I finally did it

[tvmangum]

I finally went to a different sleep doctor today--one that is actually Board Certified in Pulmonary Medicine and Sleep Medicine. He told me some of the same things that you guys have been telling me. He told me that there was no reason to be going for my third clinical titration when the data from the machine clearly showed that I was using it every night. Dr. C said as long as I was using the machine and following orders the machine will do what it is designed to do--keep me alive! He also told me that the at home titrations were of no use because they really do not provide useable information. He also told me to ignore the numbers on my machine.

Dr C also confirmed that my first sleep study and titration report were useless since in one line it says that I have moderate sleep apnea and the next sentence says that it is severe. He would have rather seen the data than the textual report that I have from the study.

He finally gave me some good advice that I am going to share with everyone else. There are many doctors out there calling themselves sleep medicine doctors and all they have done is take one or two and think they know it all. They keep their sleep clinics busy just to make $$$. At most, sleep studies should be repeated every two years just to make sure that there are no abnormal changes. He told me that he would rather have his sleep lab empty and his patients using the xPAP machine like it is prescribed rather that keep trying to make another $ in his sleep lab. I'm afraid that is what I have done the past year.

We are now going to check my thyroid and all my meds to make sure they are not contirbuting to my problems. All in all not a bad 2 hour visit with my new sleep doc. Let's see how things go between now and November 24 when I go back.

[SaltLakeJan]

tvmagnum,

Congratulaltions . . So you too discovered the difference between Board Certified Sleep Doctor and the Doctors who got in sleep therapy for the $ and use hole-in-the-wall dumps as their sleep lab. I have had four sleep tests, the first three were miserably done, including many inaccuracies as a result of their lack of knowledge. He appears to be interested in your welfare.

You have a great machine. It will give you all the information you need to know what your therapy is doing on a daily basis. After all it is quite a while in between appointments. Many doctors, mine included, do not believe in patients knowing too much about their therapy. You don't have to tell him that you checked out your LCD screen, & know your daily leak rate, AHI, AI, Hi, etc. I would advise you not to change any of your settings, your doctor has set them where he feels they will do you the most good.

Very best wishes to you.

Jan

[bdp522]

A couple of thing bother me here.

He told me that there was no reason to be going for my third clinical titration when the data from the machine clearly showed that I was using it every night.

The titration is not to show that the machine is being used every night, it is to be sure that the pressure is correct.

He also told me that the at home titrations were of no use because they really do not provide useable information.

They will show(with the software) what your pressure needs were and what events were at what pressures. You will also have the added benefit of seeing more than 1 night of info.

He also told me to ignore the numbers on my machine.

The numbers on the machine will tell you how you are doing. These same numbers can lead to changes to make your treatment more effective.

These 3 comments would have me looking for a new doctor.

Brenda

[roster]

.......... He also told me that the at home titrations were of no use because they really do not provide useable information. He also told me to ignore the numbers on my machine.

.........

From an earlier post of mine

I referred a friend who has been on CPAP for a few years and is feeling poorly to my sleep doctor. The friend came over before her consultation and I gave her some documents on what to say and ask. I also gave her copies of two Encore Pro Daily Details report. The first report showed a typical bad night using the prescription a former sleep doc had given me. The second report showed a very good night after I had everything tweaked.

The friend called this afternoon to report on the consultation. She said it was a very good meeting with the doc and she thanked me for the advice and the documentation which she took into the consultation. The doc scheduled her for another sleep study.

Before she left the doc asked, "What are those documents you have?". My friend showed the documents to the doc who was very interested in them, particulary the Encore Pro reports.

The doc asked who the documents were from. My friend told the doc, "They are from real name (Rooster), your patient who referred me."

The doc (also a female) got a big smile on her face and said, "I should have known. It could be no one else. I have no other patient like Rooster."

Then the doc said, "Before you leave, I want you to know that the study my sleep lab does for you will not be nearly as accurate as what Rooster does with his software."

Aha! This is what I have been saying. One quick night in the strange environment of a sleep lab with things glued and taped on your body and people watching you remotely with infrared cameras and listening to you with microphones and you will not sleep the same way you do at home.

