Cigna refused to cover my sleep study

palerider wrote:

jnk... wrote:The increased volume of production might bring the cost of full-data machines down to around $70 or so.

the last time I googled up something on the subject, the prs1 and s9 machines had something in the neighborhood of 150$ worth of components in them, of course, as time goes on, electronics components tend to get cheaper, so that might be less now. (I think those were bulk component prices, which tend to be much less than single unit costs)

Time, increased production runs spreading out the cost of R&D, less profit margin needed because of higher volumes, and market competition could all play a role, I believe--I mean, assuming of course that Belgium, Scotland, Trump, North Korea, and China don't all conspire to crash free trade and capitalism by the end of tomorrow, just for the fun of it. Which reminds me. I wonder if Dave has checked his 401k today.

@jnk...

You're my hero. I could not have said that any better or half as eloquently.

Aclyesia wrote:@jnk...

You're my hero. I could not have said that any better or half as eloquently.

Thanks for the compliment!

But there are much better candidates for heroship here--like maybe one of the ones who, unlike me, actually know what they're talking about.

The latest update is Cigna, carecentrix and my DR have agreed to cover and allow me to have a Home sleep study.
The earliest I could schedule it was July 27
Because of the endless delays I had purchased a used PR system one 550 and heated humidifier from another forum member well over a month ago.
I have had Two sleep studies in thr past and was prescribed a Cpap machine that bit the dust after 15+ years. different insurance and doctor so they did not have the original reports or were to lazy to research Them? All my medical records have been transferred over the years to my current doctor of 13 years.
my original Nasal mask was terrible and had to be pulled really tight to avoid leaks and left marks on my face so I purchased the PR dreamware mask on Amazon.
seemed to work very well but I was getting a lot of Centrals showing up in the data. A couple members here were very helpful and made masks they could not use available to me for the cost of postage to ship them to me. Really wonderful helpful people here on this forum.
I found when using a full face mask the central disappeared completely. Then full face was uncomfortable and I kept going back to the dreamware. I suspect the reported centrals are fake and due to the mask for some reason I have yet been able to understand.
Another member recently made a PR wisp nasal mask available to me for shipping, God bless you wonderful individuals, and using it no Centrals and really low AHI under 1 are being reported.
It's mostly comfortable but not as much as the dream ware but when I put it on I get Centrals reported for some reason. Centrals make my AHI jump to high numbers of 7 or higher.
I suspect they are fake but I do wake more with the dream ware mask than the Wisp. Does anyone understand how the mask plays this big of a role in event reporting?
Leak rates with all masks used are reported as acceptable.

Are you getting a handful of centrals when falling asleep and then on awakening, or are you getting lots all through the night? The former type is normal and often called sleep-wake junk (though not 'fake'), the latter are more likely to be a problem.

Do you know you can try various masks x 30 days each at Cpap.com for either free or just a small fee depending on the mask? There are so many out there, and some are bound to work better than what you've tried... size is important, fit's important and trying on FFMs while lying down vs sitting is important. You shouldn't have to overtighten.

If you read Pugsy's Pointers at the top of the main page, there is a good explanation .....Here is what is said about Centrals AKA Clear Airway.

Centrals or Clear Airway events (index)...we can't do anything about them with just simple pressure tweaks and we shouldn't try unless the numbers are excessive (and increasing the pressure is the wrong way to go anyway). Centrals/Clear Airway events are a whole different animal.

If your AHI is 4.9 and 3.0 of that is Central...that only leaves 1.9 for Obstructive Apneas or Hyponeas.
Obstructive Apneas and Hyponeas are the only things in the AHI that will respond to pressure tweaks.
So make sure what you want to "fix" is "fixable" with pressure tweaks.

Time to explain how the machine reports what it senses. The machine doesn't know if you are awake or asleep. It has no way to know. All it measures is air flow. Often when we spend some time awake on the machine (laying there counting sheep in an effort to get to sleep with the alien plastered on our face) the machine can flag some awake breathing irregularities (awake breathing is often much more irregular than asleep breathing) as some sort of apnea event. Commonly centrals get the flag. Hold your breath for 10 seconds...that's pretty much a "central" but you were awake. The airway is open but no air flow through the airway. We all do it fairly often but we don't realize it. If you do it while the machine is on...well the machine just records what it senses. It doesn't know that you did it on purpose.
Also sometimes people actually have centrals during sleep stage transition..especially during sleep onset. We just do it and it is normal. Now some people do it a lot and can't transition into sleep because of them they repeatedly brought back to an awake state. Then it becomes a problem and that is dealt with by using a different machine. Regular xpap therapy can't fix those.

Open airway cessation of breathing...central/clear airway event...we can't fix with a regular cpap/apap machine even if there are too many of them. In a sleep lab any awake breathing centrals would be discounted because they aren't occurring during a sleep state.

