ICD-9 Medical Diagnosis Code

327.23 Obstructive Sleep Apnea
327.27 Central Sleep Apnea
780.53 (hypersomnia with sleep apnea, unspecified)
780.57 Sleep apnea, regardless of type

Other Diagnostic Codes

518.83 Chronic Respiratory Failure
V46.1 Other dependence on machines

CPT® (Current Procedural Terminology)
CPT® is a registered trademark of the American Medical Association

CPT codes

95805 Multiple sleep latency or maintenance of wakefulness testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness

95806 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG, or heart rate, and oxygen saturation, unattended by a technologist (will not be paid by Medicare -- not reasonable and necessary)

95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG, or heart rate, and oxygen saturation, attended by a technologist

95808 ; sleep staging with 1-3 additional parameters of sleep, attended by a technologist

95810 ; sleep staging with 4 or more additional parameters of sleep, attended by a technologist

95811 ; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi-level ventilation, attended by a technologist

Traveling with Batteries

Travelers with Disabilities and Medical Conditions

If you would like to use your Cpap on the flight, you will need a letter from your physician stating that it is medically necessary. Many airlines have their own forms for the physician to fill out. You should contact the airline prior to booking your flight to find out what their requirements are for using the Cpap.

Some airlines allow passengers to use their CPAP in flight, but some do not.

The following checklist will help you in preparing for your travel abroad:
* Carry a letter from your doctor certifying your need for CPAP treatment.
* Obtain approval from the airline’s Medical Services for use on the flight.
* Arrange seating close to a power source on the aircraft.
* Confirm the type of power cord or adapter required by the aircraft.

Traveling to Higher Altitudes
Some devices now automatically compensate for altitude changes. For other devices, failure to make the appropriate adjustment may result in inaccurate pressure setting. These devices may require manual adjustment for altitude changes, so consult your local homecare provider to discuss your specific CPAP machine regarding this feature.

Cpap Noise Levels at 10 cmH20 Pressure
(dB)=decibel

PB Goodknight 420G-----------31dB
ResMed S8 Compact------------31dB
Respironics REMstar M Series--31dB
Fisher Paykel HC604----------30dB
ResMed S8 EscapeII------------30dB
Zzz-Pap---------------------------30dB
IntellPAP-----------------------26dB
Sandman-------------------------26dB
ResMed S8 EliteII---------------24dB

SLEEP APNEA:
One of the most common sleep disorders known. It is characterized by loud, constant snoring and repeated arousals caused by an obstruction of the airways and disordered breathing. There are three forms of sleep apnea:
*Obstructive
*Central
*Mixed

NARCOLEPSY:
Narcolepsy is a condition characterized by excessive and uncontrollable daytime sleepiness. The Narcolepsy sleep attacks can occur at anytime, even while the person is engaged in an activity. During sleep, people who suffer from Narcolepsy have an abnormal sleep pattern: They enter REM sleep prematurely without going through the normal sequence of sleep stages. Patients with narcolepsy often feel tiredness through most of the time. Other symptoms of narcolepsy include cataplexy, sleep paralysis, and hypnologic hallucinations.

RLS RESTLESS LEGS SYNDROME:
Restless Legs Syndrome (RLS) is a neurological condition in which patients experience irrepressible sensations in the legs or arms while sitting or lying still. Terms used to describe restless legs syndrome may include creepy, crawly, pulling, tingling, itching, or gnawing. Unlike other sleep disorders such as narcolepsy, RLS occurs only when lying in bed and not during daily routine activities. .

PLMD PERIODIC LIMB MOVEMENT DISORDER
Periodic Limb Movement Disorder (PLMD) causes jerking in the legs or arms that occurs frequently during resting or sleeping

Getting the patient acclimated to the mask only, outside of the sleep period and away from the bedroom, is another desensitization technique. It is natural for patients to need a period of time to adjust to sleeping with a CPAP mask on their face; no one is used to sleeping with such a mask. Patients who state that they cannot sleep with the mask on their face can become accustomed to it by wearing just the mask--with the exhalation port open--away from the bedroom while they do something relaxing, such as listening to music, for a while each day, preferably not just before bedtime, until they can wear the mask. (Patients who take the mask off during the night without knowing specifically why do well to try this method as wearing the mask while awake for a while may let them determine the site where the mask may become uncomfortable. Once the site is discovered, the better fit or style may be found.)

Link:
A-Flex vs C-Flex

C-Flex is a feature found on several REMstar models and it is a comfort setting that reduces the air pressure delivered by the Cpap machine each time you exhale. C-Flex has four settings: OFF, 1, 2 and 3. The numbered settings correspond to a pressure drop of approximately 1, 2 or 3 units of pressure during exhalation. Simply put, if your Cpap machine pressure is 10 and you have a C-Flex setting of 3, then each time you exhale the pressure will drop 3 units to 7. During inhalation the pressure will spike back up to 10.

A-Flex works in exactly the same way as C-Flex during exhalation. On inhalation, though, the pressure is increased more gradually to better match the normal breathing rhythm of the Cpap user. With A-Flex the pressure doesn't spike up from exhalation to inhalation. It's a smoother and more comfortable increase. A-Flex also helps to prevent the Cpap machine from delivering a pressure that is too high. The difference between C-Flex and A-Flex is subtle. The bottom line is that if you want a Cpap machine that follows more closely your natural "breathing curve" then A-Flex is the technology for you.

