thanks/report/questions

First, I would like to thank you all for the valuable information I found in this forum.

A week ago Wednesday, I had a split sleep study done. The technician mentioned that I did have sleep apnea/hypopnea, and it seemed worse on my back, but it also occurred on my side. From info I found elsewhere, I started retraining myself to sleep on side by putting a tennis ball in a sock and safety pinning it to the back of my t-shirt. I also decided to lose a few pounds. A few days later, I stumbed on cpaptalk.com and started reading.

On Wednesday, I met with the ENT and received the results from the sleep study. I was diagnosed as having severe sleep apnea/hypopnea (overall apnea/hypopnea of 30.9 with mostly hypopneas; supine apnea/hypopneas occurred at a rate of over 50 per hour, and I used to sleep on my back most of the time). Surprisingly, my snoring is mild. In the second half of the sleep study, I responded well to a cpap with a setting of 8.

The diagnosis explains a lot to me including why it's been so hard to sit down and work.

At the ENT, a cpap was prescribed. I asked for a generic prescription and asked for "self-adjusting" to be written on the prescription with a heated humidifier. I said that I would skip the usual channels, buy it myself, and deal with the my insurance company on my own. They were slightly taken aback since no one had ever done that before, but they agreed without any fuss after I explained why.

I called bc/bs to see if I could buy it on my own. I also had to deal with unicare, which I guess handles DME for my bc/bs. I talked to various people and got various stories about whether pre-certification was needed or not. The last story was that it was not needed, but I guess I will find out more when I apply for reimbursement (after $300 deductible they cover 80% up to a certain allowance). To find out how much they would cover, I needed the billing codes, which cpap.com supplied without any problem. I found it interesting that all cpap and autopap machines have the same billing code. Similarly, all masks have the same code. I told one of the people that I talked with that I planned on buying an autopap machine. They said that the maximum allowed on a machine (not including the humidifier) was only $1100. They were surprised when I said I could get an autopap for a lot less than that.

I managed to place an order with cpap.com just a few minutes before they closed at 4 p.m. central time. They were extremely helpful (and I have no financial interest---just a satisfied customer). Fortunately, someone had posted a link to their video on measuring the size of a nose so I already had that info.

I had decided upon the pb 420e with the integrated humidifier and software. The only drawback I had heard about the 420e was that it might be slightly noiser than the other two I had in mind. I figured I could get used to the noise in the short run and would appreciate the smaller size in the long run when travelling.

The integrated heated humidifier is not available, but should be shipped at the end of January. Since I was classified as severe, I spent a few more dollars and had everything else shipped overnight and received it yesterday.

My dentist (I have a wonderful dentist who is rather knowledgeable about sleep disorders) e-mailed to say that maybe I should go through a DME supplier to get help including with having a mask fitted. She mentioned that compliance with cpaps was low and thought a DME supplier might make compliance more likely. I said it was too late 'cuz I'd already ordered the machine. Besides I had already heard too many bad things about a lot of the dme suppliers.

Since I hadn't used any masks other than the one in the sleep study, I ordered two: the activa and the breeze with the nasal pillows.

Last night I tried the breeze. I seemed to have no trouble sleeping with the autopap and breeze headgear. The autopap was set to allow pressures between 4 and 20. I had placed the machine lower than the level of the bed, which I think I saw recommended here somewhere. I had some minor inconvenieces with the hose, but it wasn't much of a problem. I'll probably rig up something overhead for the hose as I saw recommended here.

This morning I downloaded the info from the machine. Most of the time (84%) the pressure was at 4; the highest pressure used was 7. I used it for 7 hours and 34 minutes. There were 6 apneas and and 4 hyponeas during that time---not bad, eh?

There were 38 "Runs (FL)". Does anybody know what those are?

I'm feeling pretty good today. Maybe it's just adrenaline or a placebo effect or ..., but I kinda' think that this autopap is going to improve things for me.

The detailed report gives info on mask leakage. At what levels should I start to worry about that? Most of the time I think there was no leakage. At one time, I thought there might be a little, but I couldn't tell for sure.

