Getting ready to confront my MD in a few weeks

I just posted this on another post, but wanted to see if I could get some feedback:

I had my titration study late July, got my equipment 1st week in August and am just going to see the sleep MD at the end of September. After I joined here and learned some things, I went to my DMEs who probably fed me alot of BS!.. The RT told me that APAP machine is "lazy therapy". Anyone ever heard of it being referred to as this? I have to admit it did make sense to me, but afterall I am still a newbie to all of this. Also, my sleep MD is in the same building as the sleep lab. The DMEs told me that this machine is all that the sleep lab RT ever orders. I was told by the sleep lab, who I called a few weeks ago and asked that their RT call me back about my machine and she never did, that the RT writes the RX for the machines. How can that be?!? Shouldn't the MD have something to say about that, even though she will agree with the lab, who works with the DMEs, so they are all connected. I like lots of people on here, did not sleep well during the titration study and the mask leaked when I turned to the side, so like a scared child, I lay still on my back all night. When I talked about feeling water on my face the next morning, the overnight RT told me I was just dreaming. This of course was all before I heard about rain out.

I just need to hear some arguements comparing the pros and cons of cpap vs apap.

What is your Rx pressure again?

... your Dx AHI? AI?

side vs back sleeping?

interest in weight loss?

stomach gas issues?

These answers may help us develop the spin you need to get your APAP.

- roberto

Your RT sounds worthless.

Rule #1: Get a copy of your PSG
Rule #2: Get a copy of your script
Rule #3: Dump the doctor, lab and dme and take control over your own thereapy.

You will be fighting an uphill battle to get your machine upgraded. If you want a better recording machine your probably better off just buying it outright and keeping the plain jane machine you have as backup.

Put your current machine on yahoo auctions to off-set the costs of the machine you want, should be able to get a couple hundred for it.

What is your Rx pressure again? I think 10

... your Dx AHI? AI? don't know

side vs back sleeping? side

interest in weight loss? very

stomach gas issues? slightly noticing some..not alot...but heartburn is acting up again and hasn't in over a year.

I know, I could kick myself for not being educated on my own health and I should know better. But I was really trusting and naive and not familiar with OSA at all in my nursing experience. I will ask these questions when I go, but I know I won't get anywhere, b/c it is such a big, busy office and they are like the CIA, don't want to give you any info. But I understand it is my right and my responsibility, so I am going in being assertive!!
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First of all tell your doc that you have begun to educate yourself and have realized that OSA treatment is very similar to diabetic treatment and you are ready to assume responsibility for your treatment.

Tell the doc you are concerend about the fact that during the sleep study you were forced to sleep on your back and that you prefer sleeping on your side. Therefore, having an APAP will allow you to use lower pressures when sleeping on your side but still have the security with higher pressure available should you unknowingly turn over onto your back.

Tell the doc you have discovered additional energy that you wish to use to exercise and lose weight and again the APAP will help minimize frequent visits to the sleep lab for re-titration.

Tell the doc that you are experiencing stomach gas and that using an APAP will allow you to use lower pressures and thereby reduce the side-effect of stomach gas.

In addition, do as Snoredog has suggested and get a copy of your study and Rx ... and if the doc is unwilling to work with your requests ... also follow Snoredog's third rule.

- roberto

Snoredog wrote:If you want a better recording machine your probably better off just buying it outright and keeping the plain jane machine you have as backup.

NyNurse33,

I agree with this statement 100% as a matter of fact I have done just as snoredog has suggested.

I bought my own Remstar APAP, card reader and got the software needed.
I felt the need to take control of my own therapy and think I am doing a much better job than any doctor or DME has done.
Of course I had a lot of help from a whole bunch of new friends who know quite a bit about the subject of OSA.

My DME keeps calling me, sooner or later they will get tired of the answering machine.

Sounds like the sleep center and the DME have themselves one cozy business relationship. You really should consider getting your rx and buying the machine. From what I can tell, unless you have incredible insurance, you will not pay much more by by-passing the DME.

