Help with Dr Appt Tomorrow-- first time with sleep doc yrs

OK... Someone with half a brain would post this long before their appointment... but my appointment just got moved UP two weeks so I am caught by surprise.

What I need to know is what I should do and ask my Dr regarding my treatment.

By way of background... I have had sleep apnea for 20 years and have seriously tried CPAP on and off from about 1998 to 2002. Gave up completely after that. However, I am the poster child for sleep apnea, being overweight (though not obese) and have a very thick neck (even when I was thinner neck was thick). I also have had a heart attack at 48 (now 52).

So I need to quit fooling around and get this under control. I finished my sleep study a couple of weeks ago... and was very encouraged because I actually fell asleep long enough to get good readings (previous study more than a yr ago was incomplete due to the fact that I didnt fall asleep soundly enough for good readings--now if THAT isn't ironic I don't know what is I will post data after tomorrow for your collective insight... but suffice it to say it will show severe sleep apnea.

So.... enough about the past! My question is this. In general, what should I ask my Dr regarding test results and treatment. SPECIFICALLY, what do I need to ask / push him to do to give me a the right prescription so that I get the best unit possible? Where I have had tremendous trouble with compliance before, I am looking specifically at ResMed AutoSet II (auto bi-level I think... but still get confused on the technology.)

Do you think that this is a good choice for someone who has had compliance issues? And how do I convince my doctor to do it?

thanks... and ideas welcome

You are 19 years eleven month too late, where have you been, You need and should have had long ago a machine that records how you are doing, and the software and reader, to monitor your condition. If you had done that, there would be no need to go back for a sleep study ever, as long as your treatment,(Which you would have had control over was working). Jim

Tired Guy wrote: what should I ask my Dr regarding test results and treatment. SPECIFICALLY, what do I need to ask / push him to do to give me a the right prescription so that I get the best unit possible? Where I have had tremendous trouble with compliance before, I am looking specifically at ResMed AutoSet II (auto bi-level I think... but still get confused on the technology.)
Do you think that this is a good choice for someone who has had compliance issues? And how do I convince my doctor to do it?
thanks... and ideas welcome

There are links under this link our-collective-cpap-wisdom.php that will be a great help before your appointment. There is even a link that will tell you exactly how the prescription should be written for certain machines. The ResMed AutoSet II is not the same as a auto bi-level but I'm not the one to expand on that...you can read about the differences between machines at the link I mentioned though.

mar

Tired Guy wrote:Where I have had tremendous trouble with compliance before, I am looking specifically at ResMed AutoSet II (auto bi-level I think... but still get confused on the technology.)

An Autoset II isn't a bi-level, though it is an Auto CPAP

In order to have a bi-level in a Resmed, it becomes a VPAP

And except under certain specific conditions one usually has to "fail" CPAP therapy before insurances will pay for a bi-level. Now is the time to call your insurance company and ask them what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than one as that will give you more bargaining/negotiating room to get the equipment that you want.

The Resmed S8 Elite w/EPR or Resmed S8 Elite II w/EPR are both fully data capable straight CPAPs.
The Resmed S8 AutoSet Vantage and Resmed S8 AutoSet II w/EPR are both fully data capable auto CPAPs.
The Resmed VPAP Auto and Resmed VPAP Auto 25 are fully data capable auto bi-level PAPs.

The VPAPs (bi-levels) are an entirely different insurance code than the CPAPs and APAPs. CPAPs and APAPs are the same HCPCS (insurance) code: e0601. Most all insurances reimburse the local DME suppliers by HCPCS code, NOT by brand and model. However, obviously a bare bone, compliance data capable only CPAP costs the local DME supplier less to purchase than a fully data capable APAP so its to the benefit of their profit margin if they can get away w/foisting off a bare bones CPAP on their clients.

A lenient mask exchange policy is important for those new to CPAP therapy. Respironics, Resmed and Fisher & Paykel all will replace most any of their mask models patients have tried and been unsuccessful w/FREE to the local DME supplier if that DME supplier will fill out a form and return the mask W/IN 30 DAYS.

Be diplomatic, but be firm, and insist on being provided w/the equipment you want (w/in reason). Insisting on being provided w/a bi-level when you only have a script for a CPAP isn't w/in reason.

When you see the doctor request a copy not only of his dictated results (1-2 pages) but also the full scored data summary report w/condensed graphs (5+ pages) for both your sleep evaluation study AND your titration study (assuming you've had both this time) AND ask that you be giving your equipment order (script) rather than the doctor FAXing it to a local DME supplier so that you can shop your local DME supplier options yourself to you can find the one w/the most lenient mask exchange policy and an RT you will feel comfortable working with. These reports are a part of your medical records and assuming you are in the USA you have a legal right to copies under HIPAA. Again, be diplomatic but be firm.

Goofproof wrote:You are 19 years eleven month too late, where have you been, You need and should have had long ago a machine that records how you are doing, and the software and reader, to monitor your condition. If you had done that, there would be no need to go back for a sleep study ever, as long as your treatment,(Which you would have had control over was working). Jim

How does your advice help him? We cannot change the past, we can only solve life's puzzle starting where we are now. Why don't you offer some advice that would help him with the situation he is in now, regardless of how he got there?

Right LoQ. He is here now asking for advice. It doesn't matter what happened in the past. Let's give him credit for giving it another go.

We all know it is not an easy road, especially in the beginning. Lots of people here for you Tired Guy, and able and willing to help!

Thanks for the education and the encouragement. I am very appreciative that so many of you took the time to write.

Regarding my experience today... pretty interesting. My Dr wanted me to get a bi-level without any pushing on my part. He was well aware of the insurance issue and felt that it could be done. He spent almost 45 minutes with me which was unexpected.

The strange part was that he answered each and every question honestly and openly (as far as I could tell) but didn't really "volunteer" much. Fortunately I was reasonably well read due largely to this forum and I am assertive (hopefully appropriately so) in terms of my health providers so I had a good dialogue even if I had to initiate quite a bit of it.

The one thing he said which was a bit of a surprise to me (and I hope I get the terms right) is that he is not (yet) a fan of auto bi-level because "the algorithms are difficult and I am not personally convinced they have it right yet so that I can have confidence it works all the time on all patients". He then steered me towards more traditional bi-level.

The other area that was interesting was that although I did reasonably well at 12 and 9 (inhale / exhale I presume) he wants me on 14 and 9 due to some confusing data in the study (related to back sleep vs side sleep).

As I sit here I realize that we actually didn't discuss the test results specifically but rather the machine / mask and treatment. I think I will find my study and post the results under a different post here and look for those of you who are adept at understanding the maze of numbers to shed some light.

Thanks again for the support.

What I was trying to get across, was the importance of getting a machine that collected data, and the equiptment to process it, and take control of your own treatment. That's what's needed to see if you are doing the correct thing. If you don't make this treatment your own, a lot of people don't. Jim