Replies to This Discussion

Permalink Reply by Judy on December 21, 2009 at 10:09pm

And THAT is doing you a FAVOR! Their sleep tech(s) were obviously poorly, under-trained, ..... I'm like you, I don't "do" ultimatums well at all!!!

A good sleep lab will provide a comfortable, quiet setting, a selection and fitting of at least 2-3 masks before settling on one for your titration, a well-trained sleep technician who recognizes when you are sleeping and when you aren't, one who knows when and how to adjust the pressure gradually and properly to do a PROPER titration.

Before I go any further I would STRONGLY suggest and urge that you write a letter of complaint about this sleep lab to your state business licensing board and to your insurance company..

Then call your insurance and ask them what local sleep labs they are contracted with and while you are at it, ask them what local DME CPAP suppliers they are contracted with. Hopefully you will have more than one option of each.

Read my reply to James Goodman's post "Coordination of Care and Follow-Up"

• ▶ Reply

Permalink Reply by Mike on December 21, 2009 at 10:14pm

I don't think you'll be able to get a CPAP machine without the sleep study because you need a physician to prescribe a CPAP, and it will be very hard to find a physician willing to write out a prescription without the benefit of a titration study. the titration study's purpose is to tell the referring physician what settings would be appropriate for your machine. without those results, they don't have much to go on. they could prescribe an open-jaw wide range APAP device with data capability and then check the data to see how you did and try to narrow the range based on the data. But that's a tough task for them, and it doesn't fit into their "natural habitat" to say the least. further, given how much difficulty you had tolerating the machine, i'm surprised you want one at all -- do you really?

• ▶ Reply

Permalink Reply by John Cosman on December 21, 2009 at 10:23pm

No, I don't really want a machine. What I do want is to have energy and to be able to stay awake at my desk. So, if the machine would allow me to do that, then yes, I want one. I'm also not sure that only three or four hours with inept techs that weren't even able to make a simple decision without calling the doctor at home is enough to say that I don't tolerate the machine.

Mike said:

I don't think you'll be able to get a CPAP machine without the sleep study because you need a physician to prescribe a CPAP, and it will be very hard to find a physician willing to write out a prescription without the benefit of a titration study. the titration study's purpose is to tell the referring physician what settings would be appropriate for your machine. without those results, they don't have much to go on. they could prescribe an open-jaw wide range APAP device with data capability and then check the data to see how you did and try to narrow the range based on the data. But that's a tough task for them, and it doesn't fit into their "natural habitat" to say the least. further, given how much difficulty you had tolerating the machine, i'm surprised you want one at all -- do you really?

• ▶ Reply

Permalink Reply by Tim on December 21, 2009 at 10:27pm

Tell your sleep specialist that you want to go to a different sleep lab for your titration, there will be several other sleep labs available in your area (unless you live in the middle of nowhere).

• ▶ Reply

Permalink Reply by Judy on December 21, 2009 at 10:30pm

Right on, John. You've got the right attitude! There ARE good sleep labs out there. And there are even good local DME providers out there. You might even try calling your local hospital to ask if they have a sleep lab and then talk to someone in the sleep lab to see if they do any home screening for OSA. Just beware, hospital sleep labs usually charge considerably more than independent sleep labs. And not all hospital sleep labs are particularly comfortable. I've read of some that are still using hospital beds for their sleep studies!!!!

• ▶ Reply

Permalink Reply by Mike on December 21, 2009 at 10:31pm

I agree with Tim. Find a different lab and go there. You can use the tool at www.SleepSearch.com to find others in your area -- be sure also to leave a review of the one that you didn't like so that others can avoid it. Also, let's say for argument's sake that you don't tolerate the machine even after going to another sleep lab. perhaps a dental device would work for you. for that decision, you'd need a consultation with an ENT experienced in sleep disorders.

Tim said:

Tell your sleep specialist that you want to go to a different sleep lab for your titration, there will be several other sleep labs available in your area (unless you live in the middle of nowhere).

• ▶ Reply

Permalink Reply by RockRpsgt on December 21, 2009 at 10:49pm

The sleep specialist is probably tied to that lab. I would talk to the PCP involved. it is also possible for your physician to prescribe an auto machine based on the results of the diagnostic study. Depending on how long ago it was. I would also be talking to the lab manager about the way you were treated during your stay. Your experience is not normal practice.