I was glad to see my doctor admit what you guys taught me. If you want a good therapy you better get the software, get educated, and take charge of your own therapy. Thank you cpaptalk members and thanks to Johnny Goodman.
.................. viewtopic.php?f=1&t=44379&p=396091#p396091

[tattooyu]

So, if my doctor is board certified in Internal Medicine and Pulmonology, does that make him a board certified sleep doctor?

[millich]

So, if my doctor is board certified in Internal Medicine and Pulmonology, does that make him a board certified sleep doctor?

No. It's a different - although related - speciality.

[DJ_Boxer]

I have an Remstar Auto M Series BiPAP with A-flex set at a straight 11cm and I have no problems with either my HC407 or Opus 360(must use the right size pillows or it could make your nares sore/create wind tunnel). As of last night, I removed the upper hose attachment for my Opus 360 and there was no noise(could of been hose placement, humidifier setting/relative humidity as factors). I also have allergies and a take a 10mg claritin every night.

DJ

[Uncle_Bob]

I thought the main attractions of the American Health system is that you have choice
I had spoken to many people who had had sleep studies ordered at "hole in the wall" sleep centers by non board certified doctors.

I spent a bit of time finding a good doc and sleep center and ended up under the care of the MD here

http://www.scottsdalesleepcenter.com/

Titrated at 7cm and my APAP uses an average around 7cm mostly (assuming good sleep hygiene)

[ScrappinMom]

I thought the main attractions of the American Health system is that you have choice

Yes, you have every choice in the world, if you are able to pay out of pocket for it. Otherwise, you are stuck with whatever you insurance company dictates.

[DoriC]

Does anyone know if there is a specific Board Certification for Sleep Medicine? I know that Pulmonologists are usually Board Certified but I'm wondering if there is an additional board certification in sleep medicine that a Dr must obtain to be called a Sleep Specialist, or is it just a subject that they have an interest in and incorporate into their practice. Many years ago I worked for a Dr who was board certified in Internal Medicine but his interest was in cardiology and that was the "heart" of his practice although he never became board certified in cardiology.

[Snorebert]

We all do have a choice if we have the money. Many who have the current public option health care (Medicare) have greater choices than those that are limited by their employers' health plans. For me, I ended up being sent to a commercial sleep mill down the road from Uncle-Bobs place. I was sent by the NP-C in my primary care docs office and it was a place where the ratio was one tech to four patients. I had to go back three times to be titrated. My results were then apparently sent to my doc (probably the NP-C) and then I was contacted by the DME run by a major drugstore chain. BTW - they set my pressure at 7.0 and I am now below 5 AHI with a self-titrated pressure of 12.5

I was given a mask by the DME when we met in a back room that was used for storage - not even a place to sit down - and sent on my way. They did call me at about six months, asked how I was doing, I said OK and that was that. I do call from time to time to get some supplies.

Luckily I found CPAPTALK fairly early on, purchased my own data-capable APAP and have been taking care of my own health ever since.

I know that there are quality docs, sleep centers, RTs and DMEs out there. Otherwise the CPAPTALK server would be constantly crashing due to the strain.

But when you are so sleep deprived and barely able to think, it becomes way too easy to let them "take care" of you. When you are in the ambulance, you are not really in a good position to shop for hospitals.

Bob- I am glad for the recommendation as my wife has shown evidence of OSA but she has a number of other health issues and I don't know if she could make it with the operation that I went to. I need to see if they will take my insurance.

PS - I keep looking for your license plate on the 101

-Clark

[rested gal]

Does anyone know if there is a specific Board Certification for Sleep Medicine?

As I understand it (and I could be reading it wrong) from 1978 through 2006 there was a specific board certification in "Sleep Medicine" handled by the American Board of Sleep Medicine. Passing that organization's board certification conferred the title, "Diplomate of the American Board of Sleep Medicine" or "ABSM Diplomate."

