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Permalink Reply by Todd Loren Sinclair on December 12, 2010 at 7:58am

If you do decide to have a 2nd study I think that since you had so much difficulty falling to sleep before you should request that your Doctor prescribe an ambien sleeping pill for you. It won't affect the sleep results but it will make it easier for you to fall asleep.

Sonia S. said:

Thanks Judy.

 

I didn't feel it was bad for the doctor to have me do another sleep study so I could get a new prescription for a new mask for my CPAP machine, especially after having lost so much weight, but I do feel that the staff, at her clinic and at the sleep clinic are not very good. First at her clinic it took many weeks for me to get a call, after I had called, from a staff member just to schedule the appointment for the sleep study. Then the behavior of the staff at the sleep clinic was not good, bad enough to warrant suspension. Then after the sleep study 3 weeks go by with no call from either a staff from the doctor's clinic or the sleep clinic, so I don't hear anything until I call the both clinics to find out what's going on.

I don't know what to do, if I should take the chance and have the 2nd night at the same sleep clinic, and hope that it goes well and that Medicare will pay the bill for 2 nights at that sleep clinic. The 1st one was supposed to be a split study, without the CPAP during the first 2 hours, then with the CPAP the rest of the night, but since I couldn't really sleep and due to the results the tech saw she said the CPAP wasn't going to be used, though the reason she gave me was that it appear I might no longer have sleep apnea. When I mentioned that I didn't think I was getting sleep she said that I was getting enough sleep for the study. Anyway, I don't know what I can do now, if I should try getting the study done at another sleep clinic, don't know if Medicare would cover a sleep study at another clinic, or just take my chances and have it done at the same clinic.

 

You said "the fact that Dr. Liberatore asked you if you would be comfortable going for another sleep study at this lab if she ensured that the sleep tech supervisor would be in charge says volumes." Does that mean you recommend I stay with the same doctor and clinic, and have the 2nd night study there again?

 

Sonia

 

Judy said:

Wait. First off, because I am so impressed, I HAVE to say CONGRATULATIONS and a 130-140 lbs weight loss!!!

 

Second, many states REQUIRE a new prescription each year for the purchase of a mask or other accessories. IF you are doing well w/your CPAP most sleep doctors will just write the script for you assuming it is the same sleep doctor who ordered your original equipment.

 

IF you are NOT doing well w/your mask and equipment, and ESPECIALLY after such a great weight loss, it is totally reasonable that a new sleep study be recommended and ordered. It becomes even more reasonable when this is a totally new sleep doctor who hasn't seen you before.

 

Its not clear whether a split-night study was ordered, or if you expected a split-night study or if you just expected a CPAP titration study rather than a sleep evaluation study. Most insurances, including Medicare, will not approve and pay for a split-night study (first part of night w/o CPAP, second part of night w/CPAP) unless certain specific criteria are met during the sleep evaluation portion of the study (the part w/o CPAP and mask). When I had my in-lab sleep studies done Medicare required a MINIMUM of 2 hours sleep out of 6 hours bedtime. Meaning for a split-night study you would have had to have a minimum of 4 hours of sleep.

 

The fact that Dr Liberatore asked you if you would be comfortable going for another sleep study at this lab if she ensured that the sleep tech supervisor would be in charge says volumes.

 

 

 

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Permalink Reply by Sonia S. on December 13, 2010 at 2:26pm

Thank you Judy, I appreciate the advice and information. Here I thought that Medicare only pays for up to 70% and the rest is the patient's responsibility. I'm so bad at writing the type of letter you suggest but I'll give it a try and hope for the best, though I tend to think that getting them to admit mistake and cover the cost of the 1st sleep study is something that will not happen. I would really be screwed if I get charged for 2 sleep studies and even more if Medicare were to deny paying the 2nd one entirely, makes me want to not take the chance and skip that 2nd sleep study, but then I'll have no treatment for my sleep problem. Thanks again for your help.

 

Sonia

 

 

Judy said:

It sounds to me that Dr Liberatore was both embarrassed and seething that you were left unattended and will be climbing on the backs of the owner of the sleep lab AND the techs.

 

I would be inclined to send a WRITTEN request to the sleep lab requesting a copy of the full scored data summary report w/condensed graphs AND the tech's notes as well as a copy of the doctor's dictated results report. The full scored data summary report w/condensed graphs AND the tech's notes should be especially interesting!!!! These are part of your medical records and as such you have a LEGAL RIGHT to them under HIPAA.

