Need some help with this problem!

Hi All,

I've been a lurker here for a bit. I've got sleep apnea, no doubt about it...all of the classic symptoms...snore, large neck, overweight, hypertension, excessive daytime sleepiness, headaches in the mornings often, ...this list could go on. Also, my wife has seen me stop breathing during the night, there's no question as to whether or not I have this problem.

Here's my dilemma. I'm an older student (mid 30's) back in grad school working on a ph.d. and my physician is one at the student health clinic. My insurance will not cover a sleep study, sleep medications, or any durable medical equipment related to a sleeping disorder. Attending a sleep study is out of the question unfortunately, due to the associated cost. I've managed to save up enough to purchase an APAP, but am having trouble procuring a prescription. My physician kind of implied in the past that a CPAP would be a good idea...which I took to mean he'd have no trouble writing me a prescription for one. Well, I've been working extra hours and have finally saved up the nearly $1K for the REMstar Auto C-Flex CPAP...one that wouldn't require me to attend a sleep study due to being an Auto-CPAP. Well, today I go in to get him to write the script and he won't do it! He says he's not an expert in the field and won't write the prescription. He finally says he'll call the sleep clinic at the university hospital and talk to someone he knows and get her opinion. Well, he calls and she tells him not to write me a script for an Auto-CPAP without at least coming in for a split night study! WTF!? I can't afford it, and he knows it!

I'm at my wits end with this sleeping disorder. I can't function well during the day and am too poor, coupled with my horrible insurance to be able to get in for a sleep study. Does anyone have any suggestions at all? I'm currently taking Ambien, which is more than I can afford in itself, and I need to get off of this medication as well. I can't believe that this doctor would risk my health and would rather medicate me than to actually address what is likely the root of the problem.! Uugh! Sorry, all, I had to vent, I'm extremely frustrated at the moment...I guess this isn't a very good first post...but if anyone has any suggestions at all I'm open for anything!

Tired-in-Tenn

Print this out Link Here

It is illogical to spend more time and money diagnosing something than treating it, especially if the treatment is safe, cheap and effective and the disease can kill.

Additionally, the only side effect of treatment if it isn't necessary is

Rhinorrhea, Stuffiness, nose abrasions, etc

You know, a prescription for a straight CPAP is all you need to purchase an APAP! Mine said simply "CPAP @ 12 cm". Call cpap.com and talk with them.
derek

Thanks Mikesus, for the reply. I told him about that presentation when we were talking...unfortunately, he's taken the stance that since his "expert" friend in the sleep clinic at the university hospital says not to write me the script without a split night study, he's not going to do it. I just can't understand the mentality of some doctors...granted, I taught the pre-med physics sections for a number of years and know that pre-med students weren't always the brightest bunch...the pre-vet students were always the brightest group in general (go figure!).... I guess I'm venting again!

Does anyone know of any other options possible? Are there any online doctors that will write prescription for an AUTOPAP? What about ordering from another country? I've been dealing with this sleeping problem since around 1994 and it has gotten to the point that I have finally decided to do something about it and now that I have, I've been met with a roadblock!

I guess it all boils down to money doesn't it? I can afford the machine now but not the sleep study...silly world we live in...

Tired-in-Tenn

Tired-in-Tenn,

Has he told you what his concern is regarding your use of the machine? You might try to explain to him that you can set the pressure range wide open from 4cm to 20cm. It will only increase the pressure if you have a need for increased pressure. The worst case would be that you spend the 1K and don't need the machine. The particular machine you intend to buy, has something called a split night feature. You hit the ramp button at the begining of the night and it stays at the minimum pressure for the first half of the night, recording your obstructive events and then switches to the standard auto mode for the second half showing you how well it treats these events. You can then download the data and take it in to show him why you were right!

Just so you know, what you are hoping to do is not dangerous or risky. There are many cases where patients are put directly on cpap without a sleep study. You are talking about going dirrectly to apap which eliminates the risk of subjecting yourself to pressure you don't need an is completely safe.

And I know there is going to be a GUEST that jumps in and states that we shouldn't be telling people to get CPAP therapy willy nilly, but the doctor behind this report seems to think that if you use cpap and you shouldn't the worse that will happen is you will be out a few bucks, and have a problem with nose sores...

As for the script, I would think that the doc would be more likely to write it for cpap than apap, and cpap.com will fill it for an auto...

Well, theres a few things I would do. The first is try to talk directly in person with someone at the sleep clinic. Print the descrpitions of the machine and mask, software that you want to buy from cpap.com. They have great descriptions of what the machines do. Make sure your well versed on the lingo-apneas, hyponeas, etc. Take you wife with you to attest about your breathing , snoring, gasping for air etc while your sleeping. Explain your financial probelms. If you hit a brick wall, then go up higher on the ladder. Try to talk to the department head. Find his office if you have too. If this fails, try again with your reg doc in person with same approach. Have wife there, cpap.com brochures. Show him you have researched this fully. Tell him again yopur financial situation. Explain that theres no way this is gonna hurt you. Tell him you will bring in data from machine to show him afterwards. After that, the only thing I can think of is to rent an auto for a month if they will let you. Then they can see data. good luck.

