sleep doctor

Hi everyone I am new to the site. I have had gastric bypass july 20 2007 I have been on sleep machine since may with mild apena. long story short i have gone from 12 to 7 and the doctor wants me to have another sleep study to see if i neeed the machine anymore, has anyone ever hear of having the sleep study at night and then have one all day long.. that is what he wants me to do, we got into a heated arguement and i asked for second opoinion. my pcp has not got copy of any sleep study until today when i asked them to send it to them.im have alot of problem wiht the doc has anyone esle ever had problem with there doc
Barb

Is the day test the MSLT (Multiple Sleep Latency Test)? AKA the nap test. You can do a search on MSLT and it'll explain it.

The other thing that they sometimes do is a titration... depending on if you're used to sleeping days or not.

Oh, yeah, many here haven't just had problems w/their sleep doctor, many here have never even MET or SEEN their "sleep doctor"! For many the "sleep doctor" is some faceless entity off in another world inaccessable to them who just dictates the results of their sleep and titration study(ies) and sends them on to the referring doctor to deal with.

Since you've given us the impression your "sleep doctor" has suggested both another overnight sleep/titration study AND a daytime sleep study it sounds like you are still tired and exhausted despite the use of xPAP and he suspects that you may have narcolepsy. Daytime sleep studies are not that usual for a sleep doctor to order so I'm sure that, like him or not, he has a valid reason for suggesting one. And my understanding is that insurances will NOT pay for a daytime sleep study unless one has first (and recently) gone thru an overnight sleep/titration study.

To satisfy your own curiosity send a letter to the sleep lab and request a copy of the full summary data report including graphs (about 5-6 pages each) and of the dictated results (about 1-2 pages each) for all of your sleep studies and all of your titration studies. There are a part of your medical records and (if you are in the USA) you have a legal right to a copy of all your medical records under HIPAA. They "can" legally charge you a "reasonable" fee so if your referring or family doctor is willing, have the copies sent to him/her (medical facilities seldom charge a fee to send reports to fellow medical professionals as a courtesy thing).

I have not been tired at all during the day or the night. they doctor just wont listen to me when i tell him i sleep less wearing the machine then when i do not. I have just recieved a copy of both sleep studies and the vartable machine results.

Where do i put my results to get some imput. i have lost 53lbs gone from 230 to 180 i feel really good and sleep really well at night dont even wake up any more.. he doesnt want to hear that

Barb,
Down from 12 to 7 what? AHI ? cms of pressure? And how do you know that?

And what is it you got into an argument about with the doc? The repeated study, or the additional day study?

I get the impression that you want to stop the cpap treatment, but don't want to do that without the doctor's approval. And the doctor - being a doctor - doesn't want to make that decision without a repeated sleep study. Which - certainly as far as the night study goes - sounds to me professional and responsible. He is listening to you - that's why he suggests a repeat sleep study.

You seem to be saying: "Hey, I lost weight, I don't have the symptoms, I don't need the machine any more". So where do you see a problem? Why do you want your doctor to agree you should stop, without a repeat study? And - not that I recommend this course of action - wyh but didn't you just stop? Why did you join our forum now, when you're convinced you can quit the therapy?

When you say "I sleep less wearing the machine" do you mean now, after your weight loss - or ever since you got the machine?


You can post the results right here.

O.

Barb,

If I interpret this correctly, it is your pre weight loss reports you've just received, and that you haven't yet had the suggested followup studies. As far as the nap study, have you asked him to explain to you why he feels it is a necessary test?

But as far as the overnight study based on your post weight loss needs, it is the responsible thing for him to recommend. Too often patients have felt so bad for so long, they interpret better to be good. Anyone who has either had a large weigh loss or surgery and feel their apnea is gone, it should be substantiated by fact.

An easier way would be to ask for a loaner autotitrating machine to use for a couple weeks. It will have data to show if you have events or not. (Unless you already have a data capable machine, in which case you could set the pressure lower and see if it then records events.) Another way to spot check is to have your oxygen monitored overnite.

If you had mild apnea in the first place, there's a good chance your weight loss did take care of it. It's just too important to not know for sure.

Congratulations on your new life without the health damaging weight. Let us know how this pans out.

