struck out with regular doc and apap

Guest · Post by **Guest** » Sat Jun 10, 2006 12:23 am

Guest

Anonymous wrote: No. That is incorrect. APAPs do not have to have defined settings just like CPAPs. They can run the full range from 4-20cms/ just the way they come from the factory.

I have read several posts that state the APAPs is set to certain ranges per a DME order. I have no first hand knowledge. I do trust that you are making a correct statement though.

Anonymous wrote: No. That is incorrect. A prescription is required.

I'm just repeating what I was told by BillMyInsurance.com this morning. I think you are correct though.

Anonymous wrote: Snooter, did you click on the links given to you in the post just after your first one?

Good links and probably on the mark. I will probably print some of them and ask my doctor and girlfriend about them. But I can see some poor family doctor on the witness stand saying…”Well I saw it on a web site”…..Why is the author of the first report not on the first page BTW?

If these studies are true, why has the insurance companies picked up on it? They could just tell the doctors to send their suspected patients home with a APAP and tell them to return the flashcard after a month of using it and get all the information they need. This could save the insurance companies big money.

Your family doc most likely sent you to a specialist, and the specialist made the recommendation. You insurance company probably requires that you see the specialist.

BTW may AHI is high, 55/Hr, duration is probably moderate 14s-mean and O2SAT OK never went below 94%. I don’t think I would have gotten all that info + Sleep stages from a APAP. I may be wrong though

My initial point is the family doc did his/her job in sending Caroline to a specialist. It is not the family doctors fault the patient took 5 years then decided to start treatment. How many of you have had a CPAP/APAP prescription giving by your family doctor without a sleep study? Family doctors rely on specialist for somethings.

Snooter

Offerocker · Post by **Offerocker** » Sat Jun 10, 2006 1:31 am

Due to my exasperating experiences, this is my humble recommendation:

Purchase an APAP from CPAP.COM (best price). Let it do its thing, or learn how to utilize it. You needn't do anything to receive the correct pressure.
A Rx for a CPAP machine will get you machine of your choice from them!

Control of your choice is most important here, and you won't have that from a local DME that I've heard. They usually don't work WITH the doctors or you, only an insurance company - that they can bill.

Avoid DME's - they will eat up your insurance money while providing you with outdated used machines. Use them for getting fitted for masks. Their experience is mostly in mask-fitting anyway.

rested gal · Post by **rested gal** » Sat Jun 10, 2006 3:00 am

How many of you have had a CPAP/APAP prescription giving by your family doctor without a sleep study?

Me. Used an autopap for two years before ever having a sleep study of any kind.

BTW may AHI is high, 55/Hr, duration is probably moderate 14s-mean and O2SAT OK never went below 94%. I don’t think I would have gotten all that info + Sleep stages from a APAP. I may be wrong though

You're absolutely right, Snooter, that a sleep study gives much more info than we can get from just an autopap machine.

However, if all a person has is garden variety OSA, even severe, an autopap is capable of giving most people excellent treatment.

I may be wrong, too. Have been lots of times. Luckily, I was right about putting myself on autopap. I couldn't have gotten such successful treatment with it, however, had it not been for a lot of very good advice from some message board posters.

Why is the author of the first report not on the first page BTW?

That's a PowerPoint presentation. Presumably Dr. Phillips was there at the Lung Association meeting giving the talk herself. Those were slides being shown during the presentation. Her name is on page 44.

Offerocker · Post by **Offerocker** » Sat Jun 10, 2006 4:46 am

rested gal wrote:

How many of you have had a CPAP/APAP prescription giving by your family doctor without a sleep study?

Me. Used an autopap for two years before ever having a sleep study of any kind.

Isn't that HIGHLY UNUSUAL? Did you have any data to provide to your doctor, in order that he/she was willing to do that for you?
Was your doctor more informed than most regarding sleep Apnea, in your opinion?

You're absolutely right, Snooter, that a sleep study gives much more info than we can get from just an autopap machine.

However, if all a person has is garden variety OSA, even severe, an autopap is capable of giving most people excellent treatment.

Luckily, I was right about putting myself on autopap. I couldn't have gotten such successful treatment with it, however, had it not been for a lot of very good advice from some message board posters.

AMEN TO THAT !!!

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, Prescription, AutoPAP Machine

sleepylady · Post by **sleepylady** » Sat Jun 10, 2006 8:11 am

Snooter cpap.com requires a prescription as all online suppliers do. Yes my dr. sets me up with specialists, though I have NEVER seen a sleep specialist. My dr. is the one in charge of my progress based on the sleep study I had. A dr. can prescribe an APAP for a set amount of time at the wide open pressure and then adjust it based on the information downloaded. I can say this as many, many, many have had it done on this forum and the other. Now saying all of that I can see why the dr. would refer her to a sleep specialist if that's what he had done previously.