Thanks Derek, Mikesus, and wading thru the muck! for the replies.

Yep, I told him all of the relevant information, even took in the print-out from the cpap.com site for him to review on the REMstar Auto unit... he took it to his office to read and he said he looked up some info on the American Thoracic Society webpage too. I explained how it worked and all... he wouldn't budge. Then, after calling his "expert" friend at the sleep center, he said he definitely wouldn't write me one without the sleep study...which he knows my insurance wouldn't cover and for which I don't have the money. I think it's a CYA thing for him, I don't understand why, but that's the impression I get. I actually liked this guy as a physician before today. I don't like someone screwing around with my health, especially now that I've saved up enough money to be able to address the problem. I was actually excited that I'd be getting an AUTOPAP and hopefully be on my way to getting back to feeling normal again!

Mikesus, I'm not sure a doc would be more likely to write one for a CPAP over an APAP...the CPAP would require a definite pressure setting, and hence, would require some sort of sleep study wouldn't it?...my doc seemed to think the APAP was a better option, but he still wouldn't write the prescription...


uugh, this is frustrating!



Tired-in-Tenn

The reason that I said cpap over apap, is that doctors tend to go where they are familiar. You might try to talk to the folks at the sleep center, but remember all they are about is kilo buck sleep studies... They prolly won't be very helpful. Definately print out that presentation from the link I sent, and maybe the sleep doc will relent...

Question. Is this the only doctor at the University health center? If not try one of the others.
Suggestion. Will your insurance cover a visit to an outside doctor, one in town. You might have better luck presenting your case to one not connected with the university.

Hi Janelle, that 's a great point, and one my wife and I were just talking about a little while ago as she was trying to calm me down. I'm going to call a local doctors office tomorrow morning that is near us and see if I can get an appointment to see him...he was my primary care physician before I went back to grad school. I'm keeping my fingers crossed! Wish me luck!

Tired-in-Tenn

I would suggest that you talk to the sleep center.....they may have provisions in place for patients with financial needs, i.e. uninsured and lack money to fund a study. There are centers out there who will accommodate the uninsured. You can go web surfing or try the American Sleep Association (if you contact them, they may know of a center that may accommodate your needs), or another organization like that. They should be willing to work with your funding, or lack of it, or set up a payment plan, etc. Some centers may even have provisions for charity cases. You never know until you go around and ask.

What ever happened to the Hypocratic Oath???? You know the thingy that states if someone is poor...they still get treatment? If your university doctor knows you need a sleep study, why can't he arrannge one with a med school? I mean Pulmonologists and RT's have to practice on someone? I may be waaaay off base here...But if I couldn't aford a hair cut...I would much rather get one for 2 bits at a Barber College, then try an cut my own hair???

NeurosurgeryNP, thanks for the suggestion, if I can't get an appointment with a doctor tomorrow or another option doesn't present itself, I'll definitely look into this.


Joe A, I hear ya! I was pretty shocked about this whole thing today too...well, pissed off is probably more the correct way to state it! Also, since returning to grad school, money has been really tight for us...in fact I *do* cut my own hair now! You can do wonders with a pair of barbers shears if you don't mind wearing a buzz cut!

Tired-in-Tenn

The problem with the hipocratic oath is that in our suit-heavy society these days, people have taken it to mean that any time there is ANY bad result after seeing a doctor (even one the doctor could have done nothing about), it is therefore suit-worthy.

And what passes for "scientific proof" in courts these days is insane. The doctor in question is covering his own butt. He has as much as admitted that he doesn't know anything about this field, and he's been told by someone who DOES know that he shouldn't prescribe it. He doesn't know any more, and he doesn't dare prescribe something to you and have you injure yourself, or you could sue him for multi-millions of dollars. (Never mind that you probably never WOULD, there are enough people who WOULD that he's got to protect himself).

It's insane to me that sending a steady progression of women in who happened to both have breast implants and one of several diseases constituted enough proof to cost Dow Chemical (I think it was them) huge penalties, even though the SCIENTIFIC method says if there are 4 cases in 1000 of a disease, and 4 cases in 1000 of that disease in women with breast implants, then getting those four women to testify that they had both doesn't indicate any causal relationship.

This is a personal pet peeve of mine. I love the idea of "trial by your peers", but the judge needs to be there to require a certain standard of proof.

Liam, scientist, or just blathering geek? Who can say?