Sleep Apnea

Types of Sleep Apnea

There are two types of sleep apnea, Obstructive Sleep Apnea and Central Sleep Apnea. CPAP is used in when a person has Obstructive Sleep Apnea. This page is devoted to general Sleep Apnea facts - syptoms, risk factors and getting diagnosed. For information on the two specific types visit Obstructive Sleep Apnea or the page Central Sleep Apnea by clicking on the word.

Sleep Apnea Symptoms

Do I have Sleep Apnea? What are the symptoms and risk factors for Sleep Apnea? See the CPAP Wiki page dedicated to these issues here.

The Boiled Frog Analogy

Maybe you’ve heard this story. If you put a healthy frog into a pot of hot water, it will quickly jump out. If you put a frog into a pot of lukewarm water, and very gradually increase the temperature, it will stay in the pot until boiled. In the hot water, the frog noticed instant discomfort and danger and took action. In the tepid water, it was lulled into complacency until unaware or unable to take action. How does this translate to sleep apnea? Have you unconsciously adapted to fatigue and eventually daytime sleepiness because its progression was so long and gradual? Have you found other reasons for fatigue, while making the best of circumstances? Are those reasons valid? You can find out by consulting a physician, taking informal sleep quizzes and, if indicated, getting a sleep study in a sleep lab. When you find the real reason for your fatigue, you can crawl out of the pot to change, improve, or reverse the condition.

Diagnosing Sleep Apnea

Who can Diagnose Sleep Apnea?

Sleep doctor, Ear/Nose/Throat doctor, pulmonologist, cardiologist, eye specialist, allergist, surgeon, dentist, other specialist

Who makes the best sleep Doctor?

A CPAPtalk thread discusses this issue here.

Visiting the Sleep Lab

For information on Sleep Study options and advice visit the page devoted to Sleep Studies.
(Click the term 'Sleep Studies' in the proceeding sentence.)

Working with Physicians, Insurance and DMEs

Physician Help

Getting into a Sleep Specialist/Sleep Lab Quickly

author unknown

This might seem like a no-brainer, but I'm going to mention this anyway just in case someone out there needs this info.

Anyone who has been into see a sleep specialist / neurologist as a new patient and then has booked a night at a sleep lab knows all too well how even in first rate medical cities (ie. Boston; Philly; Cleveland) it can easily take 1-3 months to get an appointment with a good Neurologist / Sleep Specialist. And then you're at the back of the line again to get into a sleep lab. AND THEN you're at the back of the line AGAIN to get back into see your Neurologist for the results of the sleep study. And if your results are inconclusive as they often are, add another 1-3 months for a repeat night at a sleep lab etc etc. When you're suffering from Sleep Apnea, nothing is more painfull than knowing it might take 6-8 months to finally be treated for the disorder.

So here are my tactics for getting into Sleep Specialist, Sleep Lab, and most importantly getting treatment ASAP or well within 6-12 weeks.

1. After you book your first appointment with your Neurologist / Sleep Specialist, call the scheduling desk and quickly convey that you are available on short notice if anyone else should cancel their appointment. If they say they have a long list, then pull out the "friendliness card" and make sure you're well known to the office staff.

2. After your first night at the sleep lab is booked, get on the phone to the sleep lab and do the exact same thing. Sleep Labs bill $1,000-$4,000/night so they are always eager to book empty beds, and people cancel their sleep lab nights left and right.

3. After your night in the sleep lab, you have no choice but to wait for your results to be compiled and sent to your neurologist. But once you\'re able to get into see your Neurologist for follow up, get on the phone and request that the office call you for cancelled appointments.

Hope this helps! I've been into 5 sleep studies and this always works for me.

Suggested Specific CPAP Equipment Rx/Scripts

by CPAPtalk member Slinky

(Editor's note: a doctor's prescription is required for a PAP machine and mask whether through a local DME or online. Online, a generic CPAP prescription will work for either a CPAP or APAP. At a local DME, a prescription specific for APAP will probably be required. See prescription advice and requirements at https://www.cpap.com/cpap-faq/Prescriptions.html#FGID-130 )

If your equipment order (Rx/script) will be for "just" a straight CPAP and not one of the more sophisticated bi-levels (Bi-PAP) or SV, etc. most doctors write a fairly genetic script and then most DMEs will take advantage and provide you with a bare-bones CPAP.

