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http://www.cms.gov/medicare-coverage-da ... AAAAAAIAAA&

I received this as justification for CPAP prescription

Day_Dreamer wrote:http://www.cms.gov/medicare-coverage-da ... AAAAAAIAAA&

I received this as justification for CPAP prescription

The relevant points seem to be (bolds added by me for emphasis):

Coverage of CPAP is initially limited to a 12-week period to identify beneficiaries diagnosed with OSA as subsequently described who benefit from CPAP. CPAP is subsequently covered only for those beneficiaries diagnosed with OSA who benefit from CPAP during this 12-week period.

An initial 12-week period of CPAP is covered in adult patients with OSA if either of the following criterion using the AHI or RDI are met:
a. AHI or RDI greater than or equal to 15 events per hour, or
b. AHI or RDI greater than or equal to 5 events and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

This would seem to support the experimental use of CPAP over a period of 3 months of continuous effective therapy to identify if symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or hypertension are improved in borderline cases like yours.

djhall wrote:

Day_Dreamer wrote:http://www.cms.gov/medicare-coverage-da ... AAAAAAIAAA&

I received this as justification for CPAP prescription

The relevant points seem to be (bolds added by me for emphasis):

Coverage of CPAP is initially limited to a 12-week period to identify beneficiaries diagnosed with OSA as subsequently described who benefit from CPAP. CPAP is subsequently covered only for those beneficiaries diagnosed with OSA who benefit from CPAP during this 12-week period.

An initial 12-week period of CPAP is covered in adult patients with OSA if either of the following criterion using the AHI or RDI are met:
a. AHI or RDI greater than or equal to 15 events per hour, or
b. AHI or RDI greater than or equal to 5 events and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

This would seem to support the experimental use of CPAP over a period of 3 months of continuous effective therapy to identify if symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or hypertension are improved in borderline cases like yours.

Which is exactly what you recommended!!!

Day_Dreamer wrote:Which is exactly what you recommended!!!

Well, I can't take a lot of credit for that... You have symptoms of disrupted sleep and you have a machine that is often useful in treating common causes of sleep disruptions. The recommendation that you give the machine a fair try and see if it helps is pretty much inevitable. The rest is just trying to get people to accept that if the machine does help then they may need to keep using the machine for the improved quality of life, and that is okay.

The basic message we give people who don't like the machine or the idea of it is this: Master the machine and really give if a fair try before giving up. You CAN master it, but it often takes persistence and work to get there. Once you've really given it a fair try, if you truly can sleep as well without the machine for whatever reason, great, good for you. But if you can't, then accept it, sleep better, enjoy the improved quality of life that comes with improved sleep, and move on with your life. Plenty of us have, and you can too, and after a while it isn't any more awful than having to wear glasses or take a blood pressure medicine.

jencat824 wrote:Robysue,

Sounds like you've hit on the probable basis for the Dr prescribing CPAP for Day_Dreamer. If I were in his shoes, I'd still want a second opinion.

As I said in my preface, I think Day_Dreamer is correct in wanting a second opinion. There's enough fishy stuff about how the test was conducted AND enough vagueness on the part of the doc doing the prescribing, that a second opinion is certainly justifiable.

Second opinions are great when the opinion actually matters. But there are basically only two possible medical opinions available from a doc for a borderline patient when it comes to PAP: (1) the patient deserves to find out if PAP helps him sleep better and feel better or, (2) the patient does not deserve to find out if PAP helps.

My point is that if I received opinion one from a doc, I would not jump at the opportunity to get that opinion contradicted by a second doc.

But hey, what do I know.

[/quote]
The basic message we give people who don't like the machine or the idea of it is this: Master the machine and really give if a fair try before giving up. You CAN master it, but it often takes persistence and work to get there. Once you've really given it a fair try, if you truly can sleep as well without the machine for whatever reason, great, good for you. But if you can't, then accept it, sleep better, enjoy the improved quality of life that comes with improved sleep, and move on with your life. Plenty of us have, and you can too, and after a while it isn't any more awful than having to wear glasses or take a blood pressure medicine.[/quote]

These words stuck with me all day. I am viewing things differently. I fell asleep @ 11 and woke @ 4:30 and it was as if only seconds had elapsed. I Never got back to sleep but I feel great. The machine will be mastered even with my extreme anxiety !!!!

Appointment today @ Weill Cornell... I suspect he will suggest the same things you guys have been saying. Maybe he can get some of this stuff to be covered by my Insurance as I have not completed an in lab test and It's all been out of pocket. I've spent over 2K in the last month on supplies. But a funeral would cost more

Day_Dreamer wrote:I fell asleep @ 11 and woke @ 4:30 and it was as if only seconds had elapsed. I Never got back to sleep but I feel great.

Well that is some good news... Lets hope that continues and they get a little longer over time. Life is so much better with sleep!

Let us know how the appointment with the new doctor goes.

The doctor is in agreement with what has been suggested

Even though my numbers are borderline for a CPAP machine my symptoms (high BP and Insomnia) support use of a CPAP

After more lifestyle changes we will reassess its use and possibly discontinue

He said 4-5 hours of CPAP was enough. My insomnia now causes me to wake after a 4 hours or so of useage. After I wake it is difficult to get back to sleep especially when I am masked


Thanks again to all who have made a positive contribution to this thread!!!!

I'll post back in a month

Day_Dreamer wrote:The doctor is in agreement with what has been suggested.
After more lifestyle changes we will reassess its use and possibly discontinue
I'll post back in a month

Sounds like you have a decent plan. Good luck, and let us know how it goes.

Day_Dreamer wrote:Everyone I have spoken to claims weight loss would be sufficient to "get off the hose"

Everyone you've spoken to is an idiot.

Weight loss may be a great thing in general, but there are plenty of thin apneacs.

You might no longer have apnea after weight loss, exercise, other changes, or simply spontaneously. You'll need a sleep test to verify you're cured, though.

Most people don't get cured, but CPAP can pretty much eliminate apnea for most people. "Eliminate" as in you don't stop breathing with CPAP, not "cured" as in you don't need CPAP.

By the way, DO lose the weight if you're overweight. It might help apnea. Even if it doesn't help apnea, it may improve health in general.

I hate to hear "you just need to lose weight," because many people will give up on CPAP, and then not lose the weight. Or lose the weight and not lose the apnea. Or gain it back later. Or redevelop apnea as they age.

Do the CPAP, lose the weight and then test again. Maybe you're one of the lucky ones. Just be aware you may develop apnea again as you age.

BTW, the low AHI may sort of indicate "no apnea,' but the RDI is high enough to worry about.

+1
I would also like to add that untreated apnea can contribute to obesity.
("they" may have made the causal link in the wrong direction--go figure!)