After I was on CPAP at a setting of 6 for 3 weeks and still feeling pretty bad, my new sleep doctor put me on APAP for a week to see what what going on.  I have the results from the DME but the doctor won't have them until next week.  Report states the following:

Treatment
Pressure 95th centile:   10.2cm H20
Median Pressure:           6.8cm H20
Maximum Pressure        12.0cm H20

The DME says that the doctor will probably up my pressure to 10cm but he (the DME) thinks the 6 setting (where my CPAP already is) is really what I should be on.  What???????

All I know is that I felt much better when using the APAP.  After using the CPAP last night, I awoke groggy and with a headache this morning.  Back to square one.  HELP!!!!

sleepyjean


_________________
Cheer up, sleepy Jean
oh what can it mean
to a daydream believer
and a homecoming queen.

The Monkees

Quote:

All I know is that I felt much better when using the APAP.

OK, here's where all those bucks momma sleepydave spent on her son's college education really pays off:

"Go back on the AutoCPAP."

The median pressure is the average pressure that the CPAP was on all night.  It has no practical purpose other than to add fill to the page.

The 95th percentile value will take care of 95% of your events.

The maximum pressure will take care of all your events.

If you can't use the AutoCPAP, then the pressure choice is from 10.2 - 12.0 cmH2O.  I would think 10 would be darn close enough.

But it ain't 6, that's for sure.
sleepydave

Once again, thanks sleepydave.  Glad to see that your momma's money was well spent   I figured the DME was way off.  

My insurance company has paid for 1 month's rental of the CPAP so perhaps I can return it if my doctor writes the prescription for an APAP.  That would be my goal, but maybe it's not realistic.

As always, your reply is greatly appreciated.

sleepyjean


_________________
Cheer up, sleepy Jean
oh what can it mean
to a daydream believer
and a homecoming queen.

The Monkees

Hey SJ:
If you're on rental, then I would absolutely think they would take it back.

Couple that with the CPAP report, lemme post that too for you cause it shows a couple of things:



Even tho the guy's a little wishy-washy about the level-- "Yeah, 6 is good, then again it might not be, but I think it is, unless it's not" he clearly states that you could end up in EXACTLY this postion, so this shouldn't be a surprise to anyone.

Which would lead me to ask, "On what basis could the DME possibly base that statement that 6 is OK?"

I suppose ideally, it would be interesting to see the final dispostion of all those arousals on the higher pressure, but there's a lot to be said about just plain old "feeling better."

Actually I lied about momma sleepydave footing the college bill, Uncle Sam did, but that ain't as funny.
s.d.



Last edited by sleepydave on Sun Jan 22, 2006 5:31 pm; edited 1 time in total

No matter whether your momma or your uncle footed the bill, you ran with it.  A truly excellent analysis of medical doublespeak!

diana

Hello again, sd.  Am I correct in assuming that in order to get the APAP, my doctor will have to specify that in the scrip?  I know if bought on line, having a scrip for a CPAP will also allow you to get an APAP.  I'm pretty sure though that it is different when dealing with a local DME.  If that's the case and I don't get an APAP scrip, I'm almost tempted to buy one on line for myself, but I don't know how the insurance would work with that.  I have Anthem and they're very good, but of course this being all new to me, I don't know their policy regarding CPAPS, APAPS, etc.  It seems to me that they would benefit from an out and out purchase though as compared the outrageous inflated rental cost.  Perhaps I can persuade them!  That is, if I can find someone who knows what I am talking about   

With an APAP I can get the software to keep track of my readings, correct?  

Yikes, what a rocky road this is!  It's all such a battle.......


sleepyjean


_________________
Cheer up, sleepy Jean
oh what can it mean
to a daydream believer
and a homecoming queen.

The Monkees

Hi SJ:
People use DMEs in order to insure that they will get knowledge and support about their product.

If you get the AutoCPAP from the DME, will the same person who told you 6 is good help you with the setup?

What was the question again?

10-4 on the software.
s.d.

Hi SD,

Yes, if I get the APAP scrip from my doctor, the same DME would be setting it up (probably telling me all the while that it isn't what I need).  I probably could use another DME though as there are several in my local area.  As far as giving information about the product, he was pretty good about that when I picked up my CPAP and mask.  