 

I would also send a diplomatically WRITTEN description of your sleep study experience to the sleep lab director. I would state that I felt there should be NO CHARGE for such a shoddy experience given the disgraceful and unprofessional conduct of the sleep techs. Keep it brief and to the point. I would also ask if this sleep lab was accredited.

 

Sleep labs, like local DME providers, submit a billed amount to Medicare. There is an allowed amount that the labs have agreed to accept in order to qualify for Medicare reimbursement. Medicare pays 80% of that allowed amount. You are responsible for the remaining 20% of the allowed amount. In order to qualify for Medicare reimbursement the sleep lab can NOT charge you any more than the 20% of the allowed amount.

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Permalink Reply by Sonia S. on December 13, 2010 at 2:29pm

Thanks for the suggestion, Todd, I was thinking about that but didn't know if sleep medication would affect the results of the sleep study. I hate having to do this again, more because of all the gunk they put on my scalp, I was still removing that gunk a week after.

 

Sonia

Todd Loren Sinclair said:

If you do decide to have a 2nd study I think that since you had so much difficulty falling to sleep before you should request that your Doctor prescribe an ambien sleeping pill for you. It won't affect the sleep results but it will make it easier for you to fall asleep.

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Permalink Reply by Judy on December 13, 2010 at 9:52pm

Have you ever used Ambien for sleep? I worked great to get me to sleep. But one can have a reaction to any new medication so if you've never taken Ambien before you would be best off trying it at home for a night or two. The last thing you need is to have an opposite effect from it!!!! And the sleep lab must be made aware if you take one that night. Its best to ask the sleep doctor if it is okay to take one. Most are agreeable to Ambien, some even script it for those patients who need it, but some are adamantly against it.

 

As for the gunk in your hair: buy and use one of those cheap plastic "nit combs" they use for head lice on the glued areas, wash your hair in as hot water as you can stand w/o harm, use some GooGone for your second washing, then wash your hair a third time and it should all come out. A lot of sleep labs are using a different substance that is not so hard to get out but many still seem to use the old fashioned stuff - collodiun or something like that. I forget the exact name. The newer stuff is much easier to get out.

 

It reminds me of those electrodes they put on you for an EKG, etc. It never seems to fail that we miss removing at least one of them and I find it the next time I shower.

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Permalink Reply by Crash on January 15, 2011 at 1:53pm

I realise that this thread is a bit old, but I just happened to stumble in on it. Well it seems that you are not alone with problematic sleep centers. My titration study was an absolute nightmare. It is unfortunate that you were running into so many roadblocks with your treatment. When I finally did my studies last summer, they advised similar results as yours approx 9-10 events/hr and sat. Of 88%. The centers Dr prescribed this rediculous nasal mask. It was an absolute nightmare, and I stopped use after a couple of days. When I followed up w/ my ENT a few weeks later, I explained to him the probs w/ my study (primarily just to vent) and that the mask was unacceptable. He readily wrote me a scrip for generic nasal pillows and said research what I wanted and call the homecare equpment provider. I first went with a Swift fx. It was a huge improvement, and I was able to at least start to use my cpap. I did find that stabilty was a bit of an issue to a good fit, and leaks where a chronic problem. Last week, my 3 months were up so when I called for a replacement mask, I opted for the optilife w/nasal cushion. What a huge difference. Great stability and fit, and no leaks. I have been using It 5 days now and its been great. It has a chin strap that aids in stability. Not designed to keep your mouth closed, but for me its seems to be enough to keep my mouth from falling open. I was always a mouth breather but quickly adapted to a nasal mask. There are always chin straps available if you really need something to help. It seems to me that your doctor is not being receptive to your needs. They can write a scrip for anything you need. You should have a say in your treatment. If not it seems like a different Dr is in order. I cant see why any study was necessary, certainly not to change your mask type. Perhaps to evaluate you since its been several years, but not for a mask. Any Dr. Should realise that your comfort and compliance during treatment is paramount and should do whatever it takes to assist you in achieving that. Get yourself a mask that you think you will be comfortable with and that you will use. Not what someone tells you. You have a choice. I hope everything is working out for you. Congratulations on the weight loss. And welcome to the world of well your thin, you shouldnt have apnea.... Seems like doctors are always prejudicial oe way or another.... Your thin, I really dont think you have apnea.

Please excuse any typos or reduntant rambling. Typed this on an iPad, and cant scroll back to proofread

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