CPAP - Real Need or Just Surgeon's $ Grab

I just had gastric band surgery on 3/9 through a recognized Bariatric Center of Excellence. From the start a number of tests and procedures were required and would be expected. In my initial paperwork I had to take a "quiz" on my sleep habits - the results of which indicated that I had a minimal chance of sleep apnea. At my mandatory pulmonologist appt. we went through the test again and the results were the same but the pulmonologist insisted that I HAD to have a sleep study. He promptly scheduled not only the study, but a second appt. for the following week - for a CPAP titration. Funny - I'd think you'd want the results first.

I don't need to tell anyone what an unpleasant experience the sleep lab is - I'm surprised I slept at all considering the stiffling hot room with greasy waxy wires on my head. A day or two after the initial sleep lab, I called to find out the results and to see if I needed to keep the follow up appt. I was told that though the results hadn't been evaluated I HAD to return for the CPAP titration - Huh?!

The CPAP titration was a nightmare - all the same variables as before plus what felt like an octopus strapped to my head. There was no measuring or fitting - I had my choice of nose mask or nasal pillows - that's it. I didn't sleep a bit and at 5am the next morning they let me go, telling me they got no usuable data.

Jump forward a few weeks to my final pre-surgical visit with my surgeon. She asked if I'd gotten my CPAP and I explained what had happened. I assumed because I hadn't heard from the pulmonologist, I didn't need a CPAP, but the surgeon basically told me - NO CPAP = NO Surgery! It was mandated that I bring the CPAP with me to surgery for use in recovery. Failure to do so meant the procedure would be cancelled...

The following week - still with no word from the pulmonologist - I get called to come to the local Lincare facility for a BiPap fitting. I was able to wrangle a copy of my sleep lab report - no apnea events, but several episodes of hypopnea.

So - Five days before surgery I'm fitted with a Fisher-Paykel Nasal Pillow mask and a Resmed 26940 w/heated humidifier. Got the heavy duty sell about how great my sleep would be with this. It's now been a little over two weeks and at best I'm able to sleep 2hours with it on before I have to take it off. I have a rash around my nostrils and red marks on my face from the mask. When it's on, it always leaks and eventually the cold air blowing on my upper lip drives me nuts. I can't lay on my side as the mask then gaps. Last night I didn't wear it at all - best sleep I've had in two weeks! The real kicker - brought my CPAP to surgery - they never even took it out of it's case!

Do I keep trying to use this? Is it even necessary give my "condition"?

JaxNole wrote: Do I keep trying to use this? Is it even necessary give my "condition"?

I think that IS something you need to determine.

Start Reading - start the the top of the page and read your way down.

There is - New Users, CPAP Wiki, Where a Newbie should Start....just for starters.

Good Luck

Hi - the reason they were adamant about your using the machine for surgery is that not doing so if you do have apnea can be deadly. The anesthetic really deadens various aspects of your breathing, and while normally it can be dealt with, if you have apnea, it can be very dangerous. It is usually used in the recovery room, not during surgery, but in your case they may have used one they had on hand so didn't need yours after all. Not a big deal.

As far as your continuing on with it however, that's another story (between you and your MD's, not us). It's been said that bariatric surgery wipes out the need for Cpap altogether, as well as getting rid of gallstones and Type 2 diabetes, but the effect may not kick in for some time afterward, so discuss it all with your MD's.

PERSONALLY....I would return the equipment and get an appointment with the pulmonologist. Get a copy of your sleep study and have him explain to you why you need a CPAP. If you get no satisfaction....take the reports to another doctor.

Courious...Did the surgeon recommend the pulmonologist? Who suggested where you should go for the equipment??
Perhap there are some referral $$$$$$ involved.

Welcome to the forum, and congratulations on taking control of your health. I agree with LSAT that you need to visit your pulmonologist ASAP. Before you see him, though, learn all you can on this forum, so you'll have specific information and questions. If you go in just asking "do I really need to do this" you won't be taken as seriously as you would going in asking something like "how was my pressure determined if there was not usable data at the titration?" If you have sleep apnea it is damaging your health in many insidious ways all the time, so it needs to be addressed. Arm yourself with as much knowledge as possible, then advocate for yourself. There's often a huge gap between how we SHOULD be treated by the medical community and how we're actually treated, so learn all you can and take charge. Good luck, and keep us informed.

I'm not sure about your model of machine - is it an autopap? Seems that's what you need so you can be titrated at home and have the settings adjusted based on the identified pressure needs.

I know you barely slept at the 2nd study, but how much did you sleep at the diagnostic study? Check your report and see how much sleep you had, how your sleep stages were, and if you spent much time in REM while supine. Even if you showed no apneas, if the test didn't capture enough time in the right stages and position, your apnea could be worse than the test showed. Also to be considered, how much your oxygen dropped with the hypopneas, and how many arousals were seen fracturing your sleep? It could be test were more revelatory than you know, but they would likely have known. Sorting thru these questions should bring a bit of clarity to your need for cpap. Oh, and did it assign a diagnosis of obstructive sleep apnea? You'd have to meet certain criteria for that to happen, and hypopneas can cause one to qualify.

