Very Nervous - Doctor says stop CPAP

tan · Post by **tan** » Mon Dec 22, 2014 11:27 am

palerider wrote:
tan wrote: home testing is useless for UARS, unless someone proves otherwise.
please provide references to back up your blanket statement.

Sure. I knew somehow that my bald statement will caught your attention, hehe.

#1: Unfortunately, there is no good way to diagnose UARS without going to a sleep lab that specializes in looking for it.

#2: The conclusion is usually made that sleep isn’t the reason why they feel so bad. Since UARS is much more difficult to diagnose and since insurance companies rarely reimburse for the management of UARS, sleep physicians rarely pay much attention to this common condition.

#3: My doctor's statement in my discussion with him:
UARS needs a "real sleep study," Insurance carriers are only getting worse. We can try again in 2015 or you can complain to the insurance commissioner...

Now, I understand there may be a conflict of interests for each of the businesses above, but they look credible to me.

Your move, sir!

palerider · Post by **palerider** » Mon Dec 22, 2014 2:49 pm

tan wrote:
palerider wrote:
tan wrote: home testing is useless for UARS, unless someone proves otherwise.
please provide references to back up your blanket statement.
Sure. I knew somehow that my bald statement will caught your attention, hehe.

#1: Unfortunately, there is no good way to diagnose UARS without going to a sleep lab that specializes in looking for it.

#2: The conclusion is usually made that sleep isn’t the reason why they feel so bad. Since UARS is much more difficult to diagnose and since insurance companies rarely reimburse for the management of UARS, sleep physicians rarely pay much attention to this common condition.

#3: My doctor's statement in my discussion with him:
UARS needs a "real sleep study," Insurance carriers are only getting worse. We can try again in 2015 or you can complain to the insurance commissioner...

Now, I understand there may be a conflict of interests for each of the businesses above, but they look credible to me.

Your move, sir!

if you listen to the eminent asv pusher,

• UARS (upper airway resistance)
• Flow limitation
• RERAs (respiratory effort-related arousals)

if

This process of UARS breathing can be seen in the nasal air flow tracing shown below which was obtained with a device fastened underneath the nose that measures airflow during sleep.

then even home systems, if you can get the full report from them showing flow, should be able to diagnose uars/fl/reras (though, I'd argue that you can have upper airway resistance, and flow limitations, without arousal, so that kinda throws a bit of the asv guy's theory into question.

tan · Post by **tan** » Mon Dec 22, 2014 4:41 pm

palerider wrote:though, I'd argue that you can have upper airway resistance, and flow limitations, without arousal

That is the point: "witout arousal", a fact which is impossible to determine during a home sleep study. A member of this forum mentioned having a ragged FL chart and feeling well, which makes me think that he does not actually experience arousals. Dr. Steven Park mentioned something to the effect that actual UARS patients have a higher sensitivity to sleep disrupting factors due to their overreacting nervous system.

fishmkg · Post by **fishmkg** » Mon Dec 22, 2014 6:50 pm

OkyDoky wrote:
chunkyfrog wrote:If your doctor is in an HMO, his diagnosis may be influenced by money.
Demand an overnight sleep study by an independent lab, if you can.
It would be interesting to know if it was an HMO. I worked in an HMO once when they first started being popular and learned some of the workings. When you are given a pocket full of money, for someone else's care, and how much you get to keep depends on how much you save it is tempting to consider it as my money. The clinic I worked in was a 6 doctor practice and not all were like that but it is a consideration.
Sounds to me like it was possibly time for a new machine and sleep study and your doctor "felt" that money in his pocket. I would also get another sleep study/ opinion.

My doctor is not in an HMO. He did not have anything to gain by telling me I did not need my cpap anymore. From the concerns I have heard, it's scary that doctors would make medical decisions for their patients solely based on profit margin.

Bill44133 · Post by **Bill44133** » Mon Dec 22, 2014 6:57 pm

fishmkg wrote:
OkyDoky wrote:
chunkyfrog wrote:If your doctor is in an HMO, his diagnosis may be influenced by money.
Demand an overnight sleep study by an independent lab, if you can.
It would be interesting to know if it was an HMO. I worked in an HMO once when they first started being popular and learned some of the workings. When you are given a pocket full of money, for someone else's care, and how much you get to keep depends on how much you save it is tempting to consider it as my money. The clinic I worked in was a 6 doctor practice and not all were like that but it is a consideration.
Sounds to me like it was possibly time for a new machine and sleep study and your doctor "felt" that money in his pocket. I would also get another sleep study/ opinion.
My doctor is not in an HMO. He did not have anything to gain by telling me I did not need my cpap anymore. From the concerns I have heard, it's scary that doctors would make medical decisions for their patients solely based on profit margin.

