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Ammunition for a stubborn doctor
I had my sleep study two nights ago. While the technician could not say too much, he made it very clear that based on what he saw I am headed for CPAP land. I'm glad to have the sleep study behind me, although I don't like the delay between the study and getting a device.

While I could be mistaken, I got the impression from the technician that the doctor affiliated with this sleep lab does not believe in APAP machines. The argument was that they are "reactive" rather than preventative. Based on what I have read, this is pure bunk.

I am hoping that people can provide me with the best strategy and/or some ammunition to insist on an APAP machine if the only basis for recommending a CPAP machine is a general disbelief of the effectiveness of APAP machines.

I understand that I can always find my own DME. I understand that I can always take my prescription elsewhere, and I can even find another doctor. But in a rural area this is not so easy, and I really don't want any more delay than is necessary. So tips on working with my current provider would be greatly appreciated.

Thanks in advance!
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You can bring whatever study documentation you can find, but the doc probably won't bother looking at it.

Ultimately you need to remember that the doc is a business and if you aren't happy with the service just fire them and move on to their competitors. I've done this twice over the years (not CPAP related) and each time the new doc I found was vastly better than the previous one. It's no different than taking your car to a different shop if the current one isn't up to your standards.
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(03-17-2015, 09:00 AM)wp6529 Wrote: You can bring whatever study documentation you can find, but the doc probably won't bother looking at it.

Ultimately you need to remember that the doc is a business and if you aren't happy with the service just fire them and move on to their competitors. I've done this twice over the years (not CPAP related) and each time the new doc I found was vastly better than the previous one. It's no different than taking your car to a different shop if the current one isn't up to your standards.

Sometimes in rural areas it is not as easy as it sounds. Been there, done that but I did not get the nice puce Tshirt that Retired_Guy did. It is also a little harder than finding another auto mechanic. Auto mechanics do not have to take a minimum of 8 years more schooling after high school so there tend to be more of them. Of course if the technology in automobiles keeps going the way it has been, auto mechanics may need comparable education.

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You might consider taking the position that an APAP machine has the ability to be put into CPAP mode should your therapy results indicate the need for constant pressure. Also a full data recording capability would enhance either.
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The more important issue is that your machine give good efficacy data on your therapy. While a sleep study is a good snapshot of your sleep and pressure needs, it is very limited in predicting how your pressure needs might change with changes in health (colds, congestion), weight, stress and even sleep position. The sleep lab just isn't a home environment, and it can't titrate you for the changes in respiratory resistance that will occur with the common cold or even changes in masks.

Do not accept a bottom of the line CPAP. As mentioned by On The Virge, an APAP machine can be set in CPAP mode. There are also CPAPs like the Philips Respironics 460IQ that can temporarily act as APAPs and check for optimal pressure. Some people do very well on APAP, and others find the changing pressure is disruptive to sleep. Using APAP with wide-open default pressures absolutely results in a reactive machine, rather than a preventive one. However an APAP with a properly titrated minimum pressure is pretty hard to beat as it will increase pressure when it detects impending apnea in the form of flow limitation and snores.

So perhaps you can agree and disagree at the same time. Any machine, including APAP needs to be properly titrated, but a machine without patient feedback can leave you guessing if you're being treated optimally or not, and only an APAP can self-adjust for inevitable changes. Finally, isn't this really YOUR (the patient's) decision? An APAP is just a CPAP with the ability to adjust pressure. It isn't a different class of machne. You are the one that will live with this thing for the next five years, and will pay for the costs. This is a consumer and personal decision that should not be imposed on you.
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Hi VTSleeper,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you as you start your CPAP journey.
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Am I correct in believing that SA is not a static condition? That over time, the numbers can change?

My argument [at least to myself] includes the idea that I need to keep my next machine for at least 5 years, which is what Medicare at this moment in time says. In 5 years from now, I will have aged 5 years and it's not likely that the body parts which are involved in my sleep apnea will improve.

So, I need a machine that is flexible enough to be useful in the eventuality that my sleep apnea will change in nature, not just in intensity. So unless the doctor can predict with certainty that I won't need a machine that can perform APAP, I want an APAP machine. In the long run, that's prudent and maybe even more cost effective.

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Sometimes these guys tend to get in a rut over time where they figure a one size fits all approach is best. That way they never have to think too hard about what a patient does or does not need.

But, it's no skin off their nose to prescribe a fully capable auto-titrating machine even if they do have the DME dummy it down to a cpap to begin with. So if your prescription does not state one of the top of the line fully auto machines, ask Mrs. Nurse to have the doc re-issue it specifying a Resmed Airsense A10 Autoset, set to the specifications he is recommending. The reason for a different machine? Because you are Mr. Patient, and that's the machine that you feel will give you the best opportunity to succeed.

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Well, the only ammunition I have for you is this...
Tell (Dont Ask) your doctor that you want a fully data capable Auto CPAP. You can try to placate him by explaining that an Auto CPAP can be setup as a straight CPAP. I believe that some Doctors don't understand Auto CPAP or they do understand, and are afraid you will become more proactive in your therapy, and less dependent on them.
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I'm also in a rural area and feel your pain. I generally only get to see a PA who didn't even seem to know what an auto-CPAP was when I suggested it (he's now depending on the DME's RT to make the pressure recommendations).

Some suggestions from my own reading and forum notes:

Insist you want the latest technology considering insurance is unlikely to assist in payment for another 5 years -- even if initially he wants it set to straight CPAP mode.

Another thing is to tell them him that auto CPAP users have a higher rate of compliance -- and you want to increase the odds of success.

Third is to say that the average pressure can be lower with auto CPAP and that is appealing.

Ultimately, you may prefer straight-CPAP or a very narrow auto range as some users don't like the pressure changes -- but having options with this crazy therapy is nothing but a good thing.

Whatever happens, do take control of your own therapy and don't let them stick you with anything you don't want -- this is a very personal therapy that is best customized to the needs of every user. There are no one size fits all approaches likely to have a high success rate.
Lovin' my CPAP since day 1! (January 2015)
If we aren't cleanin' it we're breathin' it!

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