Sleep Doc Followups - Yes or No?

[Grumpy48]

I had a sleep test in early 2020 and got my CPAP a couple months later. All this was done through my PCP and I never saw/consulted with a real 'sleep doc'. Other than my face to face with my PCP for the Medicare requirements, my PCP has not inquired as to how the CPAP therapy is working and I don't believe he has a means to access data either from the CPAP card or from Respironics Orchestrator to view any data if I were to bring it up during a visit.
I'm Looking for a consensus if you've had a followup and/or periodic reviews by a sleep doc after starting CPAP or not and if you did was it scheduled by the sleep doc or did you request an appointment? My AHI numbers are usually about 1.5 or less, but being on this forum for a while suggests that the AHI number alone may not give the whole picture of whether the CPAP is actually doing as intended.

[LSAT]

If you have a problem you want to discuss...make an appointment. If you are just looking for a pat on the back and someone to tell you what a good job you are doing...you can get that here....save your money.

[Mel0806]

Why would you have a PCP evaluate your progress regarding sleep apnea when he is clueless? In my opinion you should get a referral from your PCP and see a real sleep specialist who can and will read your results. My PCP referred me to a pulmonologist with no hesitation and that’s who I see for sleep apnea. I have my next follow up in October and he will go over my stats and progress.

[loggerhead12]

Mine scheduled appointments for me, every 90 days at first, then every 6 months. I stopped after the first few visits because I wasn't getting anything for my $285 per 15-minute visit. I'm going to schedule with him this year so I can get a fresh prescription for a new machine since mine is 5 years old.

[ChicagoGranny]

If you use OSCAR and have your CPAP therapy optimized, what's a sleep doc going to do for you?

My GP admits he knows nothing about CPAP. Once per year, my DME sends him a form to sign which says I need, use, and benefit from CPAP use. The DME requires this annually for insurance purposes. That's it - no sleep doc in the picture.

[LSAT]

I'm 100% with Granny. My PCP does the same for me at my annual physical. I don't need a special sleep specialist to look at my data and give me a pat on the back...Good Job. In my opinion , anyone that has been using CPAP for over a year, does not need the sleep specialist....If they do, that sleep specialist has not done a good job during that first year.

[Mel0806]

My thought is that having OSCAR does not make one an expert or even close to it. I use OSCAR regularly, but for actual diagnosis and interpretation, the only person I would trust is my pulmonologist, a board-certified sleep specialist. Who else knows if you should be moved up from CPAP to BPAP, or ASV (or if you are someone who CANNOT have ASV)? Everyone has an opinion, of course, and various experiences of those who use xPAP machines is valuable to me — but only on an anecdotal level.

[ChicagoGranny]

the only person I would trust is my pulmonologist, a board-certified sleep specialist. Who else knows if you should be moved up from CPAP to BPAP, or ASV (or if you are someone who CANNOT have ASV)?

My board-certified sleep doctor prescribed a bilevel with pressures IPAP 24/EPAP 18. Ouch!

I came here and found out how to treat successfully and easily with APAP pressure 10 min/20 max/EPR 3/95% pressure 11.6.

I won't describe my first board-certified sleep doctor except to say horror show.

[palerider]

(or if you are someone who CANNOT have ASV)?

That amazingly flawed SERVE-HF "study"?

[Mel0806]

My board-certified sleep doctor prescribed a bilevel with pressures IPAP 24/EPAP 18. Ouch!

I came here and found out how to treat successfully and easily with APAP pressure 10 min/20 max/EPR 3/95% pressure 11.6.

I won't describe my first board-certified sleep doctor except to say horror show.

Everyone has their own experiences, but to suggest someone see anything less than a doctor who specializes in the field, would be doing them a disservice, in my opinion.

My first doctor wasn’t one I would go back to either, but to bash a community of specialists because of one bad experience isn’t something I would do either.

[ChicagoGranny]

but to bash a community of specialists because of one bad experience isn’t something I would do either.

But you would do a strawman argument. I bashed the two sleep doctors that I used. The only two.

[Mel0806]

Grumpy — have your AHI numbers been validated? The numbers that OSCAR gives you can be notoriously innaccurate and if you can’t spot these inaccuracies it could be a problem. Obviously your PCP can’t tell you so the next thing I would do is ask him for a referral or look for one yourself and have him give you a referral to that doctor. I have found forums and YouTube to be informative, but I use the information as a guide as to what questions to ask my doctor, or discuss issues with him. Even The LankyLefty27 (if you know who he is) always tells you to discuss important issues with your doctor. Don’t presume anyone here knows more than a doctor. Of course, it’s just my opinion.

[Grumpy48]

Grumpy — have your AHI numbers been validated? The numbers that OSCAR gives you can be notoriously innaccurate and if you can’t spot these inaccuracies it could be a problem. Obviously your PCP can’t tell you so the next thing I would do is ask him for a referral or look for one yourself and have him give you a referral to that doctor. I have found forums and YouTube to be informative, but I use the information as a guide as to what questions to ask my doctor, or discuss issues with him. Even The LankyLefty27 (if you know who he is) always tells you to discuss important issues with your doctor. Don’t presume anyone here knows more than a doctor. Of course, it’s just my opinion.

The AHI numbers I get compare closely with what my Dream Station 2 (and previous DS1) display shows, my quick daily check on the Respironics DreamMapper, and OSCAR. Both the DS2 and DreamMapper tend to round off the values, where OSCAR gives the extra decimal point. So far as other values that OSCAR gives, no I have no idea of their accuracy, but is interesting to compare to my O2Ring oximeter when events do occur. The consequences of inappropriate advice for treatment of sleep apnea can be serious. For a good number of years my apnea went un-diagnosed and as a result my O2 sat levels at night were having significant and frequent drops through the night. As of recently I've had some hints of cardiac issues which may or may not be related to years of untreated apnea (Holter monitor for a couple of days a few weeks ago). While this forum, as well as the other forum as you said, have been good as a learning tool for use of a CPAP, I would not solely entrust my health to internet forums where the qualifications to give advice comes into question. And while an OSCAR graph may be useful and help to fine tune settings, it doesn't factor in a persons full medical history, prescripts, lifestyle, etc. which may be key factors to issues a person might be having related to apnea and subsequent therapy.

Hope you're enjoying this informative thread as much as I am

[Pugsy]

where OSCAR gives the extra decimal point. So far as other values that OSCAR gives, no I have no idea of their accuracy,

OSCAR is going to report what the machine is recording except for the rounding up or down thing.
It's going to be really, really close.
If OSCAR is inaccurate...then the machine is also inaccurate because OSCAR just reports what the machine writes to the SD card when it comes to AHI.
OSCAR doesn't put the labels on anything...the machine does the flagging and labeling.

[lynninnj]

Why would you have a PCP evaluate your progress regarding sleep apnea when he is clueless? In my opinion you should get a referral from your PCP and see a real sleep specialist who can and will read your results. My PCP referred me to a pulmonologist with no hesitation and that’s who I see for sleep apnea. I have my next follow up in October and he will go over my stats and progress.

Similar- my cardio sent me to pulmonologist who did home sleep test.

I see it as a big money maker for the pulmonologist. I have only had face to face with techs or nurses or some such and one LPN (I think?)

If my cardiologist wanted to discuss it at my next visit which is regularly scheduled, that’s one thing. I wouldn’t go out of my way to make an appointment with them though to talk about it.

Let me preface this by saying I don’t know what you need to do for insurance complaints so there you go.