What Should I Ask Sleep Medicine Doctor on First Visit

[tmr]

You cant be sure about not having apnea while side sleeping, it usually more severe on back. The Autoset is full data capable , you can check the data with software. The cpap pressure is really low, it wont even inflate a balloon at max setting.

[jaycee2]

Good to know. Thanks.

[purple]

A well run sleep study by competent people is more likely to find the right titration pressure than using a machine on auto, and find other sleep issues as well.

You might have the option to have a split night study, that is, the first part of the night in proving you have sleep apnea, the second half in doing a titration study, finding the right pressures for you. You might ask your doc about the advisability of doing a split night study, (might also save money) Also might avoid your having to go back for a second night.

Realize that you do not have to sleep much during the night for the study to successfully get accurate numbers for you. In fact, you probably will not sleep much. You would not be the first person who came back here to say you had the sleep study from hell.

From my own experience. First use of sleep apnea equipment feels like one is trying to breathe in the face of a hurricane. After three weeks, you will think the machine is blowing with such slow force that you will swear the machine must be broken. It is a matter of perception and getting used to machine.

Tell the doctors you fears about the process, and about using sleep apnea equipment. The sleep docs I have met all love to talk about how to deal with problems, and only need a little prompting. Realize that what seems to be an off hand comment from a doctor can often be gold in terms of adjustment, use of the machine. It is what the experienced docs bring to the table.

Most sleep docs, clinics maintain a list of DME's in your area, and a rating from other patients as to the different DME's stack up against one another. Try to get that list. You may be forced to use one DME by your insurer. It is best to call your insurance company yourself, and find out their exact rules.

Read the excellent post by JanKnitz about what you need to know before you meet your DME. http://maskarrayed.wordpress.com/what-y ... me-part-i/

However, my experience is that I have only had excellent sleep doctors, and honest, helpful DME's. Part of how I see DME's is that they do some things in some ways which, to a newcomer, seems wrong headed. When you first call them, they will try to sign you and get you to sign papers, give your info. Not talk to you about prices. Truth is, the local DME does not have anything to do with prices, they will honestly tell you that is more about what your insurance company does than them. Besides, I never met one that cared. They tried to be helpful to me, not worry about the profit of the company. Be like they say, "wise as a serpent, innocent as a dove." As the blog will say, you want a machine which gives full data, not just compliance data (which only proves you are using the machine so the insurance company will pay them). The ones I have dealt with allow one to swap to different masks as much as one wants during the first thirty day period. Make sure you know what the DME you are getting has as a policy for this.

FYI: Sleeping on ones back is the most difficult for most sleep apnea patients. When the power goes out, some sleep apnea patients do OK by sleeping sitting up, but probably not on ones back, as in a recliner. What ever works for you.

I strongly suspect that ones Fibromyalgia can improve with sleep apnea treatment, as can a number of other problems. Some of us are also Diabetics, I am guessing you have been screened for Diabetes as well. I believe that my Diabetes has improved because of better sleep. However, it does not happen the first night. Be aware that a large percentage of people who have a sleep study, and get a machine quit because of the frustration. You have to be prepared that not all of this is easy. For me, it was like coming back to life again. I went from waking up thinking it can not be time to get up yet, to after treatment, waking up thinking of all the things I can today. Best wishes

[jaycee2]

Thanks, purple. I wondered about self-treating with an Apap before getting a sleep study. It seems that there are some folks on this board who do that so I see that it can be done. But what if I have more than OSA? It seems overwhelming at the moment!

[Pugsy]

But what if I have more than OSA?

What if all you have is plain jane vanilla OSA that is easily managed and you take to therapy like a duck to water?

Just because someone elects to try the DIY route doesn't mean that they are banned from going down the traditional route should problems develop or things not work out so great.

You have access to a S9 AutoSet that isn't being used? You don't even have to gamble on buying a machine.
If you don't like the masks that your husband has there are ways to get others to try without breaking the bank.

[palerider]

But what if I have more than OSA? It seems overwhelming at the moment!

you take it a step at a time.

try the autoset, let it work it's magic for a night and then check the data.

make adjustments.

if you end up with no problems, great! statistically, you''re much more likely to need nothing more... if you're one of the people that need more, then you'll have some data, and knowledge, of what you need, as opposed to just being faced with the huge nebulous what ifs!??!?!!

[jaycee2]

But what if I have more than OSA?

What if all you have is plain jane vanilla OSA that is easily managed and you take to therapy like a duck to water?

Just because someone elects to try the DIY route doesn't mean that they are banned from going down the traditional route should problems develop or things not work out so great.

You have access to a S9 AutoSet that isn't being used? You don't even have to gamble on buying a machine.
If you don't like the masks that your husband has there are ways to get others to try without breaking the bank.

Great, Pugsy! Is there a way to access data without using Sleepyhead? Let's just say that am not very computer literate.

[Guest]

Is there a way to access data without using Sleepyhead? Let's just say that am not very computer literate.

There is on the resmeds but the software is much more accurate. Im sure Pugsy will give you more details but yea you should give it a go either way. Can hubby help with software?

[palerider]

Great, Pugsy! Is there a way to access data without using Sleepyhead? Let's just say that am not very computer literate.

you can use the official resmed software, remscan, but it's much less friendly.... it's made for doctors offices with boatloads of patients.