Melinda

Guest · Post by **Guest** » Sat Jun 10, 2006 9:09 am

First I would like to say this is a pretty neat forum (seems more active than sleeptalk) and I’m learning a lot, and hope nobody takes any offense to what I say or how I present it.

sleepylady wrote: I have NEVER seen a sleep specialist.

I didn’t see the sleep specialist either, but a sleep specialist did read the test results and made recommendations and my doctor approved his recommendation.

My only point was that the family doc is relying on the sleep specialist just as they do for other maladies.

reseted gal wrote: Me. Used an autopap for two years before ever having a sleep study of any kind.

Tell use your secret….about getting your autopap that is.

Snooter

One other question. Will CPAP.com sell you a APAP if you have a prescription for a CPAP?

Guest · Post by **Guest** » Sat Jun 10, 2006 10:41 am

Hi Snooter,

What machine are you using? What mask? What's your AHI? What's your titrated pressure? How long have you been on CPAP?

rested gal · Post by **rested gal** » Sat Jun 10, 2006 12:43 pm

Offerocker wrote:
rested gal wrote:Me. Used an autopap for two years before ever having a sleep study of any kind.
Isn't that HIGHLY UNUSUAL? Did you have any data to provide to your doctor, in order that he/she was willing to do that for you?
Was your doctor more informed than most regarding sleep Apnea, in your opinion?

It's pretty unusual, yeah.

No, the doctor was hardly informed at all about sleep apnea, and knew next to nothing about the machines to treat it. No, I had no data to provide the doctor. Just my own observations about being a horrendous snorer all my life and what that most likely meant.

Snooter wrote:Tell use your secret….about getting your autopap that is.

About three years ago, I simply called the old family doctor on the phone, spent less than a minute describing why I thought I had sleep apnea and how I wanted to treat it. Asked him if he would write me a prescription for an "autopap." He said yes. Trusted my judgement, I suppose.

He asked me to tell him exactly what I wanted the Rx to say and faxed it to me. I faxed the Rx to an online cpap supply company, chose what I wanted, paid for it myself and have been well treated ever since. Some links to my story:

Aug 16, 2005 subject: sleep or lack thereof

Jan 25, 2005 subject: not diagnosed yet, many ? brand new here

Nov 19, 2005 subject: First Sleep Study...finally! - rested gal

Not the ideal way to go about it...better to have a sleep study first. As an uninsured person, though, I decided to research everything I could find about sleep apnea and go the self-treatment route. Worked for me.

chdurie2 · Post by **chdurie2** » Sat Jun 10, 2006 1:00 pm

rested gal:

i think the most important thing you said there, beyond your ability to accurately self-diagnose and research, is that you had an old family doctor who trusted your judgment. that is such a biggie.

before the necessity of having an hmo came along, several years ago when i could afford private insurance, i had one doctor, a gynocologist, who knew me and trusted my judgment. i've had others, but in these days of de-humanized hmos, i get treated like a number, so i don't go to a doctor unless i have to, and there's no rapport there. plus, there are huge numbers of doctors who treat patients like idiots even if you do go more frequently.

you guys have convinced me to try to find someone with whom i don't feel so impersonally. but it's unfortunate that they're so hard to find. over the years, i find that it's increasingly rare to find someone spontaneously saying that they really like their doctor or even giving a good recommendation about a doctor.

caroline

rested gal · Post by **rested gal** » Sat Jun 10, 2006 1:10 pm

chdurie2 wrote:you had an old family doctor who trusted your judgment. that is such a biggie.

Actually, I should clarify. I had never been to the old family doc myself. Wasn't one of his patients. Have been disgustingly healthy all my life.

He had been the primary care physician for my grandparents on both sides, and my parents. He knew the family well. He knew me only through my having accompanied my father to some appointments.

