New guy w/ questions & Dr. refused APAP - CPAP Only

BeanMeScot · Post by **BeanMeScot** » Thu Jul 02, 2009 7:02 pm

An APAP and CPAP will only go to a pressure of 20. You would need a BiPap to get over 20. Idiot, doctor.

carbonman · Post by **carbonman** » Thu Jul 02, 2009 7:09 pm

Silence wrote:Hello again,
I kept calling local DMEs until I found one who only carried the S8 AutoSet II CPAP Machine and accepted my insurance. They said they stopped carrying straight CPAP machines because they saw better compliance with the APAP machines.
Take that S8 AutoSet and run.

Her rational was that she was heeding the President's call to eliminate frivolous and excessive health care costs.
What a load of crap that is.

I can't comment on her skill as a sleep doctor, but she told me several things that were untrue and I didn't like her unwillingness to work with me. I'll have to find a new sleep center and a new doctor to continue my treatment with.
Good for you. This is the only way that things are going to change.

All the best as you begin your cpap journey to your new life.

Silence

Slinky · Post by **Slinky** » Thu Jul 02, 2009 7:17 pm

Hey, Silence, my personal preference is for the Resmeds over the Respironics anyway. Your local DME supplier who has switched to providing only APAPs sounds WONDERFUL!!! Keep in mind, they lay out a lotta dough for the inventory for those APAPs and the income from the insurances usually comes in in dribbles and drabs over a 10 to 13 month period for most CPAP sales. Online DME suppliers get their money up front before they ever ship out the CPAP.

OldLincoln · Post by **OldLincoln** » Thu Jul 02, 2009 7:40 pm

I am glad you worked it out. I have a significant problem with doctors who use the argument yours did, that she is heading the call for lowering health costs. APAP machine usage consistently returns a efficacy rate in the 70% range, while straight CPAP in the 50%'s. I suggest prescribing a CPAP machine is equivalent to prescribing a 50% effective drug when a 70% is available that has fewer side effects.

This journey is for the rest of your life (unless Rooster finds a cure! ) so it isn't a decision to be taken lightly. The APAP gives you a 20% leg up on successful treatment and your doctor needs to come up to speed.

GumbyCT · Post by **GumbyCT** » Thu Jul 02, 2009 7:47 pm

Silence wrote:Hello again,

Thank you all for the input. I kept calling local DMEs until I found one who only carried the S8 AutoSet II CPAP Machine and accepted my insurance. They said they stopped carrying straight CPAP machines because they saw better compliance with the APAP machines. They said they made this move about a month ago even though it cuts in to their profit margin.
This sounds like Apria's new sales model, is it?

Besides, I can try another model when I buy a backup/travel machine out-of-pocket.
I would rather have the same or similar models for travel, if possible.

One final thought on my doctor. As I mentioned before she refused to change the prescription (which read CPAPAE601) . Her rational was that she was heeding the President's call to eliminate frivolous and excessive health care costs. When I pointed out that the price difference on-line was almost negligible she said that didn't matter because my insurance would not accept the online DME. She also said that APAP was only for folks with very high pressure i.e. 25 - 30. (I thought these machines don't even go that high). At this point I told her I wanted APAP listed as a clear option on the prescription and if she was unwilling to adjust the prescription I'd continue my treatment elsewhere. I can't comment on her skill as a sleep doctor, but she told me several things that were untrue and I didn't like her unwillingness to work with me. I'll have to find a new sleep center and a new doctor to continue my treatment with.
It sounds as if this doc has a direct interest in the DME's profits, as in an extension of her business office? Some docs do this to maximize their profits. My advise would have been to seek out another doc, so you are right on with your decision. Good for you!!!

HTH

Thanks again for the help guys and I'll keep reading and learning here.

Silence

taberge · Post by **taberge** » Thu Jul 02, 2009 8:40 pm

They said they stopped carrying straight CPAP machines because they saw better compliance with the APAP machines. They said they made this move about a month ago even though it cuts in to their profit margin.

