"Sleep Doctor" doesn't like autopaps

[GTOJim]

Dave

[/quote]


Okay,
Now have you made an appointment with the sleep doctor to show him your sleep data report? To tell him how much better you feel? And if he still blows you off, to tell him that you're firing him and never coming back?

Dave[/quote]

The day after I took delivery of my new Auto C-Flex with software, I printed out a report and dropped it off at the doctor’s office.
Someone from the doc’s office left a message on my answering machine “Doctor found my information interesting, and hoped I would send him more reports”.

I may talk to my PCP and see if I can go though him in the future. I'm not very happy with the sleep specialist.

[rested gal]

Sorry about bumping this up to the top, but couldn't resist adding this link to a topic posted later in March that explains a bit more about why some doctors are adamantly "autopap":

Mar 05, 2005 subject: Finally slept through the whole night....

That March 5 topic contains links to a 2001 "study" of four older autopap machines - a rather useless study in which the conclusion and the graphs may have unfortunately had a lot of influence on sleep doctors for years afterwards. Just my opinion - I'm not a doctor.

A good question to ask any doctor who says "Autopaps are not good, I don't prescribe them."might be this:

"Are you basing that on the Bliss study done in 2001?"

[-SWS]

A good question to ask any doctor who says "Autopaps are not good, I don't prescribe them."might be this:

"Are you basing that on the Bliss study done in 2001?"

If they answer "no" then perhaps a good follow up question might be this:

"Are you basing this opinion on folklore shared around the camp fire?"

[wading thru the muck!]

If they answer "no" then perhaps a good follow up question might be this:

"Are you basing this opinion on folklore shared around the camp fire?"

In all seriousness (not that I don't enjoy the humor), my comeback to an "no APAP" from my Doc would be, "in the unlikely event that the auto adjusting feature doesn't work for me the machine can be set as a fixed pressure machine." How can the Doc argue with that? If he does, ask him how often do you Docs meet around the camp fire?

[Mikesus]

Question that I posted in other thread regarding the study on Auto's

Link Here

[-SWS]

To be perfectly honest, I bought my initial AutoPAP with the intent of running it at fixed pressure. At the time I didn't quite trust the AutoPAP's ability to "get it right". I thought the ability to collect overnight data was in and of itself going to be a useful (albeit potentially "vague") indicator of when I might need a pressure adjustment. I would then report that indication for a pressure adjustment back to my doctor. Togehter my doctor and I would then follow up by allowing autotitration mode to determine my new fixed pressure.

Alas, the best laid plans are all too often foiled. I slept and felt better in auto mode than I actually did in fixed pressure mode. At that point my doctor and I came to the same conclusion: just run the machine in auto mode all the time. Have been doing so ever since!

[Janelle]

I believe that APAPs also have a place in the everyday scheme of the treatment of SA, such as in the case of my son. During his split night study, he absolutely, positively could not stand the mask even for a few seconds. he says he felt like he was suffocating. he is also very claustrophobic. They did not offer him any other kind of mask. He has since gone on Weight watchers, lost about 30 pounds, but realizes now that he is knowledgable about SA that he still needs XPAP treatment.

Since he basically cannot be titrated, wouldn't an APAP be a logical choice for a doctor to prescribe for him? That and nasal pillows. I hope to visit him in April and will show him my Swift. I think that would be a perfect answer for him.

[rested gal]

Good points, Janelle. I think you're right.

In fact, what you said just adds to my coming back to this topic to post a link found by Mikesus. A link which rounds out this thread by showing the "other side" - a sleep doctor with common sense accompanying her degree.

Powerpoint presentation at a meeting of the American Lung Association of the Central Coast - November 2004

Mike's great link gives excellent reasons presented by a sleep doctor who advocates that some patients who have obvious signs of OSA should be put directly on autopaps (auto-titrating cpap) without having to go through a PSG sleep study at all...not even for the initial diagnosis.