There are some perks to growing up in a small town where people knew each other.

chdurie2 · Post by **chdurie2** » Sat Jun 10, 2006 4:44 pm

rg:

so it's little rg wants an apap, does she? even cooler! are there any more of those docs around? i don't think so. if so, please point me in that direction.

my father's doc was terrific. he was an older doc, near retirement, as was my dad. i went to him for a while when i was in my early 20s, which was 30 years ago. i remember my father telling me i needed to get my own doc so that i could build my own lifetime relationship with a doc, because i would likely far outlive this guy. he did die a few years later, but a lifetime relationship with a doc has been just wishful thinking for me.

such is the world, i think, or at least, my world.

caroline

DME_Guy · Post by **DME_Guy** » Sat Jun 10, 2006 5:01 pm

Kaiser has. My brother was recently given a simple in-home study and then given a Remstar Auto to titrate him after one night of use. Of course he has connections so he's using a new Remstar Auto every night. I told him he can sale the basic Remstar or Remstar Plus (no C-flex) that Apria will give him.

I'd take an auto CPAP with no sleep study over a fixed CPAP with a sleep study.

Anonymous wrote:
If these studies are true, why has the insurance companies picked up on it? They could just tell the doctors to send their suspected patients home with a APAP and tell them to return the flashcard after a month of using it and get all the information they need. This could save the insurance companies big money.

Snooter

Wulfman · Post by **Wulfman** » Sat Jun 10, 2006 5:44 pm

One other question. Will CPAP.com sell you a APAP if you have a prescription for a CPAP?

YEP! It'll come configured as a CPAP at your prescribed pressure, but then you can go from there.....

Den

chdurie2 · Post by **chdurie2** » Sat Jun 10, 2006 8:09 pm

rested gal:

if you got an apap without a sleep study, then why did you do the 3-day intensive sleep study? I'm not putting you on the proverbial witness stand. I'm just curious.

you were the one who, when i pulled out my numbers from my old sleep study, said that i might benefit from a new study because the numbers suggest issues that may be better resolved by new technology or by compiance. you said the question was my comfort with the expertise of the sleep doc. i think the sleep doc is excellent.

i'm okay about the whole thing now. i can see that there may be issues. in my heart of hearts, i saw that when i realized those were mostly csa, not osa, numbers. on the one hand, if apap around my current level is the answer, then the sleep study will have been a waste of time. on the other hand, a machine without addressing other issues, if they can be addressed, is shortsighted.

from the sleep doc's point of view, he thought he had a borderline narcoleptic on his hands that he decided to treat using cpap because of minor apnea. i disappear and come back five years later and tell him that whatever the problem is, cpap is working pretty well for me and i want it to work better. further, they titrated me with a nasal mask, and i slept through the nite. i'm not sure you could titrate me today with a nasal mask because i have too much trouble breathing before i fall asleep, and a ton of junk up my nose, prescription or non-prescription, isn't really helping. (one caveat--the flonase does not work but the rhino-cort might work better.) So if nothing else, he wants to see what's going on.

the sleep doc didn't say he wouldn't give me an apap--he just said not without a current baseline. and i didn't realize he would do it with the cpap machine and full-face mask. that makes a big difference to me. my sleep study traumas were all pre-cpap. the titration sleep study was a breeze. i think i will get my apap, and i think insurance will pay. my impression is that this doctor gets what he wants from the insurance company.

as i'm writing this, my only question is whether the hmo pays for all of my sleep study. i didn't think of that. to be continued...

but getting back to my question to rested gal, why did you do your 3-day sleep study after apap?

thanks.

caroline

rested gal · Post by **rested gal** » Sat Jun 10, 2006 9:37 pm

chdurie2 wrote:rested gal:
if you got an apap without a sleep study, then why did you do the 3-day intensive sleep study? I'm not putting you on the proverbial witness stand. I'm just curious.

Main reason was...'cause I could get the study free -- getting to be the lab rat for a fully accredited sleep lab to test their equipment after they moved everything to a new wing of the hospital. A most generous offer that I jumped at.

I was curious after years of having read so much about other people's sleep study experiences....curious to see what it would be like to have one myself. Curious to know what a full PSG would turn up. Most of all, I thought it would be fun. And it was. Especially since I got to see my results the very next day, explained in detail before the next night's study. Great learning experience.

Already knew the lab manager through the message boards and was confident that it would be a good, sound study by RPSGT/RT credentialed people who absolutely knew what they were doing.

Might not have been "fun" had I not already been very comfortable with cpap treatment. Took my own deconstructed Aura mask with me, my PAPillow, my tape, my scrunchy to hang the hose up....LOL! Felt like home by the time I had built my nest each night.

chdurie2 wrote:you were the one who, when i pulled out my numbers from my old sleep study, said that i might benefit from a new study because the numbers suggest issues that may be better resolved by new technology or by compiance. you said the question was my comfort with the expertise of the sleep doc. i think the sleep doc is excellent.

Sure that wasn't someone else? I don't remember saying that, but then my memory isn't the best by a long shot.

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