Back from sleep study etc

[Wulfman]

If it were me, I'd be chatting with the doctor, sooner rather than later, and asking him what he expects to see from an APAP that doesn't produce any detailed data. If this was a screw-up on the DMEs part, I would think the doctor would also want to know now, rather then a month from now.......and then have to go through another month with a different machine. And, just because your doctor likes ResMed machines doesn't mean he knows diddly squat about how they work (APAPs in particular).


Den

[ozij]

Went to the Doc's at 9:00 and he said I needed to try a Resmed in APAP mode and if that didn't work, we'd go to a Bipap. He sent me to a DME and I left with a Resmed Escape II APAP.

The doc know that many insurances will not pay for a BIPAP unless CPAP had been tried and failed.
He's letting you place the calls, Jeff - "it that doesn't work" means "if Jeff doesn't feel better". Don't waste your ammunition now, Jeff. See how you feel, and go back to the doctor depending on that. Esccape II APAP is not at all a model T -- it is an APAP like the Autoset II, with all comfort features -- but without data capability.

A ResMed APAP can give very good therapy(Tattooyou for instance) -- the doctor set up the minimum at 13 based on the PSG -- he's not even sure the APAP will help -- Jeff's word will be more important here that the numbers -- and considering Jeff's story, I think that's good.

The fact of the matter is that the data from his Respironics fixed pressure machine was not enough to lead Jeff to a setting on which he felt better.

About the caffeine: keep in mind that if you stop caffeine suddenly you're liable to get bad headaches.
O.

[JeffH]

Went to the Doc's at 9:00 and he said I needed to try a Resmed in APAP mode and if that didn't work, we'd go to a Bipap.... DME and I left with a Resmed Escape II APAP. Urologist and he thinks I have a bladder problem....suggested getting off caffeine. I have two appointments Wed and Thur day morning for bladder test so maybe by the end of this week I'll be back to my ornery self...I hope so, I miss me. JeffH

Jeff,
Seems a bit odd, the MD prescribes APAP and you end up with a model T rather than the current Model available..........I agree it sounds like the DME is looking for the opportunity to offload a machine..........might be worth questioning before you are too far into being hooked by the DME. I hate it when I get home with a bag of rice with an expiration date two years earlier!!!!!

Might want to ease off caffine gradually, if you have been drinking alot of caffeine or caffeine sensitive, you may go through caffeine withdraw symptoms if you go cold turkey, so decaf on to less than decaf may be the way to go gradually. Caffeine withdraw can make you feel like you have the flu and may be disruptive to your sleep as well. Good luck with the urological tests!!!!! Is one of the tests a Cystoscopy???

elg5cats

Yes, they are doing a voiding study on Wednesday morning and a flex cysto on Thursday morning. Of course I had to look it up and it doesn't sound that bad, but my magic magnifying mind can really do some interesting things with experiences I've not had yet.


JeffH

[elg5cats]

Is one of the tests a Cystoscopy???

Yes, they are doing a voiding study on Wednesday morning and a flex cysto on Thursday morning. Of course I had to look it up and it doesn't sound that bad, but my magic magnifying mind can really do some interesting things with experiences I've not had yet.
JeffH

The voiding test is an ultrasound to check urine left in your bladder after urinating, not painful!!!!! The cystoscopy.........a numbing gel is injected (no needle) into the urethra prior to inserting the scope.......description may be more frightening than procedure!!!!

elg5cats

[ozij]

When I underwent a cystoscopy last March and asked the urologist about anesthesia (was thinking of the cpap) he said it was not necessary for females, but its different for males - males, he said, do need an anesthetic.

O.

[rjjayrt]

It is my personal and professional belief that non data capable machines are basically worthless. I don't use one and I will not put a client on one. That being said you have to realize and understand that we're in the minority when it comes to patient involved treatment of OSA. For every one person on this site who wants to be involved there are 5 others not on this site who don't want to be involved. It is what it is. Some DME's, Sleep Docs and Sleep Labs are not going to change the way they do business until more people get involved, in other words you have to hit them where it hurts, there pocketbooks. I have set over 200 patients on CPAP in the last year and not one has asked if the machine was fully data capable or if they could have an apap vrs a cpap. I give the patients the cpaptalk brochures, and explain to them the data available to them if they choose to seek it, and no one has. As long as this is the norm things won't change...

[roster]

Yep rjjayrt. It is discouraging how many CPAPers I can shock by telling them about "my software". Many of these are "educated" people with graduate degrees. Several of them are in their 20s and 30s, so it's not an older generation.

"I just thought it was a machine I would use to help me sleep."

[secret agent girl]

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[DreamStalker]

If it were me, I'd be chatting with the doctor, sooner rather than later, and asking him what he expects to see from an APAP that doesn't produce any detailed data. If this was a screw-up on the DMEs part, I would think the doctor would also want to know now, rather then a month from now.......and then have to go through another month with a different machine. And, just because your doctor likes ResMed machines doesn't mean he knows diddly squat about how they work (APAPs in particular).


Den

I agree with Den.

Jeff contact your doc and let him know you don't want to waste time without having the detailed data.

[JeffH]

If it were me, I'd be chatting with the doctor, sooner rather than later, and asking him what he expects to see from an APAP that doesn't produce any detailed data. If this was a screw-up on the DMEs part, I would think the doctor would also want to know now, rather then a month from now.......and then have to go through another month with a different machine. And, just because your doctor likes ResMed machines doesn't mean he knows diddly squat about how they work (APAPs in particular).


Den

I agree with Den.

Jeff contact your doc and let him know you don't want to waste time without having the detailed data.