ENT wants to fix my badly deviated septum, which I think is a good idea. ENT also wants to do RF coblation on the base of the tongue, which I am not sure is a good idea. Any suggestions/comments?

Thanks again for all the useful info!

--Bob

Bob, I'm impressed and so happy for you! What an excellent account of doing your own research and being pro-active in making decisions about your treatment. Sounds like a very, very good first night. You armed yourself well.

Glad to hear a good story from a fellow "do it yourselfer" Us DIYs need to stick together to get the word out. I have severe apnea with many hypopneas and flo limitations. The 420E works great for me. I asked my ENT about the RF and other surgery. He laughed and said I was way beyond that. That only works for very mild apnea. At least he was honest. He did remove a small grape sized tumor from my sinus . That helped increase airflow very much. You would think people would be sent to the ENT before the study to look for obstructions then do the study.

Try this..Go outside the Drs. office and look at his car. If it looks more than a few years old and he suggests surgery RUN. Just kidding

The point is. If they are surgeons they don't get paid unless they cut something. Thats what my GP said . I keep it in mind whenever "surgery" comes up.

Glad you were able to stay away from the DMEs.

Cheers to https://www.cpap.com

Chris

There were 38 "Runs (FL)". Does anybody know what those are?

Anyone have a clear & simple answer for this. I'd like to know as well!

A flow run (FL) is a period of reduced flow with a smaller magnitude than a hypopnia. I'm sure there are clinical definitions regarding magnitude and duration that define what is a flow limitation, hypopnia and apnea. Maybe SWS can quote this info if you are interested?

Perhaps a light-hearted metaphor instead?

Apnea="the Grand Daddy of all obstructions"; the "big one" so to speak!

Hypopnea="baby" or "adolescent" obstruction; a lesser obstruction than apnea

Flow Limitation="zygote" or "fetus" obstruction; a lesser obstruction than even hypopnea; not yet a genuine obstructive problem for the vast majority of patients, but a significantly increased liklihood of becoming an obstructive breathing problem

Flow Limitation Run=several breaths, each impregnated with signs of "flow limitation"

I believe a Flow Limitation is the same as UARS.

Apnea="the Grand Daddy of all obstructions"; the "big one" so to speak!

Hypopnea="baby" or "adolescent" obstruction; a lesser obstruction than apnea

Flow Limitation="zygote" or "fetus" obstruction; a lesser obstruction than even hypopnea; not yet a genuine obstructive problem for the vast majority of patients, but a significantly increased liklihood of becoming an obstructive breathing problem

I disagree. Each one can cause significant oxygen desaturations as well as arousals. Someone suffering primarily from Hypopnea can have the same symptoms as someone with apnea.

Bob, I have BC/BS Standard. :You said that they allowed the same, regardless of make, as the maximum allowable on machines. Is the same true on the masks. And if so, can you tell us what it is?

Also did you have much trouble filing and getting reimbursed by BC?

I would have sent you a private message but you are still listed as Guest and only Registered posters can receive private messages. Why not register. It's painless and best of all FREE.

Anonymous wrote:I believe a Flow Limitation is the same as UARS.

Apnea="the Grand Daddy of all obstructions"; the "big one" so to speak!

Hypopnea="baby" or "adolescent" obstruction; a lesser obstruction than apnea

Flow Limitation="zygote" or "fetus" obstruction; a lesser obstruction than even hypopnea; not yet a genuine obstructive problem for the vast majority of patients, but a significantly increased liklihood of becoming an obstructive breathing problem

I disagree. Each one can cause significant oxygen desaturations as well as arousals. Someone suffering primarily from Hypopnea can have the same symptoms as someone with apnea.

Curious how you interpreted my words that any one of those are expempt from desats/arousals. I'm just about exclusively hypopneas myself with plenty of desats and cortical arousals to go with those hypopneas. What exactly are you disagreeing with, then?

