Sleep Clinic a racket???

[Okie bipap]

What does it say on the lower, right hand corner of the front of the machine?

[palerider]

The machine you are showing in your profile is a single pressure machine. Is this really the machine you have?

It says "bilevel;" I guess I don't know what that means.

what exactly does it say on the front of the machine?

[KTinTexas]

The machine you are showing in your profile is a single pressure machine. Is this really the machine you have?

It says "bilevel;" I guess I don't know what that means.

what exactly does it say on the front of the machine?

Air Curve 10 S. This is what the description says on their website: "This bilevel machine has two different, adjustable set pressures which can make therapy feel more comfortable."

[palerider]

The machine you are showing in your profile is a single pressure machine. Is this really the machine you have?

It says "bilevel;" I guess I don't know what that means.

what exactly does it say on the front of the machine?

Air Curve 10 S.

Then you have the proper machine listed in your profile, and my condolences.

[TropicalDiver]

I'm beginning to think my sleep clinic is a racket. At first I was seeing my PCP and was having trouble so I got referred to this sleep doctor who's supposed to be the best in my area. I went in for another sleep study and was expecting to meet the doctor at my appointment. I was surprised to only meet with a Physician's Assistant. She does seem very knowledgeable, but it bothers me that now after several months I still haven't met the doctor. The PA told me I needed a BiPAP machine and she prescribed the pressures. (My PCP had recommended one of the self-adjusting machines.) But I'm doing the same as I was before - most I can keep the mask on is about 4 hours. Now the PA has prescribed Mirapex. She says I move around a lot and that might be why I'm coming awake and taking the mask off. I've been reading and see Mirapex has lots of side effects. Bothers me a PA is prescribing this potentially problematic medicine with no doctor in the mix. I took the Mirapex last night (cut it in half - she told me to do that) and it didn't help and it made me sick. Not taking it again and not happy with the level of medical oversight I'm getting. For my height I'm pretty overweight and no one has suggested I lose weight. It bothers me they go right to the Mirapex without even suggesting less intrusive solutions.

A few thoughts.

First, PAs (and ARNPs) are fully credentialed providers with prescribing authority (at least where I live). PAs/ARNPs first made inroads in family practice offices but now have a very significant role in many specialty clinics (including surprising places like ortho). You can always ask to schedule your appointment with the Doc (rather than the PA).

Second, you don't know whether a doctor is in the mix -- there could very well be consultations going on behind the scenes.

Third, weight loss is a good thing. And you probably knew that without the PA talking about it. That said, I have not heard of weight loss being helpful with restless legs, etc. They tried a drug, you did not tolerate it well and it didn't help.

Finally, if the PA had an MD behind her name, would you be happy with the quality of the care? If not, then seek another provider. Are you medically complex (or is your sleep disorder complex)? If so, ask for an appointment with the MD.

[TropicalDiver]

Sleep doctors mostly have no clue what they're doing beyond prescribing low volume cpaps for snorers

Sleep docs, like most providers, vary in diagnostic and treatment skills as well as in bedside manner. I am not even sure what a low volume CPAP is...

Like an other category of providers, find one that you both respect and can work well with. If not, move on to another provider.

[Goofproof]

Sleep doctors mostly have no clue what they're doing beyond prescribing low volume cpaps for snorers

Sleep docs, like most providers, vary in diagnostic and treatment skills as well as in bedside manner. I am not even sure what a low volume CPAP is...

Like an other category of providers, find one that you both respect and can work well with. If not, move on to another provider.

A Resmed plugged into 12 volts d/c! Jim

[Janknitz]

Tropical Driver said:

Second, you don't know whether a doctor is in the mix -- there could very well be consultations going on behind the scenes.

I believe (but may be wrong) that PA's to doctors are like dental hygienists are to dentists. They are not permitted to practice independently, and must have treatment plans signed off on by doctors, even if they are allowed to prescribe certain classes of drugs. I believe that's the case in most states. So there is most likely a doctor signing off behind the scenes.

