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I assume he also makes less profit with selling the Resmed machine...of course that's just my assumption. I hate the a-hole medical "pro's" who go over the top like that...I had ONE person try the intimidation route. Strangely, once I was over the shock of being told that I COULD NOT CHANG MY PRESCRIPTION, I DID change it...and my numbers are good AND I can sleep decently. Image editing that.

lytepole wrote:Well, went to first appt with sleep doc (one month on CPAP) and got in trouble for changing my settings. "This is FDA controlled! That is no different than changing a prescription I wrote to you between here and the pharmacy" (please note, I'm also not opposed to changing my medicine dosage at home if I know its safe) Doc was also upset that the DME turned on EPR for me because that wasn't prescribed.

Ugh.. I switched from straight CPAP at 12 to Auto from 10 to 12. But, I did leave with an updated prescription of 10-12.

Other words of wisdom from doc that I need to research:

1. The S9 Autoset has a horrible humidifier that only gives about 70% on auto and takes a long time to ramp up.
2. The F&P Icon Auto has a much better humidifer than the Resmed S9 Autoset - delivers more relative humidity and gets to the humidity level more quickly.
3. Using auto puts my cardiovascular health at more risk instead of having it at a straight pressure
4. The new Resmed Airsense has a better humidifier than the S9 Autoset
5. The auto mode on the F&P Icon Auto is better than the Resmed S9 Autoset


Note: The doctor is currently doing some kind of study with F&P to help improve the tracking software......

Where can I look for more information on this, especially #3? I obviously am going through treatment as I want to optimize my health, so I want to be as informed as possible.

Thoughts?

With your S9 autoset, you really do not need your doctor any more. Educate yourself as many of us have and you will be able to monitor and direct your own therapy. I agree with the other posts....Your doctor just wants you dependent on him....maybe he is planning to buy a new Lexus next year...(Side note...Sounds like your doctor may have a deal going with F&P)

I don't know what other to say than I'm getting a bad feeling about your sleep doc, at least by the description you've provided (we can't get his side of the case). I don't know what your options are regarding insurance, however if at all possible, I'd hand him a pink slip... the sooner the better.

...

Well, he wasn't a TOTAL jerk about it per se, just let me know I wasn't supposed to do that and that they needed to make those changes at the office. Also made sure to find out what DME I went to because it wasn't theirs (out of network, which is fine with me - I don't like doctors getting the financial benefit from the diagnosis they give me). Honestly, I hate specialist appointments where you get less than 5 minutes with the doc. I've spent more time looking at my sleep data than he has.

But I was primarily surprised he didn't ask me WHY I changed it, if I liked it better, and what I thought about EPR.

He would have changed my prescription today to 11.6 fixed CPAP as that was my 95% level had I not brought up the fact that I had changed it to auto 10-12, due to ear pressure issues.

I mentioned sinus problems as I was still trying to figure out humidity levels. I was surprised my sinuses didn't even get looked at.

When you go to the sleep doc, is there ever any kind of exam done, or are they always on the other side of a desk?

Over the last week, my AHI is under 1 most nights and is usually under .5. My sleep is still not great most nights, buts it getting better. The interruptions are usually related to other things (like hubby snoring, not able to get comfortable, etc) rather than about OSA at this point or waking up in a PANIC. His solution, take a full Tramadol rather than a half.

My default solution is to try to find a natural way to fall alseep and I'd rather not drug myself to sleep through hubby's snoring - doesn't seem like the most prudent solution!

I need to decide if I want to try to get into the other sleep doc my primary doc referred me to in the first place OR see if my primary doc is willing and able to just handle the prescription and management of my CPAP.

But I was primarily surprised he didn't ask me WHY I changed it, if I liked it better, and what I thought about EPR.

BINGO! Too wrapped up in his own ego to see the patient in front of him.

When you go to the sleep doc, is there ever any kind of exam done, or are they always on the other side of a desk?

Like I said, at least he LOOKED at the data or machine to discover you had changed it. I've never even MET "my" sleep doctor.

I get the sense that many (not all, of course) who go into sleep medicine really prefer not interacting with patients. Touching them goes WAY beyond interacting.

Lytepole,

Your sleep Dr is a jackass! As previously stated, you have your machine, just make sure you have a mask prescription & then cut him loose, you can manage your own care using Sleepyhead software. If you really feel you need a sleep Dr, I'd find a new one, this guy sounds like he is just out to make money for F&P and your DME.

Wardmiller,

As for humidity,its a very personal issue. I use a low setting so recently when my tank was empty, & distilled water jug empty too. I didn't want to go to the garage for another bottle so I turned off my humidifier & went off to sleep. Next day I sneezed all day long. I filled my tank the next night so the following day, no sneezes. I learned a valuable lesson - the humidifier has a purpose for me & next time I'll make the trip to the garage if I run out of distilled water again. Point I want to make is that each of us reacts differently, some folks don't need it, some do & in varying degrees. Shame on you wardmiller for your comments that its all in our minds when it really is all in our noses.