Let the office know you will be picking up copies of your initial diagnostic PSG report, your PSG titration report, and your prescription when you come for your follow-up. The reports should be 5 or 6 pages each. Then use the arguments Roberto outlined.

Find out if the doc owns part of or all of the DME before you go. Know that some states have regulations about docs & owning DME's. Hospitals don't allow docs to write orders specifying which DME to use when patients are discharged. It is a conflict of interest. Have you purchased equipment or is it rented? Do you have insurance? Is it an HMO? HMO's can effect what you will be able to get insurance to pay for. If you are renting it is relatively easy to exchange it for another.

One more suggestion in addition to all the posts above which I pretty much agree with.

I assume you have a regular physician?

He/she can write your prescription.

If he/she is willing to write for APAP you "might" be able to get insurance to pay for one. I did but it was a long nasty affair since my insurance considered it "deluxe" equiptment. Others have reported no problem when the script said APAP. I did it by insisting the DME provide APAP like it said on the prescription. Took 3 tries (and even though insurance said they "wouldn't cover deluxe equiptment, they did and didn't know it since it is the same billing code E0601 as CPAP).

If you have a good relationship with your regular physician, have them transfer your records and deal only with that office. Dump the guys who are in cahoots.

Better yet get an APAP either from another DME that your insurance company will accept or spring for it from CPAP.com (and check if your insurance works with bill-my-insurance.com too) etc. Only need the CPAP script to get apap from CPAP.com.

APAP will help you avoid another sleep study when your needs change, as well as reduce the pressure you need for a good portion of the night. Help keep you away from the evil sleep lab and evil sleep doc.

If you ever need a new sleep study, find another lab!!

NyNurse33 wrote:The RT told me that APAP machine is "lazy therapy". Anyone ever heard of it being referred to as this?

I suppose ANYBODY who has their pressure set below, say, 20, is a "wimp" by her standards. Personally I'd rather not work any harder at breathing all night than I have to. Call it lazy, the less you have to work at breathing the better night's sleep you will get. Nothing to be ashamed of. That's why I LOVE the APAP, it delivers just enough pressure to keep the airway open and the right amount of air moving. Why put up with higher pressures when you don't really need it MOST of the time.

That brings up another point about the APAP, it will respond to changing pressure requirements, which happens all night long. I spend most of the time at a pressure of 7; that is very comfortable. But sometimes it takes more pressure to do the job. The machine will respond smoothly and quickly to "up" the pressure and keep me breathing, and it does it so gently I wouldn't even know about it until I look at the data the next morning. The machine titrates me at a 9 or 10 most nights. If I had a straight CPAP set at 10, that's a lot of extra pressure to work against when I don't really need it MOST of the time. And sometimes it takes as much as 13 or 14. Again, the APAP is up to the task, something the straight CPAP is not able to accomplish.

That brings up another point,(something your RT/DME probably doesn't want you to know especially), I find the data from the APAP is VERY enlightening. That's not to say that a straight CPAP cannot cough up data, it does. But the data from a CPAP does not give information about the huge variability of the pressure changes from hour-to-hour and night-to-night. Neither can a one-night sleep study. You will be surprised at how much the pressure changes depending on the time of night, whether you are sleeping on your back or side, whether you were especially tired, had a stuffy nose, ate too much, exercised too much or too little or ran a marathon, changed your medications, forgot to take your meds, drank too much, were anxious/worried about something, were allergic to pets or seasonal pollens in the air, the temperature outdoors was hot/cold/humid/dry/windy, and on and on and on...... the list is endless. Does anybody REALLY believe their pressure requirements are a straight line the way your DME wants you to believe !?

People who are happy with straight CPAP are often unaware of how variable the pressure requirements really are, or don't mind putting up with higher than necessary pressures for MOST of the time. Others here have seen the data and choose CPAP for a variety of legitimate reasons, including economic. Most of the time it's a case of DME pushing the CPAP on a trusting naive "newbie", and then it's too late to get the better machine, or pay out-of-pocket (which they are HAPPY to sell you another machine).

