Sleep study and CPAP coercion

[salring]

I was diagnosed with moderate sleep apnea. When I underwent the sleep study here in Tennessee, I felt like the whole sleep study was geared toward fitting (selling) CPAP machines, rather than simply assess my sleeping. I was told the only real method for treatment was CPAP and really feel like the medical system was pushing this technology as it is a money maker. I decided to try out a mouth appliance - the cheapest one I could find on amazon. It took about 2 weeks to get used to the thing, but it actually worked. I am sure it wouldn't work for everyone, but just the idea that the doctor wouldn't recommend trying it made me so upset that I made a blog on how I stopped snoring on my own. Anyway, I was wondering if anyone else out there feels maybe like they have been steered only toward the CPAP based solution?

Sal

[who]

I was diagnosed with moderate sleep apnea. When I underwent the sleep study here in Tennessee, I felt like the whole sleep study was geared toward fitting (selling) CPAP machines, rather than simply assess my sleeping. I was told the only real method for treatment was CPAP and really feel like the medical system was pushing this technology as it is a money maker. I decided to try out a mouth appliance - the cheapest one I could find on amazon. It took about 2 weeks to get used to the thing, but it actually worked. I am sure it wouldn't work for everyone, but just the idea that the doctor wouldn't recommend trying it made me so upset that I made a blog on how I stopped snoring on my own. Anyway, I was wondering if anyone else out there feels maybe like they have been steered only toward the CPAP based solution?

Sal

CPAP is the gold-standard treatment for OSA, so it would have been wrong for them to steer you away from it.

Other forms of treatment (oral appliance, surgery, didgeridoo, etc.) are for people who cannot, or will not, use the therapy that does the most good for the most people--CPAP. The only way to know if a non-CPAP treatment is working well enough for you would be for you to get a sleep study using it. Other than that, you are only guessing whether what you are doing is working at all in addressing your OSA.

Perhaps you should have allowed yourself to be "coerced."

But suit yourself.

[drdebi]

I feel the same way. My Dr. dismissed any talk of a mouth appliance and went so far as to say that they rarely if ever work! Since I work in a dental office, I happen to know differently. Unfortunately, my apnea is severe enough that the appliance didn't work well for me, but with some people it is the answer. I would give anything to be able to use it as I have never "made friends" with my CPAP. If your sleep Dr. does not fabricated the appliances then he is less likely to recommend them...but truthfully not everyone is a good candidate for them.

[Patrick A]

My very first sleep study at a large and well known HMO. The did the study sent me home the next time I saw the treating Dr. He basically said yes you have Sleep Apnea, go home be well. That was in 1988. In 2005 I had a Dr. that was sharp as a tack. The second time I went to see him he called my GP and they both ordered a new sleep study.I had the study and was diagnosed with severe OSA. I have been on C-Pap ever since @ a setting of 20cm. I was still having problems, so in 2006 I bought a new machine instead of the Remstar Plus I go from APRIA RIP-OFF. I bought a Remstar Pro-2 w/c-c-flex. After a year on that machine I bought a new M-Series Bi-Pap Auto. With a setting of 25cm ipap/10 cm epap . I had a new Sleep study last December the study was to see if I was having Central Apnea's thankfully I only had one and have not developed Central Apnea, a whole new ballgame. I do not feel coerced...I feel thankful that I have doctors that care about me and my health instead of treating me like just another cash cow.

[jdm2857]

My dentist makes oral appliances for OSA, but will not consider it for a patient until that patient has tried and failed at CPAP.

[kteague]

Hope this works out for you. It does for some, but I would want a sleep study with the mouthpiece in to be sure I was as safe as I thought.

Kathy
sighing as I erase yet another version of a reponse

[Patrick A]

Hope this works out for you. It does for some, but I would want a sleep study with the mouthpiece in to be sure I was as safe as I thought.

Kathy
sighing as I erase yet another version of a reponse

I second that motion

[sonyat]

Hi Sarling,

There's an easy way to see if they were just trying to sell you a machine -- that results of the sleep study with and without the CPAP. My results were dramatically different.

There's also a difference between snoring and apnea though they overlap quite a bit. The appliance might stop your snoring, but not your apnea, or you may not have apnea at all, just snoring.

