Doctor Ordered Pressure Change

[BillPedley]

update,July 26 2014

well I have been on cpap for 6 months now. use Apria DME and I've been fighting an uphill battle with them. Finally convinced my sleep Dr.to switch to an auto machine Remstar auto system 1 still but auto instead of reg cpap with a steady pressure of 11 initially. Machine is now set to 8-18 Big deal. I feel much better..but...now the Dr.calls and say being I'm doing good AHI from 120 to 3.7,that we'll just go to 12 pressure steady from now on..go figure. I feel much much worse and am at a loss here. Any suggestions?

[Moderator Note: Thread has been split so issue can get the attention it deserves.]

[Sleepster]

Hi Bill, welcome to the forum. If you were doing fine at a pressure range of 8 - 18 I wonder why the doc is switching you to a constant pressure of 12. Call or email the doctor and ask for an explanation. If you can't get one I'd say it's time to get a second opinion.

[BillPedley]

Thanks Sleepster, I did exactly that..the person who takes care of that is conveniently on vacation but her associate told me to call my insurance. LOL the answer she gave me was the report said i was doing great on an average of 13 cfm so i really can't figure out WHY she would change to a steady pressure

[robysue]

update,July 26 2014

well I have been on cpap for 6 months now. use Apria DME and I've been fighting an uphill battle with them. Finally convinced my sleep Dr.to switch to an auto machine Remstar auto system 1 still but auto instead of reg cpap with a steady pressure of 11 initially. Machine is now set to 8-18 Big deal. I feel much better..but...now the Dr.calls and say being I'm doing good AHI from 120 to 3.7,that we'll just go to 12 pressure steady from now on..go figure. I feel much much worse and am at a loss here. Any suggestions?

Get the clinical manual for your machine. And change the machine back to Auto with a range of 8-18.

And prepare to be whipped with a wet noddle when you speak with the sleep doc and/or the DME.

When they bring out the wet noodle for whipping you about being a foolish person for changing your settings, simply tell them over and over: I feel better when I use APAP at 8-18 than I feel when I sleep with CPAP at 12 ....

[retired_guy]

Very much agree with Robysue. It sounds like they had their head on straight when they ordered you the auto machine, but somehow forgot where they put it when they decided to revert you to standard CPAP. I think docs like to pigeonhole patients too much. But around here we believe in patient empowerment, and you know what works for you better than anyone else. So go get 'em Bill, and good job!

[me50]

update,July 26 2014

well I have been on cpap for 6 months now. use Apria DME and I've been fighting an uphill battle with them

I had a nightmare experience with Apria. I returned my machine and went to another DME. My insurance company said that they knew of the problems with Apria and were trying to work with them to fix them. I suspect they haven't had a lot of success.

Watch closely what Apria bills your insurance company for. I got billed for things that I never received and some that I never ordered if I remember correctly.

[me50]

I agree with robysue and retired_guy

[trish6hundred]

Hi BillPedley,
WELCOME! to the forum.!
Good job sticking up for yourself, keep up the fight and best of luck getting this situation straightened out.

[archangle]

The medical mafia dislikes auto CPAP (APAP) and using the efficacy data automatically collected by modern CPAP machines every night.

There are some limitations to APAP and CPAP generated data, but the arguments are mostly specious.

APAP's can be adjusted to work in a narrower pressure range and eliminate the problems that "untamed" APAP can cause. All it takes is a little analysis of the in-home data the machine provides and a little effort on the part of the doctor. The argument is made that the APAP may not find the "right" pressure. That's drivel. It assumes that a manual pressure (probably chosen from a one night $leep $tudy in the lab) is right and an auto pressure in a properly chosen range by examining the actual sleep data is wrong.

The medical mafia also tends to ignore the in home CPAP data and go exclusively with the data from in lab $leep $tudies. This is downright disingenuous. In some ways, an in-lab $leep $tudy is better than home CPAP data. However, it's not an either/or situation. Looking at the home data doesn't mean you can't have or use an in-lab $leep $tudy. Home CPAP data may very well alert a good doctor that the patient actually does (or doesn't) need a new $leep $tudy.

In short, the medical mafia doesn't like APAP and home data analysis because they're not as profitable as the alternatives and it does take a little more effort and learning on the part of the doctor. Many of them also have delusions of grandeur and don't want to hand over part of the control to some machine, especially since the machine does this control without generating as much ongoing revenue as the manual process.

[Sleepster]

Moreover, there's no monetary motivation for doctors to learn how to interpret CPAP data, and in fact there is monetary motivation for them to not learn.

There are a lot of good doctors out there who do learn how to interpret CPAP data because it's a better standard of care for the patients, but you cannot simply assume that your doctor is one of them. As in all cases of patient care, it's the patients who must check to see that we're getting a better standard of care.