What seems reasonable? Another PSG or an APAP?

I saw the sleep doctor--for the whole story check my other post, but I have a question I'd like some feedback on.

I was retitrated to a 14 recently and do not feel much better. My apnea is worse in REM than NREM sleep. I barely slept at the last titration and was given a pressure change on what I found out today was ONLY A HALF HOUR of data. My doctor was on vacation so the results were read to me by a resident, and he assured me we had enough data (lesson learned there). It seems to me the PSG was almost worthless. The actual doctor told me today we really did not get sufficient data at any pressure and since I am still tired she wanted me to come for another PSG. I asked about an APAP and she was open to the idea but wondered if I needed a pressure higher than 14 so wanted me to come for a PSG and do a titration on their APAP (her words, I know they use something called a VPAP something or other so I guess they would do it in an auto mode? ugh, questions I forgot to ask).

As I drove home I couldn't help but think about my insurance company... they paid for the last PSG, $1200. Now here's another one coming. I really don't think they should have paid for my last one if they didn't get good data. Now, I did use another mask (wanted to try a new one) and it didn't go well but I thought it was more that I was in a weird place (this was not the lab I had my other studies in) and I was so tired that night I didn't think to ask them to get my Quattro instead.

The doctor does use APAP for some patients (said she sees it help about 50% and the rest do better on straight CPAP) and even shared with me what settings she would try on me but in the end I walked out with an appt for a PSG. In my mind she would have done either. I'm wondering if it would make sense to do APAP and maybe an overnight oximetry? I am thinking that my insurance company would only be out a couple hundred more to swap my Elite for an Autoset (this is what the doctor said she gives patients, she likes the Autoset II, and after seeing my ResScan reports she does think APAP would be a good thing to think about).

I'm not wild about going for another PSG, but I'm not convinced I'll get a good pressure from one night since I have so many differing results at home when I try different straight CPAP pressures.

Any thoughts?

If insurance will pickup the tab for another PSG I say to go for it. It can only assist with your diagnosis to have another session for which there is the possibility of gathering more data about your sleep & events. As a personal note it helped me for my last PSG to arrive somewhat sleep deprived. I did that by staying up later and rising earlier.

Good point. It can only help her treat my OSA better. I'll have them verify that UHC will pay again though.

2girlsmom wrote:I saw the sleep doctor--for the whole story check my other post, but I have a question I'd like some feedback on.

I was retitrated to a 14 recently and do not feel much better. My apnea is worse in REM than NREM sleep. I barely slept at the last titration and was given a pressure change on what I found out today was ONLY A HALF HOUR of data. My doctor was on vacation so the results were read to me by a resident, and he assured me we had enough data (lesson learned there). It seems to me the PSG was almost worthless. The actual doctor told me today we really did not get sufficient data at any pressure and since I am still tired she wanted me to come for another PSG. I asked about an APAP and she was open to the idea but wondered if I needed a pressure higher than 14 so wanted me to come for a PSG and do a titration on their APAP (her words, I know they use something called a VPAP something or other so I guess they would do it in an auto mode? ugh, questions I forgot to ask).

As I drove home I couldn't help but think about my insurance company... they paid for the last PSG, $1200. Now here's another one coming. I really don't think they should have paid for my last one if they didn't get good data. Now, I did use another mask (wanted to try a new one) and it didn't go well but I thought it was more that I was in a weird place (this was not the lab I had my other studies in) and I was so tired that night I didn't think to ask them to get my Quattro instead.

The doctor does use APAP for some patients (said she sees it help about 50% and the rest do better on straight CPAP) and even shared with me what settings she would try on me but in the end I walked out with an appt for a PSG. In my mind she would have done either. I'm wondering if it would make sense to do APAP and maybe an overnight oximetry? I am thinking that my insurance company would only be out a couple hundred more to swap my Elite for an Autoset (this is what the doctor said she gives patients, she likes the Autoset II, and after seeing my ResScan reports she does think APAP would be a good thing to think about).

I'm not wild about going for another PSG, but I'm not convinced I'll get a good pressure from one night since I have so many differing results at home when I try different straight CPAP pressures.

Any thoughts?

1. Get a copy of this latest PSG.
2. IF you are paying co-payments for these PSG's, you are better off putting that money towards a Autopap but NOT an Autoset. I would
recommend either a Respironics Bipap Auto or a Sandman Auto. Both are available with reports. The Autoset WILL NOT help your situation,
reason is your pressure is over 10 cm already. That machine's algorithm prevents it from responding to apnea above 10 cm. So what that means,
is it will have to be configured with Minimum pressure at 14 cm the same as CPAP on the current machine.

