Want a good laugh?

I never saw or had explained a copy of my sleep study, both of them. I don't feel I need them, as I have long since taken over my own XPAP care.

It's a good thing DME's aren't allowed to pull their own Sleep Studies. If they were allowed, they wouldn't know anyone they could trust to read them, and we all know the patients aren't smart enough to follow their treatment. Jim Happy New Year!

I question every script for CPAP or APAP that is above 15 cmH20. I am not always the most popular RT with the Doctors, but I have asked a few physicians to wear a CPAP for a few minutes set at 18cmH2O and see how they feel. Usually, after I am yelled at for even questioning a Dr's orders, I can get the DR to at the least allow the patient to start out with an APAP trial to verify the setting. At the best they get an APAP from the start and can work with their therapy from there without the hassle of a loaner machine. Have any of you asked your DME for copies of your records? I have a packet ready at each setup that I do that has any and all paperwork I have received about the patient for them to keep. I don't always have the sleep study in hand, but I tell them to remind me and I will mail it to them. I always make sure it is tucked away in their bag before they leave. What they do with it after that is up to them. I suspect that alot of them never touch it after that, but if one person was helped by having their records in hand then it was worth the effort. I know that is not standards of practice probably anywhere else, but I have had many health problems and have spent days trying track down records. It takes me two seconds to copy the records and have them for the patient. We go through the sleep study and I answer questions they didn't get answered. How many of you went to your follow and we simply told you have osa and need CPAP at xxcmH2O end of story. So many patients come in and don't even know what sleep apnea is and why it is important to treat it. Sorry to ramble, I'm sure that you all are tired of DME's trying to defend how they work.

mattman wrote:

DreamStalker wrote:Try telling that to mattman and I'm sure he would say ... but sleep docs and DME clinicians know best -- OSA patients should just take their medicine and forget about APAPs unless they have a real need.

Way to put words in my mouth, make wild assumptions, throw out something totally different from anything I've ever said and basically just go off the deep end there sparky.

Tell you what, next time you want to insult me feel free to go ahead and PM me and keep this kind of garbage off the regular boards.

Merry New Year to you too Sunshine.

mattman

My apologies if you feel I insulted you ... but I was actually just continuing my disagreement with you on a previous post from a different but related thread:

mattman wrote:

DreamStalker wrote:

mattman wrote:Don't we flat out OWE it to people to let them to try every avenue possible in an effort to find something that works for them?
mattman

That is why everyone should be allowed to try out an APAP even if most folks may do just fine with a CPAP machine.

See, that's where I respectfully disagree with you.
To me, it's incumbant upon us to start with the least expensive options and work our way up until we find something that does work. So if CPAP works I don't see any reason to move to the more expensive APAP.
The costs have got to start being controlled and I - personally - think that if I don't practice it at home then I've got no ground to go complaining about it anywhere else.
But that's the cool thing about being where we are, we are all free to respectfully disagree with each other.

mattman

Nevertheless, I called you no names nor insinuated any lack in your intelligence (My PM works too) ... I only posted to reinforce my continued disagreement with your view of patients using APAPs "unless needed".

I don't think my assumptions were wild based on several of your previous posts. The point I was making is that a patient needs to be able to use an APAP first in order to know whether or not he/she needs one ... if not then it is easy to just switch a button to change from an APAP to a CPAP. As for costs -- they are the same to an insured patient ... and unisured patients may very well be willing to pay the extra for the APAP capability.

Again, I'm sorry "I put words in your mouth" and compelled you to reply with insults. You too have a great New year as well.

