Posted 23 March 2012 - 09:19 AM
The official results won't be known for another week. My guess is based on this test and the fact that I had respiratory failure due to low oxygen level I will be recommended to go on the CPAC.
I am already service connected for hypertension and cardiomegaly. Would I file this new claim requesting secondary to either one as sleep apnea?
Posted 23 March 2012 - 09:32 AM
In actuality (with out the specifics from your records), it is more likely that your hypertesion and cardiomegaly might have been caused or increased due to sleep apnea.
Many people will have sleep apnea for years even decades before diagnosis.
I currently have a claim in for Sleep apnea that was diagnosed 11 years after service. My pulmonologist's nexus statement says more likely than not and goes on to point out the 4-5 medical facts/indicators from my smr's that back up his conclusion. Hypertension and enlargement of the heart are two of them. In service they stated my hypertension was essential (no identifiable reason).
When I was placed on CPAP they said - you won't want to wear this but you need to - I slept like the dead the first two days and was amazed as how much better I felt. Not waking up on the wrong side of the road is a big plus also. Sleep hasn't been so kind to me lately though due to the pain issues with my back/legs.
A CPAP can be a life saver and improve you quality of life big time.
Posted 24 March 2012 - 06:33 AM
Do persue the use of the CPAP, if needed, for your health reasons whether or not you get SC for it. The CPAP has a smart card in it that records whether you are using it nightly or not. I use a CPAP, and am NOT SC for it, have been using it for 3 years. I think my number was 67apnea events, meaning I stopped breathing 67 times per hour (or per night, I forget which).
If you are prescribed a CPAP, I whole heartedly recommend you use it, but you need to understand it will likely take some getting used to. You may have to switch masks, pressure, etc. The doc sets the pressure at a certain number of pounds. Mine is 9 pounds air pressure. He determined that number at the sleep study, decreasing the pressure on the cpap to the lowest number that eliminates apnea events.
Posted 24 March 2012 - 11:34 AM
As far as getting service connected for sleep apnea, a few years back when i got my c-file, one of the service officers had wrote that veteran didn't mention or make it known that he also wanted to file for fatigue. We'll, I am always tired because I can't get a good night sleep. I understand the cpac machine helps you sleep much better.
This is all being done through an outside MD referred through by base doctor for tricare prime. So when this all done, I will schedule an appointment for the VA doctor and give them all the medical reports from the hospital-sleep study and pulmonary doctor. Once that has all been documented(I will getaq copy of this visit notes),then I will carefully put together my next claim. I will let this doctor know that I am a Veteran and if he could write a nexus letter so I can get the VA to give me the machine.
Posted 24 March 2012 - 11:46 AM
I had a sleep study done by Kaiser and they prescribed a CPAP machine, the only problem was that my policy didn't cover it so if I wanted one I needed to pay for it out of my own pocket. I mentioned to my VA PCP that I thought that I might have sleep apnea and he sent me top the sleep clinic, they did a sleep study and two weeks later gave me a CPAP machine, so far I haven't seen a bill and they gave me the machine last August. So I guess what I'm trying to say is that the VA will probably make you take another sleep study.
On sc there needs to be something in your SMR about snoring or being tired. Back in the 60s and 70s nobody knew about sleep apnea and generally if you went to sick call about being tired and snoring they told you to cut back on the partying and to sleep on your side.
Posted 24 March 2012 - 01:55 PM
Posted 24 March 2012 - 03:38 PM
Posted 24 March 2012 - 04:05 PM
Posted 24 March 2012 - 08:44 PM
Getting mask adjust just right is a pain,if it's too loose you have leakages and the machine can't do it's job, too tight and you end up red marks on your face, even when they've adjusted the mask for you when they gave it to you may find that when you get home and hooked up that you need to make adjustment. Another thing that been recommended to me by a number of people is that you wash your face before going to bed, apparently the grease and oils on our skin will affect the fit. John if I use a nose mask I don't have a problem with dry mouth but I hate having to use the chain strap but if I use a nose and mouth mask I do wake up with dry mouth.. With my machine I've gone from waking just about every hour to waking up once or twice during the night although there are times when I wake up more often, when that happens I find myslef having to take a nap during the day.
Posted 24 March 2012 - 10:09 PM
It will be a week or so before they have the final results. Normally they don't hook you up to a CPAC machine during a sleep study unless the technican that was observing you noticed something unordinary.