That smart sleep doctor is:
Barbara Phillips, MD, MSPH, FCCP
Professor, Division of Pulmonary Critical Care and Sleep Medicine
Director of the Samaritan Sleep Center
Department of Internal Medicine
University of KY College of Medicine
Lexington, KY

[lifeartist59]

I was just wondering if the reason that some sleep doctors do not like apaps would be that the need for more frequent testing would be eliminated? I was told that any time I lost or gain weight over 10-15 pounds I would need another test. Since often enough, people who use cpaps are told to lose weight, they might need testing more often than every year or two? I can't believe that insurance companies haven't jumped on apap as a treatment option, since it would limit this need to retest so often.

[mindy]

I was just wondering if the reason that some sleep doctors do not like apaps would be that the need for more frequent testing would be eliminated? I was told that any time I lost or gain weight over 10-15 pounds I would need another test. Since often enough, people who use cpaps are told to lose weight, they might need testing more often than every year or two? I can't believe that insurance companies haven't jumped on apap as a treatment option, since it would limit this need to retest so often.[/url]

I doubt it - the sleep labs are overloaded now!

I love my APAP ... my doc was going to give me a straight CPAP until I mentioned that I was trying to lose weight. She then said right away that I should get an APAP so it could adjust to my weight loss.

That said, there is *some* evidence (not nearly enough) that in some situations CPAP works better than APAP. In my siutation (cardiomyopathy and congestive heart failure) CPAP was shown to help but APAP did not (study too small and preliminary to bet the farm on).

I personally think that an APAP machine makes more sense since we then have the ability to re-titrate. It's also giving me a chance to adjust to higher pressures gradually over time. Eventually I may switch it over to CPAP and then occasionally do a range. Or I may just keep a 2 point range.

Mindy

[DreamStalker]

snip ...

Eventually I may switch it over to CPAP and then occasionally do a range. ...

That is also a main reason for having an APAP ... because you CAN use it as a CPAP too ... two machines in one. Try using a CPAP machine as an APAP ... unless you are some nerdy engineer, it ain't going to happen.

OSA patients need to demand what they deserve ... an APAP! If the DME doesn't see it that way, find another or just pay out-of-pocket.

[tillymarigold]

My sleep doc *prefers* straight CPAP, and I don't think it's unreasonable to say that a doctor would prefer a machine that will stop your breathing from getting messed up in the first place rather than reacting when it gets messed up, particularly if the patient's correct pressure is fairly low so (presumably) the patient won't be bothered by having the straight pressure a little higher.

I have an auto, so obviously I disagree with him, but I'm getting a little tired of the EVERYONE MUST HAVE AN APAP!!!!!!!!! attitude around here. Some patients like autos, and they have the right to be informed, but not everyone does, and there have indeed been studies showing that some patients do better on straight CPAP. And as for the "you can set it to straight CPAP mode"... well that's all very well and good (if you have the technical know-how and desire to fiddle with your settings yourself--not everyone does!), but I paid an extra $300 to get an auto machine, and not everyone has that sort of money lying around.

Not everyone who says something you disagree with is out to get you or is incompetent! Sometimes they have very solid reasons for holding a certain opinion, and just because your opinion is different doesn't make them an idiot. There was a very interesting article I read today about parents and pediatricians disagreements over the children's care, and basically it said you should say "This is why I think we should do X, what downside do you see to that?" and listen.

Rested_gal, you didn't even ask the sleep doctor herself why she preferred CPAPs to autos or didn't like C-Flex, you just accepted the tech's (quite possibly erroneous) representation of what the doctor thought, then walked out and came here and implied her board certification should be revoked!

[rested gal]

Rested_gal, you didn't even ask the sleep doctor herself why she preferred CPAPs to autos or didn't like C-Flex, you just accepted the tech's (quite possibly erroneous) representation of what the doctor thought, then walked out and came here and implied her board certification should be revoked!