Jen

Janknitz wrote:

Touching them goes WAY beyond interacting.

lytepole wrote:Well, he wasn't a TOTAL jerk about it per se, just let me know I wasn't supposed to do that and that they needed to make those changes at the office. Also made sure to find out what DME I went to because it wasn't theirs (out of network, which is fine with me - I don't like doctors getting the financial benefit from the diagnosis they give me). Honestly, I hate specialist appointments where you get less than 5 minutes with the doc. I've spent more time looking at my sleep data than he has.

But I was primarily surprised he didn't ask me WHY I changed it, if I liked it better, and what I thought about EPR.

He would have changed my prescription today to 11.6 fixed CPAP as that was my 95% level had I not brought up the fact that I had changed it to auto 10-12, due to ear pressure issues.

I mentioned sinus problems as I was still trying to figure out humidity levels. I was surprised my sinuses didn't even get looked at.

When you go to the sleep doc, is there ever any kind of exam done, or are they always on the other side of a desk?

Over the last week, my AHI is under 1 most nights and is usually under .5. My sleep is still not great most nights, buts it getting better. The interruptions are usually related to other things (like hubby snoring, not able to get comfortable, etc) rather than about OSA at this point or waking up in a PANIC. His solution, take a full Tramadol rather than a half.

My default solution is to try to find a natural way to fall alseep and I'd rather not drug myself to sleep through hubby's snoring - doesn't seem like the most prudent solution!

I need to decide if I want to try to get into the other sleep doc my primary doc referred me to in the first place OR see if my primary doc is willing and able to just handle the prescription and management of my CPAP.

And, he doesn't understand what the 95% pressure actually means or indicates. It's not necessarily where the pressure setting needs to be. There can be numerous reasons the pressure is hitting those numbers......and they ain't all necessarily "good". Some events like flow limitations and snores can needlessly over-inflate the 95% numbers.

Any "medical person" who can write a prescription can work with you.......including a dentist.
Last December I asked my new GP to sign a new prescription I had filled out from the sample from CPAP.COM and she did. My original sleep doctor had botched the one back in 2005 and even though it has worked with my online supplier (CPAP.COM), I wanted one that actually represented what I use for pressure settings (waaaaay too high in the original).


Den

.

I just realized something..... if he was looking at my 95% rate for the last 30 days... the first 19 days I was on straight CPAP at 12. Wouldn't that have driven up my 95% reading?

lytepole wrote:I just realized something..... if he was looking at my 95% rate for the last 30 days... the first 19 days I was on straight CPAP at 12. Wouldn't that have driven up my 95% reading?

well, for those 19 days your median, 95 and max numbers would be the same

wardmiller wrote: The volume of the air you actually inhale (a lot of the air blown by the CPAP machine never enters your lungs, at least with my FFM) is about the same, before and now. CPAP increases the *pressure*, not the *volume*.

That part of your post I agree with. It's been discussed here a few times before, but most are still under the impression that CPAP blows air into your system. It does not. Like you say, it only creates a pressure. There is no "rushing" of air through the airway as many believe.

On the second point, the venerable Pugsy is using a bad analogy when she says,

Pugsy wrote:
Ward...sit in front of a fan....1 to 2 inches from your face...open your mouth...sit there for 7 or 8 hours with the fan blowing in your face and in your open mouth the entire time and tell me your mouth doesn't dry out. Think about it.

She is right that the mouth will dry out (and the eyes). But a fan blowing across the face is not analogous to a CPAP creating a pressure that splints the airway open - unless you have some kind of horrible mouth leak with a nasal interface.

As far as the necessity for humidity goes, I live in a cold, dry climate and did not use the humidifier at all this year. But that is not to say it is psychological with others. Some do get terribly dry air passages without a heated CPAP humidifier. Maybe my body will change some day and I need to start using the humidifier.

wardmiller wrote: I know I'm going to step on some toes here, but I think the value of the humidifier is often over rated. The humidity of the air you breath in your bedroom is the same as it was before CPAP. The volume of the air you actually inhale (a lot of the air blown by the CPAP machine never enters your lungs, at least with my FFM) is about the same, before and now. CPAP increases the *pressure*, not the *volume*. So, I believe the humidifier tends to satisfy a psychological need, not a physiological one.

Humidifiers might be overrated to some extent. I'm somewhat puzzled over why I get more dried out with CPAP and no humidity than I do with normal room air. However, unhumidified CPAP does seem to dry me out a lot more than normal breathing without CPAP. I think it's a real physical effect, not just psychological, but I can't explain it.

I seem to remember someone giving a plausible explanation for the drying effect, but I can't remember what it was at the moment.

If you have mouth leaks, you definitely will dry out more with CPAP than not. Also, if you end up mouth breathing more with CPAP than without it, you'll dry out more. For instance, the Oracle mask says a humidifier is required, and I find it really dries me out.

Physiological or not, a lot of people do feel much more comfortable with a humidifier.

All my doctors are intelligent, confident, and secure enough that they respect my opinions.
Of course, I speak to them as an equal--it seems to work.
(Knock on wood).

chunkyfrog wrote:All my doctors are intelligent, confident, and secure enough that they respect my opinions.
Of course, I speak to them as an equal--it seems to work.
(Knock on wood).

frog doctors must be better on average than people doctors.... *envy*