Article on Patient Population for APAP

Hi friends, New to board and on APAP for 5 months. I found the article in today's news in header very interesting. I have an appointment in three weeks with new sleep doctor and wanted to cover as many talking points as I can squeeze in during the visit. My adult daughter, my cousin and a friend all have sleep apnea but with very different medical problems and AHIs. We all received a prescription of APAP 4 or 5 -20. Each of us has been told our numbers are good (good enough), our compliance excellent and goodbye see you in 6 months. I can see that this board advocates learning all about our sleep apnea, working with the software and tweaking numbers for better results. I am all for that as I have developed quite a bit of cynicism regarding sleep medicine professionals. However, shouldn't the doctors have some responsibility according to the article above and take an active role in doing more than here is you APAP with the default settings? Thanks for any input.

There doesn't seem to be a link to the article...

http://www.sleepreviewmag.com/2016/03/4 ... ions-apap/

Having used apap after using straight cpap for several months,
the apap seemed to eliminate most of my aerophagia.
This might not work for everyone, but it made one frog more comfy.

(I had my news box turned off, and I had to turn it back on under my board preferences under my user control panel)

Doctors DO have the responsibility but for the lousy ones, there's nobody to hold their feet to the fire. That's one of the benefits of keeping patients literally and figuratively in the dark.

There are two types of doctors who go into sleep medicine: those with a burning passion to truly help patients and those who see sleep medicine as a money making machine with as little patient contact as possible. Medicare has to actually require patient contact in sleep medicine--before that it wasn't happening in most cases. I don't think Medicare has to require patient contact in too many other areas of practice. The doctors who truly care about their patients in sleep medicine are exceedingly rare.

I'm done with expecting doctors to do the right thing in areas like sleep medicine. They are essentially businessmen, and my health concerns don't necessarily jive with their motive for profit. Many of us (me included) have never even met the sleep doctor supposedly responsible for my sleep apnea care. So I have taken back MY health. I'm in charge, not them. I have run of the mill OSA, it's not rocket science. I need the occasional RX for equipment or supplies, beyond that I'm in charge.

marnne108 wrote: I have an appointment in three weeks with new sleep doctor and wanted to cover as many talking points as I can squeeze in during the visit ... received a prescription of APAP 4 or 5 -20.

Nothing wrong with working with the doctors to manage your care - IF your doctor is one who is truly appreciative of your data. I would not trust a generic statement of "you're doing good" as that means different things to different people. To some, doing good simply means you are meeting the minimum use required by insurance. I am an advocate for getting software and monitoring ones own data, but I had a friend who really wasn't comfortable with that. Her life was quite complicated with multiple serious heath issues and it was more practical for her to lean on the doctor. Regardless of how you handle things in the future, I have a bit of input to consider for discussion in your upcoming visit.

1. Are you comfortable with the low end of your pressure range, meaning is your breathing comfortable when starting or do you feel short of breath or unable to relax and fall asleep? Some need to increase the starting pressure.
2. If you are still having several events during the night, increasing the lower number can often be a preventative measure.
3. Keep in mind when your machine detects a need to increase pressure, the rise in pressure is methodical and incremental, so not always fast enough to prevent an event. Increasing the lower end of your pressure can mean it doesn't have so far to climb to meet your needs. Find out what your usual pressure needs are during the night. If it's more than a few digits over your starting pressure, you'll likely do better with an increase of the lower pressure.
4. Is your doctor monitoring your data over the internet or reading your data card when you go in? They need to be quoting you numbers from your data when you ask questions. If they do not have detailed data in front of them to discuss, that's a red flag.

The author of the article doesn't seem to know that Auto Bilevel is an option, and seems to present APAP as even superior to bilevel. Some of the wording of the article is really awkward, like how he talks about people with positional or REM OSA having the option of APAP being superior so that they won't get positive pressure on their side or in non-REM sleep. Sorry, it's not like the APAP is going to turn itself off because you're on your side! You're still getting PAP, just at a lower level- which might actually spur air hunger.

