What is with these doctors? Is breathng important or not?

[archangle]

Well, this is a golden opportunity for you to figure out how to get the right CPAP machine. The DME will probably try to screw you with a cheap machine that won't allow you to monitor your treatment.

Have you read up here on how to figure out which CPAP machines are acceptable, etc.?

[noSLEEPforYOU]

I don't know which machine the doctor prescribed. The DME should only send the machine the doctor prescribes. Should I refuse any machine that doesn't record?
I remember the doctor said something about the insurance company wanting proof that you actually use the machine. My insurance will pay 100% of anything so I would imagine they would want to upsell instead of sticking me with junk.
I don't know all the particular wording of my health insurance. If I accept the machine I imagine it will be harder to exchange it for a better one. I don't know what will happen if I refuse the machine, other than delaying therapy and sleep.
The sleep study had me on a Respironics machine.

[Guest]

Great comments, people.

[osmium sleeper]

Whoops! So here's my loose timeline.


2002-2010, it is suggested that I have a sleep study by several Drs. I put it off for various reasons, mainly being young and thinking that my life would be over if I had to wear a device while sleeping, but one reason sticks out is the discussion of revoking the licenses of those diagnosed with OSA.

February 26th 2011: 1st Sleep Study, showing OSA, something in the range of 60 AHI
March 1st 2011: 2nd Sleep Study for titration, unable to use CPAP due to nasal obstruction.
April 6th: Scheduled for my turbinectomy, which was cancelled due to my ENT having cardiac arrest.
May 30th: Scheduled for my turbinectomy with new ENT. Cancelled due to new ENT's health problems.
August 11th: FInally have turbinectomy.
September 18th: Repeat sleep study, but am unable to sleep due to all of the electrodes and leads used at new sleep center. Makes me think that the other sleep center was a scam.
October 2nd: Repeat sleep study, shows that I have 34 AHI and 90% SpO2, was not titrated for cpap because this was apparently not bad enough for a CPAP.
I finally find a new Dr to prescribe a titration study.
Dec 5th: Titration study.
Dec 20th: CPAP dispensed.

Have yet to find a mask that works...

[woodenbuick]

I got my preliminary sleep study done while in the hospital for a lung biopsy. I kept setting off o2 alarms and they brought me a machine that very night that I went home with.
Later on I had a formal sleep study. Not knowing nothing, I got lucky with the machine they sent me home with.

[tomjax]

In reading sonme of these stories, I am a bit fortunate.
I read a newsapaper article about 1995 about a surgical procedure for snoring and made an appt with the doc in the article for that surgery.
He told me I was not a candidate for this procedure and recommended a sleep study and possible a CPAP for my condition.
This did not appeal to me at all and due to my total ignorance, I let it pass.
A couple of months later while driving to work, it became neccary for me to do SOMETHING and I called and scheduled a sleep studdy- about a week later.
The next morning the techs discussed my night before- something many here say is not normally done.
Anyway, I guess I am a bit assetrtive and pushy and maybe I mesled the techs and told them the doc said I could have a PAP immediately.
They talked about it a few minutes and told me they would let me take the machine home THAT MORNING and call the doc to agree with the 12CM setting.
The DME was in the same office as the sleep setup.
I was so totally amazed with the immediate and dramatic results I got.
No sleepiness on way to work.
Totally no drowsiness.
I guess this not the case with most people, but it is mine.

[archangle]

I don't know which machine the doctor prescribed. The DME should only send the machine the doctor prescribes. Should I refuse any machine that doesn't record?
I remember the doctor said something about the insurance company wanting proof that you actually use the machine. My insurance will pay 100% of anything so I would imagine they would want to upsell instead of sticking me with junk.
I don't know all the particular wording of my health insurance. If I accept the machine I imagine it will be harder to exchange it for a better one. I don't know what will happen if I refuse the machine, other than delaying therapy and sleep.
The sleep study had me on a Respironics machine.

The DME usually gets paid the same amount of money for any CPAP machine because that's the way insurance usually works. He has a big incentive to sell you the cheapest piece of junk he can. He has incentive to lie about it.

It's like walking into a used car dealer with a sealed bag of money. If he makes a sale, the used car salesman gets the whole bag of money no matter which car he sells you. Are you going to let the used car salesman pick out the car for you? Are you going to believe his recommendations for which car to choose?

The doctor usually doesn't specify a particular machine. The prescription usually says something like "CPAP, 12cmH20, with heated humidifier and mask."

