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Interesting follow up Doctor's Appointment
(03-02-2014, 08:14 PM)SleepWrangler Wrote:
(02-28-2014, 03:45 PM)SnuffySleeper Wrote: My Doctor told me that to get an Autoset or Apap that the government sets a certain guideline that the patient MUST meet to be prescribed an Apap. ALL doctors must follow this guideline. Basically if your OSA can't be managed well enough by normal Cpap determined by your doctor then he will prescribe an Apap. He said Doctors can't prescribe all Apap's or they would get in trouble by the government and possibly a Doctor's board discipline. Oh Canada....

Hi. I've been recently diagnosed with apnea. Still gathering info and learning from this site and messages like yours. I found the Respiratory Equipment Policy and Administration Manual for OHIP.

Quote:335 Medical Eligibility Criteria for Positive Airway Pressure Systems (CPAP/APAP/BPAP)

The ADP provides Funding for positive airway pressure systems for individuals with a diagnosis of obstructive sleep apnea syndrome (OSAS) and the presence of significant symptoms or medical risks without treatment, and the absence of symptoms or risks with treatment.

The ADP has additional Medical Eligibility Criteria for APAP (see 335.01) and BPAP systems (see 335.02).

335.01 Auto-Titrating Positive Airway Pressure Systems (APAP)

Individuals requiring APAP systems must meet the Medical Eligibility Criteria for a positive airway pressures system (see 335) and the Medical Eligibility Criteria outlined below.

The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side.

The issue I'm struggling with right now is that I found it really hard to sleep at the lab for the initial test and subsequent titration follow-up. Honestly, I don't know how they measured much of anything. I didn't sleep much.

Currently I'm at the step in the process where I will get a loaner CPAP machine for a month. Will insist on an advanced machine with data logging capabilities. Maybe I can help the doctor by being prepared and by supplying useful data once the trial is complete.

Really wish I had been better informed during my initial consultation. I didn't ask any questions other than "I want to be fixed!" Not really certain what kind of apnea has been diagnosed. Will do better next time.

Cheers and good luck to you! Thanks for sharing.

Woah! Thanks for posting the medical guidelines on eligibility! That's really valuable info. So basically your sleep study must determine you need a constant pressure of 10cmh20 + and need a greater variation of 4cmh20 going from your back to side to manage your OSA to be eligible for an apap.

Do you have a link to the complete guideline/manual? Would be very interested to read more on it! Thanks
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Forgot to mention! Check out my post in this thread sleepwrangler.


You might have to switch vendors or call around to get a data capable machine in Ontario, some of the vendors in Ontario out right refuse to sell anything but an s9 escape or p&k novo (both brick machines).

Good Luck!

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I'm following this thread with a bit of interest as it shows how un-uniform health care is in Canada across the provinces. Here in Nova Scotia it is much different.

When my snoring increased and my wife complained about it enough, I asked my doctor. He said to go to a Sleep Clinic (no referral necessary) and get a sleep study done. There was no cost and I did an 'at home' study. Couple of days later, got a call to make an appointment to see my doctor. He relayed the results to me and gave me a prescript for CPAP for moderate Apnea. Then made an appointment back at the Sleep Clinic where they gave me a new S9 Autoset to trial for a month (which I bought outright - no provincial government money for PAP - then submitted for reimbursement from insurance). There was a $100 cost for the trial.

There was no talk about qualifying for different machines and no discussion about types - they just provided the auto right away. Might also have to do with having moderate (right on borderline - AHI of 15) and not doing any other studies. Might also have to do with the fact that the provincial government does not kick in any money, so the supplier bills the full amount to the patient and submits the amount to private insurance for reimbursement - might as well sell the best. Unlike what I am seeing that in the US, the supplier gets a set amount regardless of the machine provided.

Doesn't look like I'd qualify in Ontario as my average pressure is under 7.
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In the US, the DME does get a set amount IF it is covered by insurance. That is why the DME tries to give the patient the least expensive machine because profit is their main interest.

But, if a patient isn't covered by insurance, the DME gets full price which is usually outrageous.

What is sad is that for the most part, anyone involved in supplying everything to a patient, is only concerned about their profit and not the safety, comfort and the best treatment for the patient. It didn't used to be that way a long time ago before HMO's, etc.

