Saw a new sleep doc today - keeper

[yardbird]

For a host of reasons I fired my previous sleep doc (and the DME he rode in on) many years ago.

Saw a new sleep doc today as recommended by my primary care physician and I think this guy's a keeper!

I took him a summary report for the last 3 months and nightly reports for the last week. (My original sleep study is about 13 years old). He did a brief physical exam (heart, lungs, airways, reflexes, etc) and asked some questions and then looked at the data I had provided and said, "This is excellent. It saves so much time."

He is NOT recommending another PSG. "We can do one if you want to, but I really don't think we need it based on what I'm seeing." Fine by me.

He DOES have a DME that comes in, but as he explained it to me after I told him about previous sleep doc/DME .... issues....
"I have absolutely no financial connection to <name of DME>. They come in for MY convenience and yours. They're right next door. But you are absolutely free to use whomever you'd like and it's just as important that you like and trust the DME as it is for you and I to have a good relationship."

Wow..... seriously? Straight forward and honest answer I think.

He isn't real big on running an auto machine in auto mode, BUT he said when you narrow the range down (like we do) you're really tailoring the machine comfort and improving compliance so it's fine with him to run in auto like this. He did say that if you want to go to straight pressure, don't choose the low end pressure as the straight pressure. Choose the 90% or 95% number. It may be higher than your titrated pressure, but is likely to be a better starting point.

Equipment:
I told him that after years of basically being on my own, I've had to learn a lot about how the various manufacturers set up their machines, how the algorithms affect individuals (some respond better to one machine than another even if they are st to the same pressures) and that I have very specific desires when it comes to getting a new machine. He said he'll write a script for EXACTLY whatever equipment I want and will prescribe pressure presets to what I'm on now (even though it's a range in auto) because it's WORKING and he has no problem with using what works.

Interesting too was our discussion about AHI, AI, HI as scored by my machine. I said that I noticed my AHI might be 2.5, but that my AI was .1 or zero and the AHI was comprised almost entirely of hypopneas. He said not to be concerned. He said my overall health and how I FEEL was quite possibly a better indicator of the success of the therapy. He said that hypopneas can be scored in a report for a lot of reasons and that without knowing the brain activity or whether or not the patient is changing positions and a few other things, the AHI by itself is sort of like incomplete data (when compared to a full PSG study). He didn't poo-poo the data we get from our machines, and it's certainly good information, but for some people who are having difficulty "getting the numbers down" it may not be ENOUGH data. People like us who take an active interest in our therapy AND who have learned to look at the reports and also take into consideration how we FEEL can make adjustments to correct some issues but should also be ready to talk to the doctor if those adjustments don't seem to be accomplishing the desired result. Doctors actually LIKE patients who are involved in their own treatment, they're just not used to it.

Anyway, this guy is quite busy, I feel it was a great first meeting, and I feel lucky that my PCP recommended him.

[Pugsy]

Good job. Sounds like you have a keeper with a good head on his shoulders.

[Slartybartfast]

Congrats on scoring a good sleep doc. Sounds an awful lot like mine, but I'm on the other coast.

Mine was at first a little alarmed that I got an Autoset instead of the straight CPAP he prescribed, but when he saw how I set it up (narrow range bracketing the 11 cm level he prescribed from the PSG study) he relaxed. I suspect these folks frequently run into patients who screw around with their settings, not knowing what they are doing. Taking the data in like you did gives the doc the information he/she needs to make an infomred determination of what's going on with your therapy.

[Java Time]

Saw a new sleep doc today as recommended by my primary care physician and I think this guy's a keeper!

Congrats! I have one of those sleep doctors who actually "listens" as well, and I feel really fortunate.

1) Although my doctor suggested lowering my "high" pressure, he didn't force the issue and I have been making small adjustments with it over time.

Interesting about what your doctor is saying on "narrowing the range". My doctor wanted me to pull down my high side as well, although he said it was because he didn't trust the machine and was afraid it would push pressure too high and wake me up at night. I have found a few times that I do get a problem where I'm holding my breath as I reposition in bed. The machine steps the pressure up too fast and just about knocks the mask off my face and leaks start blowing out under my nasal mask. Then I have to reach over and hit the ramp button to tell the machine to calm down. This is why my "ramp" is currently set at 9.0 barely under my minimum, 9.5. I don't really need a "ramp" so much as a way to tell the machine to behave itself and return to the minimum on occasion.

I don't know if this is silly or not, but when I do hit my max roof, I get a little worried that I may need more, so I have been bumping it up. I currently have a fairly large range with a minimum of 9.5 and a max of 17.

I've been able to hold my minimum at 9.5 - 10 for over a month and seem to just about have that tuned in correctly.


2) I like my DME "tech" okay, but I don't like the DME company overall as they never answer the phone (voicemail only) and usually take over 24 hours to return phone calls. I've resorted to paying cash on CPAP.com for small things and skipping dealing with the DME and insurance. Hmm, guess that's not very smart, you've motivated me to go shopping for a new DME!

[yardbird]

Mine was at first a little alarmed that I got an Autoset instead of the straight CPAP he prescribed, but when he saw how I set it up (narrow range bracketing the 11 cm level he prescribed from the PSG study) he relaxed.

Yeah I wonder how many of the sleep docs equate "auto" with "wide open" like leaving a range of 4 to 20 or something.

When I was talking to him about the differences in algorithms and mentioned the Respironics EPR leaves me with a "rushed breath" sensation in its default setup and that the Devilbiss and Resmed machines don't seem to do that he said, "You should be in sleep medicine. You have a more detailed understanding about how these machines work than most people in this business."

and my first thought on hearing that was that there were a lot of people here on the message boards that are much smarter than me... heheheh

[Janknitz]

I don't know if this is silly or not, but when I do hit my max roof, I get a little worried that I may need more, so I have been bumping it up. I currently have a fairly large range with a minimum of 9.5 and a max of 17.

A momentary blip up to the roof is no big deal, but if you see flat lines hanging up on the "ceiling", it IS an indication that you need more pressure. I was having symptoms, and when we looked at my graphs this is exactly what we saw. Just bumping up the pressure 1 cm was enough to keep things under control, and the symptoms went away.

[archangle]

If he's willing, be sure he prescribes a pressure range, even if its fairly small. This often makes it easier to get an auto machine, especially with insurance.

[yardbird]

If he's willing, be sure he prescribes a pressure range, even if its fairly small. This often makes it easier to get an auto machine, especially with insurance.

Apparently he's willing to write it however I want. Even specifying the machine exactly. I'm thinking...

Resmed S9 AutoSet - 8cm to 12cm
-with slimline tubing
Resmed H5i Heated Humidifier

[x] dispense as written

I don't think I need the climateline hose. But I would want the heated humidifier made for the S9 series. I know the slim tubing comes with the S9, but I can foresee a DME taking stuff out of the box and trying to give me a standard hose.

If written as shown above, do you see a way for the DME to try to get out of giving me an S9 AutoSet? I don't want them offering an S9 Escape Auto or something. I know if they order a Resmed product code 36015, they get the S9 and H5i at a reduced cost as opposed to buying the S9 as product code 36005 and then the H5i separately (2 different product codes depending if you get the standard water tub or the washable one).