LOL, tilly, I always like reading your posts, but I'm not following how you think I implied that that particular doctor's "board certification should be revoked." That's a pretty big leap. I can disagree with a lot of things without wanting to have a person's head on a platter.

Yes, the tech could have been lying about what she said "the doctor" thinks. Or could have been mistaken about what she thought the doctor thought.

It was one of those, "you had to have been there" things... getting a glimpse of the interactions between the doctor and the tech she brought with her to assist during the meeting. I have no doubt they had a close working relationship and that the tech was indeed accurately repeating what she had from the doctor about autopaps and about C-Flex.

The meeting had gone on a long time and was finished. It was late, and I had an hour's drive home ahead of me. The doctor was occupied with a group of narcolepsy people asking her questions (it was a combo OSA-Narcolepsy support meeting.)

I didn't feel as much urge to go talk to a "probable" autopap-disliking doctor as I did to spend my last few minutes out in the lobby -- talking with a fellow cpap-user who had questions.

[DreamStalker]

My sleep doc *prefers* straight CPAP, and I don't think it's unreasonable to say that a doctor would prefer a machine that will stop your breathing from getting messed up in the first place rather than reacting when it gets messed up, particularly if the patient's correct pressure is fairly low so (presumably) the patient won't be bothered by having the straight pressure a little higher.

I have an auto, so obviously I disagree with him, but I'm getting a little tired of the EVERYONE MUST HAVE AN APAP!!!!!!!!! attitude around here. Some patients like autos, and they have the right to be informed, but not everyone does, and there have indeed been studies showing that some patients do better on straight CPAP. And as for the "you can set it to straight CPAP mode"... well that's all very well and good (if you have the technical know-how and desire to fiddle with your settings yourself--not everyone does!), but I paid an extra $300 to get an auto machine, and not everyone has that sort of money lying around.

Not everyone who says something you disagree with is out to get you or is incompetent! Sometimes they have very solid reasons for holding a certain opinion, and just because your opinion is different doesn't make them an idiot. There was a very interesting article I read today about parents and pediatricians disagreements over the children's care, and basically it said you should say "This is why I think we should do X, what downside do you see to that?" and listen.

Rested_gal, you didn't even ask the sleep doctor herself why she preferred CPAPs to autos or didn't like C-Flex, you just accepted the tech's (quite possibly erroneous) representation of what the doctor thought, then walked out and came here and implied her board certification should be revoked!

A little tired? … with a little attitude? … around here?

I didn’t see where anyone was called an idiot but I guess I’ll have to back and read all of the posts now.

Who said anyone was out to get ‘ya … besides the Bush-Cheney organization?

Well I disagree, though I’m not out to get ‘ya. If someone has the technical know-how to get online and post or read this forum, then they have the technical know-how to change from APAP mode to CPAP mode. Ok, so one downside to having an APAP is that IF you are paying out-of-pocket it may be $200 to $300 more than a data capable CPAP (are you tired of people having data capable CPAPs too?). For those with insurance, the code is the same and the co-pay (cost to patient) is therefore also the same (unless the DME is untruthful). But even without insurance, I would think that $200 to $300 would be well worth the cost of having the option of using APAP or CPAP regardless of which mode is best for the patient IMO (so you can just continue to be tired of it but not worry that I will be out to get 'ya ... Boo!).

RG can reply for herself but not all doctors DESERVE to keep their certification unlike all OSA patients who DESERVE to get the best treatment possible.

[rested gal]

RG can reply for herself but not all doctors DESERVE to keep their certification unlike all OSA patients who DESERVE to get the best treatment possible.

walked out and came here and implied her board certification should be revoked!

ok, re-read my initial post and see where:

Oh, and I forgot to mention....it's a Board Certified Sleep Doctor. "Doesn't like autopaps." LOL! There seem to be a lot of them out there - autopaps AND "sleep doctors" who are anti-autopap.

That was simply expressing my astonishment -- not a call for revoking a certificate. I can see where some might think that was implied. But, nope.