I can think of very few reasons NOT to own an APAP. Worst case, an APAP can be set to operate as a straight CPAP. But I would recommend that decision be made knowledgeably and with data in hand, (your sleep study AND multiple nights of data collected from an APAP). If at that point you realize that your pressure requirements are truly invariant (a rare anomaly), then why pay the extra bucks for a better machine. Except for a few dollars, I think most everybody would be better off with an APAP. It's a more sophisticated machine, it delivers better therapy, and it has the data to back it up.

I continue to be amazed at the unashamed lies perpetrated by the DME community regarding APAPs: "Insurance won't pay for an APAP". (not true). "APAPs cost three times as much as a similar CPAP". (not true, check the prices for yourself online). "APAPs are illegal except for use in sleep labs". (totally not true) "APAPs are not a mature technology". (then neither are CPAPs, automobiles, or electric staplers). etc....... I will now add yours to the list, "APAPs are for lazy breathers!" LOL !!! That's like saying SCUBA gear is for people who are too lazy to grow gills.


-Ric

I don't really agree with the following statement I am going to make, but in the sleep world of sleep labs and sleep docs, APAP is sometimes considered "Lazy Therapy". Some physicians think it looks like you don't trust your sleep lab to diagnose your patients so you order APAP to cover all bases. That maybe why that statement was made to you. Some sleep techs can get very defensive about how they come up with their numbers. APAP can seem like a dig at the quality of their study. One thing you have to remember is that this online community is a very small portion of sleep apnea patients. One that seeks out answers and is interested in their treatment. Most sleep apnea patients are not. The sleep lab may not be able to fathom why you would want an APAP or a downloadable machine. They may not have heard of patients downloading their own machines or changing their own pressures.

KansasRT wrote:I don't really agree with the following statement I am going to make, but in the sleep world of sleep labs and sleep docs, APAP is sometimes considered "Lazy Therapy". Some physicians think it looks like you don't trust your sleep lab to diagnose your patients so you order APAP to cover all bases. That maybe why that statement was made to you. Some sleep techs can get very defensive about how they come up with their numbers. APAP can seem like a dig at the quality of their study. One thing you have to remember is that this online community is a very small portion of sleep apnea patients. One that seeks out answers and is interested in their treatment. Most sleep apnea patients are not. The sleep lab may not be able to fathom why you would want an APAP or a downloadable machine. They may not have heard of patients downloading their own machines or changing their own pressures.

Hmmm ... sounds like there is a severe lack of communication and education on both the patient side (except ones here of course) and the treatment specialist side of the xPAP fence.

- roberto

I saw my MD wednesday. He asked why I was there! I told him it was a follow up after starting cpap and he said a follow up is not needed. He said you never need another sleep study once you get the machine. I started asking questions and he said I already knew more than he did and I could probably treat myself better than he could. I explained that my insurance won't pay for things with out his RX. He said let me know what you need and I'll order it. I have never seen a sleep DR. One signed off on my sleep study but I never spoke to or saw him. I have Apria for a DME...enough said. I ordered the card reader from cpap.com and will start experimenting on my own (with help from everyone here, of course!) Next weekend.

Brenda

See that is one thing that worries me. Starting to experiement on our own. So I gather you didn't have an apap before he wrote you the script? Is apria good to work with?

I had the sleep studies done and waited for months before I got a machine. I filed complaints against Apria and that's when they gave me the APAP. The original machine they had for me was given to someone else 'by accident', so I was going to have to wait until a new one came in...I complained and they brought me the remstar auto. I also had to fight for a hybrid mask. Apria is the worst company I have ever delt with. They don't return calls, they don't have answers to questions, they don't show for appointments. I have HIP HMO insurance so I have no choice in DME's but if I did I wouldn't choose apria by any means!

Brenda