Overall, his four groups of people (really five) that may specifically benefit from APAP make sense. I fit into three (two?) of them- my OSA is mild, and I only have OSA at all when I'm on my back, in REM sleep. Looking at back and REM sleep, my AHI jumps to severe. So APAP made sense for me.

He also fails to mention that APAP costs essentially the same as a data capable CPAP, and can function like a CPAP- so why not?

Many people on CPAPtalk have reported NEVER meeting their sleep doctor, let alone working with their doctor. They just deal with physician's assistants, sleep lab techs and front desk people. That's a good sign you are probably caught in a 'money sucking machine'. I know when I had my colonoscopy I never met the doctor except in a haze of drugs for one minute right before the camera went six feet up my butt. I'd just dealt with a PA for the initial visit. At least my doctor was there for the camera work!

Thanks everyone for your responses and insights. I will compile some of my own data to take to the doctor. I have both obstructive and central apneas with o2 desaturations. Since I also have heart disease and my cardiologist wants the sleep doctor to send him a complete report, maybe he will be compelled to pay attention to me. Either way, this board has convinced me that I need to be in charge of my treatment. I am 100% committed to cpap treatment and expected my doctor to at least show some interest in my treatment and not just what kind of insurance I have.

BRAVO...well said

marnne108 wrote:However, shouldn't the doctors have some responsibility according to the article above and take an active role in doing more than here is you APAP with the default settings?

You (and I) would not want to pay for it.

marnne108 wrote:this board has convinced me that I need to be in charge of my treatment.

If you want the best treatment, that is the way to do it.

Your doctor can't be there seven days a week to look at your data to see, for example, if your mask had excess leak the previous night. You can.

You seem to be a take-charge type. You should do well.

Janknitz wrote:Doctors DO have the responsibility but for the lousy ones, there's nobody to hold their feet to the fire. That's one of the benefits of keeping patients literally and figuratively in the dark.

There are two types of doctors who go into sleep medicine: those with a burning passion to truly help patients and those who see sleep medicine as a money making machine with as little patient contact as possible. Medicare has to actually require patient contact in sleep medicine--before that it wasn't happening in most cases. I don't think Medicare has to require patient contact in too many other areas of practice. The doctors who truly care about their patients in sleep medicine are exceedingly rare.

I'm done with expecting doctors to do the right thing in areas like sleep medicine. They are essentially businessmen, and my health concerns don't necessarily jive with their motive for profit. Many of us (me included) have never even met the sleep doctor supposedly responsible for my sleep apnea care. So I have taken back MY health. I'm in charge, not them. I have run of the mill OSA, it's not rocket science. I need the occasional RX for equipment or supplies, beyond that I'm in charge.

+1

Finally, I have an appointment this week with a new sleep doctor that friends and family use and like. My first sleep doctor was useless. I just downloaded my info to Sleepyhead for the first time from my DreamStation...wow! I will figure out how to post the screenshots soon. In the meantime, which reports and how many of the 5 months that I have should I print out and take to new doc? I want to take enough to show him what is going on but not so much that he falls asleep himself. My main complaints are that, I am having 02 desaturations (from recording oximetry), more hypopneas and centrals than obstructive apneas and don't feel well rested even though I always sleep with the CPAP on and am able to get @ least 8 hours of sleep per night. Any help would appreciated.

marnne108 wrote:Finally, I have an appointment this week with a new sleep doctor that friends and family use and like. My first sleep doctor was useless. I just downloaded my info to Sleepyhead for the first time from my DreamStation...wow! I will figure out how to post the screenshots soon. In the meantime, which reports and how many of the 5 months that I have should I print out and take to new doc? I want to take enough to show him what is going on but not so much that he falls asleep himself. My main complaints are that, I am having 02 desaturations (from recording oximetry), more hypopneas and centrals than obstructive apneas and don't feel well rested even though I always sleep with the CPAP on and am able to get @ least 8 hours of sleep per night. Any help would appreciated.

You might want to start a new thread for this question. I think you would get more replies.

Thanks! I'm still getting use to this board.