[CPAP] Doc taking forever to give me new CPAP settings or BiPAP

[Gideon]

Ask him to interpret it for you but you want a physical copy for when you move to the yukon in 25 years and he caught a hockey puck with his head. That it's for your medical folder at home

[Apnea45]

I am able to get this from my machine using https://myair.resmed.com/Dashboard.aspx:

(attached pdf file)

and a cropped image:

   

[DeepBreathing]

I just did a search for "legal access to medical records in Canada" which came up with a number of hits. This one seems to summarise the situation: In 1993 the Supreme Court of Canada made it clear that the information in the medical record belongs to the patient. However, the physical record belongs to the person or organization responsible for its creation, that is, the hospital or a physician in private practice.

What this means:
Patients have a right to see the content of their record at any time and for any reason, subject to certain exceptions (e.g. if there is likelihood of harm to the patient).
Any inappropriate notations can be embarrassing to, or even grounds for litigation against, the writer.
The owner of the physical record is responsible for controlling access by others in accordance with privacy law.

So you are entitled to look at the record but not automatically entitled to a physical copy. That is similar to the situation here in Australia.

Having said that, your doctor sounds like an arrogant <insert swearword> of the first order. This type of condescending attitude shows he has no people skills whatsoever. If a doctor took that line with me, he would very quickly be my ex-doctor. I agree with Bonjour's approach - you need the record for your file if things change in future. And once you've got your hands on them find yourself a new doc.

[DeepBreathing]

Apnea45 I have turned off access to your pdf file as it contains your full name. Please let me know if you want it turned back on, otherwise I suggest you make a copy with your name excluded and upload that.

Regards
Paul

[Apnea45]

I just did a search for "legal access to medical records in Canada" which came up with a number of hits. This one seems to summarise the situation:  In 1993 the Supreme Court of Canada made it clear that the information in the medical record belongs to the patient. However, the physical record belongs to the person or organization responsible for its creation, that is, the hospital or a physician in private practice.

What this means:
Patients have a right to see the content of their record at any time and for any reason, subject to certain exceptions (e.g. if there is likelihood of harm to the patient).
Any inappropriate notations can be embarrassing to, or even grounds for litigation against, the writer.
The owner of the physical record is responsible for controlling access by others in accordance with privacy law.

So you are entitled to look at the record but not automatically entitled to a physical copy. That is similar to the situation here in Australia.

Ya that explains why in dialysis (I am on dialysis also .. lucky me .. 2 machines to keep me alive) they don't give me my blood results but if I ask for certain results they will write them down for me on a scrap piece of paper that I usually end up losing. I used to be able to get a photocopy of any results but I have noticed a change and it frustrates me. The only time I have been able to get all my paperwork at once was when my family doctor died and I had to pay to get more than 6 months worth as only the last 6 months you get automatically when changing doctors. 6 months would have not even covered my most recent surgery so I paid and since I did I also made a copy for my own personal records and found out that they had the wrong kidney disease listed in my charts as to why I ended up on dialysis among other misinformation.

It is always good to have your own copy and I don't know why they are so stingy with it here. I have learned quite a bit when taking a peek when the nurse leaves the information on the computer and leaves the room to get the doctor but most of the time the nurse logs out and the doctor logs in with his own information to see it.

With the sleep doctor I thought for sure he would have given me some information or answers. Now I know better for my 2nd meeting with him. Any advice on how to get what I want / need from this type of doctor? I am young looking and I do notice doctors tend to think I am younger than I am and cannot handle any information. Yet I know better than to just blindly let the doc control my care in a one-sided fashion. Not to insult any docs but they are only human after all.

Having said that, your doctor sounds like an arrogant <insert swearword> of the first order. This type of condescending attitude shows he has no people skills whatsoever. If a doctor took that line with me, he would very quickly be my ex-doctor. I agree with Bonjour's approach - you need the record for your file if things change in future. And once you've got your hands on them find yourself a new doc.

Ya I have already been thinking of how to switch to another sleep doctor. I don't know how to go about that. I got referred to this one from my renal (kidney) doc (Nephrologist) when on rounds but I am not even sure if it was him or the transplant coordinator who set it up. I wonder if seeing the Sleep Doc once was really enough to go on judging him. Perhaps he will be better on the next meeting. .. I don't want anyone upset with me..

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Apnea45 I have turned off access to your pdf file as it contains your full name. Please let me know if you want it turned back on, otherwise I suggest you make a copy with your name excluded and upload that.

Regards
Paul

Thank you. I took it out of the file name but didn't realize it was in the file itself.

[Apnea45]

Apnea45 I have turned off access to your pdf file as it contains your full name. Please let me know if you want it turned back on, otherwise I suggest you make a copy with your name excluded and upload that.

Regards
Paul

Okay I was able to edit it with a 7 day trial of Adobe Acrobat DC.

Reattached the file from my CPAP machine now.