In Northern CA Kaiser, sleep techs (not even PA's) do all the direct care, but everything is signed off by a doctor. I've never seen the doctor. But for my run of the mill OSA the techs are great. They know their stuff.

The Woodlands is not too far from Houston which has the best medical center in the world. However, whether your insurance will cover you and you can get an appointment somewhere in Houston is another matter entirely. There are two major medical schools and ELEVEN teaching hospitals just at the Houston Medical Center, so if you feel you really need cutting edge expert care it's worth exploring if there is some way you can be seen there.

As pointed out, you don't have to be told that you need to lose weight as you already know that, and the reality is very few people manage to lose weight and keep it off long term even if it does help their sleep apnea (weight loss does not always make a difference). So I don't blame the PA for not bringing it up, when medical personnel do people rarely change their lifestyle and lose weight, and your apnea needed to be treated sooner rather than later. If you lose weight and don't need PAP anymore that's a wonderful bonus. Like someone said, CPAP can help you lose weight and it may be that the apnea is a contributing factor to your obesity, not the other way around.

[zoocrewphoto]

A few thoughts.

First, PAs (and ARNPs) are fully credentialed providers with prescribing authority (at least where I live). PAs/ARNPs first made inroads in family practice offices but now have a very significant role in many specialty clinics (including surprising places like ortho). You can always ask to schedule your appointment with the Doc (rather than the PA).

Finally, if the PA had an MD behind her name, would you be happy with the quality of the care? If not, then seek another provider. Are you medically complex (or is your sleep disorder complex)? If so, ask for an appointment with the MD.

I don't know about PAs, but I can tell you that I have been very happy with the Nurse Practitioners I have had. One was my primary caregiver for a couple years before she moved away. One time, she wasn't available, and I got an MD instead. Nice lady, but I didn't like her at all. She didn't listen to what I was there for (headache that had been going on for 2 weeks). The ARNP had determined that I was having the headache because I had been really sick with food poisoning,and I was still dehydrated, not eating well, and not sleeping well. She said if the shot wore off to come back. The MD basically said to drink more water, lose weight, and walk more. No shot. She prescribed a pill, didn't send it in properly, and the prescription arrived 3 days later, long after the headache had ended. Total waste of an appointment. And clearly, my weight was mnot the reason fora sudden 2 week headache.

I was also saved by a Nurse Practitioner. I have asthma, and I can go months or years without a problem. I had a problem in December of 2016. My inhaler had expired in 2015, and was sort of helping, but clearly nowhere near full strength. I had not been to the doctor all year (had not started on deductible), so it would have been over $300 to go to the regular doctor or about $250 to go to urgent care. I posted on facebook asking if somebody had a spare inhaler I could get. I figured if I could get one, even a used one; I could put off going to the doctor until January. I knew a friend from cat shows was a Nurse Practitioner, but I didn't know she could write prescriptions. She called in my inhaler for me.

[seniorbiker]

PA's and NP's are like any other profession...there are good and not so good. (Hopefully not "bad".) In my experience the PA's I have run into have been excellent.
In most cases they spend more time with me that the doctor. Since Obamacare there are many more people with insurance...that has made it harder to see doctors and PA's are picking up the slack for routine care.

[BamaGramma]

The local medical community seems to think this clinic is the best thing since sliced bed because they routinely do PES (Esophageal manometry).

I'm curious about what esophageal manometry has to do with sleep? I had that test done a year ago prior to having a Nissen fundoplication for GERD. It was THE most miserable procedure I've ever had done and successfully completing the test was a case of mind over matter. I hope I never have to do it again.

And I too think my sleep clinic is a racket. I had my first study done almost 20 years ago at the hospital and was diagnosed with restless legs. I've been on medication since then and rarely have break-throughs. If things don't get better with the current clinic (i.e. them actually learning what Medicare compliance is for a CPAP) then I'm going to ask to be referred back to the hospital clinic.