What do Doctors have Against APAP's ?

[pratzert]

I have seen some posts that some sleep Doctor's have resisted writing a prescription for an APAP machine rather than a straight CPAP.

Do you think it's because they know that many insurance companies won't pay for an APAP to start ? Or do they have some real "medical" reason or opinion to want a CPAP only ?

I don't see why they would fight it.... it covers the bases with the variations in pressure requirement due to sleeping positions etc. The one thing I WOULD understand, is that they insist the Minimum pressure not be set to anything lower than the pressure determined at the titration study, but doesn't the APAP take care of that as well ?

Tim

[tomjax]

It may just be their ignorance on apap and what they are being told by dme.
Many people are influenced by sound bite trivia.
They may be competent in the physiology and dynamics of sleep disorders, but woefully lacking in the day to day usage of PAP devices and masks.
IMHO, the burden is on the patients to inform them on practical matters.
The mfg and dme will always provide information that benefits them, not the patient- to a degree.

Many have posted the reactions of their docs when presented with printouts of sleep data from an apap.

In the end, the patient is in charge of his/her health and need to learn as much as possible and then educate their docs.

Perhaps some of our better writers make a posting to printout and take to their docs that shows the very clear advantages of APAP over plain cpap.

This forum is a very integral facet of that educational process.

[pratzert]

It's true that there are Doc's out there that keep up with all the studies and statistics concerning "our" affliction and the newest ideas in therapy.

But, unfortunately, even if the Doc is the best in diagnosing and understanding the ailment, many seem to be extremely behind the times in terms of the capabilities and function(s) of the Therapy Equipment.

If laymen, such as ourselves, can grasp the function(s) of the different types of machines, why is it so difficult for some of the Health providers and insurance companies to understand how/why one machine is better than the other, and can actually SAVE money and improve the patients quality of life over and above a plain standard CPAP.

Thank GOD for these forums and the information they disseminate.

It appears that the onus is on "US"... the Patients... the help educate those who are supposed to be "Treating" our particular ailment. It's a tough sell to try to tell a Doctor or insurance company what you think is best for you.

Tim

[GoofyUT]

Wow!!!! Hold on there, Tex!

Before you go jumping to the the conclusion that medical professionals and Sleep Docs in particular are neandrathal and can't keep up with technological developments nearly as well as all of us campers cruising forums like this one, keep in mind that its to the manufacturers' benefit to make sure that each and every sleep doc knows about each and every new whiz-bang invention just as soon as its ready to market. that's how they sell the suckers since sale is restricted to the sale or order by a PHYSICIAN.

Our doc shave been exposed to APAP, and get continuously exposed to new developments and refinements WEEKLY by cute, young, well-dressed detgail guys and gals who go around from clinic to clinic informing docs about why their product is best.

SLeep Docs maintain reservations about APAP for good clincial reasons:There is no proof that it is MORE effcetive than CPAP. It may be harmful for those who have experienced heart failure. It remains unstandardized, and each of the manufacturers algorithms are different. There has been no consensus conference regarding which of these algorithms represents the best practice.

So, cool your jets and trust your sleep doc. if you don't find another, and another till you do, and then listen to and follow his/her advice.

Chuck

[tomjax]

[quote="GoofyUT"]

SLeep Docs maintain reservations about APAP for good clincial reasons:There is no proof that it is MORE effcetive than CPAP. It may be harmful for those who have experienced heart failure. It remains unstandardized, and each of the manufacturers algorithms are different. There has been no consensus conference regarding which of these algorithms represents the best practice.

So, cool your jets and trust your sleep doc. if you don't find another, and another till you do, and then listen to and follow his/her advice.

--
This helps me understand your name- Goofy

Trust your sleep doc-
That is about as goofy as it gets.
Not a good general statement. Go back and read up on what many here post about what their docs say to them.

When they deserve trust, then we should give it. Until then, be wary.
Be skeptical. Trust those with on the nose experience.

[GoofyUT]

Don't get personal. No need.

As I said, trust your sleep doc. If you don't, get another, and another until you do. Then, listen to them, fer chrissakes.

[yardbird]

tomjax-

oops.. you may have missed part of Goofy's post. If I read it right, I think what he's saying is that you need to trust your sleep doc. If you DON'T trust them, then it's time to find another one.

Doctors have very strong CYA thoughts. I love my primary care doc. She LISTENS. If I have an opinion or question she treats it in the way I deliver it. If I have data to back up my opinion or if I refer to specific studies when asking a question, she's been known to take the time to read the study and call me in the evening to discuss it. She believes very strongly in patients helping themselves to be healthy BUT she's not going to stand by and do nothing if she even SUSPECTS something may not be good for you.

So that whole trust thing... it could be a whole topic on it's own. My sleep doc was so amazed at my knowledge not only of my apnea, but of the machines and what's the difference between how Respironics implements exhalation relief as opposed to the way Resmed does it. He looked at the data I was printing out from EncorePro/MyEncore. He told me that what I am doing is GREAT and that he wished all patients would learn so much about themselves and their treatment. Then he basically told me he doesn't need to see me again unless there's a problem.

ack... I have rambled once again.

I think SOME docs don't know enough about the real long-term use of APAP and simply feel safer prescribing CPAP. It's that CYA thing. Ever see a doctor's expenses for malpractice insurance? You'd cover your butt too.

