An interview with Professor Barbara Phillips

[BiLevel48]

I would agree with her on almost every point but one (or better said, I would add to her point) - while I agree that you shouldn't need a titration test to get insurance to pay for a device, I think that establishing the correct airway pressure through sleep study is necessary ...

I agree with DocWils, 100%.

I was a little alarmed when the headline here seemed to question the veracity of a sleep study. Certainly they are not perfect, but what better way to get to the bottom of what is going on?

But then the headline is a little misleading; what she seems to be irked about is not the veracity of the study as much as it is the fact that it is the knee-jerk reaction for insurance (who ironically pays for it).

Another part is that it is a lucrative profit center for "sleep institutes"; if I were 25 years old and starting a practice in medicine I would be tempted to start a sleep center myself, both to help people, but also to help put my kids through college and pay for rent on that villa in Italy every summer.

So there is a tendency for sleep docs to push it, whether its a good idea or not for any particular patient candidate. The overhead for a $3700 sleep study is use of the facility for a night and sharing the cost of one technician's shift among multiple studies for that night. Schedule 5 PSGs on a Wednesday and the profit is in the $18,000 range for that single 7-hour time frame. And that was just on Wednesday.

But maybe there is a better way.

I think they started with a better way for me, because they started with a home study to get a general view of what my issues were. That alone was enough to get insurance to fork over for an APAP. But they also forked over for a full PSG later on; also probably a good choice.

Maybe another way is to send someone home with an APAP for a couple of weeks, and then use that info rather than a PSG study to get a starting point on a patient's therapy. That would certainly be less expensive; you could use that same APAP on hundreds of candidates, with basically the cost of a mask and DME instruction being the bottom line costs.

Then a sleep doc could parse that data and decide how important further study is, and the insurance co. could either opt for a PSG or opt to just allow a prescription for an APAP. The best interests of all parties are probably served by that.

I do have a question for anybody that might see this. Does anybody know of any lectures on PAP therapy or Sleep Apnea that are on video somewhere? I use YouTube a lot, but do not seem to have found anything that may have been uploaded from somebody who was at one of her lectures, but does anybody know of anything that might have video of her speaking? I really would like to see some publishings, or slides of presentations. I love this kind of stuff.

[Mich]

I would like that doctor to explain how come so many military members with perfect body weight (BMI) have sleep apnea?

I know that some pulmonologists are considering sending patients home with an Autoset machine for a month instead of a titration study as they consider that a month's data is more reliable than a one-night titration study.

[BiLevel48]

I would like that doctor to explain how come so many military members with perfect body weight (BMI) have sleep apnea?

I know that some pulmonologists are considering sending patients home with an Autoset machine for a month instead of a titration study as they consider that a month's data is more reliable than a one-night titration study.

Yeah, I haveheard that too. rather than putting them through another titration, they are just sent home with an APAP machine, and then, they rely on that as their means of titrating.

The only things that I don't like about that is it is a machine, therefore, It only does what has been programmed.

AND, you can easily make the machine think that you are having apneas.

I have a ResMed S9 VPAP AUTOset and during the daytime one evening, I was sitting in my room, and I switched the mode to VAUTO, and then, I within like three minutes had gone from an IPAP of 10 and EPAP of 5 to an IPAP of 25 and an EPAP of 18 which during this time, I was just fooling the machine by performing different simulated airway obstructions. Even a cough can trigger the machine to think that there are Sleep related Breathing Disordered Events, SRBDEs and I found that out pretty quickly. And then, I actually did something rather unconventional. What I decided to do was get the VPAP AUTOset to simulate an Auto CPAP instead of AUTO BiLevel. I set the Pressure Support at 0cmH2o and set the IPAP and EPAP exactly the same so as to simulate AUTO Titrating CPAP. I did this on another night.

In like 10 minutes I got from a Straight CPAP of 5cmH2o to like 14cmH2o CPAP. I am not sure if any of you who use VPAP S9 AUTOset devices have ever actually adjusted the settings to simulate an AUTO Titrating CPAP or if you have heard of that being done. I think of these kinds of things all of the time. But there are some good and some bad things about AUTO titrating PAP devices.

[DocWils]

Another part is that it is a lucrative profit center for "sleep institutes"; if I were 25 years old and starting a practice in medicine I would be tempted to start a sleep center myself, both to help people, but also to help put my kids through college and pay for rent on that villa in Italy every summer.

Nope - still waaaaaay more money in cosmetic surgery, especially liposuction and that sort of thing. I knew a top heart surgeon who was earning basic wages for that sort of thing (here they mostly are on hospital staffs, so the pay is nowhere near private practice, even when you are the top of your field) and he decided to switch to liposuction - opened his own posh clinic, never looked back - and he looks twenty years younger, not from cosmetic work but because he doesn't have the weight of possible mortalities on his head every time he cracks a chest.

For a while he kept trying to tempt me into the game, but I resisted. I have a thing about cosmetic work when it is just for show...... heck, I don't even like piercings or tattoos..... punching holes in your body to hang things on just seems wrong to me.

[Mark Douglas]

It is all a rope-a-dope as the machines are the same. The software is the only difference. All they really need do is ship a standard chassis and you buy the appropriate mode software. Need an upgrade to bilevel? No problem. Of course as a biz model not gonna happen.

