Faulty Information from my NP??

[Scamper]

I just returned from my yearly visit to the sleep apnea services clinic in my town. The NP told me something that I simply don't really think is true, and I would like to get feedback here. She told me that if a person has need for a pressure setting on their CPAP of under 15 and the person isn't diabetic and doesn't have high blood pressure the normal practice is NOT to treat the person with CPAP (or anything else). I've been treated since 1997 and have never heard anything like this and don't see anything on the net like this. In fact, I find it shocking as 15 is a pretty hefty pressure setting. And of course it seems to be the CPAP treatment is all about apnea events, not just pressure settings. Has anyone here heard this before and/or care to comment?

[Pugsy]

Well......I have never ever heard of such a thing. Pressure needs are unrelated to "severity" of OSA.
Only comments I can think of is "what a load of BS". "Sure glad I am not relying on that NP for my care"
I guess it is okay to suffocate with O2 drops to 70% and minute long apneas just because someone might only need a lessor pressure to stent the airway open....news to me and not very reliable news from everything I have ever read.

[JohnO]

That's Crazy Talk.

The pressure is not the thing. Number of events is the thing (or, at least, a thing). Amount of oxygen in your blood is the thing (or, at least another thing). Now, maybe the NP was relaying a story of how things used to be, but in this day and age, I can't believe any employee at a sleep clinic would be spreading such information.

I'm pretty new here, but I think the goal of the titration study is to see how -little- the pressure can be and still stop the apneas, since a lower pressure is generally more comfortable that a higher pressure.

Are you sure she didn't mean fewer than an AHI of 15? Now I could see not treating someone who didn't have many apneas, but since the goal of treatment is to get apneas below 5, I think (at least in this day and age) they would treat at 15, since that is still "mild" but on the edge of moderate according to the Wikipedia page.

http://en.wikipedia.org/wiki/Obstructive_sleep_apnea

[brucifer]

I just returned from my yearly visit to the sleep apnea services clinic in my town. The NP told me something that I simply don't really think is true, and I would like to get feedback here. She told me that if a person has need for a pressure setting on their CPAP of under 15 and the person isn't diabetic and doesn't have high blood pressure the normal practice is NOT to treat the person with CPAP (or anything else). I've been treated since 1997 and have never heard anything like this and don't see anything on the net like this. In fact, I find it shocking as 15 is a pretty hefty pressure setting. And of course it seems to be the CPAP treatment is all about apnea events, not just pressure settings. Has anyone here heard this before and/or care to comment?

Your NP should be reported for stating such nonsense! You and other patients could be missing out on valuable CPAP therapy. Ask her/him for the source of that information. I once had a clueless NP who would let on that she knew more than she actually did. She wasn't my NP for very long.

[archangle]

I just returned from my yearly visit to the sleep apnea services clinic in my town. The NP told me something that I simply don't really think is true, and I would like to get feedback here. She told me that if a person has need for a pressure setting on their CPAP of under 15 and the person isn't diabetic and doesn't have high blood pressure the normal practice is NOT to treat the person with CPAP (or anything else). I've been treated since 1997 and have never heard anything like this and don't see anything on the net like this. In fact, I find it shocking as 15 is a pretty hefty pressure setting. And of course it seems to be the CPAP treatment is all about apnea events, not just pressure settings. Has anyone here heard this before and/or care to comment?

She's an idiot. See if you can get whatever doctors she works with to straighten her out. Of course, the doctors may be idiots, too.

[Wonderbeastlett]

Well I guess all my symptoms were just in my head then!!

I think that's just plain stupid! I had enough trouble with my sleep center for the very same ignorance. They said because my AHI was 6.4 and I have low blood pressure, I didn't have OSA. Even though right on my test results it also showed stage 4 and REM sleep was 0%! The problem with all of this is that she could be killing off other people because she doesn't know what shes talking about.

[xenablue]

Ditto on the stupidity of the NP - I have SEVERE OSA and my pressure is 9-10 only, in fact I do OK at 7. Since dx my AHI hasn't gone above 0.9.

What a moron!!!

Cheers,
xena

[Pugsy]

Even if she meant AHI of 15 and not pressure I wouldn't want to go by that. When I first started therapy my pressure that was prescribed was not quite sufficient and my AHI was ranging around 10 and I still felt absolutely horrid.
It wasn't until I got it below 3 that I actually had the killer morning headaches and the nocturia go away and felt better. Yeah, 10 AHI was better than pre cpap but I had no reduction in the outward symptoms of OSA and I sure didn't want to go through all this work and not feel better.

[VikingGnome]

The MEDICARE requirements for paying for CPAP:
AHI over 15 = Definitely treat with CPAP
AHI 5-15 and have high blood pressure or heart disease = Treat with CPAP
AHI less than 5 = No treatment

Most insurance companies follow MEDICARE requirements.

[Scamper]

Thanks to all who responded, you confirmed what I thought...the NP (who said she had 25 years of experience) is way, way off. I do not know why it is so difficult for me to find good sleep apnea care, but over the past 15 years I've been to all the major clinics (3) in my area and have gotten so much incorrect information that it is truly frightening. One clinic prescribed a medicine for sleeping and pulled a long-time medicine I had used saying it was no longer considered the 'correct' medicine. Then when I went back for my yearly checkup they told me they didn't prescribe the new medication, that it was NEVER used for this purpose. I was furious, went home and pulled the prescription, went back and showed them the doctor's name - and got a blank stare. I left that practice, needless to say. Unfortunately, the practice I'm with now is no better. Last year they pulled me off my iron supplement for restless legs, saying my levels were fine. I knew they were not and found out they were reading 3 year old ferritin readings. And this time in addition to the NP declaration about not treating less than 15 pressure, she didn't even bother to ask for an update of my medications. I'd go elsewhere, but I think I've run out of places to try.

I have excellent doctors in other areas. Does anyone else have this problem? Is there a lack of quality in this area, or just perhaps in my area?

[chunkyfrog]

What is your insurance? this sounds like how they treat veterans! or the indigent.
Something is dreadfully wrong.

[brucifer]

Thanks to all who responded, you confirmed what I thought...the NP (who said she had 25 years of experience) is way, way off. I do not know why it is so difficult for me to find good sleep apnea care, but over the past 15 years I've been to all the major clinics (3) in my area and have gotten so much incorrect information that it is truly frightening. One clinic prescribed a medicine for sleeping and pulled a long-time medicine I had used saying it was no longer considered the 'correct' medicine. Then when I went back for my yearly checkup they told me they didn't prescribe the new medication, that it was NEVER used for this purpose. I was furious, went home and pulled the prescription, went back and showed them the doctor's name - and got a blank stare. I left that practice, needless to say. Unfortunately, the practice I'm with now is no better. Last year they pulled me off my iron supplement for restless legs, saying my levels were fine. I knew they were not and found out they were reading 3 year old ferritin readings. And this time in addition to the NP declaration about not treating less than 15 pressure, she didn't even bother to ask for an update of my medications. I'd go elsewhere, but I think I've run out of places to try.

I have excellent doctors in other areas. Does anyone else have this problem? Is there a lack of quality in this area, or just perhaps in my area?

At least you're taking charge and advocating for your own health care. Good job!