A-Flex Pressure Relief Technology

A-Flex is designed to work with our clinically proven auto CPAP algorithm to improve comfort even more by matching pressure delivery to the patient’s entire breathing cycle. Like C-Flex, A-Flex provides flow-based pressure relief at the beginning of exhalation. Like Bi-Flex, A-Flex softens the pressure transition from inhalation to exhalation to provide additional comfort in an auto-CPAP mode. The pressure profile mirrors the patient’s breathing, and with the auto algorithm intelligence, it will respond to the patient’s therapeutic need throughout the sleep session.

C-Flex Pressure Relief Technology

C-Flex pressure relief technology makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief varies based on the patient’s expiratory flow and which of the three C-Flex settings has been selected.

The real brains behind C-Flex is our patented Digital Auto-Trak & Sensitivity. Digital Auto-Trak is a highly sensitive algorithm that tracks each breath and detects the onset of inspiration and expiration – even in the presence of mask leak. It then responds by triggering C-Flex to provide an adaptive pressure relief right when the patient needs it. And delivering the right level of pressure relief when patients need it makes therapy more natural – and more comfortable.

Link:
Bi-Flex vs C-Flex

Bi-Flex Pressure Relief Technology

Bi-Flex pressure relief technology offers pressure relief at inhalation and exhalation to make BiPAP therapy more like natural breathing. By tracking each breath, Bi-Flex pressure relief technology delivers pressure relief at three critical points in the breathing cycle:

1. the transition from exhalation to inhalation
2. the transition from inhalation to exhalation
3. during exhalation.

C-Flex Pressure Relief Technology

C-Flex pressure relief technology makes sleep therapy more comfortable by reducing pressure at the beginning of exhalation and returning to therapeutic pressure just before inhalation. The level of pressure relief varies based on the patient’s expiratory flow and which of the three C-Flex settings has been selected.

The real brains behind C-Flex is our patented Digital Auto-Trak & Sensitivity. Digital Auto-Trak is a highly sensitive algorithm that tracks each breath and detects the onset of inspiration and expiration – even in the presence of mask leak. It then responds by triggering C-Flex to provide an adaptive pressure relief right when the patient needs it. And delivering the right level of pressure relief when patients need it makes therapy more natural – and more comfortable.

AI - Apnea Index
Apnea: Absence or cessation of breathing.

HI - Hypopnea Index
Hypopnea is a decrease in airflow by at least 50% for ten seconds or more, with a 3% desaturation of blood oxygen level.

RDI - Respiratory Disturbance Index
Includes apneas and hypopneas, and may also include other respiratory disturbances such as snoring arousals, hypoventilation episodes, desaturation events

Apnea Hypopnea Index is the number of apneas and hypopneas per hour. This index, as well as oxygen saturation levels (O2 Sat), is used to determine how severe a case of Sleep Apnea a patient has. AHI calculation: add the total number of apnea events, plus hypopnea events and divide by the total number of minutes of actual sleep time, then multiply by 60.

AHI:
< 5: Normal
6-15: Mild
16-30: Moderate
>30: Severe

NPI: National Provider Identifier

National Plan and Provider Enumeration System (NPPES)

https://nppes.cms.hhs.gov

Stage 2: In the second stage, all eye movement stops. The brain begins to relax, which is evident by brain waves slowing. There may be occasional bursts of rapid brain function during this stage, but generally, everything is slowing.

Stage 3: The next stage is evident by further slowing of brain waves. Your body itself rarely moves. The brain waves are very slow at this point, so slow they are referred to as delta waves. This slowing may be interspersed with small, but fast, waves. Stage three is also the start of deep sleep.

Stage 4: In the fourth stage of sleep, the brain produces almost only delta waves, the extremely slow brain waves. Stage four is also a part of the deep sleep stages. Here, it is very hard to wake someone from their sleep. There is no eye movement and no movement of muscles. In children, the fourth stage is also the most common stage for bedwetting, night terrors or even sleepwalking.

Stage 5: Things change considerably in REM, the fifth stage of sleep. This stage of sleep is characterized as the dream phase, but there is much more going on within the body at this time.

Do I have to get my own prescription?
Cpap Discount Store will obtain your prescription for you. You will need to provide us with your physician name, address, and phone number. We will do the rest.

What if I have not seen my sleep doctor recently?
If you have not seen your sleep physician within a year, then your sleep physician may not want to write a prescription unless you make an appointment with them.

What if my Sleep Doctor does not write my prescription
We will send for a prescription to your Primary Care Physician.

Can my Primary Care Physician write a prescription for a cpap mask?
Yes, your Primary Care Physician can write a prescription for your cpap mask. You will need to provide us with your primary care physicians name, address, and phone number.

What if I am having trouble obtaining a prescription?
Call Wayne Parkhurst at 508-476-2626
Many times we can obtain a prescription when you think there may be no way.

Link:
Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

http://ajrccm.atsjournals.org/cgi/content/full/167/5/716

American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 716-722, (2003)

Use the following scale to choose the most appropriate number for each situation:
0 = would never doze or sleep.
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping

Situation ------------------- Chance of Dozing or Sleeping

1. Sitting and reading............................. ____
2. Watching TV ....................................... ____
3. Sitting inactive in a public place ..... ____
4. Being a passenger in a motor
vehicle for an hour or more ................. ____
5. Lying down in the afternoon ............. ____
6. Sitting and talking to someone ......... ____
7. Sitting quietly after lunch
(no alcohol) ....................................... ____
8. Stopped for a few minutes
in traffic while driving........................... ____

Total score (add the scores up)
(This is your Epworth score).................. ____

Scoring the Epworth Sleepiness Scale
1 - 6 Congratulations, you are getting enough sleep!
7 - 8 Your score is average
9 and up Seek the advice of a sleep specialist without delay