Questions about PAP therapy that never seem to get answered

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
15+yearSleepPro
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Questions about PAP therapy that never seem to get answered

Post by 15+yearSleepPro » Thu Aug 28, 2014 6:45 am

Hello, I am a Registered Polysomnographic Sleep Technologist or RPSGT (as my name states) for 15+ years and I did sleep studies for about 10 of those years and I now work on the DME or Durable Medical Equipment side of sleep disorders. I see many patient's that for years upon years have been on the wrong mask, do not wear there mask or use the PAP therapy simply because they were not seen by a competent DME Clinician or a doctor that really cared, therefore using the therapy is too daunting. I wanted to start this topic for anyone that has questions about the therapy they use or has simply never been informed of the basic principles of Sleep Apnea/OSA or was only showed how to use the machine and told "you have to wear this". I will try to always be available to answer all posts to this topic. Jeff

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Re: Questions about PAP therapy that never seem to get answered

Post by Guest » Thu Aug 28, 2014 6:57 am

15+yearSleepPro wrote:I see many patient's that for years upon years have been on the wrong mask, do not wear there mask or use the PAP therapy simply because they were not seen by a competent DME Clinician or a doctor that really cared, therefore using the therapy is too daunting.
Jeff,
Welcome to the forum.

I think you will find the consensus here feel that it is the DME that is the weak link in therapy. And that DME's are who forces the wrong mask on patients.

So unless you will start to police the DME's I don't think there is a solution for the "Love of Money".

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Julie
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Re: Questions about PAP therapy that never seem to get answered

Post by Julie » Thu Aug 28, 2014 7:10 am

The trouble with this forum is that it's too good! There are many really knowledgable and experienced people here who help newbies and others with every conceivable issue related to OSA, Cpap and e.g. UARS, PLMD, intractable insomnia, technical aspects of machines, masks, meds, PSGs, ignorant MDs, and 1,000 other things you've probably never thought of, so while we always appreciate help from 'outside' please don't take it personally if not many take you up on your offer at this time... we've been lucky enough to find help on our own, plus be in a forum with such low-level 'moderation', unlike others out there that are so restricted in their self-imposed mandates about what and how to post.
Last edited by Julie on Thu Aug 28, 2014 9:59 am, edited 2 times in total.

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49er
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Re: Questions about PAP therapy that never seem to get answered

Post by 49er » Thu Aug 28, 2014 7:12 am

How do I find someone like you to help me with mask fitting, particularly since most DMEs could care less about doing the job properly as guest alluded to.?

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chunkyfrog
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Re: Questions about PAP therapy that never seem to get answered

Post by chunkyfrog » Thu Aug 28, 2014 7:59 am

Ideally, competent, involved professionals would be everywhere---doing their jobs,
not just punching a clock and "moving merch", often under orders to do no more.
We can't be there to personally fit a mask, but we can post links to masks that have worked for us--
often styles the DME's "can't get". (Why is lying acceptable? --just wondering)
It is a travesty that the business has done its darnedest to eliminate effective patient care (customer service).
I can imagine the frustration felt by any dedicated professional who has been "downsized",
not due to a lack of need, but corporate greed.

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Re: Questions about PAP therapy that never seem to get answered

Post by Drowsy Dancer » Thu Aug 28, 2014 8:09 am

15+yearSleepPro wrote:Hello, I am a Registered Polysomnographic Sleep Technologist or RPSGT (as my name states) for 15+ years and I did sleep studies for about 10 of those years and I now work on the DME or Durable Medical Equipment side of sleep disorders. I see many patient's that for years upon years have been on the wrong mask, do not wear there mask or use the PAP therapy simply because they were not seen by a competent DME Clinician or a doctor that really cared, therefore using the therapy is too daunting. I wanted to start this topic for anyone that has questions about the therapy they use or has simply never been informed of the basic principles of Sleep Apnea/OSA or was only showed how to use the machine and told "you have to wear this". I will try to always be available to answer all posts to this topic. Jeff
Jeff, welcome. The experience of professionals is invaluable.

I have a question of a somewhat different sort about your experience. What was it like to switch from, shall we say, diagnosis to implementation? You went from doing sleep studies to, I guess, mask fitting and the like?

Also, are split night studies as effective as two night studies? How about using an APAP to verify/refine an initial titration?