Of course we don't always know if we were awake or not. The machine can't tell us and we don't have EEG brain wave data available at home. So we have to make an educated guess.

Centrals..even if real and occurring during sleep...aren't normally a problem. It's normal to have a few. Even people without any sleep apnea diagnosis can and will have them happen from time to time.
How many is too many? Hard to say but if you are seeing 5 per hour...every hour...every night that you can't explain away by being awake maybe...see your doctor. It may not be anything but whenever in doubt about something you see on your report....go see your doctor.

Julie wrote:Are you getting a handful of centrals when falling asleep and then on awakening, or are you getting lots all through the night? The former type is normal and often called sleep-wake junk (though not 'fake'), the latter are more likely to be a problem.

Do you know you can try various masks x 30 days each at Cpap.com for either free or just a small fee depending on the mask? There are so many out there, and some are bound to work better than what you've tried... size is important, fit's important and trying on FFMs while lying down vs sitting is important. You shouldn't have to overtighten.

I suspect it's sleep wake/junction and I'm calling that fake centrals as the Apap machine does not know when I'm actually sleeping or not.
What I don't understand is why the Dream ware mask wakes me up more than the Wisp or the Comfort full face mask. Both are much more uncomfortable to ware for me than the dream ware so it's just not logical to me.

LSAT wrote:If you read Pugsy's Pointers at the top of the main page, there is a good explanation .....Here is what is said about Centrals AKA Clear Airway.

Centrals or Clear Airway events (index)...we can't do anything about them with just simple pressure tweaks and we shouldn't try unless the numbers are excessive (and increasing the pressure is the wrong way to go anyway). Centrals/Clear Airway events are a whole different animal.

If your AHI is 4.9 and 3.0 of that is Central...that only leaves 1.9 for Obstructive Apneas or Hyponeas.
Obstructive Apneas and Hyponeas are the only things in the AHI that will respond to pressure tweaks.
So make sure what you want to "fix" is "fixable" with pressure tweaks.

Time to explain how the machine reports what it senses. The machine doesn't know if you are awake or asleep. It has no way to know. All it measures is air flow. Often when we spend some time awake on the machine (laying there counting sheep in an effort to get to sleep with the alien plastered on our face) the machine can flag some awake breathing irregularities (awake breathing is often much more irregular than asleep breathing) as some sort of apnea event. Commonly centrals get the flag. Hold your breath for 10 seconds...that's pretty much a "central" but you were awake. The airway is open but no air flow through the airway. We all do it fairly often but we don't realize it. If you do it while the machine is on...well the machine just records what it senses. It doesn't know that you did it on purpose.
Also sometimes people actually have centrals during sleep stage transition..especially during sleep onset. We just do it and it is normal. Now some people do it a lot and can't transition into sleep because of them they repeatedly brought back to an awake state. Then it becomes a problem and that is dealt with by using a different machine. Regular xpap therapy can't fix those.

Open airway cessation of breathing...central/clear airway event...we can't fix with a regular cpap/apap machine even if there are too many of them. In a sleep lab any awake breathing centrals would be discounted because they aren't occurring during a sleep state.

Of course we don't always know if we were awake or not. The machine can't tell us and we don't have EEG brain wave data available at home. So we have to make an educated guess.

Centrals..even if real and occurring during sleep...aren't normally a problem. It's normal to have a few. Even people without any sleep apnea diagnosis can and will have them happen from time to time.
How many is too many? Hard to say but if you are seeing 5 per hour...every hour...every night that you can't explain away by being awake maybe...see your doctor. It may not be anything but whenever in doubt about something you see on your report....go see your doctor.

I understand perfectly what your saying.
The centrals when reported are massive and within short periods of time of 15 mins or less. the rest of the night will be central free.
The thing is this only happens with the PR dream ware mask and that is what has me stumped.
What might be happening with the mask that would cause this?
My preference is to use the Dream ware mask as it is the most comfortable of any I have tried so far. It feels many time like I don't even have mask on at all.
The high clusters of CA's however when using it gives me pause and I can't understand why the mask would cause this.

Contact Cigna and ask how to get an appeal to have your lab sleep study covered.

SewTired wrote:Contact Cigna and ask how to get an appeal to have your lab sleep study covered.

I have called but they only forwarded me to CareCenrix who handles all sleep related approvals for them.
Carecentrix said the DR could ask for a review. that was suppose to happen a month ago and The letter I received yesterday from Cigna says 4 channel home sleep study only has been approved.
4 channel Home sleep study is a Type 3 that only monitors:
•2 respiratory movement/airflow
•1 ECG/heart rate
•1 oxygen saturation

I recently sent a email to the Cigna Patient advocate reprehensive to see if they might be able to help.