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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Junebug999
 
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why would a doctor not want to prescribe an auto cpap?

Postby Junebug999 on Fri Sep 24, 2010 3:28 pm

I'm trying to think of the reasons why a sleep doc would not want his patient to have an auto cpap?

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Re: why would a doctor not want to prescribe an auto cpap?

Postby jdm2857 on Fri Sep 24, 2010 3:59 pm

Some sleep doctors cling to the notion that the only useful sleep data comes from an in-lab sleep study. And while it is true that the instrumentation in the lab yields data that an APAP cannot, the artificial conditions and one-night-only limitation of a lab affect the data collected in other ways. This notion may be reinforced by the financial interests some doctors have in a sleep lab.

And for other doctors, it may be more of a control issue. How can a machine make as good (or better) of a pressure decision than I can?

APAPs are not a panacea. But, aside from a little more cost, there is no disadvantage to having and APAP instead of a CPAP. And an APAP may just save some patients from future in-lab studies.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby Junebug999 on Fri Sep 24, 2010 4:09 pm

boy oh boy...it's good to learn hoow this stuff really works :(

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Re: why would a doctor not want to prescribe an auto cpap?

Postby Janknitz on Fri Sep 24, 2010 4:28 pm

Call me cynical, but perhaps a doctor has a financial interest in the DME company and wants to be sure that profits are maximized. :twisted:
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Re: why would a doctor not want to prescribe an auto cpap?

Postby kempo on Fri Sep 24, 2010 4:46 pm

They don't want to be second guessed by a machine. It makes them feel like they could be replaced by a machine that thinks and acts on its on. Future cpap machines will replace Doctors in most cases. Kind of like cruise control on a car. Who would have thought of such a thing 60 years ago.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby Uncle_Bob on Fri Sep 24, 2010 4:50 pm

Junebug999 wrote:I'm trying to think of the reasons why a sleep doc would not want his patient to have an auto cpap?


When he has a financial interest in the on site DME that wants to supply your CPAP machine at lower cost.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby LinkC on Fri Sep 24, 2010 5:00 pm

1. Because some patients do better on CPAP than APAP.

3. Because he/she knows it takes unnecessary events to drive an APAP to an effective pressure. Events that would be eliminated by CPAP at that effective pressure.

(I have a question for those who think their Dr's decisions are profit-driven and/or are in cahoots with a DME. Why are they still your Dr and/or DME?)

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Re: why would a doctor not want to prescribe an auto cpap?

Postby elena88 on Fri Sep 24, 2010 5:21 pm

having used both cpap and apap and bipap pressures..

there is no reason I can think of, accept its newer technology, and many people cling to old habits.. (besides the little extra cost)


I would be willing to bet, if your doc is a computer geek, you might be more likely to get an auto.

apaps can run as cpap, its the wave of the future...


I imagine we wont be having this conversation in a few years..

gosh, where have those horses and buggies gone?

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Re: why would a doctor not want to prescribe an auto cpap?

Postby jdm2857 on Fri Sep 24, 2010 5:53 pm

LinkC wrote:1. Because some patients do better on CPAP than APAP.

3. Because he/she knows it takes unnecessary events to drive an APAP to an effective pressure. Events that would be eliminated by CPAP at that effective pressure.

(I have a question for those who think their Dr's decisions are profit-driven and/or are in cahoots with a DME. Why are they still your Dr and/or DME?)


1. But even in that case, if the CPAP pressure stops yeilding good therapy, a switch to APAP mode may just help determine a new straight CPAP pressure without the need for another PSG.

3. But that thinking requires one to be at the highest required pressure for the entire night. For those whose pressure needs vary with position or sleep stage, an APAP can up the pressure only when it is needed. And contrary to what many here say, I have seen how rapidly my APAP will increase pressure in response to a single significant snore.

Finally, I don't have that opinion of my sleep doctor, and I don't deal with a DME. I do agree that one should run quickly from heath care providers whose foremost motivation is profit.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby LinkC on Fri Sep 24, 2010 6:12 pm

jdm2857 wrote: But that thinking requires one to be at the highest required pressure for the entire night.


Yes. Yet another potential advantage of CPAP. No arousals from constantly changing pressure,

Note that I neither said nor implied that either mode is always better than the other. As with most anything, some people react differently than others. A wise and competent Dr will consider all options in a specific case.

The OP asked for reasons a Dr might prescribe CPAP instead of APAP. All he was getting were the tired old DMEs-are-the-devil rants.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby Eeyore_1 on Fri Sep 24, 2010 6:48 pm

I'm a newbie so take this with a grain of salt but I would say it depends on the results of your sleep study. My sleep study indicated that the pressure required to overcome the apneas ranged anywhere from about 6 to 13 and would run all night with the worst occurring around 3 AM. The way it was explained to me it made more sense to prescribe an APAP because of the wide range of pressures required. If the pressures required had been clustered closer together than an CPAP could have been prescribed and set at the highest pressure required.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby DoriC on Fri Sep 24, 2010 7:00 pm

An auto might also be recommended if you are diagnosed with positional sleep apnea and require higher pressure only when you turn onto your back but not all night.

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Re: why would a doctor not want to prescribe an auto cpap?

Postby Junebug999 on Fri Sep 24, 2010 11:00 pm

AHA!!! that's it. The doc who does not want to prescribe an apap DID tell me I had positional hyponea (sp?). He said I had more hypo...on my back than on my sides, but did have them on my sides. I'm going to remind him of that. I'm going to tell him I want the APAP, and if he still says no....then I'm getting another opinion. I hate to not "go along" with docs...they hate that...and about 25 years ago, I even had a doctor yell at me because I spoke up about something that I needed to speak up about (eye doctor). But I'll just get another opinion if I need to. If the DME isn't cooperative, then I'll find one who is. This is my life, my sleep problem, I've been untreated even though diagnosed in 2002, and I'm done turning over all decisions to doctors and medical staff. I'll listen, but I'm being a fully participating patient in all decisions from now on. I have to be courageous to do this though, and that's not easy when you're tired. Plus, if there is any problem with the sleep doc, it probably means I have to get another primary care doc also, because the primary care doc is a type of "my way or the highway". bleah....

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Re: why would a doctor not want to prescribe an auto cpap?

Postby Junebug999 on Fri Sep 24, 2010 11:02 pm


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Re: why would a doctor not want to prescribe an auto cpap?

Postby Sillyme on Sat Sep 25, 2010 6:28 am

[quote="Junebug999"] This is my life, my sleep problem [quote]
Hear Hear!!! We need a CPAP User's Bill of Rights. We are going to be tethered to this machine for 1/3 of the rest of our lives. We need some measure of control unless our 'professionals' are willing to communicate with us and tweak our equipment on a weekly or even daily basis.
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