Strategy:Persuade Sleep Doc NOT to do another sleep study

Hi guys:

Strategy time: I made an appointment with my old sleep doc, who is very good, but not all that accessible because he's so busy. He did my 2001 study and persuaded my insurance company to give me a cpap machine, even though he said the numbers were borderline, with an overall index of 5. (Apneas 14=central 12; obstructive 2; hypoapneas 19, all obstructive=total 33).

I told the assistant that I gave up on cpap after a month in 2001, but that I had recently come back to it and had been compliant for three months. This time it had been initially successful, but now the pressure is like nothing, and I want an APAP machine. I got an appointment in 2 weeks, but the assistant said the doc would most likely want another sleep study, given that the data is 5 years old. This is what I was afraid of. When I told the assistant that the pressure had been okay when I first started it in 2006 but had collapsed over the last few months, she said I could discuss it with him, but he probably would want another study because we may be talking a major difference in pressure. When I asked whether couldn't we adjust the pressure by increments over time, she said he would go up 1 cm but not gradually increase a bunch of times.

So all you research/tech gurus: Can you point me to the peer-reviewed sleep research that shows that docs and patients can reliably titrate in-home with a sophisticated cpap/apap and/or some software.

I guess my point of view is that in the year 2006, with software and sophisticated equipment, I shouldn't have to do a sleep study. (I currently have a sullivan v elite, which measures only compliance.) Am I wrong?

I think this guy is really good, and I understand that he is into patient care rather than equipment supply, and he may be fine about it when I point out to him that there is no reason to think that my pressure needs may not change again as I just get used to the equipment/prescribed pressure. But I also can see him saying that with a new sleep study, we'll at least know that we're starting out at the right level, if pressure needs tend to naturally change over time. Do they?

So I would like to give him all the research that shows that you can in-home titrate for a patient where the apnea diagnosis has already been made, cuz I'm a little fuzzy on my facts.

Or the thing to do is also go to my regular doc, show him the sleep study and ask him to prescribe an apap machine, and play dumb about having
made an appointment with the sleep doc?

Can you guys please help? My resistance to another sleep study is that I hate them, they take forever to get written up and acted upon, and I don't think it's necessary. It seems to me that you can save the insurance company a bunch of money by writing a prescription in this instance and going from there?

What do you guys think? Thanks a bunch.

Caroline

I would only suggest that there are a TON of things that can be done in a sleep study that cannot be as reliably done at home, or even at all.

Obviously, the most notable being brain activity. This is an incredible measure of what kind of sleep you are actually getting.

The other side will be simply that they can monitor you and make sure for example that the numbers are acurate. They can remap sensors if one goes bad or gets knocked off.

They can double check on the fly if certain numbers seem out of the norm to make sure that it is not simply a false reading, etc.

In a nutshell, I would go with your doctor. You've obviously had some changes, it's been 5 years. Get another sleep study and get an accurate base-line to start from - then start playing around.

Bingo

I am of the other point of view.

I have absolutely no desire to ever again do a sleep study. May not be the medically correct opinion but that is the way I feel. Two times there was more than enough for me.

I would probably have gone to my regular doctor and told him/her that my machine was getting old and this time could I please replace it with an APAP. May I have a prescription please? Or even get a CPAP prescription(forgetting about mentioning APAP since one specifically for APAP is not necessary at Cpap.com. I don't know if you are trying to get insurance to pay for this or it is out of pocket. I seem to remember someone posting back a while that insurance companies may want a new sleep study if it is a couple years old in order to pay for a new machine.

If the only purpose for a second sleep study is to titrate your pressure, you can do it yourself at home over several weeks (or less) with an APAP that includes memory & software to transfer data to a PC, such as the Respironics APAP, software, smartcard reader, etc. I showed my sleep doc the results of my self study before a lab was able to titrate me, and he agreed that I was getting ideal therapy without having to confirm with another sleep study.

Count me in the side that opposes another titration study unless there is a clear concern of a condition that is detectable with such a study.

Count me in the group that thinks APAP can do a much better job of determining pressure than a sleep study- one night in a strange bed etc.


As far as a study that documents patients ability to self titrate, print this one out and take to him/her.


http://www.sleep-solutions.com/clinical ... n_CPAP.pdf

While I agree with Bingo that it would be useful to get another sleep study, especially given the centrals (real? poor acquisition, as in belts slipping during the study?) that were found in your first study of years ago, here are two links that might provide you the ammunition you're looking for.

One is a study in which patients were able to successfully titrate their pressure at home -- using straight cpap machines and no software, even!
Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure? Published: American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 716-722, (2003)


The other is a presentation by a noted board certified sleep doctor.
Not Every Patient Needs to Go to the Sleep Lab Powerpoint presentation by a well respected board certified sleep doctor/pulmonologist, Dr. Barbara Phillips, at a meeting of the American Lung Association of the Central Coast - November 2004

P.S. Talk to Dave!!

Snoregal & HP:

Snoregal, my head is where yours is on sleep studies. I'm going to have to wait a whole bunch of time, go through the aggravation of a third sleep study, only to be told my pressure is 10 instead of 8?

just called my insurance company, and they said i do not have to go to a sleep doc or get a sleep study done. I can just go to my regular doc, who has to submit it for a risk utilization review if it's over $500, and if eligible, they give him a list of approved providers. If under $500, just buy it and submit the claim.

so i have appointment with regular doc a few days before sleep doc. so we'll see. maybe time to check with billmyinsurance.com to see if we can just do this through cpap.com.

Caroline

Rested gal:

Thanks for the links. I can see both sides. I guess my preference would be to get the APAP machine and then we can talk sleep study.

Why don't you go to work for one of these companies/facilities? You know too much just to be a consumer. They need you.

Caroline