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Problem with doctor
#11
RE: Problem with doctor
If you could just get a good APAP like the Resmed Airsense 10 Autoset, and observed the data, you probably would not need a sleep study. As long as your diagnosis of obstructive sleep apnea is in place, there is no reason you cannot self-titrate using an auto CPAP. Most insurance agrees.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#12
RE: Prublem with doctor
(07-23-2018, 02:51 PM)Sleeprider Wrote: Needless to say, I disagree strongly with your doctor and think you should part ways.  Here is a good article in our Wiki that says your doctor is clueless.  http://www.apneaboard.com/wiki/index.php..._and_BiPAP

:) JK but ya know...

We should add into wiki page definitions

Duck: a supposed Doctor which doesn't have a firm grasp on licensed medical expertise but covers the lack of this by making lots of unintelligent gibberish in a vain attempt to hide their incompetence.

PS I've not met anyone like this today at my Hospital visit. Bored to the limit here. ..


Oh BTW my opinion is APAP makes most sense to start. Cookie cutter CPAP for all is not a good answer. It's just lazy duck issue.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: Problem with doctor
What do you call the person who graduated at the bottom of his medical school class?

(wait for it)

Doctor!

I agree that the bottom line is that you don't have confidence in your doctor and you are better off switching. I got disgusted with the doc that did my sleep study (35 events/hour) and bought my own machine and mask and eventually nasal pillows. No Rx so no insurance but I found good deals on ebay and Amazon. I'm also an RN so I was comfortable researching the pros and cons of different features, and I considered the APAP, ERV, and humidifier absolutely essential. It just makes physiological sense to have the machine apply the minimum pressure needed in each situation.

Hopefully you will find someone to work with to help you achieve a solid night's sleep!
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#14
RE: Problem with doctor
I agree with the others. Your gut is telling you the dr isn't leading you in the right direction. And I'm inclined to agree with you, especially since I experienced something similar.

My dr was unwilling to do an auto. I pressed, so he agreed to do a 30 day trial to determine if maybe I'm needing a different pressure. I had a CPAP (not APAP) at the time, and apparently it had a setting that allowed for 30 days - and *only 30 days* - of auto ability. Ultimately, I realized he didn't want to "allow" me to get a different machine because *he was my DME* and he would *not make as much money from me* if I traded out machines. Not only that, but I got the impression he was lazy and didn't want to be bothered with figuring out if another pressure might be better for me.

I share that with you so you can see that your situation isn't unusual, and it's important for you to make your own decisions based on what your gut is telling you.

In my situation, I fired that dr/DME and took my Rx to a different DME that would "allow" me to have an APAP. And then I adjusted the settings myself, to find what is optimal for me.
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#15
RE: Problem with doctor
If I were in your situation, I would postpone sleep study until you have been off the antidepressant for at least two weeks. Half life of some are longer than others, but two weeks is pretty good to be sure the medication is out of your system. Most antidepressants suppress REM sleep. As long as you are still taking even at a low dose or still have med in your system, your sleep study will be suboptimal. You will not have enough or any REM sleep to have an adequate sleep study. REM sleep is when your apnea is at its worst. Your sleep study will not show what your breathing is like during REM and the result will not show your real pressure needs.

Both of my sleep studies done 12 year apart showed ZERO REM sleep while on two different antidepressants each time. I have been off all but Wellbutrin for 6 months now and have some REM sleep some nights now. This has totally changed my CPAP needs. With REM sleep, I am having more OA events with higher AHI. I was on Bilevel settings of 21/17 for 5 years with good AHI (always below 2) when on antidepressant mostly because no REM. Off all but Wellbutrin, 21/17 is not adequate. I have just been switched to Auto Bilevel so PAP pressure can adjust for pressure needed during REM sleep. That is the whole purpose of Auto PAP. It provides the lowest pressure necessary to prevent OA events and but adjusts the pressure to higher setting temporarily when needed during REM or positional changes. The pressure drops when the higher pressure no longer needed.

Any sleep doctor that refuses to prescribe auto PAP doesn't understand the improvements it can make to sleep. The old one pressure CPAP has been shown to provide inferior treatment. You either choose a pressure that is high for the entire night to prevent OAs which usually introduces CAs. Or you choose a pressure that is lower and allow more OA events which can be worse during REM or supine position. Either choice is not optimal treatment.
Everyone has a bad hair day once in a while.  Same with a night on xPAP.
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