[Pugsy]

There is data available on the S9 AutoSet LCD screen but doesn't give as clear of a picture as I would prefer if I were going the DIY route.

[sleepy1235]

So I would like to propose these criteria for consideration.

1. If the doctor is going to request a sleep study, ask him for a copy of the written protocol of the test and what it is based upon. In regards to what it is based upon I mean from which medical papers was it derived. Preferably it should be a standard protocol that has a name and reference number. They have been published. http://www.aasmnet.org/resources/clinic ... 040210.pdf

If the doctor doesn't have a written protocol you can stop the discussion right there and leave.

2. Ask your doctor your doctor what he or she expects to learn from the study. Is it just going to be the pressure that your apneas disappear? Is there going to be considered Respiratory Effort Related Arosuals (RERA) due to upper airway resistance syndrome? What about flow limitation related arousals?

3. Ask what type of result and report you will receive after the sleep study. Just getting a pressure setting isn't enough. Ask if the report will be in writing. It is important that you get the report, because the next sleep doctor will want to see it.

4. Insist that the CPAP machine be data recording. Not just the hours of sleep you used it, but detailed data. Ask the doctor what data does it record and what statistics it provides.

5. Ask about how the CPAP machine is chosen and the range of choices. If the range of choices is just one brand, inquire why. The doctor, the sleep center, medical institution might have some deal with a single brand locking them in. Ask them if there is this type of agreement.

6. Ask what the options are for purchasing the CPAP yourself through a supplier you find.

7. Ask about the follow up. When you get your CPAP, or maybe just a new setting, how will effectiveness of treatment be assessed? How long will it take to have an impact? If "sleep debt" is brought up, at what point will this will definitely ruled out as an issue if you still feel sleepy?

What will be the action taken if in the period in which the treatment is expected to be effective isn't working?

What is the doctor's plan to get you from point A (sleepy) to point Z (rested).

To you the goal is feeling rested, and if this isn't the doctors objective then I think there is a problem. The goal isn't to get a pressure for a CPAP machine, or to get a CPAP machine, or do a sleep study. The goal is to get a good night's sleep. The doctor should be clear at this.


If during your questioning you get a dismissive attitude or the attitude that "I am the doctor and you are the patient" get another doctor.

In particular watch out for the "sleep is mysterious" attitude. Yes, scientists are very challenged by the phenomenon of sleep, but either the doctor is effective or not and either you are going to get a good night's sleep or not. This "sleep is mysterious" attitude is often an excuse in which the doctor feels that he or she isn't accountable for a positive outcome.

I think that sleep treatment could be much better if patients raised their expectations.

Perhaps there should be a sleep doctor assessment document made up.

Additionally:
if it comes to the point later where an additional sleep study is proposed, that is a 2nd sleep study I think some things should be asked.

1. Why was the first sleep study inadequate such a 2nd sleep study was necessary?

2. If a 2nd sleep study is going to be done, what will be done so that a 3rd sleep study isn't necessary.
Additionally, I think the sleep doctor should be knowledgeable on how CPAP machines implements the therapy.

A pressure is just a number until the CPAP machine applies it to you. The nurses should also know how the machines work and the implications of the set ups.

The doctor needs to be familiar with all of the different kinds of machine - CPAP, APAP, BiPAP, AutoBiPAP, ASV - and when each one is appropriate, keeping in mind the restrictions placed by many insurance companies that a patient needs to "fail" with each level before they can move to the next (except for CPAP to APAP, which are the same supplier code).

Also, you need to ask the doctor if you can do a home sleep study if the first one in the lab fails (or if you have good reasons for wanting to do one at home). The doc needs to explain why you need an overnight PSG if he thinks you do need one.

[jaycee2]

Thank you for all the suggestions on what to ask the Sleep Medicine doctor on my first visit. It intend to print these out and take them with me.

On the topic of DIY, I have use of a Quattrro FX size medium. If I want to try another size or model, how do I get my hands on one without a doctor? This morning when I woke up I felt exhausted and breathless, not a great way to start the day as many here have no doubt experienced.

I am so glad that I found this board.

[Guest]

I have use of a Quattrro FX size medium. If I want to try another size or model, how do I get my hands on one without a doctor?

Search Craigslist for a mask. Check ebay too.

Start a NOTEBOOK with questions or notes for yourself about things such as how you feel or other things to jog your memory when with the doc. Make notes daily.

[Pugsy]

If I want to try another size or model, how do I get my hands on one without a doctor?

Do you have a copy of your husband's cpap RX? If you do you can use it to order online from cpap.com.

Do you have to use a full face mask like the Quattro FX or do you think you can breath through your nose well enough to use a nasal mask of some sort?

Replacement mask parts don't require a RX but complete mask packages do if ordering from online supplier. You can buy the replacement parts and build your own mask as long as you know which parts to get. Depending on which mask...EBay can be a good source especially for nasal pillow or nasal cushion masks. Just have to know which parts you need.

Sometimes your local Craigslist might have someone selling a mask you could use. Sort of depends on where you live. Where I live...masks aren't very plentiful from Craigslist.

[tmr]

I use this site, 1800cpap.com . If you buy the mask and headgear separately, you should have no problem.