Correct!
4. 1 and 3
Switching masks may help compliance but we know of no data that switching from one mask to another improves symptoms or AHI. Patients who self-report nightly CPAP use often inaccurately assess their compliance with therapy. Before assuming a patient is compliant with therapy, objective documentation is required not only for clinical purposes, but is necessary for insurance reimbursement. Modafinil or another wake promoting agent is indicated only if there is no alternative explanation of her hypersomnolence. Because she had not responded to CPAP, her insurance company was willing to allow an overnight polysomnography (Figure 1).
Figure 1. Representative samples of the patient’s overnight polysomnography. Areas of interest are indicated by red arrows.
The sleep tech noted no snoring or apneas during the sleep study. Her electroencephalogram while awake was normal.