Doctors Answers (7)
I am so with you about needing treatment. However, if you are that sleepy you may have another sleep disorder such as Narcolepsy. That is ruled out by documenting that #1. You don't have another sleep disorder such as sleep apnea #2. treatment has not resulted in the expected improvement in daytime alertness, etc. So if you don't have the previous studies unfortunately you must start from the beginning (for all insurances), meaning likely you will need at least a baseline sleep study. Depending on your symptoms, you may also need a daytime nap study. My advice is to find a sleep center in your area that is accredited by the AASM and has a board certified sleep specialist. Make an appointment for an evaluation. They/he/she will determine if you need specialized testing such as the daytime nap test that helps evaluate for a neurologic reason for daytime sleepiness. If you need CPAP treatment, they could help you. I would strongly advise you to get an evaluation with a sleep physician as your symptoms appear to be serious. Good luck. You are so correct that you need evaluation and treatment.
Selection of an appropriate treatment for sleep apnea depends on demonstrating the presence of sleep disordered breathing as well as determining the severity of the sleep apnea. The best way to diagnose and determine severity is with an overnight sleep study. This can be done in the sleep laboratory or with in-home testing devices. Once the diagnosis is made, appropriate therapy is selected by the physician in consultation with the patient. If positive airway pressure (PAP) therapy is selected, there are several types of PAP devices and several ways of determining pressure levels. Continuous positive airway pressure (CPAP) provides the same pressure during exhalation and inspiration and the pressure is determined with a sleep study or a trial with another device called Autotitrating positive airway pressure (APAP). APAP devices regulate the pressure up or down and can be used as stand-alone therapy with no need for a laboratory study, or to determine the most appropriate level to set CPAP at. A prescription is required for a PAP device and most insurance companies require demonstrating the presence of sleep apnea by a sleep study in order to cover the cost of the device.
A CPAP therapy device requires a Physician's Script.
If you have had a sleep study which demonstrates sleep apnea you should be able to find a physician to write an order for you to get a CPAP machine. Some persons need a bi-level but most need the continuous positive airway pressure (CPAP). The pressure settings may vary but if unknown you should start with an auto titrating unit and the results can be downloaded into a computer to determine if you are being effectively treated. Having no access to prior medical records may be an issue. A home study to show that you have sleep apnea may be an economical choice. Being so sleepy and falling raises the question of another sleep disorder, narcolepsy with cataplexy which would best be addressed by a sleep specialist. About 50% of patients with narcolepsy also have obstructive sleep apnea.
Unfortunately, if your last polysomnogram or CPAP study is greater that 2 years old then retesting is required so that insurance will pay for your unit. The quickest way is to perform a split study overnight so you can get started with CPAP again right away and have an auto-titration done at home to optimize therapy. If you are able to get the results of your past sleep studies that would be to your and your treating physicians' benefit.
The way I understand your question and problem, you definitely need to be treated. Now the question is what pressure is going to be the most appropriate, and if your sleepiness will persist despite being adequately treated for sleep apnea. I think you should contact a board certified sleep specialist in your area to help you figure out how best to pursue. Sleep study is a test, and it helps determine what is wrong with the sleep. It has its limitations, like you mentioned that during yours there was no REM sleep. AutoPAP, which is a self-adjusting machine, can also be a good option. Either way, a sleep specialist will help you determine what is the best route to take.
Unfortunately, no medical equipment provider will fill an order without results of a previous sleep study. You have a right to obtain your records from those other studies. From there you may be able to have a home Auto-Set trial to determine what pressure you need. If you paid for the equipment yourself and went through the Internet, you would only need a prescription from a doctor. You really should have expert help so you can successfully use the CPAP at home and get the benefits you deserve.