Hopefully you can sort thru the mask issues and start getting better and more sleep on the machine. Hope you will keep us informed of how this progresses for you.

My wife went through this about a year ago. The surgeon is covering all aspects of this surgery. Yes it is normal, at least in this part of the country, that they do this. What isn't normal is the way they did it.

As far as your questions, you may or may not need it after you start losing a lot of weight. There are cases of sleep apnea becoming worse after losing weight. However the majority of cases are "lose weight, lose the machine" I know that the latter was the case for my wife. 6 weeks afterwards she didn't need it at all. Keep trying to and call the pulmonologist to schedule an appointment to go over the sleep study and your needs.

As far as the mask goes, I assume that you have an Opus 360 mask.

The best way I have found to adjust this mask is to loosen all the straps and put it on. Then take the pillows and put them into your nose and play with them until the leaks stop. Then tighten all of the straps until it holds the pillows where you had them. The small hose on the front plays a role as well. If you don't have that in the right spot, it will pull on the pillows causing leaks. It took me a couple of nights to adjust it so it wouldn't leak no matter where I slept.

Allen

The number you gave us is for the humidifier and not the machine itself.

If they didn't get any useful data, I doubt they could justify a bipap -- at least in my opinion.

What is the complete name of your machine -- not the humidfier. It should be written on top Resmed makes the S8 series and the S9 series. Your humidifier is the one for the S8 machines so assume you have one of those -- Escape, Elite, or Autoset II.

It is possible that the doctor is trying to find your pressure requirements with an apap (Autoset II).

I would call the pulmo doctor for a follow up and see what is going on -- as the others have suggested. Also, read as much as you can so you can ask specific questions.

* Allen476 - Interesting coincidence, I'm in your area - assume your wife went thru Ellis?

*LSAT - Ah yes, the surgeon and pulmonologist are both affiliated with the same hospital. In fact the sleep study HAD to be at their facility(a nice hour drive to and from), rather than the one affiliated with the top rated hospital in my area. The pulmonologist wrote the script and sent it to Lincare (thankfully in my area) - I had no choice in where to go. In fact when they called to schedule my fitting their first available appt was three weeks after my surgery - it was only when I mentioned that I was a bariatric patient thru Ellis having surgery on 3/9 that Lincare was able to get me in the very next day.

*Julie - I get the "Why", but found it odd that despite all my medical records(which I had to provide) including the two day surgeries I've had in the past two years(same duration and sedation as the lap band procedure) indicating no post-surgical issues, the entire Sleep Lab/Titration/Fitting was mandatory. Oddly enough, there was no need prior to any of these other procedures for sleep lab testing as a precaution. I also weighed more at the time of both procedures and each operation was at a top-rated facility; Memorial Sloan-Kettering. No CPAP - mine or the hospital's was used during my recovery - my husband was with me the entire time.

Good input all around and definitely giving me some quality talking points. The next appt with the pulmonologist is in May - a "required" follow up and I'm not sure who I'll be seeing as the doctor would did my initial consult was not who I saw for the "pre-surgical clearance".
Pulmonologist #2 briefly reviewed the results with me as in, "You need it and you'll feel so much better..." He did not give me a copy of the report - I snagged that from the Lincare rep. It was interesting to note that my "Brief History" included the following comment, "...history of excessive sleepiness, tiredness and fatigue..." - conditions I never reported having?

Other high points:
*Sleep efficiency 84.7% - Normal
*Slow Wave Sleep 37% - Normal
*REM 18.7% - Normal
*Arousal index of 26 events per hour
* No Leg jerks
*Normal sinus rhythm

I guess my quest for info is the feeling that I was tucked into a convenient category - Obese = Sleep Apnea - either as a method to guard against a liability issue or as a way to pad the coffers via my insurance company. Let's face it - if it were just a liability issue, why not have a CPAP at the ready for every patient undergoing surgery?
It's also interesting that the Lincare rep alluded to something about having to use the machine for at least three months before my carrier would pay the claim and having to check the data card to prove compliance. I see by the Lincare paperwork it's a month-to-month "lease" w/a minimum one month required. Just seems like a lot to go through when I not only have no cardiac issues, no pulmonary issues and have never sought help from my primary physician for "sleep issues". Thanks for all your feedback!

JaxNole wrote:... I guess my quest for info is the feeling that I was tucked into a convenient category - Obese = Sleep Apnea - either as a method to guard against a liability issue or as a way to pad the coffers via my insurance company. ...

First, I doubt seriously that that this is to pad the coffers of your insurance company. They would rather you NOT need a CPAP unit. Not everything is a conspiracy!

If you also had no other signs of sleep apnea, I suspect as others have suggested this is intended to help you as you use medication that can and will depress your central nervous system. This is not liability. They know your sleep will be comprimised without it. Again, no conspiracy. They just want you to get well. Doctors tend to not like it when the patient dies due to a complication that could be avoided! No greed. No conspiracy. Though it's not good for business, most doctors actually do get into the business because they want to help others.