Posted 25 March 2012 - 12:04 PM
Posted 25 March 2012 - 12:18 PM
I had to return to the clinic three weeks later, and this time I was fitted with a mask and monitored using cpap. I lasted 4 maybe 5 hours.. I did not sleep at all... it took all my will power not to rip the mask from my face.. which in the end I did. Not only did I rip the mask from my face... I went home at 3: AM.
A month later the va issued me a cpap machine. I tried 4 or 5 different mask each with the same result, as long as I had the mask on I did not sleep at all, I could not even fall asleep. I finally determined waking up durning the night was better than no sleep at all. Of course another problem with me was when I took the mask off, I was not getting my oxygen either which I need 24/7....
The doctor at Randolph insist that my apnea is not secondary to my asthma/copd.. but she never took the time to look at any medical records, or explain to me what it could not be secondary. This was two years ago.
I am just now considering an IMO from a private sleep clinic.......
Posted 25 March 2012 - 04:49 PM
Posted 25 March 2012 - 05:18 PM
It can take 3-6 months to get a specility doctor from the VA. Normally I can get an referal and see actual MD within 3-4 weeks. In my case, I had the sleep study within 2 days of having the doctor sending the request in.
No need to die while waiting for the VA to get you an appointment. . Today's paper in my home town listed a Vet who recently died at the VA during surgery. The same almost happened to me at a private hospital as the VA never provided the healthcare that would have found I had other issues. I had told them repeately I had problems sleeping for years. I was quickly referred to this sleep study from my private insurance. Shame on the V A once again!
Posted 25 March 2012 - 09:58 PM
My first mask was a nose mask and I rarely had a problem with it but there were a few nights that I couldn't get my breathe and ripped the mask off during the night, now I have a nose mouth mask and so far it's working great.
I think that there's a way for you to use oxygen with the CPAP but I'm not sure how it gets hooked up.
You're right that it take a long time to see a specialist, I waited for three month for my appointment with the sleep clinic, I have Kaiser so I get most of my medical treatment thru them but with them I would have had to pay almost $900.00 for the CPAP machine which the VA gave me for free, the VA also gives me all of my CPAP supplies for free rather than me having to spend $200 every six months for a mask.
Posted 25 March 2012 - 11:30 PM
Mmmmmm.....something does not sound right in VA logic. If you cannot sleep at all with the Cpap I wonder if you have tried sleeping pills with it? The thing is with the copd and other problems there is a lot of stress on your heart and lungs. I would find the best doctor in your city who has a connection to a sleep lab and do the whole thing again. The waking up and snoring from apnea is bad and a pain,but the strain on your heart is the real danger since you already have copd. You need to see if the cpap is even working for you and the only way is for you to fall asleep with it on for a few hours. I am wearing my cpap but I am very sleeping when I wake up in the morning and I wake up many times at night.
Yes.. I have considered another sleep apnea test.. however just the though of going through it makes me sick... I know I need to do something because I usually sleep in my recliner 5-6 hours a day because I am not sleeping at night. I am also trying to find a place that will review my medical records and determine if my asthma/copd and allergic rhinitis caused or made teh apnea worse... Of course I am over weight so that is another problem, but I've only been overweight for about 7 yeas and I had this problem back when I was in service. Of course back in 1986 when I retired no one knew anyting about sleep apnea, of if they did, it was never mentioned to me....Recently my doctor told me if I could lose weight my breathing, back, and knees would improve.. but that is eaiser said than done. He also told me my weight is my biggest medical problem....so who knows.....
Posted 26 March 2012 - 06:49 AM
If would be nice if we could all get our apnea SC'ed but that is not the main thing. The main thing is to get it treated. I am having a pretty hard time with mine. With my Cpap I wake up pretty frequently. I get very dry even with humidifier. It seems when I get a good seal it makes my face very sore the next day. When I get it loose enough to not pinch I have a lot of leakage and I still wake up about 5-7 times a night. I am often very sleepy during the day. I want this to work so I will continue to see the doctor. I see both private and VA doctor. When I wear the mask I don't snore my wife tells me. I may have had apnea for a long time since I have had sleep problems for years and I did have sleep problems in the army. There is a particular instance where I went sort of wild from lack of sleep one time in the army and it is documented. I got no treatment, of course.