I would suggest that you ask your doctor to write a very explicit equipment order so that you get EXACTLY what you want and really need. The following are some suggested orders (not that I am recommending one machine over the other, just to give you and your doctor an idea).

You will notice the similarities to each suggestion.

1] Exact brand and model of machine

2] Scripted pressure (the autoPAPs have a pressure range rather than a set pressure)

3] Scripted amount for lower pressure at exhalation

4] Starts w/4 cms of pressure and ramps up to your set pressure after you get to sleep

5] Allows you to access your nightly data via the LCD screen

6] While the integrated humidifiers are most convenient for travel and take up less space on your nightstand, in really dry situations sometimes they can't provide as much humidity as you might need or want. For many the integrated humidifiers are more than satisfactory.

7] This ensures that you can try several masks, including a Full Face mask (sometimes they insist on a script specifiying full face if the script just says mask, or will only provide the exact mask mentioned in the equipment order).

Sample 1 1] Respironics REMstar M Series Pro w/C-Flex (w/heated humidifer if you prefer)

2] Pressure ---- cms (whatever your pressure is)

3] C-flex setting 3 (or whatever your doctor suggests)

4] Ramp off (unless you prefer it on)

5] Show AHI/Leak feature On

6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifer. If so just add "w/heated humidifier to the REMstar Pro"

7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

Sample 2 1] Resmed S8 Elite w/EPR (w/heated humidifer if you prefer)

2] Pressure ---- cms (whatever your pressure is)

3] EPR setting 3 (or whatever your doctor suggests)

4] Ramp off (unless you prefer it on)

5] Efficacy & Usage Data access

6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifer. If so just add "w/heated humidifier to the Resmed S8 Elite)

7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

Sample 3 1] Respironics REMstar M Series Auto w/A-Flex (w/heated humidifer if you prefer)

2a] Minimum pressure (whatever your doctor has determined)

2b] Maximum pressure (whatever your doctor has determined)

3] A-Flex setting 3 (or whatever your doctor suggests)

4] Ramp off (unless you prefer it on)

5] Show AHI/Leak feature On

6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifer. If so just add "w/heated humidifier to the REMstar Auto w/A-Flex"

7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

Sample 4 1] ResMed S8 AutoSet Vantage (w/heated humidifer if you prefer)

2a] Minimum pressure (whatever your doctor has determined)

2b] Maximum pressure (whatever your doctor has determined)

3] EPR setting 3 (or whatever your doctor suggests)

4] Ramp off (unless you prefer it on)

5] Efficacy & Usage Data access

6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifer. If so just add "w/heated humidifier to the REMstar Auto w/A-Flex"

7] Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice.

To the best of my knowledge the only other fully data capable CPAPs (as of January 2008) are the Puritan Bennet GoodKnight 420E autoPAP and one other Puritan Bennet GoodKnight straight CPAP. I'm not sure of the correct model. Nor do I know the specifics for those Puritan Bennet's or I would have included them. Those who have the 420E really like them so hopefully further information can be included by someone who knows the Puritan Bennet devices.

Glossary for PSG (Sleep Study) Terms

The PSG Glossary is the first section of the CPAP Definitions page.

Get a copy of your sleep study report. You can refer to it from time to time as you learn more about your treatment. If you visit a specialist (sleep doctor, Ear/Nose/Throat doctor, pulmonologist, cardiologist, eye specialist, allergist, surgeon, dentist, etc.), give them a copy of your sleep study.

Insurance and DME Help

Dealing with Insurance and DME's and getting the data-capable xPAP machine you need

by slinky (compilation of various posts)

Often beginners to CPAP end up with the low-end, non-data capable xPAP's. However, we know that the ability to monitor your own progress (AHI, leaks, etc) greatly increases compliance and allows you to make knowledgeablechanges to your therapy (hopefully with the help of your sleep doctor).

Insurances WILL cover data capable machines. DME's WILL supply you with data capable machines, and here's how to ensure that you end up with a data-capable machine (or the machine and mask you want) when dealing with un-helpful Insurance, DME's, and doctors:

1] Call your insurance company. a] Ask them what local DME CPAP suppliers they are contracted with b] Ask them what your DME CPAP benefits are: copays? deductibles?

2] Since you found this forum I can guarantee you that you are NOT going to be satisfied w/anything LESS than a FULLY DATA CAPABLE CPAP. a] Start checking out CPAPs at cpap.com. Never mind price at this point. Just check out the features. You can choose those CPAPs that interest you and cpap.com offers the opportunity to run a comparison of features of those that interest you. b] Check out autoPAPs separate from "just" CPAPs. You might well get "auto fever" before you are done reading here.