[path2others]

Very good points have been stated in this thread. Since I have started with my APAP (2 weeks ago) I am running into more people who are using a CPAP machine. Most are happy with just letting the doctor decide what machine is best and are not interested in the technical things. I am visiting by BIL today who is having trouble getting back on his cpap after open heart surgery. His machine is from 1997 so I want him to try cflex and apap since they want him to have another sleep study.
I am a retired nurse and I always like to research and gather all of the information I can find. I pushed for an APAP because I like to have choices. This whole idea of home monitoring your sleep is a lot like the self blood sugar testing for the diabetics. The labs,hospitals and doctors did not become obsolete - the people who have the disease just became able to take better care of them self.
The medical system moves like an elephant, very slow and deliberate but it gets there eventually.

[Goofproof]

Let's see if you were a farmer and you sold eggs and chickens. You had two kinds of chickens. One had to be fed and only laid one egg a day, and could be sold for $3.

The other chicken was self feeding (free range), and it laid three eggs a day. This chicken only cost a little more $3.35, and provided a better value for it's owner.

If you were the farmer selling both kinds of these chickens and wanted to stay in business selling eggs, which kind of chicken would you want your customers to buy?

If you were the customer, which chicken is the better value and which would you want. Also the Auto chicken has a feature like C-Flex, which if you don't want the Eggs you can turn it off. Jim

You have just finished Farm Learning 101.

[GoofyUT]

Well, here's Farming 102, bud................

What if the damn self-feeding, 3 egg a day, $3.35 chicken and its eggs made some folks gassy or sick when they were eaten???

Then, that chicken and its eggs have NO VALUE to folks who can't use them for their intended purpose, and the $3.00 chicken and its single, solitary egg turns out to be a MUCH better value.

Different strokes for differnt folks, bud.

Its a complex issue. So, don't try to simplify like that!

Folks need to take the time to work with a knowledgable sleep doc that they trust to find the BEST POSSIBLE solution for THEM (and only them). It don't matter whether is APAP, CPAP, BiPAP, VPAP, BiLevelPAP, xPAP, nasal pillows, ful fask masks, fluffy hoses or whatever. Its whatever combination works best for them. And, that ain't always a spiffy new APAP that, like the eggs, makes you gassy or sick.

Chuck

[pratzert]

Quote: "What if the damn self-feeding, 3 egg a day, $3.35 chicken and its eggs made some folks gassy or sick when they were eaten???" UNQUOTE

Ya, But the chicken above, can be turned into other chicken ( This one: "One had to be fed and only laid one egg a day, and could be sold for $3." )

With merely with the push of a few Buttons on its BEAK if it gets you gassy or sick.

Now THAT'S My kind of Chicken.

[NightHawkeye]

As I said, trust your sleep doc. If you don't, get another, and another until you do. Then, listen to them, fer chrissakes.

Well, that process certainly worked well in my case . . . I've seen way more physicians than I can count on my hands and toes combined, had two sleep studies a dozen years apart, and finally ended up diagnosing my own sleep apnea and proving it to the satisfaction of the sleep doc, who then wrote me a prescription for a machine . . .

Moral of the story: Be your own advocate. Treat physicians as you would any other business person. And, for damn sure hold 'em accountable. If what they say doesn't ring true, challenge it. I've dealt with some physicians who were about as . . . (pick your own description).

Regards,
Bill

[snoregirl]

Back to the basic question. I wonder if some docs (not mine) resist APAP since they know that the insurance will be a hassle and it will ultimately take the doc's time and energy to defend their prescription to the insurance company (happened in my case), which still might not be honored (happened in my case, except luckily the DME caved and gave me what I wanted after 6 weeks or so). And if CPAP will work (I didn't say work best) for now why not avoid the hassle and prescribe that unless the patient really pushes the doc?

Just a thought.

[txtornado]

I have seen some posts that some sleep Doctor's have resisted writing a prescription for an APAP machine rather than a straight CPAP.

Just thought I'd chime in that my doctor had no problem writing me a scrip for an APAP instead of a CPAP. Note - she is not a sleep doc, but my general internist.

When we discussed my sleep study results I told her I wanted an APAP because though the recommended titration was 11cm, the results stated that "REM sleep was not recorded at this pressure or throughout the study and thus the titration is not considered optimal." Based on that she wholeheartedly agreed that APAP, with software so I could monitor my treatment, made sense for me.

I think that good communication and trust with your doctor is vital. In my case, I very easily got what I thought was best for me. But what if my doctor had resisted? Well, if she had a valid medical reason for not wanting to prescribe APAP and was willing to engage in a useful dialogue with me about it, I'd probably go along with it - because she knows me and knows my medical history, and I trust that she has my health as her top priority. But if I thought she was just playing an insurance game, I'd be looking for a new doctor.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, Prescription, APAP

[Goofproof]

[quote="GoofyUT"]Well, here's Farming 102, bud................

What if the damn self-feeding, 3 egg a day, $3.35 chicken and its eggs made some folks gassy or sick when they were eaten???

Then, that chicken and its eggs have NO VALUE to folks who can't use them for their intended purpose, and the $3.00 chicken and its single, solitary egg turns out to be a MUCH better value.

Different strokes for differnt folks, bud.

Its a complex issue. So, don't try to simplify like that!

Folks need to take the time to work with a knowledgable sleep doc that they trust to find the BEST POSSIBLE solution for THEM (and only them). It don't matter whether is APAP, CPAP, BiPAP, VPAP, BiLevelPAP, xPAP, nasal pillows, ful fask masks, fluffy hoses or whatever. Its whatever combination works best for them. And, that ain't always a spiffy new APAP that, like the eggs, makes you gassy or sick.

Chuck