KansasRT wrote:I question every script for CPAP or APAP that is above 15 cmH20. I am not always the most popular RT with the Doctors, but I have asked a few physicians to wear a CPAP for a few minutes set at 18cmH2O and see how they feel. Usually, after I am yelled at for even questioning a Dr's orders, I can get the DR to at the least allow the patient to start out with an APAP trial to verify the setting. At the best they get an APAP from the start and can work with their therapy from there without the hassle of a loaner machine. Have any of you asked your DME for copies of your records? I have a packet ready at each setup that I do that has any and all paperwork I have received about the patient for them to keep. I don't always have the sleep study in hand, but I tell them to remind me and I will mail it to them. I always make sure it is tucked away in their bag before they leave. What they do with it after that is up to them. I suspect that alot of them never touch it after that, but if one person was helped by having their records in hand then it was worth the effort. I know that is not standards of practice probably anywhere else, but I have had many health problems and have spent days trying track down records. It takes me two seconds to copy the records and have them for the patient. We go through the sleep study and I answer questions they didn't get answered. How many of you went to your follow and we simply told you have osa and need CPAP at xxcmH2O end of story. So many patients come in and don't even know what sleep apnea is and why it is important to treat it. Sorry to ramble, I'm sure that you all are tired of DME's trying to defend how they work.

KansasRT,

You're DEFINITELY one of the GOOD ONES! Thanks for hanging around this forum.
When I changed my setting from 18 to 10, my logic was that 10 was at least more pressure than I was getting "pre-CPAP" and that if it wasn't enough, I could always change it (since I had the software to monitor it), but son-of-a-gun if it didn't turn out to be a good setting. Starting out at a HIGH pressure is not a "fun" experience.
It actually pissed-off my doctor when I want back for my first meeting with him after starting and I told him I had changed the pressure already. I didn't care.....I had the printouts in hand to prove otherwise. He couldn't believe I could do that good on that setting and tried to say the reports weren't accurate. From his remarks, he also (apparently) thought it took some kind of "magic" to change the settings on the machines, too. DUH!

Thanks again for your input.

Den

Just to clarify: it is NOT illegal for patients to see or receive a copy of ANY of their medical records. It is only illegal for the patient to access those records via the storage facility themselves. i.e. a hospital employee going into the hospital's data storage to access their own personal data. Think about this: that person COULD conceivably alter or change their records if they were allowed access.

Every patient has a LEGAL RIGHT to a COPY of their entire medical record. The records themselves BELONG to the generating facility, whether lab, hospital, clinic, imaging facility, doctor, etc. BUT patients have a legal right to a COPY of those records. The 'generating facility' does have the right to charge a "reasonable" fee for copying.

This pertains to the USA. I have no idea about the legal rights in other countries.

Generally speaking the most EXPENSIVE way to get copies of your medical records is thru an attorney (worker's compensation cases, law suits, etc.) and the CHEAPEST way to get them is thru a cooperative doctor if the generating facility wants to charge you when you request them. (They don't charge you anywhere near what they would charge your lawyer and often won't charge you anything). For the most part, as a professinal courtesy, doctors do not charge each other for transfer of patient records, nor do hospitals, imaging facilities, etc. generally charge a physician for copies of patient records.

I decided to resurrect this thread to add some final information.

I DID (finally) receive the correct reports this weekend.....and a little sticky note with an apology from one of the clerks at the clinic.
I'm still sorting through the categories and numbers in it, but I did determine a few things.....some of which surprised me.

I was led to believe by my sleep doctor (who actually took NO part in writing this report) that my AHI was in the 70's......it was ACTUALLY 47.1.
No Centrals. No Mixed.
No PLMs.
Desats down to 66%....Range = 66 - 94%......mean = 84%
Still trying to decipher the "sleep efficiency" part of it, but due to the fact that it was one of the worst night's sleep I ever had......I'm not going to put too much stock in that part. I'm sleepin' GOOD now.

The pressure during the study that "eliminated the obstruction" was 16 cm. ("....however he was only asleep for 4 minutes at that pressure")
I still don't know why he decided to prescribe 18 cm.

Anyway.....IMO they STILL got it wrong (pressure-wise). I'm sure that 16 or 18 cm. WOULD take care of more of my events, but I'll settle for where I'm at (12) and sleep much better.

Den

Wulfman wrote:Still trying to decipher the "sleep efficiency" part of it, but due to the fact that it was one of the worst night's sleep I ever had......I'm not going to put too much stock in that part. I'm sleepin' GOOD now.

University of California at San Francisco wrote:Sleep Efficiency is defined as the percentage of time in bed spent asleep. Thus, if a subject wishes to have an 8-hour sleep period, takes 30 min to fall asleep, wakes up 30 min before the scheduled end of the sleep period and experienced a number of awakenings interrupting sleep for a total of 60 min, the sleep efficiency is 6 hrs/8 hrs = 75%.

