Had a lovely visit with my Sleep Doc this afternoon

So it was my third follow-up visit with my Sleep Doc this afternoon. We chatted a while about restless legs, and blood pressure, and this and that, and it was all very jolly.

And then I said listen, we've got a bunch of stuff to talk about, and she said "Oh," and I pulled out my ream of charts and figures and what-not from Encore Pro, and I said "I bought a RemStar Auto with C-Flex". and she said "That's nice, what is C-Flex?". So I told her that I was having a problem exhaling against the pressure of CPAP, and she said, "Well, let's get you a bipap" and I just sighed, and told her about C-Flex and she said "I must tell my boss about this". Sigh again.

So I said let's talk about my diagnosis and titration. I said, you told me that I was having more than 30 apneas/hour, and yet I see very very few on my Encore Pro reports. So she dug out the initial study and we looked: zero apneas. So she dug out the titration study and we looked: zero apneas. So I asked her why she told me I was having 30/hour and she said" You had hyponeas", and I said why did you call them apneas, and she said "Most patients don't know the difference between hypopneas and apneas, so we just call them all apneas. Anyway a hypopnea is almost an apnea." So I sighed again.

So I said let's talk about my titration. She looked at her records and said, "Well you're a bit of a strange case." I said that's what they all say, but how so in this instance, and she said "Well, we started you at four, and your hyponeas decreased with pressure, and we settled at eleven, but an hour before the end of your study the hyponeas started up again but we didn't have time to retitrate you so we decided to set you at 12." I said that's nice, but you never found out what was happening and she said no. And then she said "We could probably set you at a lower pressure if you wish", and I said "AutoPAP, remember? Self-titrating, automatic, adjusts itself.... no need to define a set pressure." She said "Well, it might make it easier for you to breathe", and I mumbled through a sigh "C-Flex".

She said "Can I keep all those lovely charts and what-nots, I want to show them to the RT's and my boss", and I said sure, there's more where those came from.

And then she said "When can I see you again?", and I said we really have to stop meeting like this, my wife is getting suspicious. She said, "Well I can wait a year", and I tried to break it to her gently and said I would call her in a year's time.

I excused myself, walked slowly to my car and thought "Gimme a break..."

derek

You are going to send her a bill, right?

What does she really do for a living... if sleep medicine is but a passing hobby?

Derek,

You did say sleep DOC? Does this person actually have a medical degree? Is it from Barbados? WOW! I would never go back to her again. Atleast you get an appology from me about your "I don't have apnea" signature. You may be the first on the forum to OSH. Obstructive Sleep Hypopnia!

Don't leave us though, we like having you here.

And then she said "We could probably set you at a lower pressure if you wish"

LOL!! Well, so much for that all important NOT TO BE TAMPERED WITH BY THE PATIENT....... magic (reverent tone) PRESSURE that the sleep lab charges thousands of dollars to find for you... and the doctor charges out the ying-yang to prescribe for you.

"could, probably, if you wish" - "Hey, patient... what pressure would you like to have? And would you like fries with that?"

Derek, what a story! LOL!! I am sooooo glad I have an autopap. I know you're glad you have one, too!

I'm laughing at the story and the way you told it, but seriously; just think of the elderly and the people who don't know about apnea message boards....the thousands of sleep apnea sufferers who are trying their best to do what the doctor says and "comply" - but simply have to give up.

People,
My post was tongue-in-cheek because I could see the (almost) funny side to it, but there are serious issues here.
We did, of course, discuss issues in greater depth than I indicated above. The doc comes from the Neurology Department of a very well known hospital, but her specialty is not sleep medicine. She spends one day/week at the sleep lab I have been attending. As a person I like her a lot, and we have had some good conversations in the past about common research interests etc.

She said I was having frequent "arousals" during the night. (wifey might be interested in this fact ) and that they prescribed CPAP to take care of that. There was no O2 desaturation, and everything was hypopneas.

However, I now have more questions than answers. I intend to contact my primary physician today and ask for an evaluation at a different facility.

- I know I have had a sleep disorder for years (that's what drove me to the initial study)
- I have definitely been sleeping better since starting xPAP. My wife says I am much more peaceful in bed.
- I apparently do not have an apnea problem.
- I have hypopneas, but these went largely untreated at the level used in the titration study (I also observe this in the Encore Pro records - they come in bursts at all pressures)
- The big question is: what is xPAP doing for me? It's obviously helping, but how? It's not reducing/eliminating apneas since they are insignificant; it seems to be reducing hypopneas slightly. My AHI this morning was 0.4. Some of you might remember that with CPAP at 5 cm, the AHI was 3.3 (with no apneas).

I intend to continue on the AutoPAP until I resolve these issues, in fact I ordered an Activa mask last night. But, I do intend to get to the bottom of the issue. I'll be sticking around here, and will bore you all with progress reports.

Best wishes,
derek

I sent a long email to my regular doc before leaving for work this morning.

There was a reply already when I got here, in which he said he was really confused also, because the report he received also has the "a" word to describe my condition!

He, very reasonably, said that he will contact the sleep doc and discuss the issues, and then we will decide whether to seek another opinion.

derek
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I got OSH -- b'gosh!

derek,

Thank you for the great post!

I'm going back to my pulminologist Tue. to have a real discussion with him, (never went back after my sleep study) just relied on the RT from the DME.

I know.....I know.........but I didn't know about this board, or anything else to do with OSA, so I just followed orders like a good little sheep.

Well after 1-1/2 years of struggling with this.......I found "cpaptalk.com"

Believe me, things will be different at the docs office this time or I will have a new pulminologist. I can't wait to start talking to him about obstructive apneas, hypopneas, central apneas, and why is my pressure set where it is...etc....etc!

Thanks again, derek!

and all of the others on this site that are so much smarter than me.