If it was me, I would put that money towards a Bipap Auto, I would return the Elite to the DME. If there is any Central modality seen on your
PSG I would go with a Sandman Auto. But if the pressure is going to be 14 cm and/or higher, I would select the Bipap Auto, but before I'd
spend money on that I'd want to see the PSG results. Nothing worse then buying a machine you cannot use.

This is what your doctor should be doing, determining via the PSG what machine/pressure results in the best sleep. IF you just had a PSG and
now they are wanting another, you TELL your doctor and Sleep lab that you will only agree to have another PSG IF they can assure you a
experienced Tech will be performing the PSG, no trainees. Also understand most insurance will pay for 2 PSG's per year and many have limitations
on how many you can have. We are in November, close to the end of the insurance calendar year. Your doctor makes like $600 to interpret
one of those reports (just to tell you what it means on the report), make sure you get your money's worth.

I called the insurance and as long as the doctor has recommended the PSG for medical necessity it is covered. The Dr office said that is no problem.

I got in on a cancellation for 11/10, they called today and had that open for me. I will show up good and tired.

Snoredog, thanks for the tips. The last PSG was done by someone who has worked there for years. I really think my crappy sleep there is what messed everything up.

2girlsmom wrote:I called the insurance and as long as the doctor has recommended the PSG for medical necessity it is covered. The Dr office said that is no problem.

I got in on a cancellation for 11/10, they called today and had that open for me. I will show up good and tired.

That's great! The more info, the better... so that additional full PSG sleep study is an excellent thing to do. Glad there was a cancellation. We'll be looking forward to hearing how it goes!

I will definitely post as soon as I know something. I am SO glad I can go Monday night--I said no at first but then remembered Tues is Veterans Day and my mom is off. She can keep the kiddos. Hubby has to go to work EARLY, so hopefully my mom will just let them stay the night. DH should like that, a quiet house... he can play video games to his hearts content.

Greedy witch that I am, I'd go for both the titration AND the exchange of the Resmed S8 II Elite for the Resmed S8 II AutoSet!!!

Good luck, God bless, let us know how things turn out and may you sleep well and give 'em GOOD data to ponder!!!!

Yeah, I'm not one for scamming the insurance company or anything like that, but if the doc (who is also head of neurology) felt like I needed a PSG after looking at the ResScan data at different pressures, and hearing I'm still tired... hey I'm all for it. Too bad the sleep study rooms aren't as nice as the other rooms in the hotel. My mom will keep the girls all night so that is a big relief. Hubby will enjoy the quiet. I have a $5000 limit on DME before they need a letter of medical necessity, and I think I'm only around $1000 at this point, and it's the end of the year, so bring on an auto Bipap, an autopap, a vpap, whatever she thinks will finally treat my OSA and help me feel human on a daily basis.

I was also titrated at 14 cmH20 and felt lousy for quite a long time. I was switched to an auto set at 10 to 20 ( as a trial for a week) and after 2 days felt a dramatic difference. I now use auto all the time, and sometimes I am at a 90% of 15.5 but most of the time my 90 % is at 11.5. Good luck with the sleep study on Monday, and I would push for the auto. If you don't use it in auto mode you can always set it for cpap.

The sleep doc is open to using an auto long term as long as it helps me. She is willing to pretty much do anything to get my osa treated well and said sometimes that means apap and sometimes it means changing cpap pressure. I can't wait to see what they find out and I will definitely make myself tired for Monday night!

2girlsmom wrote: ... I will definitely make myself tired for Monday night!

With two young daughters that shouldn't be too difficult!!!

Hey, look at it this way...

You've learned a lot more about OSA, about the treatment machines, about your own data, and about sleep studies in general. You can go into this one with a "this is going to be INTERESTING" attitude.

Prance into the sleep lab like a true cpaptalk lab rat. Nose twitching, tail swinging! Totally relaxed and... as sleep deprived as you can make yourself beforehand. Have fun.

rested gal wrote:Prance into the sleep lab like a true cpaptalk lab rat. Nose twitching, tail swinging! Totally relaxed and... as sleep deprived as you can make yourself beforehand. Have fun.

That is an image worth remembering!
O.

Slinky wrote:

2girlsmom wrote: ... I will definitely make myself tired for Monday night!

With two young daughters that shouldn't be too difficult!!!

The only problem is I might just be giddy to be in the lab where no kids can wake up in the night!

RG, you're too funny. I keep thinking, wow what will they see this time if I actually sleep? I am finding it interesting. LOL