Thus, it's more a measure of how long it took you to fall asleep than anything.

blarg wrote:

Wulfman wrote:Still trying to decipher the "sleep efficiency" part of it, but due to the fact that it was one of the worst night's sleep I ever had......I'm not going to put too much stock in that part. I'm sleepin' GOOD now.

University of California at San Francisco wrote:Sleep Efficiency is defined as the percentage of time in bed spent asleep. Thus, if a subject wishes to have an 8-hour sleep period, takes 30 min to fall asleep, wakes up 30 min before the scheduled end of the sleep period and experienced a number of awakenings interrupting sleep for a total of 60 min, the sleep efficiency is 6 hrs/8 hrs = 75%.

Thus, it's more a measure of how long it took you to fall asleep than anything.

According to the charts, it doesn't look like I got into stage 3 or 4, but did in stage 1, 2 and REM.
It was just one of those nights that I'd almost swear I didn't sleep....or at best, very lightly. It was a terrible night, but I got through it.

Den

I hear ya, Wulfman. I ran into the same thing w/my titration study - only slept 42 minutes out of the entire night. Sleep efficiency? 11%. And I didn't do a whole lot better when they brought me back for a second titration study. Only slept 98 minutes. Sleep efficiency? 28%. Whoopee!

No stage 3,4 or REM the first study but, ha! I manged to make it to stage 3 the second. No stage 4 or REM tho. Still I beat ya tho, I did make it to stage 3 - for 11 whole minutes. Two of the roughest nights of "sleep" (?) I've EVER had!

O.K. after reading the titration horror stories here, I was titrated at 16cm during my sleep lab test, I do have copies of both tests (two night study) what i want to know is assuming i get the software, do i need to let my sleep doc know about any plan to tweak my setting's before i do it. My doc wants me to bring my smart card to my appointment's with him and they would know if any setting's were changed, I think they just want to check compliance data not sure though. If i did get the software and found any boo boo's on the part of the lab person who titrated me i darn sure would want to fix that pressure, as 16cm is pretty high and if a lower more comfortable pressure would work with satisfactory results then i would lower that 16cm pressure in a heartbeat.

Dale

Dale,

That kinda depends on your relationship with your doctor.....and how soon you have to go back and how soon you get the software.
In my case my doc and I were about to "come to blows" and I could have cared less whether he liked the fact that I had changed my pressure right off the bat. But, I had the Encore Pro and MyEncore printouts from the reports to show him and so I kinda had him over a barrel......except that he tried to say that they couldn't be accurate.
I purchased the software and reader with my machine, so I had everything from "Day One".

I would think.....if he's one that would believe the software reports.....that if you can prove to him that you're doing as well or better at a lower pressure, then go for it.

Best wishes,

Den

Den Wrote
That kinda depends on your relationship with your doctor.....and how soon you have to go back and how soon you get the software.

I have an appointment with the sleep doc this Tuesday, don't know how often he wants to see me after this appointment. Plan to get that software soon by the end of this month. Think i might just feel him (the doc) out with the software plan and see what he say's about it.

Dale

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CPAPopedia Keywords Contained In This Post (Click For Definition): Smart Card

I don't have a per-say sleep doc. My Internalist suggested I have a sleep test. Of course, a respiratory specialist looked at the titration from both studies and came up with my Rx setting for a Bipap. The assigned DME was of no help except to use up what insurance I had left for rental fees. That was about 5 yrs ago and since then my Dr. is no longer in that office and my new Dr. is not very concerned about OSA it seems. I never got a copy of my titrations, I guess I should. I use the Respironics 1.5 software and monitor my own and with the Auto Bipap, it's about like a sleep titration every night. My AHI is normally below 2.0 and much of the time below 1.0. My Rx was for 12/8 and normally that has been my average. I have it set at 8 for Epap making 10 the Ipap to begin. So far, I see no reason to consult with a sleep theraptist. I have several friends with cpap or bipap and whom say they rip them off during the night. I think the only way to benefit is through compliance so I have become used to mine and use it all night, never taking it off except for bathroom call and then putting it back on.