I spent about 30 minutes on the phone with the head of the DME I went to yesterday. The first part was about how his little RT manager treated me and the second was about this subject. He offered to get me the data machine but I would have to pay the difference. After talking to him the point of view that he and the sleep doc come from is looking at data over a 30 day period of time tells you more than night to night. I'm still not sure what I'm going to do, but I know now that I'm not stuck with this machine for the next 5 years if I don't want to be.


JeffH

[jules]

what will the 30 days of data be - how much each night or what pressure and AHI's you had?

I assume it will be just how much each night - totally worthless --

why should you have to pay the difference? am I remembering right you are on medicare?

[Wulfman]

"Pay the difference"........WTF?

The CPAPs and APAPs ALL have the same insurance code. How much is a 30-day/night trial on a different machine supposed to cost?


Den

[Catnapper]

When I was a newbie, my doc ordered an APAP because he said the sleep study was like a snapshot and only showed what happened that one night. He wanted to have me collect a month or 6 weeks of data to see how I did over time at home in my own comfortable bed, etc. He definitely looked at the data to see where the pressure stayed and did the most good. I requested an RX for the M series auto and he wrote it when I showed him (back then) that it had exhale relief. At that time the ResMed did not have it on auto mode.

I may be asking for trouble here, but I prefer the way the Respironics software displays the data. The first auto I had was a ResMed, and I asked for weekly printouts of the data from it. At that time, I had pestered the DME guy enough that he gave them to me just to shut me up, and he gave me enough cards to take one to him every week. I am willing to admit I was a newbie, so I may have missed something wonderful in the ResMed data.

When I changed to bi-pap it was such a relief. I always thought they were mainly for high pressures. It turned out that when I complained that I was still struggling to exhale, especially during those insomnia times, they said I failed cpap. That is all it took. Rested gal is the one who wrote that exhaling with bipap makes you feel like there is no pressure as you exhale. She is right. I started sleeping better with it. Then in my bi-pap study, the tech found that as the pressure went up, I started to wake up at 13, so 12 became my upper limit. I wonder if all techs would notice that as a problem. Jeff, I would ask the doctor that question to see if he can look at the data to see if the higher pressure caused you trouble.

Jeff, it was not clear if it was the Doc or the DME who did not like the algorithms of the Respironics. If it was the DME I would consider that an opinion not necessarily based on experience. If you trust the Doc and he has a good basis for that statement then I would certainly respect that. I think I have read here that the ResMed and Respironics react differently to an apnea. Someone can provide the details, I am sure. If I remember correctly, the Respironics can be set lower than the ResMed for most of the time and then let it increase the pressure when needed. I think it is easier to sleep with lower pressure, at least for me. I have had excellent reports from my machine, and always have total AHI under 1 and frequently 0.0 using a lower bottom pressure and fairly small range. It is my impression that a cpap is set at the high point to achieve the best AHI, where an auto can be set lower to catch most and adjust as needed. Please correct me or clarify what I said if need be.

My daughter-in-law has used cpap for as long as Jeff has, 10 or 11 years. I let her borrow my extra bi-pap machine when she was having difficulty sleeping. I showed her how to collect the data to take to the doctor. He was delighted and gave her a prescription based on that alone, as a self-titration. She was quite accustomed to using cpap with no problems, but fell in love with the bi-pap the first night.

I guess I sound like I am pushing bi-pap but based on my experience, that is the best therapy of all. It certainly was the most comfortable of the 4 machines I have used. I value sleep very highly and will do whatever I find that helps make it better.

If you are not interested in checking the data Jeff, then it won't bother you not to have it. I have checked mine all along although now I do it weekly instead of daily. How else are you going to know what is happening when you are asleep that messes up your rest? I would think the doctor needs it to help you find your optimum therapy. Some doctors go by how you feel, so he may think it is not necessary if that is his style.

As far as paying extra for the full data machine, you could look on cpap.com at the machines and see what the actual difference in cost is. If they are close to the same, the DME is taking advantage of you if he charges a lot more than that. Does anyone know if the code for the machines is the same? He could be trying that old trick where a cpap and auto cpap have the same code so he gets the same amount from insurance, but wants to make extra from his patients by telling them it is a more expensive machine. I see Den already caught that!

I wish you all the best and that whatever you choose to do, it is the perfect solution for you. It is time to feel better!

Catnapper - Joanie

[roster]

When I was a newbie, my doc ordered an APAP because he said the sleep study was like a snapshot and only showed what happened that one night.

Why can't all sleep docs figure that out? Like by next Tuesday please!

[DreamStalker]

If it were me, I'd be chatting with the doctor, sooner rather than later, and asking him what he expects to see from an APAP that doesn't produce any detailed data. If this was a screw-up on the DMEs part, I would think the doctor would also want to know now, rather then a month from now.......and then have to go through another month with a different machine. And, just because your doctor likes ResMed machines doesn't mean he knows diddly squat about how they work (APAPs in particular).


Den

I agree with Den.

Jeff contact your doc and let him know you don't want to waste time without having the detailed data.

I spent about 30 minutes on the phone with the head of the DME I went to yesterday. The first part was about how his little RT manager treated me and the second was about this subject. He offered to get me the data machine but I would have to pay the difference. After talking to him the point of view that he and the sleep doc come from is looking at data over a 30 day period of time tells you more than night to night. I'm still not sure what I'm going to do, but I know now that I'm not stuck with this machine for the next 5 years if I don't want to be.


JeffH

Hold your ground Jeff. Tell them you want to be treated like a patient and not a victim.