Are you on a full face mask or just the nose? I had terrible problems with TMJ and waking up with my mouth open and the air rushing out (so dry I couldnt swallow) Full Face solved those.
Posted 26 March 2012 - 07:06 AM
Another thing that is adjustable on the machines is somehting called "ramp" this setting uses a lower pressure setting at first and then increases it up to theraputic level. Last I knew my setting was 12.9 and at one time I think it was 14. I have never liked ramp up settings because I always feel like im not getting enough air so I shut it off and we go straight to full pressure. When I started using VA healthcare they issued me a machine and that machine also would dump the pressure on exhale. After ten years of full pressure all the time, it just was so strange i shut off that function also. That function also caused the noise of the machine to oscilate with my breathing and it drove the wife nuts. In the rare instance that I am not sleeping at home my wife has to turn on a small fan to make up for thier being no noise from the CPAP.
Reading through the BVA decisions on Apnea is interesting because they will point out no "in service" evidence of apnea, but in the rating schedule it clearly indicates someone can have apnea and be asymptomatic.
If denied, because I wasn't complaining I will argue that I had the medical indicators and the rating schedule clearly shows that the Veterans Administration anticipated/recognized that someone could have sleep apnea and not exhibit outward symptoms of it.
Posted 26 March 2012 - 09:27 AM
Posted 26 March 2012 - 11:12 AM
I am on the full face mask but I still get dry. I have a humidifier built into the cpap and I have a separate humidifier that goes full blast all night and yet I still get dry. I do find that If I get the mask pretty loose I do better. If it is real tight it hurts my face and drys me out so bad I can even speak. Many people I talk to throw they mask away because of problems but that is not the answer. I have TMJ also. The snoring is bad but I worry about my heart.
Posted 26 March 2012 - 03:52 PM
From what I was told at the VA sleep clinic the dry mouth is due to you sleeping with your mouth open, if I use the nose mask and chin strap my mouth doesn't get dry nut when I sleep with the nose and mouth mask my mouth does get dry. Like you I've played with the humidifer that's attached to the CPAP and it makes no difference. Untreated sleep apnea will cause heart damage and death.
Posted 26 March 2012 - 06:17 PM
I have deviated septum and can't breath through my nose very well.
Posted 26 March 2012 - 07:51 PM
I'm not sure if it'll help with the dryness but they do make a total face mask which covers the nose, mouth and eyes, kind of like a gas mask. One of the things that I've found is the fit of my mask will depend on my position, lying on my left side the mask fits fine but when I turn onto my right side I get leaks, I don't know about when I'm on my back because I can't sleep lying flat on my back. In the back of my mind there's a memory of someone telling me something about a true fit mask that you don't need to adjust but I'm not sure how that works. I hope that you find something that works for you.
Posted 27 March 2012 - 10:58 AM
Posted 27 March 2012 - 11:45 AM
We wouldn't even need to make custom mask, I don't know if you've priced makes but the cheapest ones are about a hundred dollars and you're supposed to replace them every six months. If I had had to buy the full face mask that the VA gave me it would have cost me $195.
I did an experiement last night, I set my humidifer to its highest level and it made no difference in the dryness of my mouth. Yow know John I can live with the dry mouth as long as the machine does it's job and I get a good night's sleep. It's a hell of a thing when a sixty-five-year-old man has to take a nap two hours after he wakes up in the morning.
Have a good day,
Posted 27 March 2012 - 12:05 PM
Posted 27 March 2012 - 01:41 PM
My CPAP Doc wanted to do an operation where he would put a medal gizmo that is permanent in my lower throat he said would solve need for CPAP. I told him hell would freeze over before I did that.
Lastly the tempurpedic bed VA gave me has made it possible for me to sleep on back making CPAP work a lot better. Bed also keeps me from thrashing around as much as I used to do.
Good Luck John
Posted 27 March 2012 - 02:48 PM
Lugnut AKA Buddy
Posted 27 March 2012 - 04:09 PM
I used to have to take a nap every day at 11AM but now that I'm using the CPAP machine I rarely need a nap even later in the day. I'm under the impression that if you're a mouth breather then you're going to have a dry mouth in the morning. From the sounds of it you're not getting the full benefit of the CPAP machine, you might want to call the sleep clinic and talk to them about it, maybe they can help you.