[montana user]

Hello,. sleep tech here..I have posted a few times about the dental device and OSA. We have a dentist here who is pushing it big time. I agree there is a time and place for it, but most people do not benefit from it. As a few have said ( and Im not saying this because I do sleep studies, but I also have OSA and want the BEST treatment for people) getting a sleep study while wearing the dental device is a great idea. If it is not treating the apnea, then you are still at risk for stroke, heart attacks, high blood pressure, etc. I do not make any money off the CPAP's that this hospital sells, but they do work when given the chance. Good luck and keep us informed!!!

[echo]

I was side tracked for three years using a dental device because I couldn't get a referral for a sleep study. While it helped somewhat, it did not stop the apnea completely (only after starting cpap did I get better). So I am actually MAD that the dental device distracted me and delayed the CPAP treatment for 3 years!!

You MUST have another sleep study with the dental device to make sure it's stopping your apnea! Otherwise you're only guessing... And In the meantime the sleep apnea will continue to wreak havoc on your body.

And those dental appliances ain't cheap either! I paid nearly a $1000 for mine, and it only lasts a few years until the springs need replacing (which they can't, so you get a new one). AND it's not covered by insurance, at least for me. There's also no way to adjust them if your needs get worse or less, eg weight loss/gain. Until they come up with a 100% proven alternative to CPAP, I'll be sticking with MY LIFESAVING CPAP.

If a heart surgery was "foisted" on me because I needed it, I wouldn't refuse it just because they were trying to make money on me with expensive surgeries, and instead ask for cholesterol reducing pills. Ok that's not the best analogy but hopefully you get the point.

[who]

"3.4.2 To ensure satisfactory therapeutic benefit from OAs [oral appliances], patients with OSA should undergo polysomnography or an attended cardiorespiratory (Type 3) sleep study with the oral appliance in place after final adjustments of fit have been performed. (Guideline)
". . . data has shown that even relatively low AHI are associated with adverse health outcomes, and especially in patients with comorbid disease or risk factors, may be important. Since the rate of treatment success is not predictably high with OAs, treatment should be assessed for efficacy with objective testing. Additionally, some patients experience an increase in AHI with OA treatment. This recommendation is based on 2 level I and 5 level V studies.—AASM Practice Parameters; SLEEP, Vol. 29, No. 2, 2006. http://www.aasmnet.org/Resources/Practi ... icance.pdf

[Wulfman]

I was diagnosed with moderate sleep apnea. When I underwent the sleep study here in Tennessee, I felt like the whole sleep study was geared toward fitting (selling) CPAP machines, rather than simply assess my sleeping. I was told the only real method for treatment was CPAP and really feel like the medical system was pushing this technology as it is a money maker. I decided to try out a mouth appliance - the cheapest one I could find on amazon. It took about 2 weeks to get used to the thing, but it actually worked. I am sure it wouldn't work for everyone, but just the idea that the doctor wouldn't recommend trying it made me so upset that I made a blog on how I stopped snoring on my own. Anyway, I was wondering if anyone else out there feels maybe like they have been steered only toward the CPAP based solution?

Sal

I read your blog. It sounds like you're in denial. You're also equating snoring with sleep apnea. Snoring CAN be an indication of Obstructive Sleep Apnea........but, a person can have snoring without apnea and can have apnea without snoring. Just because you can eliminate the snoring doesn't mean that it's going to eliminate the sleep apnea. I agree with "echo" in that you would definitely need another sleep study with your dental device to verify whether or not it works.
At least YOU got referred to an ENT. They didn't even ask me or try to determine if I could "breathe" through my nose.......but, my CPAP has helped to overcome my nasal restrictions and eliminated my mouth-breathing during my sleep, which I believe were a large part of my problem......and, it's alot cheaper than surgery.

Also, the prices you mentioned in your blog for the CPAP equipment and annual costs are higher than what it CAN be purchased for.


Den

[Janknitz]

I think it’s OK to be a little wary. The truth is that “sleep medicine” has become a huge cash cow for sleep medicine doctors, sleep labs, and durable medical equipment providers. There’s a lot of money to be made on sleep consultations, sleep studies, and the provision of equipment and supplies, and there is a lot of room for abuse in our for-profit medical system.

That said, you have to admit that you may also be in denial and using this as an excuse. The fact that people are profiting from sleep medicine and there is room for abuse does not mean that you don’t have a serious health issue that needs to be addressed more than casually.

You should understand that “moderate apnea” is rarely treated completely with a mouthpiece. You may have stopped snoring, but that doesn’t mean your apnea is reduced sufficiently to avoid the deleterious effects to your health. It might be, but you have no way of knowing without testing to be certain.

