believe it, but the check cleared.

My original sleep studies were early in 2010,
grandfathered in, because the clinic is not a Medicare provider.
No mention has been made of another sleep study;
and I am not foolish enough to bring it up myself.
All my providers are aware that I KNOW what Medicare requires--or not.
--or they will be made aware, if they try to scam me.

vandownbytheriver wrote: ↑

Sat Feb 10, 2024 3:18 pm

My doctor tells me that insurance and Medicare want a study every 10 years

You are blaming the wrong party! Your doctor is FOS!

Your doctor is full of cheese.

Here's the American Academy of Sleep Medicine Guideline: https://www.cms.gov/medicare-coverage-d ... Id=227&ver

There is insufficient evidence to suggest that routine PSG and/or HSAT should be performed in patients who are responding adequately to PAP treatment as determined by symptom control and adherence to therapy.8,12,13 If symptoms return despite good adherence to PAP treatment, PSG or HSAT is appropriate. If there is an unexplained change in adherence, or there is clinical suspicion of a separate sleep disorder, then a repeat PSG may be considered, and might include PAP titration.3 If there is suspicion of another sleep disorder such as narcolepsy, then PSG should precede other testing, such as a multiple sleep latency test.

I can't find anything in the Medicare guidelines that shows a requirement for a new study every 10 years or ever. Ask your doctor to show you where he is getting that information--you want it in black and white. I'll bet he cannot. And if he intends to jeopardize your coverage for CPAP, find another doctor.

Janknitz wrote: ↑

Sun Feb 11, 2024 7:07 pm

Your doctor is full of cheese.

Here's the American Academy of Sleep Medicine Guideline: https://www.cms.gov/medicare-coverage-d ... Id=227&ver

There is insufficient evidence to suggest that routine PSG and/or HSAT should be performed in patients who are responding adequately to PAP treatment as determined by symptom control and adherence to therapy.8,12,13 If symptoms return despite good adherence to PAP treatment, PSG or HSAT is appropriate. If there is an unexplained change in adherence, or there is clinical suspicion of a separate sleep disorder, then a repeat PSG may be considered, and might include PAP titration.3 If there is suspicion of another sleep disorder such as narcolepsy, then PSG should precede other testing, such as a multiple sleep latency test.

I can't find anything in the Medicare guidelines that shows a requirement for a new study every 10 years or ever. Ask your doctor to show you where he is getting that information--you want it in black and white. I'll bet he cannot. And if he intends to jeopardize your coverage for CPAP, find another doctor.

Wow.

Thanks folks... I did in fact talk to an insurance chatperson today... there is no requirement for a periodic split-night sleep study. I also found that my doctor apparently owns the lab, or at least has his other office in the same building... a budding conflict of interest IMO.

I will not be going back for another torture session. I found a reputable hospital lab (Ascension Seton Heart Hospital) and have asked for a referral for a *titration*, not a split-night study.

I did find this interesting guide... which explains why there was an old S9 on the bedstand at the lab. Lots of interesting info here... I've seen some of the waveforms on YT videos before:

https://document.resmed.com/en-us/docum ... er_eng.pdf

vandownbytheriver wrote: ↑

Mon Feb 12, 2024 9:05 pm

Wow.

Thanks folks... I did in fact talk to an insurance chatperson today... there is no requirement for a periodic split-night sleep study. I also found that my doctor apparently owns the lab, or at least has his other office in the same building... a budding conflict of interest IMO.

Likely a billing code he used which doesn't mean it is a requirement by any means.

Conflict of interest no doubt. As it would be if the doc is also selling cpap equipment too.

Yea, no way I would go back plus I would wait til the last minute to cancel any pending appts.
Get copies of any records you need from that office first.

Glad you got it sorted out.

bwexler wrote: ↑

Sat Feb 10, 2024 8:20 pm

I never knew you could fail a sleep study.
My first one 13 years ago went smooth mild apnoea only 84 AHI.

Borderline for *severe* OSA is 30. With 84 events per hour you're *cookin'*! My original AHI was higher than that. Perhaps you meant 8.4? More than one event per minute is agony, BTDT.