I started with the nose mask and although I did have a few times where I ripped it off because I couldn't get my breathe it worked pretty good, I'd wake up in the morning remembering that I breamt but not what the dream was and I can't remember doing that for years. When it came time for a new mask they gave me a full face mask which did not work, I was getting up every hour finding that the mask mask had slipped and no longer covered my mouth. I talked to the sleep clinic about the problem and they gave me a larger mask which works great, I get up once of twice a night to go to the bathroom or roll onto the other side, for me it's easier to disconnect the hose at the mask, my machine sits on a bucket on the floor which makes disconnecting the hose from there difficult. The other thing that I find that makes it easier for me is to have the hose come over the headboard that way I don't get tangled in the hose if I roll over.
Posted 27 March 2012 - 04:44 PM
Posted 28 March 2012 - 09:33 AM
Posted 29 March 2012 - 06:36 AM
Pete 53- how did you get the VA to give you an tempurpedic bed?
ILP gave it to me after a four year hassle. It was worth the hassle. To get ILP Voc Rehab must determine that they can not rehab you than they send someone to your home to evaluate you. The tempupedic bed was the evaluators idea I had no idea that they would do it.
Posted 29 March 2012 - 09:31 AM
It says the following: 1. Very mild and rem-associated obstructive sleep apnea/hypopnea Syndrome of uncertain significance, although this was associated with REM-associated hypoxemia.
2. Suboptimal response to CPAC at settings up to 9 CWP while supine, although this setting would likely prove adequate if the patient were able to main sleep on his side.
1. Because of the patients symptoms and associated hypoxemia, it appears likely the treatment for this patients albeit rare Obstructive Sleep/Hypopnea syndrome is warranted.
2. If sleep in the lateral position could bestrictly maintained, CPAC at settings as low as 6 CWP would aprove adequate,
Well, I called the VA this morning. They have no appointments available for 6 months.(No wonder Vets are so upset) They told me to bring all the medical reports done through tricare and they will request the doctor to approve me for a cpac machine at my clinic. Hmmmm. You mean they will approve this without another sleep study, ect-
Edited by COOL BREEZE, 29 March 2012 - 11:23 AM.
Posted 01 April 2012 - 01:22 PM
And even if you did'n't get one through tri-care, I would appreciate what type of model and accessories-functions that you have on yours. I rather pay a little more for a good machine then get a cheap generic one they try to pawn off on you. I expect the company that gave me my study, is going to contact me once they show I have been approved and try to sell me one of there cheap models. From what I heard, I can go with whatever company tri-care authorizes, not specifically the one that provided the study. I am looking for what type of models that may authorize
I have a relative who could't afford one, so a friend gave here one that is quite noisy. Unfortuantely her husband doesn't let her use it as it doesn't let him sleep
Thanks for your input.
Posted 01 April 2012 - 01:33 PM
Posted 01 April 2012 - 02:39 PM
Posted 05 April 2012 - 04:26 PM
I am still waiting for tricare to receive an order from my base doctor who originally authorized the sleep study. The sleep study clinic called today for me to come in and get fitted. Nope-no authorization from tricare so you are out of luck. Why should I pay a copy payment of 20% when I am going to get this free from the VA. Don't need 2 models.
VA is giving me a respironics pro 1 model set on the 1 setting.
Posted 05 April 2012 - 05:27 PM
Posted 06 April 2012 - 09:37 AM
You are so right on this.
I can't remember the comedian who said this but "I want to die peacfully in my sleep like my father, not screaming in horror like his passengers"!
Years ago, a friend of mine who stayed at our house for New Years, said during breakfast "Dude you got Apnea" I took him seriously, I had always thought I couldn't sleep due to stress and my back pain. But after a sleep study and a CPAP. I stopped waking up on my way to work, and after the first night of use I actually woke up the next morning amazed that I actually had a dream, couldn't remember when the last time I had a dream the previous 8-10 years.
I don't wake up on the wrong side of the road anymore, and my wife can actually sleep in the passenger seat now (I think she was to terrified before).
My father was diagnosed with apnea and couldn't/wouldn't use his machine and ultimately it killed him. Take this seriously people. Apnea will start doing things to you that you don't even realize. It messes with hormones, cortisal, generalized inflamatory reactions, after a while these small changes can push you over the edge for more serious chronic diseases.
Take care and sleep well!