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CPAP better than APAP for cardiac issues?
#11
(05-21-2015, 09:07 PM)zonk Wrote: Introduction: page 1
... It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas

Hello Zonk,
Thanks for that but I think that only refers to so-called 'complex sleep apnoea' that may be exposed during CPAP/APAP treatment and is I believe defined as obstructive events less than 5/hr combined with central events more than 5/hr.

There's a good description in
doi: 10.1183/20734735.042412. Verbraecken
Breathe September 1, 2013 vol. 9 no. 5 372-380

And thank you for all the replies so far to my original post - many suggestions to ask my doc to provide references. Could be a * leeeetle* problem with that! - not sure how many of you have had medical care in France? But asking doctors for information or evidence or references etc seems to go very contrary to the French way of doing things... I shall try to ask her though, just don't want to run the risk of being dismissed from her practice as she is a very good doctor (and, yes, I have already been sacked by a French doctor! - "You have so many questions, it is clear you do not have any confidence in me, so I think it is better that you do not return to see me" ...

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#12
(05-22-2015, 01:48 AM)Asjb Wrote: But asking doctors for information or evidence or references etc seems to go very contrary to the French way of doing things... I shall try to ask her though, just don't want to run the risk of being dismissed from her practice as she is a very good doctor (and, yes, I have already been sacked by a French doctor! - "You have so many questions, it is clear you do not have any confidence in me, so I think it is better that you do not return to see me" ...
So good medical care only if you don't question it.

Hmmm. I wouldn't do good there. I question and ask for references from all of my doctors. A good doctor shouldn't have issues with that regardless of where you are. How else would you know if they are actually good?

I don't have afib and have never had a heart attack, but I do have CHF and have been on a BiLevel Auto for more than 9yrs. My cardiologist was not involved with that decision but he is well aware I use one, what I use and the pressures. He has never said anything other than good. Sleep helps with your condition.

I've fired a few primary doctors as they clearly didn't know what they were doing and couldn't defend the positions or treatments they were suggesting.

Medical care is no good if it isn't accurate.

Current Settings PS 4.0 over 10.6-18.0 (cmH2O) BiLevel Auto
TNET Sleep Resource Pages
CPAP Machine Database
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#13
(05-21-2015, 08:36 PM)me50 Wrote: It isn't always accurate that doctors have information before we do.

Oh, totally, I agree with you. It's hard for them to keep up on everything. I have all these rare things wrong with me (diabetes is the only 'normal' thing I seem to have!), and while you can find stuff on the internet, most of the recent studies are only available through medical services where you have to pay a large annual fee to access. But yeah, my GP didn't know that statins were actually contraindicated for women - I gave him 3 links on that (including Lipitor's own study of 2000 women that showed women taking Lipitor were more likely to have a heart attack than women not taking it.). It took 2 years before the state stopped harassing doctors about pushing statins on their female diabetic patients despite the fact that the study had been around for a couple of years before that.
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#14
(05-21-2015, 09:07 PM)zonk Wrote: ...Introduction: page 1
... It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas

That should not be taken out of context.

That quote refers to how the algorithm used to work. The point of the white paper is that the enhanced algorithm is much more accurate, so that particular lack of recommendation does not apply to modern APAP technology; it applies only to the previous technology.

That statement is there to validate why the enhanced algorithm was enhanced in the first place.

Resmed claims here that all APAPs are using the enhanced algorithm, and since this paper was written in 2010, it is probably safe to assume that any new APAP will contain this algorithm (from Resmed, at least).

Bottom line, if your APAP is newer than about 2011, this should not be an issue, and the old thinking does not support this particular sleep doc's theory at all, since the enhanced algorithm has made that a moot point. For five years.

Maybe this sleep doc needs to revisit the concept of continuing education.
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#15
(05-22-2015, 07:02 AM)krelvin Wrote:
(05-22-2015, 01:48 AM)Asjb Wrote: But asking doctors for information or evidence or references etc seems to go very contrary to the French way of doing things... I shall try to ask her though, just don't want to run the risk of being dismissed from her practice as she is a very good doctor (and, yes, I have already been sacked by a French doctor! - "You have so many questions, it is clear you do not have any confidence in me, so I think it is better that you do not return to see me" ...
So good medical care only if you don't question it.

Hmmm. I wouldn't do good there. I question and ask for references from all of my doctors. A good doctor shouldn't have issues with that regardless of where you are. How else would you know if they are actually good?

I don't have afib and have never had a heart attack, but I do have CHF and have been on a BiLevel Auto for more than 9yrs. My cardiologist was not involved with that decision but he is well aware I use one, what I use and the pressures. He has never said anything other than good. Sleep helps with your condition.