Welcome to the cold cruel world.

tan · Post by **tan** » Mon Dec 22, 2014 7:09 pm

fishmkg wrote:
OkyDoky wrote:
chunkyfrog wrote:If your doctor is in an HMO, his diagnosis may be influenced by money.
Demand an overnight sleep study by an independent lab, if you can.
It would be interesting to know if it was an HMO. I worked in an HMO once when they first started being popular and learned some of the workings. When you are given a pocket full of money, for someone else's care, and how much you get to keep depends on how much you save it is tempting to consider it as my money. The clinic I worked in was a 6 doctor practice and not all were like that but it is a consideration.
Sounds to me like it was possibly time for a new machine and sleep study and your doctor "felt" that money in his pocket. I would also get another sleep study/ opinion.
My doctor is not in an HMO. He did not have anything to gain by telling me I did not need my cpap anymore. From the concerns I have heard, it's scary that doctors would make medical decisions for their patients solely based on profit margin.

There will be a new type called ACO. They will be given some kind of bonus for keeping the costs of healthcare down while providing better (statistically) care for population. I suspect that "better" in the last sentence will be measured in AHI and compliance hours, when it comes to sleep apnea, I am afraid.

Wulfman... · Post by **Wulfman...** » Mon Dec 22, 2014 7:12 pm

fishmkg wrote:I have had OSA for probably most of my adult life. I was finally diagnosed and began treatment 7 years ago. After suffering from various health issues over the years, I have been blessed with good health as of late. I am off all medications, exercise regularly and have lost a great deal of weight. At my last doctor's appointment, my doctor felt my OSA would no longer be present. I remember all too well what my life was like before my OSA was treated. Once it was treated, I was no longer afraid to go to sleep, knowing I would feel great in the morning. For this reason, I am very dependant on my machine (if you are new to the cpap treatment, stick with it.... it will be all worth any struggles you may have at first). My anxiety sky rockets when I think of not using my cpap. I have taken short naps without it recently. In the past, I would have woken up feeling terrible with a headache. However, that has not been the case as of late. Sooooo, last night, I decided to try something. I have the S9. I lowered my pressure range to its lowest settings for the min/max. I set them both at 4. Let me tell you when I put the mask on I was very nervous. I did fall right to sleep and managed to stay fast asleep for 4 hours. When I woke up I felt fine.... still anxious though. When I checked my AHI it was 1.7 events for the 4 hours. I checked my pulse to see if my heart was working harder and it was normal for me at around 60 bpm. I was too nervous so I ramped up the pressure for the rest of the night.

Where does an AHI for a “normal” person without OSA register? I really can’t imagine not using my cpap anymore. I am afraid to go back to how I felt before treatment but if I don’t need it anymore that would be wonderful. It may take me a long time to get rid of my dependence but it would be worth it if it is true. Any advice would be so appreciated. Short of another sleep study, any other ideas to test myself further? I don’t know what to do.

From my perspective, I don't see that you have anything to lose by staying on CPAP therapy. I mean, "it's only air" and breathing well during the night can't be bad.

I'd also be leery of a doctor who proclaims something like that without substantiating data to back it up.

Your call. But, I wouldn't advise selling the equipment anytime soon if you're not going to continue using it in the short term.

Den

.

Sleeprider · Post by **Sleeprider** » Mon Dec 22, 2014 7:23 pm

I'm sure the idea a physician would make decisions based in incentives is pretty offensive to most of the medical profession. The answer to this question is pretty simple....first, congrats on the weight loss and health gains! You are aware of how you feel, and anxiety is a normal component of that. Your risk of going without CPAP seems pretty slight since you may resume using it if your sense of well-being is the criteria of whether to continue with that decision.

Most of us (speaking for myself) are immediately aware of the closure of the respiratory tract and suffocating feeling that arouses us to take another breath. I was forced to deal with a night without the machine when I recently went on a trip without the power supply. I felt the same anxiety you are expressing here. The difference is, my sleep was clearly disturbed. I survived, and would do so again, but it was very unpleasant. It seems if your apnea is resolved, you should be able to deal with the anxiety and assess the quality of a night with out pressurized air. If it is indeed full of arousals or feeling bad in the morning, you have a choice. Try it! If you don't like it, you have a machine and know how to use it.

OkyDoky · Post by **OkyDoky** » Mon Dec 22, 2014 7:55 pm

My comment wasn't to paint HMO doctors with a wide brush but to consider the possible underlying currents of a decision made without a sleep study. Doctors are human and come in a great variety of personalities with their own life circumstances and some fail to make good choices. I have doctor friends and respect the work doctors do and after 25 years as an RN I consider myself a retired "medical professional".