Beginning in 2007 however, various medical specialties began offering their own examinations in "sleep medicine." Apparently passing a "sleep medicine" exam within one's own specialty would give the doctor a certificate for having passed the exam.

http://www.aasmnet.org/Certification.aspx

One of the links on that page goes to the current info:

"BOARD CERTIFICATION IN SLEEP MEDICINE - Current (2007 – Present)

The board certification examination in sleep medicine is offered every two years by these member boards of the American Board of Medical Specialties:
American Board of Family Medicine
American Board of Internal Medicine
American Board of Otolaryngology
American Board of Pediatrics
American Board of Psychiatry and Neurology

The training requirements to sit for the sleep medicine exam will be waived for Diplomates of the American Board of Sleep Medicine who apply to take the exam in 2007, 2009 or 2011. Visit the Web site of the board through which you have your primary certification for full eligibility requirements, for exam details and to apply.

Contact the AASM national office for more information about board certification in sleep medicine."

[tvmangum]

The doctors that I saw on Tuesday told me that he had completed a post doctoral fellowship in Sleep Medicine along with his Pulmonary fellowship. When I go back in a month I'll check the certificates on the walls.

On another question, I have found the ResScan software and was wondering if I really need to go the expense of getting it and a card reader or USB reader. Comments, thoughts or suggestions are welcome.

[Uncle_Bob]

We all do have a choice if we have the money. Many who have the current public option health care (Medicare) have greater choices than those that are limited by their employers' health plans. For me, I ended up being sent to a commercial sleep mill down the road from Uncle-Bobs place. I was sent by the NP-C in my primary care docs office and it was a place where the ratio was one tech to four patients. I had to go back three times to be titrated. My results were then apparently sent to my doc (probably the NP-C) and then I was contacted by the DME run by a major drugstore chain. BTW - they set my pressure at 7.0 and I am now below 5 AHI with a self-titrated pressure of 12.5

I was given a mask by the DME when we met in a back room that was used for storage - not even a place to sit down - and sent on my way. They did call me at about six months, asked how I was doing, I said OK and that was that. I do call from time to time to get some supplies.

Luckily I found CPAPTALK fairly early on, purchased my own data-capable APAP and have been taking care of my own health ever since.

I know that there are quality docs, sleep centers, RTs and DMEs out there. Otherwise the CPAPTALK server would be constantly crashing due to the strain.

But when you are so sleep deprived and barely able to think, it becomes way too easy to let them "take care" of you. When you are in the ambulance, you are not really in a good position to shop for hospitals.

Bob- I am glad for the recommendation as my wife has shown evidence of OSA but she has a number of other health issues and I don't know if she could make it with the operation that I went to. I need to see if they will take my insurance.

PS - I keep looking for your license plate on the 101

-Clark

I think i should have been clearer on what i meant by choice but i think you have the best understanding. For example i know other people at work who have the same insurance as me have gone to some real basic sleep centers that have not so nice beds, shared bathrooms, no showers etc etc. I know the main objective is to get a good study but the place i went to just seemed really nice and professional.
Before my study i had an appointment at the center during the day. I was there for 45 mins and was shown around the hotel style rooms with en-suite bath and showers, I was shown a DVD about sleep apnea in one of the rooms on large flat screen TV over a cup of coffee. The infa red camera was explained to me and then i was shown inside the monitoring room where they reassured me that the person doing the study only looks at a max of 2 people per night. Finally i was introduced the mask i got to try about 4 or 5 on to see how i felt and if i had a favorite etc.
The study itself was as pleasant as it could be. I got dressed into my PJs in the en suite bathroom where i had a large Bacardi and coke (which i provided). I then watched a DVD while the tech wired me up and slapped on the mask. I took a sleep aid and was out like a light. In the morning i was able to shower and grab a bagel on the way out and then went directly to work.
The titration was similar except there were no bagels.

It seems the sleep study experience varies so much even with the same insurance. I'm glad i took the time to find this place and i would recommend it to anyone.

[roster]

......
On another question, I have found the ResScan software and was wondering if I really need to go the expense of getting it and a card reader or USB reader. Comments, thoughts or suggestions are welcome.

Do it and someday you will post here, "That was the best investment I ever made in my health, my job, and my ability to enjoy life."

You will never want to do without it again.

Make sure it is compatible with your machine.