A Forum For All Things CPAP
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RBIUS and the other superstars.Once again, CG, you need to work on your overall comprehension.ChicagoGranny wrote: ↑Thu Jan 31, 2019 9:15 am^This shows from time to time in your posts. Please understand that we are the payers. Insurance companies aren't allowed to print money. They can only get it from us.
Here ( https://tinyurl.com/http-www-PaleRiderVotesDeath ) is your Death Panel, and it's been cheerily built up by all elected partisan officials. Quit voting for Democrats and Republicans.
Someone, take granny to get her glasses cleaned.ChicagoGranny wrote: ↑Thu Jan 31, 2019 3:13 pmHere ( https://tinyurl.com/http-www-PaleRiderVotesDeath ) is your Death Panel, and it's been cheerily built up by all elected partisan officials. Quit voting for Democrats and Republicans.
Not exactly the analogy I was going for there, Jeff. I was thinking more of the "You can't fix bad sleep with a CPAP machine".
I miss your being here to make that point regularly in specific instances. It is one of the most important points to be made on this board, in my opinion.
I agree with that 100% medically speaking. It is a founding principle of the entire idea of medical testing. However, even though impractical under the present system, another way of coming at the situation is to accept that maybe close to 50% of the population, or more, deserve to see if PAP might be helpful to them. "Helped by PAP" may be a completely different section of population from "pathologically sleepy." Great service has been done by keeping PAP fully in the medically supervised realm for a time, but further service might be accomplished by the technology, as safe as it is, by allowing for expanding its application, in my opinion.
I get down to the city to see my wife's family about once or twice a month. But that's a rough car-driving day. So wave at Front Street Pizza on the way by and just imagine me with my SLEEPYDAVE sign up!
I'd agree with this, in fact I threatened to sue my insurance company if they didn't approve based on not getting the sleepiness/fatigue questionaire since from the sleep study it was clear I had apnea. They approved the next day and had a special "handler" call me the day after that to make sure I was satisfied and wouldn't start the class action law suit I had threatened. They obviously already knew it was an issue or they wouldn't have taken me so seriously.jnk... wrote: ↑Thu Jan 31, 2019 7:32 amI believe that either can be a symptom of sleep-disordered breathing. Fatigue may be the key symptom in the young female UARS-ish phenotype. And my position is that people who have had SDB for years often do not recognize either symptom in themselves effectively enough to report it/them in any questionnaire. Payers don't get that. But many respected practitioners do, I believe. Thus an industry built on fudging numbers.
I believe many in the population might benefit from PAP despite the fact that medical science has not yet developed a practical, inexpensive, effective way to identify all the people who might benefit from PAP. And I believe this study can be used as ammunition to support that position. The line in the sand made by payers that someone with an AHI of 4.99999999 will obviously not benefit from PAP and someone with an AHI of 5.0000001 will is not a sane position for deciding who gets to try to improve their lives by improving their sleep. Especially is that so when there are more definitions for hypopnea than there are hot dog carts in Midtown.
The real message for the medical community may be about refining definitions. But the larger message for the planet is that people should have the right to get to something that improves sleep and life itself without playing games with definitions that people only pretend make sense, in the larger picture.
"What numbers should we use to define a subset of a disease?" is all well and good as a question, for those who think white coats are a fashion statement. But, "How can we help people we don't have the tools yet to identify?" is still a valid question to be explored outside the turf wars of the medical communities. That is why the larger question for me is more one of, "Should this person get the chance to find out whether PAP helps?" and not so much, "What specifically defined condition does this person have so I can explain it to payers in a way they understand?"
When medical people find themselves in the situation of being required to be the gatekeepers who decide who gets denied an opportunity to try a simple mechanical fix for a simple anatomical problem with profound health and safety repercussions, that distorts medicine in a way I personally am not comfortable with. It makes a test a basis for potentially hurting rather than for potentially helping. The doc has his view of that. Payers have their view of that. But patients get caught in the middle and end up on the losing end.
In my opinion as just some guy in a funny hat on the Internet.
Lol Totally agree. You have death panels either way so the argument that a public system would have "death panels" is irrelevant, and perhaps completely backward since a public system could theoretically be legislated away from deathpaneliness... either way we're still screwed though unless there is litigation reform which is the big block to getting enough doctors and to the cost of the whole thing.palerider wrote: ↑Thu Jan 31, 2019 1:13 pmOnce again, CG, you need to work on your overall comprehension.ChicagoGranny wrote: ↑Thu Jan 31, 2019 9:15 am^This shows from time to time in your posts. Please understand that we are the payers. Insurance companies aren't allowed to print money. They can only get it from us.
In the typical doctor, patient, insurance relationship, 'payer' is the insurance company, they're the ones that pay, that determine whether or not they're going to pay for a treatment, device, etc.
They are the 'death panels' that the republicans harped about would come into existence should there be any kind of health care legislation, conveniently ignoring the fact that the death panels were already in existence.
Thanks!total_nonsense wrote: ↑Fri Feb 01, 2019 10:59 amLink to full text https://sci-hub.fun/10.1016/s2213-2600(15)00043-0 if anyone is interested.
So some sleep-disordered breathing is present in nearly 100%. Take away the yes or no diagnosis, and the common-sense approach would be to make PAP trials cheap enough to be available to the not-as-yet diagnosed.Almost every individual had some degree of sleep-disordered breathing. Moreover, an increasing number of apnoea and hypopnoea events per h was associated with augmented comorbidity. This finding reinforces the idea that sleep-disordered breathing should be considered as a disease with a continuous spectrum, rather than as a definite yes or no diagnosis.