Kathy

the only reason the doctor is doing the third sleep study is because i incisted on having it..He did not want to do one..he said i did not need to do third study. But we are now doing one. after I left his office 3 days later his office called and wanted to change the sleep study date and time so I could do one at night and stay the following day. He never told me about this and never explained why, the other day he called and just said this is what we need to do. I asked why and his only response was because I want to see how tired you are during the day.
I got mad at that point and said why didnt you talk to me about this test when I was there and he said he forgot,, forgot heck, he was just mad I wanted the 3rd study done since the weight loss..
I have to get a doctors release from the cpap machine because I am a busdriver and want to do the right thing and not just quit. I will lose my license from a job i really love.. I want to do what is right but i guess we just dont see eye to eye, It was my idea not his to do the 3rd sleep study but he did order and left it alone after the agrument.

I have also asked for other test like the auto machine and the oxygen level monitor and he said I dont need it.. so what do I do but seek another opinion..

The reason I joined the forum was because I wanted to know if it was just me having problems with my doctor or if other people do indeed have issues with doctors.. I really wanted to get some help and people opionion.The doctor is a pulinalist (spelling) not the doctor that read the results.


results of 1st sleep study read as follows( with no mask )
93.4% sleep effiiency was normal
predominant sleep stage was 2, deepsleep was wll represent at 5.3
rem sleep was 17.6 of normal Lightly reduced but cycled normally throught the night. 21.8% slep on back
48% on right side
30% on left side
15.6% arousal incex was slightly elevated
38% of the arousal wer due to respiratory events the est were spontaneous. 61-93 heart rate varriedin a normal band
14 obstructive apneas and 45 obstructive hypopneaus. they occureed during Remsleep,which is why she did not meet criteria to split. the patient had clearly more events when sleeping on supine than on her side. Non Rem side wa 3 on rem back was 8.6 Rem sidwas19.8 rem back 54.5
there was prominent destauration suring these events sesaturated only briefly lsudring one Rem period to 75%. the patient did not spend that much time below 90% only 19.6 minutes. There were no cardiac arrhythmias. there was some mild snoring. there were no significant periodic leg movements.
assement: The patient with mild obstrctive sleep apena on the basis of number of events per hour of sleep. they appeared to be aggravated by position and certainly by REM sleep, but there wa rather dramatic desaturation. In light of hte dramatic desauration and bldy positioning> I strongly consider nasal cpap particlarly if gastric bypass is being contempled. other condiseration are wieght reduction, body position, Ent evaluation the patient should be counsled in terms of driver saftey and sleep hygien.

2nd study results
For this study patient was used a full Resmed medium sized mask.,overal sleep efficiency was normal 93.4% sleep staging was relatively nrmal as well with prdominantly stge 2 sleep was 52%significant amout of deep sleep at 15.6 % of sleep and normal amount of Rem at 22.6% of sleep which cycled normal throught the night, Patient sleep on her back 48% of the time and then split between her left sid and right side. patient had nrmal sleep latency, arousal index was slight ly elevated at 16,. of the arousal 32%were due to respiratory events. the rest weer spontaneous heart rate caried in a normal band. there was no significantdesaturation noted that was not artifacual. patient had a small number of respiratory events. she had 16 obstructive apnea 4 mixed 1 cent4ral 37 hypopneas, overall the apnea/hypapneaindex was 8.5 patient seemed todo very well n 13cm she had 30 minutes of study time slept during Rrem and supine sleep. the apnea/hyplpnea index wentto zero. on 14cm ther esemed to be moredifficult with events. I wonder if there may have been some mask leaking. onthe basis this information would probably start the patient at 13cm and assess clinical response.

That is the result of both sleep study hope someone can explain to me.. I really dont want to be difficult because he never explained it to me..
thanks
Barb

Sounds as if you have pissed off your doctor. My suggestion would be to talk with him and get it out of the air OR find a new sleep doctor.

Anonymous wrote:Sounds as if you have pissed off your doctor. My suggestion would be to talk with him and get it out of the air OR find a new sleep doctor.

If you look at his folder you will probably see the initials AH and you will continue to get this treatment every time that you see this guy.

Ok Barb, I'm glad you responded with so much detail. And I understand why you want the doctor to let you off cpap formaly.

Let's separate the "what" he did from the "how". The "how" was infuriating, and not fair. His refusal to let you try an automatic machine, and refusal to measure your oxygen at night is beyond my understaning, could be part of his power plays with you.
However, most of the what does make sense to me.

Since you are a bus driver, and want to stop using cpap, it does make sense for the doctor to want to see how tired you are during the day - he can't let you off cpap on your say so - because the lives of many other people depend on your wakefulness - it is better for all sides to prove that you are indeed as wide awake as necessary, and as wide awake as you think.

