Looking For Tips On How To Interact With The Doctor

Won't comment on anything else, but what he said about GERD was crap. SOME people find Cpap does help it, but not all people, esp. depending on the root cause (of their GERD).

Mike208 wrote:Well, saw the doctor. He said I have not given it much of a chance to work, that I have adjusted the pressure way down and then up, not allowing myself to get accustomed to the machine. My point was that the initial pressure was not working, the reduced pressure set by the sleep tech did not work, so I reduced it further, which did not work. I noticed the AHI's were up so I took the pressure back up. Still had the air in the belly issues, still fighting to exhale, and the AHI was still up. I also brought up the fact that my GERD seems worse since using the machine. He said that doesn't happen, that he has never seen CPAP make reflux worse. He said, in fact, it helps. Okay, well, not for me.
So, here's what we're doing. He set the machine on 11 with a reduced pressure upon exhaling. I think that's 6. He said to wear the mask an hour before bed and that will help me to get accustomed to it. I see them again in three weeks. If I'm still having issue then it will be fairly obvious that I can not tolerate CPAP. Gee, ya think?

Nobody can tolerate CPAP.

Until they realize they have to.

Mike208 wrote: He set the machine on 11 with a reduced pressure upon exhaling. I think that's 6

those pressure settings are not possible on an autoset, might want to check again.

palerider wrote:

Mike208 wrote: He set the machine on 11 with a reduced pressure upon exhaling. I think that's 6

those pressure settings are not possible on an autoset, might want to check again.

Why is that?

Mike208 wrote:

palerider wrote:

Mike208 wrote: He set the machine on 11 with a reduced pressure upon exhaling. I think that's 6

those pressure settings are not possible on an autoset, might want to check again.

Why is that?

why what?

palerider wrote:

Mike208 wrote:

palerider wrote:

Mike208 wrote: He set the machine on 11 with a reduced pressure upon exhaling. I think that's 6

those pressure settings are not possible on an autoset, might want to check again.

Why is that?

why what?

why is it not possible? it's not possible because you can't set an autoset that way.

why should you check? well, if you don't actually want to know what pressures the machine is set for, then I guess there's no reason to...

I never said I wouldn't check. I will check but why would the doctor say that? He should know the capabilities of the machine. If that's the case then he lied to me and my trust in him is a big fat ZERO!

All he can set is the EPR which will only reduce a max of 3. 11-3 does not equal 6

Mike208 wrote: I never said I wouldn't check.

I never suggested you wouldn't.

I don't think it's fair to pick at me for what I said or didn't say. Nor is it fair to make assumptions as to what I care about. I came to this forum for help, not to be picked on. I stated what the doctor said. I am not an expert and don't know what the capabilities of this machine are. If it, in fact, can not be set that way he should know that. And if he let me walk away thinking that's what he did then he pulled a fast one on me and that pisses me off! Why would he do that? What would be the purpose?

Mike, I think you just saw appeasement from a guy who figured you'd never know the difference.

The inhalation pressure and exhalation pressure on your machine (Autoset) cannot be set in the way the doctor described. There is an exhalation pressure relief (EPR) that is a "comfort" setting that allows the machine to lower pressure 3 cmH2O less than the pressure it is giving during inhalation. This is unlike a bilevel machine that can provide a wider range of relief, and uses a different algorithm to do that.

If he told you that he was setting the machine with inhalation and exhalation pressures, he was stretching the truth.
If he told you he set inhalation at 11 and exhale at 6, he lied, or at best doesn't understand the limitations of that auto CPAP.

If he will give you those prescribed IPAP an EPAP pressures in the form of a prescription, then you would have everything you need to get the DME to swap the machine for a BiPAP.

I checked the machine and the pressure is on 9. The EPR is on level 3. Ramp is on auto. The doctor DID SAY that he would lower the pressure upon exhalation. What he DID NOT say is what he was doing had to do with the EPR. So, yes, the machine can not be adjusted the way I was led to believe. He failed to make me understand exactly what he was doing and that pisses me off. But, it is what it is. I will try this and if I still have the issues then.....

The good part is, he conceded to your concerns, even if he didn't admit it.

The negative is, he in fact deceived you, mostly in the interest of keeping you in a less capable machine. Why? What's in it for him?

Sleeprider wrote:The good part is, he conceded to your concerns, even if he didn't admit it.

The negative is, he in fact deceived you, mostly in the interest of keeping you in a less capable machine. Why? What's in it for him?

That's what I'd like to know. He said that if we can't do it with this machine it just won't work. I'm one of those people who can't tolerate CPAP. He mentioned that my next best alternative was to see a specialist dentist for a possible mouth piece. I don't know how much this applies but he looked at my throat and said I have one of the narrowest he's seen. He asked if my ENT discussed anything he could do with that. I told him the ENT discussed surgery but felt that my chances of having a great deal of success would be slim.

Mike208 wrote:I don't think it's fair to pick at me for what I said or didn't say.

nowhere did anybody 'pick at' you.

Deep breaths, Mike. Hard when you're sleep deprived, I know.

If you have your equipment in your signature correct (it appears to be an auto-adjusting CPAP, what we call an "APAP"), then the machine cannot be set with an "exhalation pressure of 6". A Bipap can be set that way, but not an APAP. It can only be set either on a range of pressures (e.g. 6 to 11) or a fixed pressure (e.g. 11). The exhalation backs off pressure 1-3 cm depending on setting from whatever pressure your machine is providing at that breath. E.g. if pressure is set at 11 and max pressure relief is used, during exhalation the pressure will be 8. If a range is set (e.g. 6 -11) depending on the pressure of that breath (e.g. 9) the exhalation pressure will be up to 3 cm/h20 less, or 6 cm on that breath.

Maybe you do have a Bipap? If not, I don't think your doctor was deliberately misleading, maybe he thinks he ordered a BiPap for you or maybe he doesn't really understand your machine?

I am one who has good relief of GERD WITH CPAP, but I know many people do not. A big reason is aerophagia--swallowing air when on CPAP which really affects GERD. Has anyone here brought that up with you and suggested things you can do to reduce or avoid aerophagia--on another thread perhaps?

Finally, if you "fail" CPAP, there are other options like BiPAP. You may have to find another doctor to help, if this one is ready to give up so easily.