My visit to the Sleep Doc...A "GOOD" one!!

Well, I was back to the sleep doc yesterday, armed with loads of data and ideas picked up here. My primary purpose was to get him to order me the "RemStar Auto PAP with CFlex" after being on the "RemStar Pro with CFlex" for 22 months.

He greeted me (I haven't seen him for 18 months) with "So how are you? Awake, vibrant and full of energy??" I shared that I was better than before CPAP, but was still having problems. I admitted that I had increased my pressure from 11 to 12.6 due to increased symptoms last summer (following more weight gain ...) and that I felt an APAP would serve me better. When he asked me "Why?", I was able to share the anecdotes from everyone here.

We then got into a discussion about how sleep science is changing (he feels it will be changing--whereas we think it IS changing already) due to the availability of APAP. He sees the day coming when home autotitration will replace the sleep study, but refuses to accept that practice at this time. His rationale is the possibility of REM rebound causing asystole--and thus death. (REM rebound is the phenomenon that we OSA'ers go through when we first start CPAP and enter REM sleep for the first time in YEARS. This deeper, longer and more active period of REM can have extreme hypoxia associated with it, and the heart may STOP--asystole!) This consequence of starting CPAP can be handled in the sleep lab, but would probably cause death at home. From a malpractice viewpoint, he is unwilling to subject himself to the potential lawsuits should this happen.

(Since I was unaware of REM rebound/asystole, I did a MedLine search. There is ONE REPORTED CASE of this ever happening!! Talk about covering your ***! )

So, we agreed to disagree about using APAP as first-line treatment without a sleep study, but he did AGREE that APAP would probably help me, and wrote up the script. When I told him I wanted the RemStar Auto with CFlex, he said "They don't make an Auto with Cflex!" I assured him there was such a machine, and that it had been out for about a year. I even quoted him the CPAP.COM prices for the CPAP vs APAP with CFlex. That's when he said that I spend too much time on the Internet chat rooms!!

Bottom line--I get the AutoPAP with Cflex and a new humidifier. When I asked him to order me the sofware and reader, he said that he always orders that with the APAP, and that he wants data after a month.

So, all is not lost, fellow xPAP'ers! Good Docs DO EXIST. INFORMED PATIENTS CAN help guide their own treatment! If you don't like what your doc says/does--FIND ANOTHER ONE!!

I'll let you know when my DME gets me the new machine...
Grant

Hi Grant,

Interesting story. Even though you happily were able to get what you wanted, sounds like you really had to fight for it, armed with your information found here. I'm impressed. How could your doctor poo-poo the use of the internet, when clearly you learned more than the doctor by USING the internet? Great that you were able to get what you wanted. Most interesting!
Good going!

Linda

G-- forbid you should be more well-informed than they are!

I had a similar experience with my pulmonary sleep doc. Good guy, and ultimately very supportive of the way I wanted my treatment to go, but boy, was he defensive!

At least the good ones will admit they are driven in part by fear of lawsuits. Not this is a good thing, but it helps to understand why they get so darn touchy. Almost as if no one in the world but physicians have the right to find, digest, and apply information.

Perhaps we should bow as we enter the office, and address them as "Oh Great One" -- sorry, just get frustrated sometimes javascript:emoticon('8)')

hopeful wrote:G-- forbid you should be more well-informed than they are!

I had a similar experience with my pulmonary sleep doc. Good guy, and ultimately very supportive of the way I wanted my treatment to go, but boy, are they defensive!

At least the good ones will admit they are driven in part by fear of lawsuits. Not this is a good thing, but it helps to understand why they get so darn touchy. Almost as if no one in the world but them can understand, digest, and apply information.

Funny this mention of of doctors' fear of lawsuits. Just today I was viewing Liam's website (can be viewed by clicking on his name), where he wrote a rant about how doctors nowadays are scared into being careful, scared of lawsuits and therefore don't try new things that might help patients. As said in the posts here, the good doctors are being scared and inhibited from acting outside the box.

...... Still, if a doctor typically helps patients by prescribing OSA treatment, they should try and stay abreast of the latest developments in the technology and improvements to the treatment. I bet if the doctors themselves suffered from sleep apnea they would definitely know all about the latest equipment!!

When you get your software, make sure that you set it to not erase data (there is a couple of posts on how to do it) And download the data every night.

Glad it worked out for ya!