3] Prepare a WRITTEN request for: a] The doctor's dictated results of BOTH your sleep evaluation AND your titration studies b] The full scored data summary report w/condensed graphs for BOTH your evaluation AND your titration studies c] The script (equipment order) so that you may "shop" your local DME options d]If you will not be seeing the sleep doctor for a consultation again FAX this above request to him and keep the proof of FAX. If you will be seeing him BEFORE you receive your equipment then you can just GIVE the request to him TO BE PUT IN YOUR RECORDS as well as discuss the results w/him.

WRITE, don't call

WRITE, don't call, this sleep lab/clinic and request a copy of the doctor's dictated results of both your sleep evaluation AND titration studies (about 1-2 pages each), AS WELL AS the scored report (full data summary report w/condensed graphs - about 5-7 or more pages each) from both studies AND your equipment order (script). This might also be a good time to diplomatically express your disappointment that doctor isn't interested enough in your therapy to want to monitor your data from a fully data capable CPAP.

That letter just MIGHT get you another appointment w/that doctor, your reports AND the script you want for a fully data capable CPAP. Maybe not an autoPAP, but at least a fully data capable CPAP.

It might even be a good idea to send that letter CERTIFIED MAIL, RETURN RECEIPT REQUESTED as PROOF that you HAVE requested those copies which you have a legal right to under HIPAA if you are in the USA. It also signals to the lab and doctor that you ARE serious about wanting them. Keep a copy AND all your receipts of having sent it.

With those copies you have almost all you need. The only other thing you will need is your family doctor to write the equipment order YOU WANT.

For examples of how scripts should be written see the section Suggested Specific CPAP Equipment Rx.

Don't get your heart set on an autoPAP. That can be a tough one to get, especially if you are stuck w/this same DME supplier which you might well be depending on how long you've had your current CPAP.

Also give consideration (if you already have a non-data-capable CPAP) that you will be better off getting the same brand of CPAP, just a fully data capable model, so that the humidifier doesn't have to be replaced as well. The more equipment this DME supplier has to exchange the harder they are going to fight providing it. AND your insurance is NOT going to be happy if they have to purchase another humidifier, all they know is they purchased A humidifier, not which one nor that a Respironics integrated isn't going to fit on a Resmed or vice versa. They most likely would refuse to do so and you'd end up buying the humidifier out of pocket - or going w/o.

Treating Sleep Apnea

To learn more about Treating Sleep Apnea, visit the page devoted to CPAP newbies, found on the CPAP Wiki sidebar or here.

The ABCD's of Treating Sleep Apnea

by sleepguide submitted by ozji

Here's a simple way to remember what I wish I had known at the very beginning of my own Sleep Apnea treatment: my ABCD's of Sleep Apnea treatment. The hope is that you will not have to stumble over or run into as many obstacles as I did.

A is for Attitude

The key is that oft-repeated phrase: "whether you think you can, or you think you can't, either way you're right." Sleep Apnea treatment has much to do with attitude. What got me over the hump is realizing that even if it doesn't kill me as fast as cancer or a heart attack would, it slowly would undermine my body and accelerate my path to death, all the while eating away at my quality of life. It's also 100% treatable if the proper treatment is used. Given those two facts, I choose to get serious about treatment. It was as easy as that.

B is for Buying

Tough to hear, but yes, having Sleep Apnea means you will at one point or another have to shell out dough out of your own pocket. We Americans have an attitude that when it comes to maintaining our cars or our lawns, it's normal to pay something to keep these things in good order, but that when it comes to our own bodies and health, someone else, whether it be insurance companies or Medicare, has to foot the bill. Granted, we pay taxes and insurance premiums to cover this stuff, but the hard cold truth is that it won't foot the entire bill. We can agitate for better health care, but in the meantime, we need to take ownership over our lives and pay the difference between what insurance and Medicare will pay and what it will not.

Once we have this consumer mindset toward our own health, we gain more control and can be more proactive. Data capable machines are better to get than dumb black boxes. Auto-adjusting machines give you more options than "straight" machines. The latest mask on the market represents the latest technology in making these things comfortable to use, and will most likely be easier to use than the one that's in your closet not being used because it makes the bridge of your nose sore. You can get all this stuff online, if you're willing and able to fork over the cash.