Sludge · Post by **Sludge** » Tue Dec 23, 2014 5:46 am

tan wrote:
palerider wrote:
tan wrote: home testing is useless for UARS, unless someone proves otherwise.
please provide references to back up your blanket statement.
Sure. I knew somehow that my bald statement will caught your attention, hehe.

#1: Unfortunately, there is no good way to diagnose UARS without going to a sleep lab that specializes in looking for it.

#2: The conclusion is usually made that sleep isn’t the reason why they feel so bad. Since UARS is much more difficult to diagnose and since insurance companies rarely reimburse for the management of UARS, sleep physicians rarely pay much attention to this common condition.

#3: My doctor's statement in my discussion with him:
UARS needs a "real sleep study," Insurance carriers are only getting worse. We can try again in 2015 or you can complain to the insurance commissioner...

Now, I understand there may be a conflict of interests for each of the businesses above, but they look credible to me.

Your move, sir!

So you got

Dr. Jacob Teitelbaum does frequent media appearances including Good Morning America, CNN, Fox News Channel, the Dr. Oz Show and Oprah & Friends. He lives in Kona, Hawaii.

Dr. David Lawler, DDS has a practice limited to the management of temporomandibular joint pain (TMJ), chronic head and neck pain as well as the management of sleep-related breathing disorders.

My doctor

Teitelbaum references are 10 years old, pre-dating 2 rules changes and are so general they are totally worthless:

Unfortunately, there is no good way to diagnose UARS without going to a sleep lab that specializes in looking for it. Unlike sleep apnea, which actually prevents air from getting into your body and causes the oxygen levels in your blood to drop, UARS does not cause this or necessarily even a decrease in airflow. It is simply the increased work of breathing, which tends to repeatedly disrupt sleep during the night. If you are going to have a sleep study, check with the lab before doing so to be sure that they will be checking for UARS and know how to do it right. Although in the past the "gold standard" for doing this testing required putting a small tube down into the esophagus, newer technologies that look for pressure changes in your nose or even alterations in breathing or pulse wave signals is already making this testing more user-friendly.

"Know how to do it right"?

Seriously?

Seriously?

How do you do that?

Lawler is a dentist, and anyway how does your reference prove that HST is worthless if he's doing them for UARS:

http://www.centerforsoundsleep.com/test ... diagnosis/

Your doctor is nameless, that's not a reference. That barely qualifies as an opinion.

I'm going back to watching Weather in Motion on TheWeatherChannel.

Come get me when you get some meat.

Sludge · Post by **Sludge** » Tue Dec 23, 2014 5:55 am

tan wrote:I knew somehow that my bald statement will caught your attention...

Yeah, those bald statements will do it every time:

49er · Post by **49er** » Tue Dec 23, 2014 6:23 am

Sludge,

If Tan's references are not valid, my question to you again is are there up to date references that mention how to accurately diagnose UARS during a home study test? As I previously mentioned, if it is difficult to do during a full scale study, I have doubts that it can be done accurately during an HST. But I would love to be proven wrong since you are a sleep professional.

49er

Sludge · Post by **Sludge** » Tue Dec 23, 2014 7:19 pm

49er wrote:If Tan's references are not valid, my question to you again is are there up to date references that mention how to accurately diagnose UARS during a home study test? As I previously mentioned, if it is difficult to do during a full scale study, I have doubts that it can be done accurately during an HST.

Oh c'mon, there's a million ways to do it.

Probably the easiest and quickest way would be Peripheral Arterial Tonometry (Watch PAT).

tan · Post by **tan** » Tue Dec 23, 2014 8:52 pm

Sludge wrote:
49er wrote:If Tan's references are not valid, my question to you again is are there up to date references that mention how to accurately diagnose UARS during a home study test? As I previously mentioned, if it is difficult to do during a full scale study, I have doubts that it can be done accurately during an HST.
Oh c'mon, there's a million ways to do it.

Probably the easiest and quickest way would be Peripheral Arterial Tonometry (Watch PAT).

well, a reference to its use with a Home sleep test will do. Should I expect 999,999 more links now?

tan · Post by **tan** » Tue Dec 23, 2014 9:16 pm

Sludge wrote:
tan wrote:I knew somehow that my bald statement will caught your attention...
Yeah, those bald statements will do it every time:

Do you mean the Appeals Court's grammar is not correct in the following (English is not my native, still learning idioms):
...Delaware law does not support Sunde's bald assertion that the...

Very Nervous - Doctor says stop CPAP

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