I think (?) my question was that if I have to go the online route, do you think I  1. should
and  2. Will have any luck with reimbursement from Anthem.  I know this isn't your field of expertise, but thought perhaps you might have heard what others' experiences have been.

Thank goodness that Uncle Sam spent the money on your education    Better than a $500.00 wrench!

sleepyjean


_________________
Cheer up, sleepy Jean
oh what can it mean
to a daydream believer
and a homecoming queen.

The Monkees

sleepyjean wrote:

... do you think I  1. should and  2. Will have any luck with reimbursement from Anthem.  I know this isn't your field of expertise, but thought perhaps you might have heard what others' experiences have been.

Thank goodness that Uncle Sam spent the money on your education :-D   Better than a $500.00 wrench!

sleepyjean

The best thing to do is to call Anthem and document names, time, date etc. of all conversations, copies of all receipts, etc.  I don't want to say "sure this happens" cause I've seen different opinions come out of the same office depending on who you talk to.

Yeah, good ol' Uncle Sam-- course, there was that little chore I had to do for him to get that coin.
s.d.

Sleepjean,

I live in Ohio and have Anthem Blue HMO Federal insurance.  I have a APAP rented for a month, but I just finished by titration sleep study last Thursday so I am waiting for the doc to write the summary report and write the prescription.  He said he would write an APAP prescription if I wanted one (nice doc, eh?).  Once I have that, I am going to try to make sure the insurance company follows through with the policy guidebook.  I contacted them a couple of weeks ago when I first was diagnosed and they said "10 months rent to own" only.  However, I want to purchase the system outright.  I am 100% compliant since my wife is sleeping without my snoring (she is also an RN).  I am going to present the insurance company with a cost comparison:

10 months rental @ $200/month = $2000 (that what the DME is charging for the Repironics REMStar AUTO CPAP)

versus

$780 to purchase at CPAP.COM

The insurance pays 80%, so in the first case I would pay (10)($40) = $400, versus (0.2)($780)=$156 in the second case.

I will post an update on my experience....

Please let us know how you do....

DRG

Ok, now I have my own APAP.  Yay, I think!  The pressure range is set at 6 - 15.  I am still waking up feeling very tired.  Could the range be the problem?  Or,  perhaps the number of arousals (250) that I still have.  No one, except you, sleepydave,  addressed the arousals at all.  Could they be the reason for the extreme fatigue?

Now into my second month  - what a hassle.  I just want to feel rested...and can't seem to get there.

Thanks.

sleepyjean


_________________
Cheer up, sleepy Jean
oh what can it mean
to a daydream believer
and a homecoming queen.

The Monkees

Hi SJ:
Ah, yes, I remember it like it was yesterday...

All Them Arousals

In re: the APAP, you've already got a report that says 12 is enough.  It would be nice to get the software to see how high the pressure goes.  But if it never went to 15, then having a "too high" pressure is academic anyway.

We have also said that 6 is probably not enough.  If you're doing a lot of RERA-ing, then 6 could be just allowing a lot of problems to occur.  If you were gonna do something, kick that up a bit.  But I don't think that's it either.

PLMs?  Maybe, but Effexor might be generating the leg movements.

GERD?  Also could be, but still not high on the list, at least not just yet anyway.

So that brings us back to the Effexor.  That can certainly generate the sleep fragmentation.  And that Xanax can create problems, too.

So I'd say to get back to the MD and review those drugs.  Stopping them abruptly on your own could create twice as many problems as you already have, including withdrawal symptoms, worse depression, worse insomnia, and nightmares through REM rebound.  So you're gonna need a backup plan.

Regardless of the plan, this is gonna take a bit.  I know it seems like a long time, but you've only got a handful of days that the CPAP was/is working properly, so give it a bit more of a chance.

OK, so just settle in with the APAP.  Sit down with your MD and see if you can get the drugs worked out so that you have a happy medium between treatment of depression and sleep fragmentation.

If you are able to get off the drugs, get another sleep study.  See if all the arousals disappear.  (Do it on CPAP, we can figure out what pressure to use.)  If the arousals disappear, voila, then you just have to pick your priorities, or perhaps the better sleep quality will offer enough benefit by itself.

This will happen.  Just probably not today.
dave