C is for Collaboration

Getting well with Sleep Apnea is tough to do on your own. The reason is that there's a lot to know, and that there's no "one-size-fits-all" answer to how to make it all work. So you will need to rely on others. The doctor should be your primary collaborator, but for that to be the case you will need a rare type of doctor -- one who's not defensive about what he/she doesn't know, and who will treat someone like yourself (assuming you don't have a medical degree) with an ounce of respect and an open mind. Often doctors can learn a lot about this stuff from their patients, but it's a rare doctor indeed who will try.

Which is why you'll also need to research all you can online, and reach out through forums like this to others who have Sleep Apnea. Even though we don't have medical degrees, the kind of day-to-day stuff you need to know about Sleep Apnea can often be discovered by interacting with other regular people in similar circumstances.

D is for Documentation

Get a copy of your full sleep study and titration reports. Then ask your doctor for, and obtain, as open-ended a prescription for a PAP device and mask as possible -- doctors can write a script for, say, a "ResMed Mirage Micro Nasal Face Mask" (specific), or they can simply write a script for "a mask according to patient's comfort and choice" (open-ended). Make sure they write the latter. Armed with your full sleep report and open-ended prescriptions (which you should keep in a safe place, by the way), you'll give yourself the ability to double check on things and get advice from everyone in the world you trust, including the people on this forum. In other words, you'll give yourself options and control.

Selecting your CPAP Equipment

For information regarding specific PAP equipment and choices see the page devoted to CPAP.

Relevant CPAPtalk Posts

Symptom Posts

Is it you or sleep apnea? http://www.cpaptalk.com/viewtopic/t17785/I-am-not-sure-everyone-understands.html?sid=2226cb049bfe94a360773a79e7d9ac78

Awareness for doctors and patients http://www.cpaptalk.com/viewtopic/t25205/Waking-Up-to-the-Problem-of-OSA--Improved-Recognition.html

What took you so long to seek diagnosis http://www.cpaptalk.com/viewtopic/t22134/What-took-you-so-long.html

What led to diagnosis http://www.cpaptalk.com/viewtopic/t23161/What-led-you-to-your-diagnosis-of-apnea.html

All ages http://www.cpaptalk.com/viewtopic/t27149/Can-young-people-have-Sleep-Apnea.html

Sleep apnea symptoms http://www.sleepdisordersguide.com/sleep-apnea-symptoms.html

More consequences, scroll down for the post from neversleeps: http://www.cpaptalk.com/viewtopic.php?t=16134&postdays=0&postorder=asc&start=15

Non-snorers with sleep apnea http://www.cpaptalk.com/viewtopic/t13698/Any-non-snorers-with-obstructive-sleep-apnea.html

Sleep apnea but not tired http://www.cpaptalk.com/viewtopic/t24108/I-have-severe-sleep-apnea-but-Im-not-tired-anyone-else.html

Weird symptoms http://www.cpaptalk.com/viewtopic/t24642/so-what-was-you-wierd-not-listed-symptom.html

How long have you had sleep apnea http://www.cpaptalk.com/viewtopic.php?t=21675&postdays=0&postorder=asc&start=

How SA affects life and health, scroll down for the post by countrygent http://www.cpaptalk.com/viewtopic/t26485/Well-Here-Goes.html

Dad refuses to see doctor http://www.cpaptalk.com/viewtopic.php?t=15831&postdays=0&postorder=asc&start=0

Trucker headed to court http://www.cpaptalk.com/viewtopic.php?t=16490&postdays=0&postorder=asc&start=0

Lucky to be treated http://www.cpaptalk.com/viewtopic/t16484/Im-SOOOOO-Lucky.html

See the peer coaching articles at http://smart-sleep-apnea.blogspot.com on Sleep Study Tests, Introduction to Sleep Apnea, More Sleep-Related Web Sites, and CPAP Machine Choices.

Sleep Lab Posts

Discussion threads:

http://www.cpaptalk.com/viewtopic/t14035/Cheap-Sleep-Apnea-Screening-Diagnosis-and-Auto-CPAP-Rx.html

http://www.cpaptalk.com/viewtopic/t14578/At-Home-Obstructive-Sleep-Apnea-Screener-Now-Available.html

Comments from a SleepStrip engineer: http://www.cpaptalk.com/viewtopic.php?t=14035&postdays=0&postorder=asc&start=15=Sleep Symptoms=