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Don't want to have new sleep study


#1

I didn’t get a CPAP right away after having a sleep study in 2014. My insurance said it would cost $1,000.00 plus a monthly charge of $200.00, which I could not afford. I tried just doing without, but was having more and more issues with daytime sleepiness and brain-fog. My doctor decided to try me on night-time oxygen to see if that would help, and it helped a little. Then my doctor said surgery on my nose and throat would help. Because I work out of town, I was not able to get surgery scheduled for some time, when I finally was able to go, the doctor had changed his mind about what kind of surgery would work. I finally got the surgery and was again prescribed a CPAP. Since I am on Medicare I was told it would be covered. So, I got the machine, had some issues getting used to it, but after six months, I can see that it is really helping me. Now Medicare has said that since I didn’t get the CPAP within 6 months of my sleep study, I have to have another one. The doctor has reviewed the data from the CPAP and says it shows that I obviously need it. I don’t want to go through another sleep study, but can’t seem to find a way around it. Anyone have any suggestios to offer?


#2

First of all, is Medicare your primary insurance? And were you on medicare when you had your sleep study?

Medicare guidelines are pretty strict on what they will and will not cover. They consider non usage as being non compliant and require a second study because of that. The other issue is that you’ve had a surgical procedure since your first study, and that alone could require another one.

However, if medicare is not your primary insurance, I don’t believe you have to go by their guidelines.


#3

@kentcaylor You raise a very good point.
@tuggle What is your insurance? If you give me the company and plan type, I would be happy to check for you.


#4

I have friends who did some kind of “HOME” sleep study. I don’t know the cost or where to get the equipment but I can look into it if you want me to. Google might know. It’s somewhat new on the market.


#5

Google results $249 Medicare Approves Coverage for Home Sleep Studies - SleepApnea‎
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#6

I ended up having to have 3 sleep labs. The first time I was put on the CPAP. That didn’t work for me. The second test, medicare wanted another to see if the BiPap machine would work because they are more extensive than the CPAP. Then doctor ordered another because the air pressure was not right. I use this one every night all night.

I have a question. Why are my apnea so high each night? Anywhere from 20+ each night. I am so tired every day. The doctor said not to worry about them. I do because my son died of sleep apnea. He had a sleep lab and was told he did not have sleep apnea so was not on anything. Would someone please address this for me.


#7

@Hardt - Thanks for the link. That can help so many.

Best wishes,
MotherT


#8

Eve,

Are you using a nasal mask, or full face mask? If you’re using a nasal mask, you might be mouth breathing, which could greatly reduce the efficiency of your machine. If you’re using a full face mask, it might not be fitting right and leaking. The other thing is the pressure might still not be right for you.

One other thing comes to mind. There are 2 types of apnea, obstructive and central. Obstructive apneas happen when your airway closes off; you try to breathe but can’t. A central apnea happens when your brain tells you you don’t need to breathe. You can breathe, but don’t.

You might be having central apneas, although I don’t know how they could just appear after your sleep study. Unless of course the Tech and the Doctor saw them in the study. In fact bi-level is often used to treat central apneas.

I would have a chat with your Doctor about the issues I’ve mentioned.


#9

I tried the home study since I’ve had a CPAP for many years and needed a new one. Medicare would not use it, it had to be a full, in a lab one.


#10

kent, thank you for you input. I do use a full face mask. It is the Phillips Amara View. There are times when I have air leaks. I am a mouth breather. The pressure was set after the last sleep study but there are times when I have trouble and need to take it off for a few minutes. I wear it at least 7 hours a night.

I do have both obstructive and central apnea. As the sleep lab tech said, “I’m one of the lucky ones”! Am I right, that the machine forces me breath when I have one of the apneas? I am so tired of being tired!


#11

Hi Eve,

The Amara View is a great mask, but needs to be properly fitted even more so than other full face masks in order to keep it from leaking.

There could be a couple of reasons you’re struggling at night. Your mask is leaking and/or you’re still having central apneas, which is why your AHI is still quite high.

If you are still having central apneas, they do sometimes ‘work themselves out’ as your body adjusts to breathing normally again. This might be why your Doctor is telling you not to worry.

The other thing is that, even though bi-level is frequently prescribed for central apneas, it can actually make them worse. (I’ll explain how in a follow up if you want).

Do you know if you have whats called a back up rate set on your machine? What that does is basically force you to breathe whenever a central apnea occurs.

Also bi-level can be adjusted so that it deliers breath’s more quickly or more slowly depending on your breathing. But that’s something your bi-pap provider would have to address.

If I were you, I’d talk with your Doctor about these concerns; specifically ask about central apneas, back up rates, and different sensitivity settng for bi-level.


#12

Kent
I started out with a small Amara View mask, then after complaining about still having air leaks, the RT supplier got me a medium. It is better but I still have some air leaks. I tried 5 different full face masks. Most of them made me closterfobic and had more air leaks. The RT was ready to give up on me. I saw the Amara View in a add and asked her about it. It is better than anything else that I have tried.

I have been on the BiPap since September 6, 2016. How long does it take to ‘work themselves out’ and get me breathing normally again?

Yes, I would like for you to send more information on how the bilevel can make central apnea worse.

I don’t know if I have the back up rate set on the machine. All I know is that it has different pressures for when I am awake or asleep. That was set after the last sleep lab. Now I don’'t feel as tho I am being smothered.

You have given me more information than anyone else. Thank you so much! I feel as tho I have things to ask the Doctor. I really didn’t know what to ask him before. Thanks again!


#13

Eve,

We breathe based on the amount of carbon dioxide (C02) in our blood. When CO2 gets high enough, our brain tells us to take a breath. We then pause for a short moment until that level gets high again. You’ll notice you breathe quite regularly, so it doesn’t take much C02 to cause this.

Bi-level has a high and low pressure setting. High pressure for breathing in, low pressure for breathing out. This actually causes you to take deeper breaths, which is good. The problem is, now you’re getting rid of more C02 than your body is used to. So now your brain tells you not to breathe for longer periods of time until C02 level rises again. This is what a central apnea is.

Once your body adjusts to this breathing, those central apneas should go away. I say should, because this doesn’t always happen. There are reasons a person will continue to have central apneas. Certain heart diseases in particular are usually the culprits here.

A back up rate on bi-pap is a setting that will ‘kick in’ and 'force you to breathe if you do stop breathing on your own.


#14

Kent
I so appreciate all the information you have given me. I wish the doctor or the RT’s that handle your equipment would tell us some of these things.

You said that there are some conditions that hinder us. I also have acid reflux (under control), restless leg syndrome (under control), and leg and foot cramps. Last night I was up four times because of the cramps. Could this be my ‘culprit’? I will be having blood lab this next month. Wondering if I am low on potassium?

Again, thank you. I will be discussing all of this with my Doctor.


#15

It’s important to check the qualifications and good standing of the location you go to for the test.
Some technicians are dedicated. Others are not.


#16

Hi Kent
It has been a while since I have been on the Sleep Health Forum. I will be having the 4th in hospital sleep lab this Friday night. The doctor said that with central sleep apnea the machine might be making things worse. He is going to try to put me on oxygen only. I also have obstructive apnea. I still have so many air leaks each night. I do use the machine all night with adjustments along the way! I would really like to get things to work right. I don’t like feeling tired all the time.

You did give me some good information that I could talk to the doctor about. That was when he decided to do another lab. So thank you!


#17

Thanks for the update, Eve, glad I could help out.