(11-08-2015, 10:14 PM)PaytonA Wrote:
(11-08-2015, 09:27 AM)49er Wrote:
(11-08-2015, 08:24 AM)StoopidMonkey81 Wrote: Just a curiosity. I get the feeling that sleep studies want to keep things very basic and titrate patients using simple CPAP, and hence that's what gets put on the prescription. Still, I get the feeling that most people here use AutoPAP with a pressure range. Is this at the recommendation of a sleep study or doctor, or is this largely the result of personal experimentation?
When I was initially diagnosed with sleep apnea, it was through a home study. Since I didn't have health insurance at the time, the sleep doc's only option was to prescribe an autopap machine. She prescribed it at 9-20 which still needed some adjusting but was definitely better than the 4-20 that is normally used.
When I had a titration study last year, I was already using the VPAP-S so obviously an autopap wasn't going to be prescribed unless I said I wanted to go back to that type of machine.
But you could have used the VPAP Auto which has an S mode as well as the bilevel auto mode.
I chose not to get a prescription for a new machine such as a VPAP Auto because it seemed that changing pressures on the APAP I previously used were greatly disturbing my sleep and I feared the same thing would happen in this situation. I was also concerned about insurance coverage issues.
Does the sleep study center or your doctor prescribe CPAP/APAP? It probably depends on your doctor. Both of the sleep studies I have endured were done at hospital sleep centers that had a medical director (physician) that was a "sleep specialist". In both cases, they read and interpreted the output from the polysomnowhatitz and I am sure they included a diagnosis and probably a prescription. However, it went back to my GP in both cases who did their own spin on it. My first doc said he didn't rely on the sleep study doc and preferred to read the polysomnothingy hisself. Straight CPAP set at 9.0. That was like back in 2005? Don't know about my current doc. Three days after the sleep study the internist's nurse called and said they were sending over an order to DME supplier and I should expect a call later in the week to go get fitted up with a new APAP machine (DME was the same place I went for the study). At the time, I was a ResMed fanboy and that particular DME supplier only sold Respironics and Transcend so I decided to go to another DME supplier that sold ResMed. First DME supplier made no issue, recommended another supplier and even faxed over the Rx.
If you think you are going to stay with that ENT, and you had to convince him to write a script for an APAP by telling him you wouldn't use it in APAP mode, then you probably shouldn't change it until you are past those first few visits. If they take the data and look at it. In my experience, most of the time, short of insurance required compliance certification, the docs only interest has been "Are you still using your CPAP? Is it doing any good?/are you sleeping better" checking the box and moving on from there. If you do choose to set it up in auto and take data reprots in with you for the visit (regardless of which doctor) get whatever software comes from the MANUFACTURER of the machine (in addition to Sleephead, if you choose to use Sleepyhead - Sleepyhead is great, but I think doctors, particularly ones that don't have the time to really get into all the ins and outs of PAPing, and who have never seen Sleepyhead, are more comfortable seeing Phillips/Respironics Encore reports for Respironincs users or ResMed ResScan reports for ResMed users. They will trust the DME manufacturer's trademark on the reports and probably will not invest time learning about SH).
(11-08-2015, 08:48 PM)DariaVader Wrote: My doc never considered prescribing anything but APAP. I had a home study for diagnosis, and skipped the titration study. I have 100% coverage for both the study and the PAP and supplies, and the Insurance company recommends home study, but not if other sleep disturbances are suspected. My Doc could have easily justified a lab study, but actually feels the home ones + APAP are a better tool for 90% of the time.
I think that even in Canada I would qualify for apap since my pressure needs during REM are markedly higher than non-REM. This is the "old fashioned" requirement for APAP in the US as well.
Interesting Daria. Makes me wonder if I would be prescribed an APAP in the US as I had 7 events non-REM and yet 25 during REM. Which probably explained the bad REM headaches I awoke with. As you know though, here in Canada I was only prescribed a fixed CPAP.
APNEABOARD - A great place to be if you're a hosehead!!
EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
IIUC, a pressure requirement difference of at least 4 pts due to either position or sleep phase change is the justification for APAP in CA. I hang around 8 or 9 until I REM when it shoots up to 12 to 14 doesnt really go higher unless I leak. My sleep position during the test was all on my side - I tried to back sleep for them, but I cannot breathe at all on my back and have *never* been able to sleep on it.... but if I had been medicated in a lab, they would have seen that too. I have absolutely no consciousness of pressure changes while sleeping unlike some others, and have EPR set to 3... count me as a huge auto fan! I seriously doubt I could tolerate straight CPAP at the 13 or 14 I'd need to allow me to REM.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
Practising during the day can help you to keep it at night
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
- Place your tongue behind your front teeth on the roof of your mouth
- let your tongue fill the space between the upper molars
- gently suck to form a light vacuum
(11-08-2015, 08:24 AM)StoopidMonkey81 Wrote: I get the feeling that most people here use AutoPAP with a pressure range. Is this at the recommendation of a sleep study or doctor, or is this largely the result of personal experimentation?