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Jeff241
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Re: Questions about PAP therapy that never seem to get answered

Post by Jeff241 » Thu Aug 28, 2014 8:27 am

Drowsy Dancer wrote: Also, are split night studies as effective as two night studies?
I guess I'll piggyback on this question.

How much does people's insurance dictate what type of study they get?

I ended up having a two night study mainly because I didn't sleep enough for titration. Plus I have good insurance.

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Last edited by Jeff241 on Thu Aug 28, 2014 8:36 am, edited 1 time in total.

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englandsf
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Re: Questions about PAP therapy that never seem to get answered

Post by englandsf » Thu Aug 28, 2014 8:33 am

Great thread - where should the "mask choice step" live?

Seems to be forced in at the end of a sleep study, the beginning of a titration or as part of a short delivery/pick up. My DME did a good machine intro but had no real mask advice or input. I happened to research FFMs and ask for an F10 (so new I got a free sample). Turns out I get mega claustrophobic/overheated and really needed pillows.

With mask type, fit and seal being the commonest (it seems) failure point, why can't we depend on someone in the process to ask a few questions and recommend some simple steps to get the right mask type and model?

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JQLewis
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Re: Questions about PAP therapy that never seem to get answered

Post by JQLewis » Thu Aug 28, 2014 8:46 am

Guest wrote:
15+yearSleepPro wrote:I see many patient's that for years upon years have been on the wrong mask, do not wear there mask or use the PAP therapy simply because they were not seen by a competent DME Clinician or a doctor that really cared, therefore using the therapy is too daunting.
Jeff,
Welcome to the forum.

I think you will find the consensus here feel that it is the DME that is the weak link in therapy. And that DME's are who forces the wrong mask on patients.
I can't agree. Why are the doctors who fail to follow up with their patients or properly monitor their therapy not the weak link? Why are insurance companies which set up irrational rules for compliance which do not care about the effectiveness of the therapy not the weak link?

@Jeff: Welcome. I hope people here can benefit from your knowledge. What I'd like to know is what you think can be done to change the way sleep medicine is practiced? What's struck me since getting involved with sleep medicine is how short-sighted the people are who administer treatment. Everyone, DMEs, doctors and insurance companies, would gain greater profits from making sure about details like mask fit, but they don't bother. How can these people be made aware that there's more $ to be made by actually helping patients?

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49er
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Re: Questions about PAP therapy that never seem to get answered

Post by 49er » Thu Aug 28, 2014 9:00 am

JQLewis wrote:
Guest wrote:
15+yearSleepPro wrote:I see many patient's that for years upon years have been on the wrong mask, do not wear there mask or use the PAP therapy simply because they were not seen by a competent DME Clinician or a doctor that really cared, therefore using the therapy is too daunting.
Jeff,
Welcome to the forum.

I think you will find the consensus here feel that it is the DME that is the weak link in therapy. And that DME's are who forces the wrong mask on patients.
I can't agree. Why are the doctors who fail to follow up with their patients or properly monitor their therapy not the weak link? Why are insurance companies which set up irrational rules for compliance which do not care about the effectiveness of the therapy not the weak link?

@Jeff: Welcome. I hope people here can benefit from your knowledge. What I'd like to know is what you think can be done to change the way sleep medicine is practiced? What's struck me since getting involved with sleep medicine is how short-sighted the people are who administer treatment. Everyone, DMEs, doctors and insurance companies, would gain greater profits from making sure about details like mask fit, but they don't bother. How can these people be made aware that there's more $ to be made by actually helping patients?
JQLewis,

I mostly agree with everything you have said regarding doctors being the weak link in the therapy. However, I don't feel there is any motivation for most of them to help patients since they are mostly already doing well financially. Any time a patient leaves, they can easily find folks to replace us.

By the way, when I called a local sleep doctor's office who mentioned on their website that they helped patients with pap therapy issues, I called in an attempt to find out more information. Initially, they didn't want to answer my questions and persisted in getting me to make an appointment. Finally, I was put in touch with someone and did not get the sense they understood the relevant issues.

And for mask issues, a patient was sent to a DME. Hmm, if you were truly serious about helping people with pap therapy tolerance issues and problems with the mask are the number one issue with compliance, wouldn't you care enough to handle this issues yourself? I guess not.