You have the legal right to buy your CPAP from any supplier. Be sure they're "in-network" for your insurance. Find out who the local in-network DMEs are for your area. Be ready to try several and play them off of each other to get the right machine and good service. You'll get better service if the DME knows you're ready to walk out and try another DME. A second DME may be willing to offer more to get your business. Get a written copy of your prescription. It will help you buy equipment online, or get an emergency replacement if you have problems when traveling.

I recommend you go into the DMEs office to get your machine. That helps prevent them from playing the game of "I only brought this particular machine and mask," and laying a guilt trip on you. You'll have a better choice of masks as well. It's a lot easier to walk away and find another DME if you're in their office. If they do deliver your machine, be sure to figure out the machine you want. Don't be surprised if they "accidentally" bring the wrong, cheaper machine.

Do NOT let them scam you into the wrong machine. Many of them are used car salesman types who are used to manipulating people. You can wait a few days to get the right machine, which will make a big difference in your health.

Most machines record "compliance" data that records when you use it. This is useless in terms of telling you how well your treatment is working. Compliance data is to benefit the insurance company, not the patient. For the same price to you, you can probably get a fully data capable machine that will record every apnea or breathing event, and even have EKG like waveforms of your breathing. There is free software you can get online that will show you this data. A competent sleep doctor can read this data and see how your therapy is going. It's like having a mini-sleep test automatically every night you use CPAP.

Doing CPAP without full data collection is like having a heart patient in the hospital and not bothering to hook him up to a heart monitor.

Try to get an Auto CPAP machine. The DME may lie to you and say you can't have one because the prescription is for a manual machine. The prescription might say one fixed pressure, but an auto CPAP can be set to do that. If you want to try APAP later, you have the option. Some APAP machines record more data than their manual CPAP machines.

I'll recommend a PRS1 Auto or a ResMed S9 AutoSet. PRS1 Pro or S9 Elite are good manual CPAP machines.

Do NOT accept a PRS1 PLUS or S9 Escape or Escape Auto. They record a lot less data. Don't accept an older model like a ResMed S8 or Respironics M series.

If possible, call up the DME and find out ahead of time what machine they're going to give you, and post it here before you get it. Don't accept the wrong machine as a "temporary" machine.

[Paul56]

I have been fortunate not to have to deal with doctors too much in my life. I am getting really pissed off at this whole situation. My first sleep study was on December 1. I was told results would be ready in two weeks. That seemed ridiculous at the time but I figured that was just to give them plenty of time. I received the results after two weeks and was told that I have severe sleep apnea and that I needed to have another test. The earliest appointment was December 30th they were not able to treat me so another appointment on Jan 7th.
They were finally able to treat me, the doctor sent the prescription out to a medical supply place and now I have to wait until next week to make an appointment for them to bring machine out and show me how to use it.
I am sure glad breathing or sleeping isn't important, I can't imagine how long it would take if I had a real problem.
Somehow I figured that if you have a problem they would bring a machine out that day and worry about fine tuning after that.

I had a similar experience when I was diagnosed... that was complicated by
the fact I had a sleepless first night of sleep study and a 2nd session needed
to be scheduled.

It did not help they placed me in a room beside the nurses station and I had
to list to them talking, joking and laughing most of the night. I commented
about that politely and with the next session they placed me way down the
hall... where I listen to the intermittent announcements from the hospital
pager system all night long that was equally annoying but I still managed
to get enough sleep for the study.

Welcome to the trials & tribulations of sleep apnea treatment. At least
you have found this forum where there is a plethora of varied experience
on the subject.

You may end up doing what I have... never did have a sleep doc, but I did
fire the DME and took charge of treatment on my own. I purchase my own
equipment and don't bother with insurance and their silly requirements for
this.

[Janknitz]

Nosleep, heed Archangle's words and DO NOT walk into a DME's lair without first reading my blogpost "What you need to know BEFORE you meet your DME" ( linked in my signature below). You are a sitting duck with a great big neon sucker sign on your head until you educate yourself about the games DMEs play.

Use this gap in time wisely or you will soon regret it.

As for your doctor, you owe it to his other patients to let him know, in writing, why he is no longer your doctor. Maybe he will think twice about dismissing blatant symptoms of OSA because the complaining patient isn't overweight. If your insurance gives bonuses to docs who don't make many referrals you should file a complaint with your state's insurance regulators and state medical board because your doc was putting his pocket over your health.