May 11, 2010

Sleep Apnea

Sleep Apnea Equipment

I have sleep apnea and diabetes. I was diagnosed with sleep apnea about 26 months before the diagnosis of diabetes. Sleep apnea and diabetes have links to each other and have risks for each other. Sleep apnea can and does affect our control of blood glucose levels, and not in a positive way.

However, this is not the purpose of this discussion. David Mendosa has some excellent information about the relationship of diabetes and sleep apnea on his site for your reading. Use the search engine in his site and it will return many results on his site. He also includes his struggle with getting diagnosed and obtaining good instructions on the use of a CPAP machine.

Sleep apnea can also lead to memory changes, depression, and irritability. Sometimes it contributes to high blood pressure, heart failure, stroke, and heart attack.

I wish to cover some of the developments over the last few years in equipment and the progress in education available on the internet. Until about two years ago, I was not aware of the many different types of equipment that are now available. In my research for this, I have discovered how lucky I was to have doctors willing to listen and take action. I will attempt to give you enough information to make an informed decision and to review the choices available on the internet.  I would urge you to learn as much as you can before getting the equipment so that you know what your options are and to prevent getting equipment that is unsuitable for you.

Once you have completed the sleep test at a sleep lab and it is determined that you have sleep apnea and the severity level, check with your insurance company what your coverage is and what they accept for equipment. Please learn what the replacement policy is for supplies, and replacement parts. This varies from insurance company to company and with Medicare and Medicaid. The doctors only have so many codes for use of equipment so most people only receive equipment of minimal costs, which may not be the best for you.

After finding out what is allowed by your insurance company, do some investigating and ask your doctor for as much information as he can give you. Some doctors are not receptive to patients that are proactive, so be as careful as possible, but do get a copy of the information from the sleep study. Most will suggest several local suppliers and let you choose, but your choice should not stop there. Learn about the severity of your sleep apnea, what type of machine or appliance would be best for you. If a machine is best, especially if you have severe sleep apnea, learn what mask would be best for your needs. Ask whether you should have just a machine, or one with a water pass over, or a humidifier. Your doctor should be able to answer most of these questions.

If you choose a local supplier, and I would suggest you investigate this option, you will not have restock fees (15 percent or higher), there will generally a trial period of 30 days so that if you are not satisfied you can return the equipment (this is not available from most online suppliers), and there are people that should assist you in getting the proper fit..

By using the local suppliers, normally a sleep therapist will assist in getting you what the doctor prescribed or calling the doctor to alter the prescription if there are changes needed. They should also have someone to measure you for a mask and they should explain the use and care of the different parts. Definitely ask many questions and get what is best for you, including service. Please make sure that you get a new machine and not a used one. Because of the restrictions by insurance and Medicare, make sure that you understand the rules for replaceable parts, and what your insurance will cover.

If you have mild to moderate sleep apnea, then there are more options. I will have more on that in another blog.

Until just before Thanksgiving 2009, I had an older model of CPAP with a cold water container for the air to pass over that is now longer available. The parts are no longer available. In terms some of you may understand, my equipment was three generations removed from the current technology. However, there are more manufacturers with a variety of types of machines. Some now exist for travel around the world and they will operate on the different electric standards outside and in the US.

Now I am using a VPAP machine that is much quieter. Now that I am past the test period, I have the machine set for the best results. If I need future adjustments, it will be much easier.

You should take time to read and explore the following web site.

American Sleep Apnea Association   This site has a forum to answer your questions and that will lead you to other sites and provides much information. The Association does not list all machines, appliances or masks from all manufacturers. If you have sleep apnea or are interested in the equipment, please take time to explore the site and learn about sleep apnea, the equipment, and some of the processes you will need to be aware of if you have or suspect you have this disorder.

Federal law requires that sellers of sleep apnea equipment have a valid prescription on file before they ship or supply you with your machine or appliance.

The different types of machines are:

CPAP – Continuous Positive Airway Pressure

APAP – Auto Adjust Positive Airway Pressure

BiPAP – Bi-level Positive Airway Pressure

VPAP – Variable Positive Airway Pressure

Auto-titrating Continuous Positive Airway Pressure To determine the concentration of (a solution) by titration or perform the operation of titration. In this case by pressure. This is the most complicated of the machines and possibly one I would be cautious about having.

After having auto-titrating machine during the sleep study lab, I would still urge caution, but would not hesitate to consider having one. The one used for me was very quiet.

Then in addition to the above types, a determination needs to be made if you need a humidifier. This is where full disclosure to the prescribing doctor is very important. If you have allergies, sinus infections, regular colds or cold like flare-ups, sleep with mouth open and have many dry mouth mornings – discuss this information with your doctor to get the right machine and mask for you.

Next is the type of mask which will be best for you. Types are nasal masks, full-face masks, nasal pillow masks, and other headgear and chinstraps. The biggest problem is getting the correct one for you. Whoever is setting up the order should cover this and you should verify that you are getting the correct size of mask. They should also discuss with you whether you have seasonal or chronic allergies, whether you have a deviated septum, do you awaken with a dry mouth, do you need heated humidification and they should measure your nasal bridge – average, tall, wide, narrow, or flat.

Most insurance companies have a strict schedule of what they cover and what they will replace and when. Do not try to get fancy as they will not as a rule allow exceptions to policy. Do talk to your insurance company and ask for the schedule.

No Mask

Now that you have digested all of this, consider if you want a mask and check out this site.  This needs to be considered by some people. Not everything works for every person. There could be medical reasons making this more important than the masks.

Many commercial web sites want to sell machines, masks, and other supplies for sleep apnea.  I will not endorse any. I give this site only for the information it contains to assist you in learning about the equipment.