Even though I really like my primary doc, it is a nightmare b/c his receptionist doesn't listen, I believe she cannot handle the job by herself, and she practices medicine without a license unbeknownst to the doc (in other words, I brought in my medication list and I pointed to one of my medications and said, I need to know if this is safe for me to take so please ask the doc and let me know and her reply was, sure you can take that medication and she had not seen my chart, medical history or my recent year-end medical tests and even if she had, she is not qualified to make that decision). That is just one of many examples of her inability to handle her job and when requested by a patient to have the doc call, she doesn't give him the message. She also told me to take 1000 IU of vit d3 and I went to the office to pick up info the doc wanted me to have and he was standing there when I came in. I asked him how many IU of vit d3 he wanted me to take daily and he looked at me and said 2000 IU. I knew that his receptionist had not asked him because 1000 IU was a lot less than he had prescribed for me but my insurance wouldn't cover the medication.

EDIT: Health care in the US isn't what it used to be
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(02-28-2014, 04:17 PM)ThatOtherGuy Wrote: I have my first follow up coming up in a few weeks and plan to take my laptop with me with the Rescan software and data in order to discuss with the technician and the doctor. Hope they are positive about it. I personally think when a patient is engaged about their treatment its a good thing, they're taking ownership of the problem.
The sleep scientist was impressed that I was that engaged in my treatment that I had the software and would analyse the data. He used the laptop to get all the exact information he needed without resorting to asking lots of questions, just the facts. The sleep doctor was also very happy with the results I was getting and the interest I was showing. Normally they'd schedule another followup in 3 months but were happy to go 6 months and if all was well after that to allow me and my GP to manage the apnea until I felt it necessary to go back to the clinic for any follow up tests. The doctor said that there may be a slim chance of not needing the machine in the future but it was slim since an OSA issue is normally a physical problem that with weight loss will only reduce in severity and may not entirely go away. I'm not too worried, I am very used to being a hosehead now so its not a big deal to me, particularly if I continue to feel as good as I do.
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Huh. I'm in Ontario and my doctor wanted to put me on an apap trial because they couldn't find a good set pressure. So I asked him why not just prescribe apap? and then he was like.. Oh yeah I guess we could! Lol. Guess the guidelines really limit on how much they prescribe apap. He then prescribed cpap for my husband and he asked why not apap. Then our doctor explained the guide lines about apap. They have to justify the costs, but honestly wouldn't more sleep studies outweigh the cost of apap?
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(04-01-2014, 08:08 PM)Thefabulousmrsk Wrote: They have to justify the costs, but honestly wouldn't more sleep studies outweigh the cost of apap?

I agree with you. The costs of the sleep studies far outweigh the price difference between a CPAP / APAP (price difference is typically $50-$100 between CPAP and APAP). My second sleep study, was an additional $400 (insurance negotiated rate -- paid out of pocket by me) -- doctor wanted the study because the sleep-center said they couldn't find an optimal pressure.

Granted, my doctor did give me the option to skip the second study and get an APAP, but I didn't know about this forum in those days and I chose poorly Smile
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RE: thefabulousmrsk:
Seems to me if you and your husband are both on a machine you could get one machine, a little "T" fitting and experience togetherness in a whole now way! Hmmm, wonder what the "Sleepyhead" software would think of that?
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(04-01-2014, 08:20 PM)retired_guy Wrote: RE: thefabulousmrsk:
Seems to me if you and your husband are both on a machine you could get one machine, a little "T" fitting and experience togetherness in a whole now way! Hmmm, wonder what the "Sleepyhead" software would think of that?

What? I thought you would have had your cats hooked up to this thing with you by now! Too-funny
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(04-01-2014, 09:25 PM)SleepWrangler Wrote:
(04-01-2014, 08:20 PM)retired_guy Wrote: RE: thefabulousmrsk:
Seems to me if you and your husband are both on a machine you could get one machine, a little "T" fitting and experience togetherness in a whole now way! Hmmm, wonder what the "Sleepyhead" software would think of that?

What? I thought you would have had your cats hooked up to this thing with you by now! Too-funny

I tried that on my kitty named "Skinny." Now she's named "Puff"
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