Someone pinch me. That cannot be for real.

She also said that APAP was only for folks with very high pressure i.e. 25 - 30.

That sentence alone screams ignorance. I hope you find another doctor. You can go online and search the sleepnet's website to find accredited doctor. http://www.sleepnet.com/slplabs.htm

BTW, when a doctor puts you at a pressure of 10, it is usually because that is a starting point on a machine and then they work their way up if the therapy isn't working. It is kind of the easy way out when they can't interpret a sleep study...just a thought.

ozij · Post by **ozij** » Fri Jul 03, 2009 1:41 am

I agree: Run away from that doctor she apparently does not know the difference between a bi-level machine, and an automatic, self-adjusting one.

Everything your doc said about the APAP (price - higher, costs insurance more, pressure capabilty - goes up to 25, to be used for people with high pressure -above 15) is true of bi-level machine, aka BIPAPs. Not true of APAPs. Who knows what else she muddles up like that.

O.

jdm2857 · Post by **jdm2857** » Fri Jul 03, 2009 12:37 pm

FYI -- What Respironics calls a BiPAP, ResMed calls a VPAP. So you might hear that name. Trademarks, both.

elg5cats · Post by **elg5cats** » Fri Jul 03, 2009 3:19 pm

Silence Hello all, My doctor refused to consider any other options.

I personally cannot continue seeing a physican who takes a negative controlling parental approach with me........when this happens, I'm done with the doctor. No matter what the level of expertise or experience a doctor has, excessive control when not indicated is not repairable in what I need out of a patient/customer doctor relationship. I think there are times a doctor rightfully says but never no without a good expectation and reasoning, not just because "I doctor said, NO." You have to make your own decisions about your health care providers as an adult. You may be receptive to a doctor who takes parental authoritative approach with you. If you don't, then you may want to cut you losses, get your studies and find a different provider. This doctor will only become more frustrating. The last two times I've given poorly communicating MD's a second chance, it has only added one more frustrating experience to the mix.

I have the ResMed AutoSet. I like the following features. It's Auto, Quiet, small, and fits the decor of my room. Additionally, my bed partners approve of the AutoSetII as well.

elg5cats

jdm2857 · Post by **jdm2857** » Fri Jul 03, 2009 4:08 pm

I had my initial sleep study as part of a research study. Wound up in a non-xPAP group.

In order to save money, after reading here I decided to try to find a doctor who would write me a prescription for an APAP, without a titration study.

My (very good otherwise) PCP said he couldn't without a titration. He referred me to a sleep practice. I called them and the NP said that no way would they start with an APAP. I got the same answer from other practices. Finally, I went to the outpatient Sleep Center at the major University Hospital that was running the research study. Asked to speak someone familiar with the way the doctors practices. Explained my situation (PSG results, symptoms, and desire to skip a titration) and got a very positive reaction. The NP felt that any of the 11 physicians there would consider my request reasonable, and barring some other medical findings would probably write me a prescription.

And that is exactly what happened at my first appointment. My physician was very friendly and knowledgeable, and was surprised at how much I already knew about OSA and xPAP. She was surprised that I wanted the software, and told me that I would be her first patient to make suggestions on their settings. But she was very receptive to the idea.

So you have to shop around a bit. The best doctors are not afraid of knowledgeable patients.

New guy w/ questions & Dr. refused APAP - CPAP Only

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Re: New guy w/ questions & Dr. refused APAP - CPAP Only

Re: New guy w/ questions & Dr. refused APAP - CPAP Only

Re: New guy w/ questions & Dr. refused APAP - CPAP Only

Re: New guy w/ questions & Dr. refused APAP - CPAP Only

Re: New guy w/ questions & Dr. refused APAP - CPAP Only

Re: New guy w/ questions & Dr. refused APAP - CPAP Only

Re: New guy w/ questions & Dr. refused APAP - CPAP Only

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