Tim said:

Tell your sleep specialist that you want to go to a different sleep lab for your titration, there will be several other sleep labs available in your area (unless you live in the middle of nowhere).

• ▶ Reply

Permalink Reply by Josef Halepaska on December 22, 2009 at 9:19am

What you describe sounds just almost exactly like my experience. I stuck with it though. I was suposed to have a split night but it turned into 2 seperate nights and I ended up with a prescription of 16. Between my insurance and I, we paid $6,000 for this study. I had a very miserable 13 months and finally talked my sleep doctor into a data capable apap. The prescription he wrote was 4-20. The machine pretty much instantly auto titrated me. Looking at the data, it was fairly apparent that my 90% pressure was a 10. Problems like mask leaks, problems breathing, all become easier as the pressure is lower as opposed to higher. There is a web site cpapauction.com that auctions off equipment, a lot of it new. You have to have a prescription on file before you can bid. I intend to get my regular doctor to write me a prescription for an apap with a 4-20 setting. I feel real sure he will write it. I have read about these on line physicians who will write you just about any prescription after an on line consultation. That would be another option. I've watched fully data capable machines selling for under $300. between my insurance company and me, we were paying $600.00 a year rent for a bare bones machine that retails for $400. Hope this helps.

• ▶ Reply

Permalink Reply by RockRpsgt on December 23, 2009 at 12:44am

if your 90% average is 10 why not tighten the range a little. Say 9-15? At a range of 4-20 you are basically going through a titration every night.

Josef Halepaska said:

What you describe sounds just almost exactly like my experience. I stuck with it though. I was suposed to have a split night but it turned into 2 seperate nights and I ended up with a prescription of 16. Between my insurance and I, we paid $6,000 for this study. I had a very miserable 13 months and finally talked my sleep doctor into a data capable apap. The prescription he wrote was 4-20. The machine pretty much instantly auto titrated me. Looking at the data, it was fairly apparent that my 90% pressure was a 10. Problems like mask leaks, problems breathing, all become easier as the pressure is lower as opposed to higher. There is a web site cpapauction.com that auctions off equipment, a lot of it new. You have to have a prescription on file before you can bid. I intend to get my regular doctor to write me a prescription for an apap with a 4-20 setting. I feel real sure he will write it. I have read about these on line physicians who will write you just about any prescription after an on line consultation. That would be another option. I've watched fully data capable machines selling for under $300. between my insurance company and me, we were paying $600.00 a year rent for a bare bones machine that retails for $400. Hope this helps.

• ▶ Reply

Permalink Reply by Tim on December 23, 2009 at 2:56am

If your machine is set with a range of 4-20, you are also at risk for it to "run away" - it can go to a high pressure and stay there trying to correct the central apneas that it is causing.

• ▶ Reply

Permalink Reply by Josef Halepaska on December 23, 2009 at 8:17am

Thanks, that's exactly what I have done is set the minimum to 8.

Rock Hinkle said:

if your 90% average is 10 why not tighten the range a little. Say 9-15? At a range of 4-20 you are basically going through a titration every night.

Josef Halepaska said:

What you describe sounds just almost exactly like my experience. I stuck with it though. I was suposed to have a split night but it turned into 2 seperate nights and I ended up with a prescription of 16. Between my insurance and I, we paid $6,000 for this study. I had a very miserable 13 months and finally talked my sleep doctor into a data capable apap. The prescription he wrote was 4-20. The machine pretty much instantly auto titrated me. Looking at the data, it was fairly apparent that my 90% pressure was a 10. Problems like mask leaks, problems breathing, all become easier as the pressure is lower as opposed to higher. There is a web site cpapauction.com that auctions off equipment, a lot of it new. You have to have a prescription on file before you can bid. I intend to get my regular doctor to write me a prescription for an apap with a 4-20 setting. I feel real sure he will write it. I have read about these on line physicians who will write you just about any prescription after an on line consultation. That would be another option. I've watched fully data capable machines selling for under $300. between my insurance company and me, we were paying $600.00 a year rent for a bare bones machine that retails for $400. Hope this helps.

• ▶ Reply

▶ Reply to Discussion