[Apnea45]

1. Obstructive: The muscles of your upper airway relax in your sleep, allowing your tongue to fall back and/or your soft palate to collapse. This obstructs (blocks) the airway. This is the most common form of apnea and should respond very well to the machine you have. There is an excellent video demonstrating how this all works in our wiki: http://www.apneaboard.com/wiki/index.php...=Wiki_Home  Scroll down to the bottom of the page.

2. Central apnea: In this case the brain does not send the "breathe now" signal to the lungs. This may be due to a number of reasons including neurological disorder, reaction to medications, being at high altitude and others. It can also be idiopathic which is doctor-talk for "I really don't know". Finally it can be brought on by your body adapting to CPAP, as the increased airflow reduces the balance of CO2 in your blood. Central apnea is best treated with a machine called an ASV (adaptive servo-ventilator) which is a more sophisticated (and expensive) form of CPAP.

Thank you for explaining Central Apnea to me. That makes sense. In adjusting to the CPAP will my body eventually accept it and stop holding my breath?

[Sleeprider]

Apnea45, I have looked over the information in this thread and have some thoughts concerning your therapy with your Resmed Airsense 10 Autoset for Her. First off, your CPAP machine is a very good one, and we can probably get you dialed in if you will try some experimentation with our guidance or coaching. Your current setting are 6.0 minimum, 18.0 maximum and EPR 3 in Autoset for Her mode. Your usage of the machine is extremely erratic, and consists of very short therapy sessions that are fragmented and ineffective. The one chart you posted with detailed data (below) appears to have started at a pressure of 4.0 in ramp, and upon the conclusion of a 10 minute ramp, the pressure increased rapidly to the maximum and stayed there. At this high pressure you were clearly uncomfortable and showed a mixture of obstructive and central apnea.

It is clear why you don't experience any benefits from the machine, and we need to get you more comfortable so you can start putting together more consecutive hours of therapy and get somthing like sleep for a change. In order to do that, we need to change your settings and talk about your sleeping position. First, you should start with a trial of much lower pressure. I recommend the machine be set in Autoset mode with a minimum pressure of 6.0, Maximum pressure 10.0 and EPR at 1 and Ramp OFF. If we can get a few hours of data at these settings, we can move to the next step. Your data suggests you may experience what we call positional apnea, which results from a tucking of your chin. If you are using more than one pillow, or sleep in a position where your chin is tucked toward your chest, you need to find ways to correct that. A tool many member have found useful is a soft cervical collar which supports the chin, prevents tucking and closure of the airway, and also can help with leaks. Read this http://www.apneaboard.com/wiki/index.php...onal_Apnea

The purpose of limiting pressure and correcting positional issues is to get enough meaningful data to help you further optimize your settings. We don't want the machine going to very high pressures unless they are needed, and your previous results show you don't tolerate that well. Most importantly, you need to relax and get some time with the therapy. I do think you need to carefully assess the possibility that much of your problem arises from airway alignment problems, and fix that first. CPAP cannot force your throat open when it is occluded due to position.

[Apnea45]

I recommend the machine be set in Autoset mode with a minimum pressure of 6.0, Maximum pressure 10.0 and EPR at 1 and Ramp OFF.  If we can get a few hours of data at these settings, we can move to the next step.  Your data suggests you may experience what we call positional apnea, which results from a tucking of your chin.  If you are using more than one pillow, or sleep in a position where your chin is tucked toward your chest, you need to find ways to correct that.  A tool many member have found useful is a soft cervical collar which supports the chin, prevents tucking and closure of the airway, and also can help with leaks. Read this http://www.apneaboard.com/wiki/index.php...onal_Apnea

The purpose of limiting pressure and correcting positional issues is to get enough meaningful data to help you further optimize your settings.  We don't want the machine going to very high pressures unless they are needed, and your previous results show you don't tolerate that well.  Most importantly, you need to relax and get some time with the therapy.  I do think you need to carefully assess the possibility that much of your problem arises from airway alignment problems, and fix that first.  CPAP cannot force your throat open when it is occluded due to position.

Okay I got into the advanced settings "Clinical Menu" and changed my set up to how you said:

   

[Apnea45]

Just saw the "Sleep Doc" today and he said he thinks I need the BiPap but that the ResMed AirSense 10 For Her is only CPAP he says. He gave me a prescription for "BiPap at 12/6cm". I called the distributor that I got the CPAP from and they said they don't have the BiPAP. I guess I would have to call the 2 other places I got on a list to see if they do. So far I have been told there is a place hours up north in Hamilton Ontario Canada ...

The purpose of limiting pressure and correcting positional issues is to get enough meaningful data to help you further optimize your settings.  We don't want the machine going to very high pressures unless they are needed, and your previous results show you don't tolerate that well.  Most importantly, you need to relax and get some time with the therapy.  I do think you need to carefully assess the possibility that much of your problem arises from airway alignment problems, and fix that first.  CPAP cannot force your throat open when it is occluded due to position.

I had been falling asleep on my back but then turn to my side. I am a side sleeper.