[BiLevel48]

Another part is that it is a lucrative profit center for "sleep institutes"; if I were 25 years old and starting a practice in medicine I would be tempted to start a sleep center myself, both to help people, but also to help put my kids through college and pay for rent on that villa in Italy every summer.

Nope - still waaaaaay more money in cosmetic surgery, especially liposuction and that sort of thing. I knew a top heart surgeon who was earning basic wages for that sort of thing (here they mostly are on hospital staffs, so the pay is nowhere near private practice, even when you are the top of your field) and he decided to switch to liposuction - opened his own posh clinic, never looked back - and he looks twenty years younger, not from cosmetic work but because he doesn't have the weight of possible mortalities on his head every time he cracks a chest.

For a while he kept trying to tempt me into the game, but I resisted. I have a thing about cosmetic work when it is just for show...... heck, I don't even like piercings or tattoos..... punching holes in your body to hang things on just seems wrong to me.

You know what?I TOTALLY TOTALLY AGREE WITH YOU! Piercings and Tatoos are just ways to make people look good and all of that, but really if you ask me, Its wrong. You look good the way God made you, and to start having all of these operations and stuff to make you look better and when people have 20 or so tatoos and piercings, in my opinion, Its just abusing your body when your body was perfectly fine before all of that. People pay a LOT to get these unnecessary operations, and I just think its sad. Utterly sad.

[Mark Douglas]

Kevin "bloody" Wilson had something to say about that LOL

[novatom]

Great interview. I found her "heavier and older" comment interesting. It isn't all due to that. My pulmonologist and my general practitioner have both said to me, "you're the last guy I'd look at and think you have sleep apnea." I know a number of folks like myself who exercise regularly, have BMI in the good range and light use of alcohol who I am sure have sleep apnea. I'm on a bit of a mission to convince them to get checked.

I do have to say, though, that the risks from "inappropriate CPAP" are pretty scary.

That was my response as well. I'm surprised she made that generalization, especially for an expert. I am not overweight and also exercise regularly. I'm 5' 9" and my weight fluctuates between 165-175 lbs. Some of us were just born with smaller airways.

---

I would agree with her on almost every point but one (or better said, I would add to her point) - while I agree that you shouldn't need a titration test to get insurance to pay for a device, I think that establishing the correct airway pressure through sleep study is necessary ...

I agree with DocWils, 100%.

I was a little alarmed when the headline here seemed to question the veracity of a sleep study. Certainly they are not perfect, but what better way to get to the bottom of what is going on?

But then the headline is a little misleading; what she seems to be irked about is not the veracity of the study as much as it is the fact that it is the knee-jerk reaction for insurance (who ironically pays for it).

Another part is that it is a lucrative profit center for "sleep institutes"; if I were 25 years old and starting a practice in medicine I would be tempted to start a sleep center myself, both to help people, but also to help put my kids through college and pay for rent on that villa in Italy every summer.

So there is a tendency for sleep docs to push it, whether its a good idea or not for any particular patient candidate. The overhead for a $3700 sleep study is use of the facility for a night and sharing the cost of one technician's shift among multiple studies for that night. Schedule 5 PSGs on a Wednesday and the profit is in the $18,000 range for that single 7-hour time frame. And that was just on Wednesday.

But maybe there is a better way.

I think they started with a better way for me, because they started with a home study to get a general view of what my issues were. That alone was enough to get insurance to fork over for an APAP. But they also forked over for a full PSG later on; also probably a good choice.

Maybe another way is to send someone home with an APAP for a couple of weeks, and then use that info rather than a PSG study to get a starting point on a patient's therapy. That would certainly be less expensive; you could use that same APAP on hundreds of candidates, with basically the cost of a mask and DME instruction being the bottom line costs.

Then a sleep doc could parse that data and decide how important further study is, and the insurance co. could either opt for a PSG or opt to just allow a prescription for an APAP. The best interests of all parties are probably served by that.

I do have a question for anybody that might see this. Does anybody know of any lectures on PAP therapy or Sleep Apnea that are on video somewhere? I use YouTube a lot, but do not seem to have found anything that may have been uploaded from somebody who was at one of her lectures, but does anybody know of anything that might have video of her speaking? I really would like to see some publishings, or slides of presentations. I love this kind of stuff.

I wonder if anyone's ever done a "TED" talk on this subject.

[me50]

I would like that doctor to explain how come so many military members with perfect body weight (BMI) have sleep apnea?

I know that some pulmonologists are considering sending patients home with an Autoset machine for a month instead of a titration study as they consider that a month's data is more reliable than a one-night titration study.

yea, I made the same comment without talking about military members in a post on a previous page of this thread.

[me50]

regarding tats and piercings, there are a small % that gets tats and piercings all over their body. A lot of us get them as a memorial to someone special that has passed away and don't have sleeves, facial tats, leg, back and chest tats. God made us how we are and we grieve and memorialize how it works for us and for some, me included, it was with a tat. \

Plastic surgery is another story. Some plastic surgery is necessary when there has been cancer or the person was burned, etc., but plastic surgery for vanity is another story and the surgery has to be done over and over if one wants to stay looking 20 when they are 70. I had a former employer who swore she would never, ever have plastic surgery like all the other dance moms had and a few months later, she had plastic surgery and her skin was pulled so tight her eyes were slanted and she looked horrible.