The price of a good night’s sleep

I’ve been diagnosed with obstructive sleep apnea since 1999.  At the time I was having trouble staying awake during the day and more than once while driving I almost fell asleep behind the wheel.  After the second instance of that happening, my wife suggested I see my GP, since there might be a major problem going on. That, and since I do the bulk of the driving for our family, she wanted to be sure getting from A to B wasn’t going to be a problem going forward.

Even though it was 20 years ago, I still remember the conversation I had with my GP.  He quizzed me about a few things, and then suggested that sleep apnea might be the cause of my problem.  He recommended something called a ‘sleep study’ and scheduled me to go to a hospital near us to have the procedure done.  I didn’t know anything about it at the time, but when I got to the place at 10 in the evening, I was in for a bit of a surprise.

As I understand it, the way sleep studies are mostly done today are in NO way similar to the way they were done 20 years ago.  You’d think I was being wired for sound, or set up for a moon shot the amount of electrodes that had to be attached to my body, my head and so on.  By the time they brought me to the bed that I was supposed to be sleeping in (just about the most uncomfortable bed ever designed) it took two technicians to walk beside me holding all the wires that were going to be plugged into the machine next to the torture rack/bed.  I don’t think I’ll ever forget how the technician looked at me sympathetically as I lay on the bed in my shorts and t-shirt (for many, many years I slept sans clothes but not this night) and then tried to turn on my side.  “Sorry,” he said “you have to sleep on your back for this to work.”  On my back??  But I sleep on my side.  Oy.  Sleep on my back, with enough wires attached to my body to drown me from sheer weight if I fell in a bathtub, and someone is going to be watching me from a room nearby (with a window no less) for the next 7 hours.  Oh, the joy.

I’m still fairly certain I didn’t get more than 2-3 hours of actual sleep.  When they came in at 5 am to unhook me from the machine, I blearily said as much to the technician and he said that despite the fact he could tell I didn’t actually sleep all that much, he did get some good readings, enough that the otolaryngologist (yeah, I had to look up the spelling of that one too) was going to be able to diagnose if there was some sort of problem that needed to be addressed.  When I asked what -his- opinion was, he mentioned that during my few sleep periods, it did indeed seem like I had stopped breathing a couple of times and he thought it was a good idea that I’d had this procedure done.  Off I went home to get some real sleep.

After going to the ear nose and throat doctor soon after, it was confirmed that I did indeed have sleep apnea and needed to decide whether or not I was going to treat it via surgery (not recommended at the time) or via a machine called a CPAP.  Sleep apnea was sort of in its infancy so the equipment to treat it was hideously and prohibitively expensive. respironics_virtuoso_lx_cpap_system_3The machine that was used to filter and channel the air going into my body cost $8,000 and if I didn’t have insurance covering the cost, I wouldn’t have been able to get it.  The machine was about the size of a breadbox (do people even use breadboxes anymore?), it had flexible plastic tubing that led to a mask that covered my nose and strapped to my head to keep it in place.  If I wanted a humidifier that would add moisture to the incoming air, that required a secondary piece of equipment (nowadays the humidifier is a small box on the side of the machine and pretty much comes standard), at a secondary cost and even more tubing.  I opted for just the basic machine and mask. RVLX-cm For collecting the readings, the machine had one 9 pin port which as I recall was used sporadically by the doctor, about every six months.  The original doctor I was referred to wasn’t the doctor that was overseeing my treatment.  This other doctor didn’t seem all that involved in things, and after the first couple of years went by, he finally said that he really didn’t think he needed to see me anymore. He wasn’t collecting readings, I’d just go to his office, he’d ask a couple of questions, he’d write a prescription for a new mask and that was it.  Nowadays, it’s recommended that the machine be replaced every 4 years.  In order to get a new machine, my old one actually died after 17 years!

I’m reminded of all this because about a month ago I needed a new mask.  The ones I had been using (and have been comfortable with) are no longer made.  This past September, I got the last one my provider had in stock, and she mentioned I needed to choose a new model the next time I saw her.  After looking over the options, I decided on one that was a little less bulky than the one I’d been using for the past 10 years.  This one has a nasal pillow, it sits on the nose only, and the headgear goes around the skull, but doesn’t have a secondary pillow that rests on your forehead.  Over the last few years I’d been noticing irritation in that area, and even broke out in a rash a few times from a possible reaction my skin was having with whatever latex material the pad was made from.  I’d tried several topical creams and ointments to counteract the reaction, but ended up using my sleep cap as a barrier between the pad and my skin.  That worked (sort of), but it was a bit unwieldy to keep doing.  Hence the need for a new plan of attack.

At the time of fitting, the equipment rep said that there was going to be only a $40 charge for the mask, since my insurance was ‘probably’ going to cover most of the cost.  Only anymore my yearly deductible is so high that by the time I finish burning through that, most of the year is gone.  (I don’t go to doctors all that much)  While I was paying that bill, I noticed in passing that the overall bill for the mask was $254.00 USD.  Two hundred and fifty dollars for something that’s mostly cloth and plastic!  Geesh.

Monday, I received a bill for the remainder of the cost of the mask.  Even after insurance adjustment and the payment that I’d made, I supposedly still owed $157 for the remainder.  One of the items listed didn’t make sense and I mentioned that to my wife.  Apparently the mask is broken down into three separate pieces, so as to make it more expensive, I guess.  But after looking at the user guide for the mask online, it seems like I’m being double charged for the components.  There’s a charge for the entire mask system, and then two more charges for components that make up the mask.  Adding an additional $75 to the overall bill.  I printed off the parts of the guide that detail the pieces of the mask, and their corresponding item numbers.  I’ll be taking all the paperwork to the medical supply place later today to argue my case.  I can only hope that they agree they made a mistake and deduct that from the bill.  Otherwise I’m out a considerable amount of scratch for things that I don’t actually have.  Or I don’t think I do.

Either way, it’s a high cost of doing business, or staying healthy.  I read somewhere on social media the other day the main reason the American medical billing/insurance system is so screwed up goes back to Nixon presidency.   Apparently, President Nixon was doing a favor for a friend of his and without thinking things through, turned the health care business on its ear by making it ‘for profit’.  I expect he didn’t understand what juggernaut he was putting into motion, but 46 years later, we’re still getting buried under his mistake.  With no end in sight.

Hope you’re still awake at the end of this.  If not, get some sleep.


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