UARS/RERA events manifest as flow limitations. However, flow limitations are not exclusive to UARS/RERA events. Flow limitations can also happen because of simple allergic rhinitis, bronchial swelling, incipient hypopneas, etc.

Hi Janelle,

As I understand it, my BC/BS allows up to $1146 for the cpap or autopap machine (not including the humidifier). All of these machines are billed under the medical code E0601, which is on the invoice I received from cpap.com.

For humidifiers, I believe my BC/BS allows up to $327. All humidifiers are billed as E0562.

For masks, up to $99.99 and the code is A7034.

For headgear, up $30.68, and the code is A7035.

I believe I am reimbursed 80% of the amount spent up to these maximums (after I've met the annual $300 deductible). The amounts seemed rather generous compared with the prices at cpap.com.

I don't know if all BC/BS policies allow the same amounts. I've heard various stories about needing and not needing pre-certification. I have the name of the person who seemed to be the final authority and told me I didn't need pre-cert.

I haven't applied for reimbursement yet, so I don't know if I'll have trouble or not.

From other posts, I'm guessing that I might be allowed to purchase a new mask after a certain number of months under the policy. However, I don't the details.

--Bob

Janelle wrote:Bob, I have BC/BS Standard. :You said that they allowed the same, regardless of make, as the maximum allowable on machines. Is the same true on the masks. And if so, can you tell us what it is?

Also did you have much trouble filing and getting reimbursed by BC?

<snip

I think pre-cert if only necessary under Basic (the cheaper) option but not under Standard. If you have a prescription I think the DMEs still have to check with BC/BS before they can give it to you.

From what the DME told me, BC/BS will buy you a mask every 6 months and a CPAP every 5 (in spite of the fact they are only waranteed for 2 years max). Don't know about the humidifier. Sure would like to get the new one for integrating with my 420E

Where do you possibly get BC/BS with a deductible of $300. I pay $770 PER MONTH, with a 70/30 split, and a wopper $1500 deductible. Needless to say I am self-insured.

Saw my family practitioner today for something else and he had a 1 pg letter from sleep study ctr. . He said in medical school (get ready--headsa bobbin') sleep apnea's were laughed at thought of as no big deal. But now he's seeing "the light" I told him they are a cash cow, he seemed ''quite interested'' as he had "another patient" with apnea, put him thru all kinds of tests, heart, he had congesitve heart failure, big time. Otherwise seemed ok, well I don't know about anyone else, but CHF is no laughing joke, and well, long story short, he has a CPAP and is doing much better. He said he's rethinking the whole subject. At least a decent enuf doc to admit he's open minded enuf to know he doesn't know it all. He said he knew I'd do ''my homework" on this, and he said he hoped it helped. But that the sleep doctor told me straight out (who sent me for the study) that compliance by patients with using CPAP's is very low.

They give it to you in one hand, and take it with the other.
So there ya' have it.

Poisson wrote:Hi Janelle,

As I understand it, my BC/BS allows up to $1146 for the cpap or autopap machine (not including the humidifier). All of these machines are billed under the medical code E0601, which is on the invoice I received from cpap.com.

For humidifiers, I believe my BC/BS allows up to $327. All humidifiers are billed as E0562.

For masks, up to $99.99 and the code is A7034.

For headgear, up $30.68, and the code is A7035.

I believe I am reimbursed 80% of the amount spent up to these maximums (after I've met the annual $300 deductible). The amounts seemed rather generous compared with the prices at cpap.com.

I don't know if all BC/BS policies allow the same amounts. I've heard various stories about needing and not needing pre-certification. I have the name of the person who seemed to be the final authority and told me I didn't need pre-cert.

I haven't applied for reimbursement yet, so I don't know if I'll have trouble or not.

From other posts, I'm guessing that I might be allowed to purchase a new mask after a certain number of months under the policy. However, I don't the details.

--Bob

Janelle wrote:Bob, I have BC/BS Standard. :You said that they allowed the same, regardless of make, as the maximum allowable on machines. Is the same true on the masks. And if so, can you tell us what it is?

Also did you have much trouble filing and getting reimbursed by BC?

<snip