The important, thing in your first sleep study is that numberwise your obstructive sleep apnea is mild - but as far as oxygen desaturation it concerned, and depending on your sleep stage (normal sleep has 5 stageds) or position, the effects of your apnea can be pretty bad - as he says: daramtic desaturation, and not enough resaturation. It isn't doing any harm to you heart - yet. But it may in the future - and you don't want that to happen.

REM sleep comes from Rapid Eye Movement, and that's the stage where most dreams occur - and for many of us the most severe apneas. Apnea is non breathing, hypopnea is partial non-breathing - still not good.

Somtimes, sleep studys are a "split night study" - half the night they try to see what's wrong, half the night they try to find the right pressure for you (titrate - move up and down till they find what's good). In your case, they couldn't titrate you the first night - so you had a two night study, which is actually better.

The results achieved on you titration were no so brilliant - numberwise either - though basically the doctor is saying - it looked good at 13 in the lab, lets see how it works in everyday life. The important difference is your oxygen saturation: it is much better now. Probably the only time desaturation was recorded was when the finger thingie dropped off your finger, (that's an artifact - caused by the measuring technique and irrelevant to your real oxygen level.

Considering your bad desaturation levels (people in the hospital are given oxygen when they drop below 90%) and the way cpap helped it, I wouldn't be in such a hurry to give it up. Those desats can cause much harm to your body. And on cpap you get much more deep sleep, which is when you body really rests and heals.

In addition to dramatic desats, you are also aroused from sleep by other, unknow reasons.

For many of us, starting with cpap felt like it was doing our sleep more harm than good. But once we got over that hurdle, it became a thing to treasure. I wonder of your doctor gave you any support at all in getting used to using cpap.

If you tell us more about the machine and mask you have, we may be able to give you some hints on making the treatment easier.

And I believe your PCP can write the DME a request to track your pulse oxygen for a night or 2.

O.

Resmed is the name of the full face mask..I have tried the pillow nasal pads and the nasal mask. cpapa resmed machine. lincare is going to reset the machine at 8 then bring it back to me.

Thank you for all your help I truly want the best for me and Where I drive bus the saftey of others..I want to do what is best.
Barb

Your further explanation shed a whole new light on things and what your doctor has ordered is now understandable. What Ozij has said makes so much sense!!! Certainly the doctor was remiss in not explaining his reasoning as well as Ozij has explained the likely reason but ... hey, he obviously isn't the most diplomatic person you've met. Be that as it may, go ahead and do the two studies. Get them out of the way so you can get back to driving your bus.

Look on the top of your CPAP machine. The full name of the machine will be there: Resmed S8 Compact, Resmed S8 Escape or Resmed S8 Elite.

Resmed makes 4 full face masks. Go to the following URL and tell us which of them you have:

https://www.cpap.com/advanced-find-cpap ... sks-Resmed

Then go to your Profile at the top of the page, click on it and scroll down to near the bottom of the page where you can select which equipment you are using. IF their is no choice of the mask you have just leave the Mask selection blank and type it in the Comments box. Then each time you post we can immediately see what equipment you are using and you won't have to remind us each time you post. You will also have the choice of your equipment appearing as pictures or as text. While pictures look kind of neat, the text option is easier for us the know exactly which CPAP you have as all models of a manufacturer look alike.

Also, you don't need this sleep doctor to order an overnight breathing test. Your family doctor can order an overnight oximetry for you.

Resmed is the company that makes your mask, but it's not the name of the specific type of mask you have (they make different kinds). Is it an Ultramirage? A nasal mask (one that covers your nose alone), or a full face mask that covers your nose and mouth - in which case it might be an Ultramirage II, or something else entirely. BTW, I wonder if your doctor's saying to come in and stay overnite (for the daytime test) was his way of trying to help you get it all done at one time, rather than having to come back in twice? Doctors are not in the habit of trying to make patients' lives miserable, and if we don't always understand why they do things, it doesn't mean their intentions are bad.

I have added what type my mask is and the type of machine. thanks for the imformation it does make it alot easier to have it on here,,

I dont know what the doctor is trying to do but all I know is that I dont have to see him anymore and I will be seeing another doctor. My pcp is setting up appointment with a new one. I will not have to travel a hour to see him either that is going to be better also. I have to stay positive about this because I have been getting really stressed over it.

I will ask about the oxygen test.

again thanks for listening i truly on want whats best

Barb