The other problem is the sleep specialists do not have a broad background of sleep issues. So if you go to someone with a neurology background and your issues are more ENT related, that neurology guy is not going to pick up on that and vice versa. The pulmonology person is not going to pick up on neurology issues that might effect sleep. Or if you have other issues that may be impacting successful therapy, you're the one who has to take charge as chances are the sleep specialist is not going to help you with that.

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Re: Questions about PAP therapy that never seem to get answered

Post by Luthie2006 » Thu Aug 28, 2014 9:07 am

I agree. Most DME's are horrible. The one I had gave me the wrong MACHINE. It was ordered properly and he gave me a BRICK, as Pugsy and Chunky Frong told me the first week I started CPAP in May. I quickly told my wonderful sleep clinician (who is great!) and she called the DME and asked why they gave me such an ancient machine without DATA. I paid $1200 through insurance with this either way! If it wasn't for Chunky Frog and Pugsy during my first few days, I would NOT HAVE KNOWN that I was SOLD such an old machine! I had my sleep clinician deal with the DME. I don't deal with them. I have bought more masks on CPAP.com and find them to be more reliable, but much more expensive but worth not having to deal with the DME.

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englandsf
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Re: Questions about PAP therapy that never seem to get answered

Post by englandsf » Thu Aug 28, 2014 9:12 am

I think the "interface" between the doc and the DME is worthless most of the time. My doc sent me to one person at a DME who then quit and the doc had no replacement DME to recommend. I was in mid start up phase and in a mask crisis that only this group and some old friends on FaceBook got me through.

If the doc does a titration study (For about $2K in my case) why doesn't that include some mask option testing and recommendation? All I got was an old set of pillows (right solution but disgusting looking) and a newer FFM (wrong for me it turned out).

If the DME sets you up then they should surely go through the basic mask types (FFM, nasal and pillows) with the patient - yes?

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SleepyEyes21
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Re: Questions about PAP therapy that never seem to get answered

Post by SleepyEyes21 » Thu Aug 28, 2014 8:20 pm

chunkyfrog wrote:Ideally, competent, involved professionals would be everywhere---doing their jobs,
not just punching a clock and "moving merch", often under orders to do no more.
We can't be there to personally fit a mask, but we can post links to masks that have worked for us--
often styles the DME's "can't get". (Why is lying acceptable? --just wondering)
It is a travesty that the business has done its darnedest to eliminate effective patient care (customer service).
I can imagine the frustration felt by any dedicated professional who has been "downsized",
not due to a lack of need, but corporate greed.
First let me say welcome to Jeff. From the looks of the many responses and questions so far, you may have just found your next 'full time job' here

I think chunky's post is hitting closest to one of the underlying problems that many of us here have (besides sleep apnea.) All of us PAP'ers and likely the average patient in need of care for a sleep problem, have certain expectations of all of the professionals involved in treating sleep disorders (PCP's, DME's, etc.) As we experience any perceived failures of these professionals to adequately address our questions/ issues/ problems related to apnea treatment, we then consider said professionals to be "the weakest link" in the chain. The reality is that each of us play a part in the 'chain;' each of us needs to be able to do our best and give our best effort to keep the 'chain' most effective overall.

As PAP'ers, we expect our docs & DME's (as chunky said) 'to ideally show competency in their respective fields by doing what WE expect them to know and do.' And as WE all have experienced, some do well at this, some do so-so, and some fall way, way short.

My questions for Jeff are:

1. Do you know the minimal educational, knowledge and/ or training requirements for the RT (or selling) person for a DME, or does this vary from state to state?

2. Are there any requirements for ongoing product training for DME's/ RT's?

3. Besides fitting PAP'ers for their necessary equipment, what (in general) are other employment responsibilities a DME/ RT might have in any given day?

4. From your professional perspective, are there any expectations that RT'S/ DME's have of their PAP'er customers?

5. From your experience, what would you say is the number one reason most people fail with CPAP therapies?

Interesting conversations!

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Re: Questions about PAP therapy that never seem to get answered

Post by LSAT » Thu Aug 28, 2014 9:00 pm

Our "sleep pro" has left the building.................

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Re: Questions about PAP therapy that never seem to get answered

Post by palerider » Thu Aug 28, 2014 9:08 pm

LSAT wrote:Our "sleep pro" has left the building.................
maybe works nights and sleeps during the day... not to imply that sleep techs are vampires

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