questions to ask a sleep doctor

Hi, there is a finally a cancellation so that I can see the sleep doctor on coming Tuesday (my original was end of Nov). I had a sleep study done, both central and obstructive with AHI 40. Tried bi-pap for 7 days with 17/12 setting, but I returned it since I can't sleep at all, the amara full face mask, the strap makes me headache and feel suffocated.. The more I read from this site and research on line, it seems I probably have to treat with a bi-pap or apap again? Besides bring my sleep study...what are the important questions to bring up to the doctor? I wish there is an alternative way to treat this besides the cpap machine. I just can't tolerate the full face mask (my mouth is opened, and I sleep on my back due to neck and spine pb, but I'm trying to sleep on my side now....). Any mask suggestions and what apap or bipap machines are better? I used the dreamstation with humidifier, but still have a dry mouth and throat. The humidifier seems not working.

You apparently have complex apnea with both central and obstructive events. Bilevel therapy is still primarily an obstructive sleep apnea treatment device, and to fully treat your complex apnea, you may need bilevel ASV (adaptive servo ventilation). Probably the easiest machine of this type to adapt to is the Resmed Aircurve 10 ASV. Ask your doctor if you can try one. My guess is no matter what you ask, the doctor will want to run a titration study. He is not going to get caught up in your problems of adapting to therapy or masks other than to try and figure out if your intolerance of your previous unit may have been due to continuing central events. The doctor will want to review your Dx, and develop a strategy to get you into the correct therapy device at the correct settings. I think you''re headed for a sleep study.

Keep an open mind, and be prepared to answer his questions. Your job is not so much to have questions to ask, but to concisely communicate your symptoms, therapy issues, and past studies.

Thanks so much about the ASV info, I didn't know that is designed for Central apnea pb. I had my sleep study already, 60% is central and 39% is obstructive. So I googled the ASV, B-PAP and Apap on line, it seems ASV can be more comfortable to change the pressure for patient. For me, I had hard time to fall into sleep, 4 hours will be awaked since the RAMP only about 10 minutes, then it went up to 17/12. It probably help if it doesn't send any pressure when I am still awake and struggling with falling into sleep. Is the ASV the most newest berating machine for mix apnea in the market?

if (when) you have your titration study, ask what equipment they use. If it is ResMed equipment, then it will be easier for your machine to have the settings right if it is a ResMed.

OTOH, if they use Respironics equipment, then Respironics will be easier.

Doctors who work with a sleep lab using one of these manufacturers have a very difficult time translating the setting from ResMed to Respironics and vice-versa. (I've been there and done that and it is hard, especially with ASV machines.)

As to questions for your doctor:
Ask for a copy of all your sleep studies.

Ask which DMEs they work with so you can check with your insurance company about whether or not any of them are in network. Its a real hassle to discover that the one the doctor recommends in not in your insurers network.

Ask for a copy/original of the scrip for the equipment. You may want to choose a different DME than the one your doctor generally works with and this will make that transition better. Its also a better bargaining chip in negotiating with the DME if you have the scrip (give them a copy not the original) so they know you are not a captive audience. Since you are really unlikely to get a simple CPAP machine but more likely to get an ASV machine, it won't be necessary for the scrip to state full data recording but it won't hurt to have that in the scrip. Its also good to include the heated humidifier and heated hose in the scrip so you don't have to go back and justify purchasing them later.

Ask for the scrip that the mask to state "Mask of patient's choice". That also gives you better options.

Discuss with the doctor the issue of determining how well your therapy will be going. How will that be measured? How will the therapy dialogue progress as this is an ongoing process and changes will necessarily happen over time. Indicate that you would like to be an active participant and will, if possible, be looking at your own data and providing any copies that the doctor will find helpful.