"Obstructive sleep apnea is classified by severity: Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour) Moderate obstructive sleep apnea means that your AHI is between 15 and 30. Mild obstructive sleep apnea means that your AHI is between 5 and 15."
https://www.hopkinsmedicine.org/health/ ... 20and%2015

Second one was only a titration for my Bilevel ASV machine (not even included in Philips recall) also went smooth.
The last 5 years I have been lucky enough to find used ASV machines here and have paid out of pocket. However my newest machine, I mentioned after the fact to my insurance company that if I got a new machine through them, their first 2 monthly payments would be more than covering 80% of what I paid for my lightly used machine. They actually sent me a check for the 80%. I almost didn't believe it, but the check cleared.

Hee hee... I found the vAuto firmware... put it in... it works. Hacktastic! Benefits of being an embedded engineer... that AS10 can be whatever I want.

vandownbytheriver wrote: ↑

Mon Feb 12, 2024 9:38 pm

bwexler wrote: ↑
Sat Feb 10, 2024 8:20 pm
I never knew you could fail a sleep study.
My first one 13 years ago went smooth mild apnoea only 84 AHI.

Borderline for *severe* OSA is 30. With 84 events per hour you're *cookin'*! My original AHI was higher than that. Perhaps you meant 8.4? More than one event per minute is agony, BTDT.

Maybe Rubicon will clear this up but IMO anyone who got a prescription for a cpap failed their sleep study.

IF so, that means this place is loaded.

SleepGeek wrote: ↑

Mon Feb 12, 2024 10:02 pm

Maybe Rubicon will clear this up but IMO anyone who got a prescription for a cpap failed their sleep study.

IF so, that means this place is loaded.

Fourteen years ago it was plainly explained to me that I would have to do my best to sleep 4 hours or I would have to come back for another night. This was called a 'split study' where the first half is developing an AHI number and the second half is titration.

My best recollection (these were trying times, obviously) was that the tech came in after my attempts and said 'you didn't quite meet the time but here' and slapped that sweet, sweet air to me. I didn't have a choice anyway, I was sleeping like crap at home. I did chug half a bottle of Nyquil and brought my favorite pillow and fan, most comfortable shorts/shirt etc. I think my AHI given was '> 100', which is insane when you think about it... most folks just get an integer, not a range ending at infinity.

I won't be going back to that lab... they had other problems, like answering the phone when called etc... but they followed the split-night criteria to the letter, which is impossible for someone like me to follow.... I'd want an anesthesiologist on-site for what it would take for me to sleep for that.

Here, read *this*:

<>
A Split night study is a combination of a Diagnostic study and a Titration study. It is performed when a pt shows signs of severe Obstructive Sleep Apnea. You would be started as a Diagnostic Sleep Study and if you show enough Obstructive Sleep Apnea events ( Apneas are total airway collapse, Hypopnea’s are partial airway collapse) within the first 2 hours of sleep ( emergency setting would show symptoms of more than 20 events or more of airway or partial airway collapse per hour). You would be started on the treatment portion of the Sleep Study which is called a Titration(using Cpap) Some Physicians will also order a Split night Polysomnogram if they feel that the patient might be severe enough to warrant immediate treatment
...

******The Split night Polysomnogram is not a test that you can fail.******

(emphasis mine) Nearly everyone falls asleep during the study. Most people do not sleep as well as they do at home. This will not affect the results. In most cases, you do not need to sleep for a full eight hours to find the source of your problem.
</>

https://sleeptightdc.com/services/split ... eep-study/

So, yeah... I guess different labs do different things. I did *not* need a diagnostic... I only needed a titration.

My first sleep study was a split night.
We were living in our motorhome and traveling full time. The first study was done in Las Vegas. The day after I completed it I was leaving Vegas. When I arrived in the lab parking lot I called to tell them I was there,,they came out and handed me the study results through the driver's window. I left for San Diego. The day after that I visited my friend who happened to be an MD and a hosehead.
He looked at my study, gave me a prescription, called his DME and told them I was on the way and to take good care of me. I had my S9 Autoset and my Tap Pap No Mask a couple hours later.

I get really annoyed when I hear that it takes months for some of you to get your results and your equipment.
As a group we shouldn't allow the system to treat us that way.
The MDs and DME should not be considered the customer of the manufacturers, the patients, US, should be..
By the way, I know AHI of 84 is not considered mild apnoea. You all just don't understand my humor.