My good friend who happens to be a neurologist and now a full time sleep doctor told me that he normally prefers a sleep study that gives him a static pressure that he can dial into a regular static CPAP. He considers this the "Gold Standard" for OSA care.
I told him a few years ago that I wasn't interested in paying $1000-$3000 for a sleep study, nor even a cheaper home study when I already know I have OSA. I could purchase an auto APAP for $200 used and use software to verify my events at night. Why pay so much for a study when the cure is cheaper? A sleep study is like paying $3000 for a test to see if you need a new alternator in your car, when you can just pay $200 for the alternator repair and be done with it.
We talked about my symptoms and he was willing to write me a prescription for an Auto APAP machine which let me see what pressures were giving me the lowest AHI and then I can narrow the band until we get the best results.
I was given a static pressure CPAP machine. It was good at first, but its effect seems to have faded with me. The trend seems to be the APAP devices and I will be asking at the clinic for a review of my situation. I am so sleepy.
(11-08-2015, 08:42 AM)justMongo Wrote: My Opinion:
The sleep study, titration and straight CPAP route is old school.
It makes more money for the equipment provider.
More enlightened physicians are inclined to prescribe autoPAPs.
In some locals and other countries, a trial on an autoPAP is routine.
The equipment provider makes NO money from the sleep study and titration, unless you are getting your equipment from the sleep center itself. The DME only gets reimbursement for the CPAP and supplies. And yes sleep centers can make a lot of money off of a PSG and separate Titration.
Yes, most DME companies do not provide an AUTO machine unless the doctor prescribes it specifically. Some will prescribe an AUTO if the polysomnogram (PSG) was inconclusive or what is more the norm these days is that the insurance company will only pay for a PSG but not for the titration, so an AUTO has to be prescribed.
My DME provided AUTO's for years until the insurance companies kept lowering their reimbursement rates so it made good business sense to provide PRO versions instead of the AUTO. Some doctors will prescribe an AUTO just in case they want this option in the future.
(11-09-2015, 07:01 AM)OMyMyOHellYes Wrote: Does the sleep study center or your doctor prescribe CPAP/APAP?However, it went back to my GP in both cases who did their own spin on it. My first doc said he didn't rely on the sleep study doc and preferred to read the polysomnothingy hisself.
Some PCP's are quite capable in interpreting PSG's and making the appropriate recommendations, but others have no idea what to even look for. On that same issue, many doctors have no clue how to write an Rx for some PAP machines (AVAPS, AutoSv, etc), let alone read a PSG. I work for a DME and i can't tell you how many times we have to contact sleep doctors to correct Rx's. Some write Rx's for settings that make no sense or for machines that are not capable of those settings. Often the patient might know more about the machine itself or available masks.
I would encourage everyone who had a PSG and titration done to have it read by a board certified sleep doctor. Then make an educated decision about what brand machine you request from your DME.
Thanks for the info! Let me rephrase the question as a follow-up? Let's say I start my therapy at the static pressure prescribed by me ENT. Are there any indications I should watch out for that would suggest that APAP would work better for me, such as particular events in SleepyHead or physical indications?
Speaking as a physician who happens to have OSA:
"Sleep medicine" has exploded as a medical specialty, meaning it is a recognized income source for ANY doctor who wishes to treat OSA patients, whether or not the doctor really knows about OSA or not. Physicians who are actually Board Certified in Sleep Medicine should be the most knowledgeable, and best equipped to recommend the best treatment for their patients. But, since anyone with a medical license can treat OSA patients, the quality and depth of true understanding varies. Thus, you, as the patient, have to be careful regarding recommendations from your doctor, if they don't make sense. Always remember: seeking a second opinion is your right as a patient.
Recently, I decided to upgrade my failing 10 year old "brick" machine, and discussed my choices at length with my CPAP machine/supplies provider, whom I trust. I gave the specific information about what I needed to my personal physician, who admitted he did not know much of anything about CPAP machines, he wrote the prescription the way I needed, and I got what was necessary. I thought to myself that it was fortunate that I was not a brand new patient, as negotiating through this therapeutic minefield and finding a GOOD is difficult.
I have been very impressed with the depth of knowledge and detailed experience shown by many, many individuals on this forum. There is a wealth of information here that is available to all, and so many who are willing to help. So much of CPAP use detail is known only to those who have experienced the problems, and solved them. You will find help here, just for the asking.