You say you have stopped snoring with the mouthpiece and that you think this is enough. I say, “put your money where your mouth is”. Do a new sleep test with the mouthpiece in place. Or, at the very least, sleep with a recording pulse oximeter with the mouthpiece in place. For the new sleep test, go back to the lab where you were first tested or any other lab. Let them know that if your apnea still requires treatment despite the mouthpiece, you will not under any circumstances deal with their recommended DME so that you will have no worries that they will get a kickback from referring you for equipment. Maybe you will have more faith in the results if you remove their profit motive.

Make sure you get a copy of the study, and learn to understand what the graphs show. If you truly have a much lowered AHI (under 5) and your oxygen levels stay consistently above 95% with your mouthpiece in, then all is well. You were absolutely right and you earned your bragging rights.

But, if you are still showing significant symptoms, then you do need treatment, no matter who is profiting from that need. You can use something like an online provider, auction site, or Craig’s list to get your equipment and minimize the profit motive of the individuals in the sleep medicine chain if it makes you feel better. But the most important thing is to get treated if your apnea persists so that you can go on living a long, healthy, skeptical life.

[salring]

Thank you all for your replies! I definitely think it would be a good idea to have a sleep study with the mouthpiece in as many of you have suggested. My wife has indicated that my breathing is not interrupted like it was before using the appliance and I do feel substantially more rested in the morning. That is why I think it has taken care of my sleep apnea and snoring although I agree it would be good to have hard data behind it. Maybe a few things would also clarify why I felt that the sleep study was a little contrived.
1. I was told I could only sleep on my back and needed to due to all the sensor wires, etc. I rarely (if ever) sleep on my back naturally. I've always used a pillow between my knees while on my side.. it just feels more comfortable to me. Sleeping on my back basically causes me to have much more pronounced snoring. I didn't feel like I was getting an accurate assessment on what I would be experiencing at home.
2. No one informed me that before the first study I would have to have a second sleep study for fitting the device.
3. Even though I got a referral to the sleep doctor, I ended up paying around $1500 out of pocket for the study. I would have a bit of trouble to cough up that kind of payment again without really messing up my budget. My health plan is a "P" grade Blue Cross & Blue Shield one which people has said is pretty good (?) please correct me if I am mis-informed.
4. The video that I was played about the sleep study process was basically an advertisement for a particular brand of CPAP.

For those of you that say I'm in denial.. you may be right a little bit. However if something seems to work so well, that I can easily travel with, costs little or nothing, and doesn't require really any maintenance - why choose a more cumbersome and expensive way?

Thanks again for all your input. I do appreciate it.
S

[Wulfman]

Thank you all for your replies! I definitely think it would be a good idea to have a sleep study with the mouthpiece in as many of you have suggested. My wife has indicated that my breathing is not interrupted like it was before using the appliance and I do feel substantially more rested in the morning. That is why I think it has taken care of my sleep apnea and snoring although I agree it would be good to have hard data behind it. Maybe a few things would also clarify why I felt that the sleep study was a little contrived.
1. I was told I could only sleep on my back and needed to due to all the sensor wires, etc. I rarely (if ever) sleep on my back naturally. I've always used a pillow between my knees while on my side.. it just feels more comfortable to me. Sleeping on my back basically causes me to have much more pronounced snoring. I didn't feel like I was getting an accurate assessment on what I would be experiencing at home.
2. No one informed me that before the first study I would have to have a second sleep study for fitting the device.
3. Even though I got a referral to the sleep doctor, I ended up paying around $1500 out of pocket for the study. I would have a bit of trouble to cough up that kind of payment again without really messing up my budget. My health plan is a "P" grade Blue Cross & Blue Shield one which people has said is pretty good (?) please correct me if I am mis-informed.
4. The video that I was played about the sleep study process was basically an advertisement for a particular brand of CPAP.

For those of you that say I'm in denial.. you may be right a little bit. However if something seems to work so well, that I can easily travel with, costs little or nothing, and doesn't require really any maintenance - why choose a more cumbersome and expensive way?

Thanks again for all your input. I do appreciate it.
S

I had been reading the forums prior to my sleep study and had heard stories about sleep labs MAKING their "victims" sleep on their backs. So, going into mine, I asked up front whether I had to do that.....because I CAN'T sleep on my back......and was told to just sleep in my normal position(s).

It also sounds like you either hadn't met your deductible or they were really sticking it to you for the sleep studies.
The total cost of my split-night study was BILLED for less than what your one was.......and my insurance had a lower negotiated amount.


Den