Posted by munkyBeatz on April 19, 2012 at 23:01:02:In Reply to: Disappearing APNEA? posted by ggazcamper on January 04, 2012 at 07:41:28:
I know it's been a while since you posted this, but figured I'd post a reply with good information directly relating to your questions.
Insurance: Yes, insurance companies do have different interpretations in regards to 'need' for PAP therapies. Medicare specifically, requires an apnea/hypopnea index of greater than 5 events per hour for a recorded study to be considered a mild case of obstructive sleep apnea, with 4% desaturations in oxygen levels for each obstruction. So, in your case, you more than likely had less than the required minimum to be considered for PAP therapy for Medicare requirements.
Apnea levels dropping?: Yes, there are many factors that can cause obstructive sleep apnea to become less or more severe over time. There are some generalized indications such as weight loss of more than 10-15 pounds for this, but again this is a generalized item. There are also many generalized factors that can lead to increased severity of sleep apnea. However; this is not something that can/should be generalized completely for any individual, and needs to be taken on a case by case basis, with a full review by a board certified sleep specialist.
Clonazepam: Clonazepam can affect sleep studies for some individuals, particularly if that patient has REM dominant obstructive sleep apnea. [Google: REM Sleep]. Clonazepam and other cyclobenzaprine medications are REM suppressants, meaning they decrease the amount and frequency of REM a patient has during a given night of sleep. Since a typical diagnostic sleep study last approximately 6 hours, this can [I stress can] affect the number and length of REM periods observed. However, a patient must have REM dominant sleep apnea for this to be a considering factor. Which, again must be fully reviewed by a board certified sleep specialist.
Waking due to non-use of CPAP: Your MD was most likely correct in stating that you are having trouble sleeping through the night without the CPAP if you have been compliant with it for years [using it nightly]. Just as many patient find it difficult to sleep through the night with a PAP device in the beginning, they also find it just as difficult to sleep without the device if they no longer have a clinical indication for it. This information is all subjective though, and could be different in your case.
In summary, each patient must be taken on a case by case basis. I tried to give you some generalized information, which should NOT be taken as medical advice. With Medicare, if you have underlying conditions, such as hypertension or other cardiovascular issues they will allow for sleep studies to be performed more often. You can also, check with your sleep specialists and see when/if another sleep study could be authorized if you feel the need for it, to re-assure yourself the findings of your most recent study. One recommendation would be to make sure that if you haven't seen a physician that is board certified by the American Academy of Sleep Medicine, that you ask to be referred to one for your next study if you have not seen one in the past for your sleep related issues. They have specialized training in sleep disorders in general, and not limited to just obstructive sleep apnea. Again, seeing a board certified sleep specialist and following their recommendations will suit you better than taking generlized information from the internet as medical advice, as it will better suit you as an individual in the future.