I've fired a few primary doctors as they clearly didn't know what they were doing and couldn't defend the positions or treatments they were suggesting.

Medical care is no good if it isn't accurate.

have you found a good primary care doc and cardiologist now or are you still looking?

In my recent lifetime (especially the past 3 years, I have found plenty of inadequate and non-caring docs) and I think I may have found a good doc now. At least she is willing to look things up if she isn't sure.

For instance, I was having a big problem with my ear. She thought that the best test to order would be a CT Scan (which I do NOT like) and they sent me on my way to the facility while they got the approval (stat) from the insurance company. When I got to the facility, they told me she had changed it to an MRI as she checked and for my situation, that was the best test that would show what was going on. She was correct.

I don't expect my doc to know everything about every condition, which test is the correct one, they can't do that. I do expect them to look it up and my doc has walked out of the room and checked her reference material to look up whatever she needed to and I appreciate that. Most docs in the US don't do that.

I suspect a lot of the reason is that they feel the need to get patients out as quickly as possible because insurance companies don't pay as much now. I have been at my doctor's office sometimes for 2 1/2 hours where she was available for my appointment time and she would go see another patient while I was getting a procedure done and then come back to me. I didn't mind that because she was genuinely concerned about me and was willing to take the time with me to get it right. She has ordered by blood work stat (she did that with the MRI as well because of my symptoms and extreme swelling and pain) because of my current symptoms because she wants to get a correct diagnosis and treatment started for me. That is as good as it gets when it comes to the way a lot of doc's offices are done now days.
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#16
(05-23-2015, 09:57 PM)me50 Wrote:
(05-22-2015, 07:02 AM)krelvin Wrote:
(05-22-2015, 01:48 AM)Asjb Wrote: But asking doctors for information or evidence or references etc seems to go very contrary to the French way of doing things... I shall try to ask her though, just don't want to run the risk of being dismissed from her practice as she is a very good doctor (and, yes, I have already been sacked by a French doctor! - "You have so many questions, it is clear you do not have any confidence in me, so I think it is better that you do not return to see me" ...
So good medical care only if you don't question it.

Hmmm. I wouldn't do good there. I question and ask for references from all of my doctors. A good doctor shouldn't have issues with that regardless of where you are. How else would you know if they are actually good?

I don't have afib and have never had a heart attack, but I do have CHF and have been on a BiLevel Auto for more than 9yrs. My cardiologist was not involved with that decision but he is well aware I use one, what I use and the pressures. He has never said anything other than good. Sleep helps with your condition.

I've fired a few primary doctors as they clearly didn't know what they were doing and couldn't defend the positions or treatments they were suggesting.

Medical care is no good if it isn't accurate.

have you found a good primary care doc and cardiologist now or are you still looking?

In my recent lifetime (especially the past 3 years, I have found plenty of inadequate and non-caring docs) and I think I may have found a good doc now. At least she is willing to look things up if she isn't sure.

For instance, I was having a big problem with my ear. She thought that the best test to order would be a CT Scan (which I do NOT like) and they sent me on my way to the facility while they got the approval (stat) from the insurance company. When I got to the facility, they told me she had changed it to an MRI as she checked and for my situation, that was the best test that would show what was going on. She was correct.

I don't expect my doc to know everything about every condition, which test is the correct one, they can't do that. I do expect them to look it up and my doc has walked out of the room and checked her reference material to look up whatever she needed to and I appreciate that. Most docs in the US don't do that.

I suspect a lot of the reason is that they feel the need to get patients out as quickly as possible because insurance companies don't pay as much now. I have been at my doctor's office sometimes for 2 1/2 hours where she was available for my appointment time and she would go see another patient while I was getting a procedure done and then come back to me. I didn't mind that because she was genuinely concerned about me and was willing to take the time with me to get it right. She has ordered by blood work stat (she did that with the MRI as well because of my symptoms and extreme swelling and pain) because of my current symptoms because she wants to get a correct diagnosis and treatment started for me. That is as good as it gets when it comes to the way a lot of doc's offices are done now days.

This is rare these days. This is why I like my pulmonologist. First he is extremely competent but he has no ego. He will spend time calling/emailing experts to find complex answers. Simple answers are a Google search and fifteen to thirty minutes away.

My previous PCP left the practice to be an attending at the local hospital. He was also great with no ego. My current PCP appears to have no ego as well. Beyond that I haven't seen her enough to judge much else. She does call promptly with abnormal lab results and sees me the same or next day.

We both are very lucky but I do feel a trend in the USA towards younger docs being more caring and open minded while leaving their ego at home. They also seem more willing to learn on the spot as needed. I believe this is more of a cultural change with my generation.
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