But yes, you probably did encounter the tendency of people to shove you into a convienent corner. Not everyone who is obese has sleep apnea. Nor is everyone who has sleep apnea obese. But folks such as Lincare have this hammer called CPAP. They know how to hammer very well. They get a bit confused when we present them with a screw. But what the heck. It sort of looks like a nail, so they hammer away at it.

But again, no conspiracy. And I doubt seriously that either the doctor or the insurance company were motivated by greed. Both would rather avoid extra work that won't pay that much (or will actually cost them .. in the case of the insurance company).

So, if you don't need it after you are off your meds - GREAT! You have no idea how much we will celebrate with you!! We all wish we could do that. But do NOT trash us when we know that for us, it is something that can save our lives. Trust me, most of us could care less about the doctors or DMEs or insurance companies. We want something that will help us stay healthy. And until we find something more effective, we want to help others make this work as well as possible. Again. That's no conspiracy. Just simple decency. We want to help others, instead of having them face all the problems we've faced.

[ jbf gets off soapbox ... and remembers to turn and wish JaxNole success with both surgery and healing process !! ]

*Julie - I get the "Why", but found it odd that despite all my medical records(which I had to provide) including the two day surgeries I've had in the past two years(same duration and sedation as the lap band procedure) indicating no post-surgical issues, the entire Sleep Lab/Titration/Fitting was mandatory. Oddly enough, there was no need prior to any of these other procedures for sleep lab testing as a precaution. I also weighed more at the time of both procedures and each operation was at a top-rated facility; Memorial Sloan-Kettering. No CPAP - mine or the hospital's was used during my recovery - my husband was with me the entire time.

The reason for the different treatment for the two surgeries is probably that the surgeon for the lap band is more aware of the correlations between obesity and sleep apnea. The others were treating a specific symptom and had tunnel vision. You should be happy that this surgeon is aware and smart enough to look at all the side effects.
Once you are finished with the machine, if you own it you can always sell it.

My apologies to anyone who felt I was "trashing" them. All best and thanks for your feedback. I'll step out of the fray.

JaxNole wrote:* Allen476 - Interesting coincidence, I'm in your area - assume your wife went thru Ellis?

*LSAT - Ah yes, the surgeon and pulmonologist are both affiliated with the same hospital. In fact the sleep study HAD to be at their facility(a nice hour drive to and from), rather than the one affiliated with the top rated hospital in my area. The pulmonologist wrote the script and sent it to Lincare (thankfully in my area) - I had no choice in where to go. In fact when they called to schedule my fitting their first available appt was three weeks after my surgery - it was only when I mentioned that I was a bariatric patient thru Ellis having surgery on 3/9 that Lincare was able to get me in the very next day.

*Julie - I get the "Why", but found it odd that despite all my medical records(which I had to provide) including the two day surgeries I've had in the past two years(same duration and sedation as the lap band procedure) indicating no post-surgical issues, the entire Sleep Lab/Titration/Fitting was mandatory. Oddly enough, there was no need prior to any of these other procedures for sleep lab testing as a precaution. I also weighed more at the time of both procedures and each operation was at a top-rated facility; Memorial Sloan-Kettering. No CPAP - mine or the hospital's was used during my recovery - my husband was with me the entire time.

Good input all around and definitely giving me some quality talking points. The next appt with the pulmonologist is in May - a "required" follow up and I'm not sure who I'll be seeing as the doctor would did my initial consult was not who I saw for the "pre-surgical clearance".
Pulmonologist #2 briefly reviewed the results with me as in, "You need it and you'll feel so much better..." He did not give me a copy of the report - I snagged that from the Lincare rep. It was interesting to note that my "Brief History" included the following comment, "...history of excessive sleepiness, tiredness and fatigue..." - conditions I never reported having?

Other high points:
*Sleep efficiency 84.7% - Normal
*Slow Wave Sleep 37% - Normal
*REM 18.7% - Normal
*Arousal index of 26 events per hour
* No Leg jerks
*Normal sinus rhythm

I guess my quest for info is the feeling that I was tucked into a convenient category - Obese = Sleep Apnea - either as a method to guard against a liability issue or as a way to pad the coffers via my insurance company. Let's face it - if it were just a liability issue, why not have a CPAP at the ready for every patient undergoing surgery?
It's also interesting that the Lincare rep alluded to something about having to use the machine for at least three months before my carrier would pay the claim and having to check the data card to prove compliance. I see by the Lincare paperwork it's a month-to-month "lease" w/a minimum one month required. Just seems like a lot to go through when I not only have no cardiac issues, no pulmonary issues and have never sought help from my primary physician for "sleep issues". Thanks for all your feedback!

Never heard of Ellis. Are you near NYC? I am about 3 hours from Manhattan due west.


IMHO, get a new pulomonologist, ASAP.


Hope all is going well, just remember to follow your diet.

Allen