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Who generally is in charge of your CPAP settings?
#1
This was something I wasn't sure about when I got my CPAP and was talked about setting it up and how my doctor would be involved with stuff like I guess judging what settings to use and such.

Is it usually your primary doctor or a sleep specialist that does this? Because I don't have a lot of faith in my primary and I'm always relieved when I end up getting referred to a specialist. In my case, I did a couple of sleep studies, went back to my primary after a few weeks to let them get the results, and was told yes, I had apnea. So then my primary sent in the request for my CPAP equipment and I eventually got it. I figured this was kinda normal.

But after that introduction by the CPAP provider, I wasn't sure my primary would be doing that kind of stuff. And after 2 months of having my CPAP, I got a letter from the last sleep study center I went to essentially saying they'd tried to contact my primary and never heard back from them (but hey, you have apnea by the way), so I'm worried that maybe someone got cut out of the process.

So who usually makes the calls on your adjustments?
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#2
If you don't do it yourself, you're missing out on the best possible optimization of your therapy. You have access to the efficacy of your therapy by downloading SleepyHead, and learning how to interpret the results. In my case, I had a diagnostic sleep study in 2008, no titration study and was provided a prescription for auto CPAP and self titration. It's simple to learn the basics, and the forum can help get you up to speed and offer insights.

Be sure to retain copies of your prescription and sleep studies for your records. At each appointment with your physician, you should discuss your CPAP therapy, what you've done an how you feel it's working for you. If you do that, you will never need another sleep study and you won't pay a specialist to advise you on something you can do better.
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#3
Usually the sleep specialist. The Specialist usually implements the actual setting change by passing the task to the equipment provider.
It doesn't always work that way; especially in large group health organizations.

With most insurance, there is supposed to be a closed loop feedback to the insurer. The patient visits either the specialist or primary doctor to meet the requirement of a face to face meeting. Compliance is also normally required to permit the patient to keep the machine. The latest generation machines can report data back to the equipment provider via an internal cellular modem. If they share that info with the managing physician, the physician can have the provider make remote adjustments to the machine.

There are always variations on any process -- and it sounds like the loop didn't get closed in your situation.
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#4
Hi Mezzrow,
WELCOME! to the forum.!
Good luck to you with your
CPAP therapy.
trish6hundred
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#5
Thanks guys.

Mongo, yeah, that's where I'm at. I've got the modem installed and I need (or at this point, needed) to see my doctor in the first 90 days, I just passed that. Technically I fulfilled it in the sense that I went back to the doctor a few weeks ago, but that's where I got the sense that I could easily run into trouble because these guys don't seem to know much and then a day or two later is when I got that letter from the sleep study center saying "Hey, we tried contacting your doctor but never heard back from them...".

Since I'm still in the first year of me technically not owning it, I'm not supposed to mess with the settings (though I did once just to enable the leak test option, which didn't do much for me anyway), so I'm not going to mess with the settings at this time.
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#6
Since most primaries have no training on cpap machines, you should focus on the sleep specialist as your go-to doctor for this. It's no different with diabetes. While primaries are better trained on it today, unless your doc has extra training on T2 diabetes, you are generally best off working with a specialist and diabetes educator/nurse as your go-to.

That said, you will get your BEST RESULTS doing it yourself (a) because you are motivated to improve your health, (b) because you can access the data daily and make adjustments immediately vs. waiting weeks to see the doctor and © you will understand your needs, particularly if something changes. This is particularly useful when you don't have effective medical assistance, as is sadly the case of many people who seek assistance in these forums.

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#7
(11-10-2016, 02:45 PM)Mezzrow Wrote: But after that introduction by the CPAP provider, I wasn't sure my primary would be doing that kind of stuff.

It sounds like your primary doctor dropped the ball on this. Since he's the one who ordered the sleep study, he's the one who gets the results, along with the interpretation and recommendations from the doctor who is the sleep lab's specialist.

Either the sleep lab or your primary doctor will then refer you to a medical equipment provider who will set you up with a machine and fit you with a mask.

Since you seem to have been left in the dark during all this, I would call or email your doctor and ask about the need for pressure adjustments. Ask for a justification.

Here's where it gets to be a disappointment. Someone should be looking at your data and recommending adjustments. The doctor may be content to look at only that portion of the data that tells the number of hours per day you're using the machine. That's called compliance data. He may be required by your insurance company to do that. And as to recommendations for pressure changes his attitude may be that since the sleep study results and interpretation recommended a pressure of 9 cm, that's the appropriate pressure, unless you're complaining of problems such as pain from swallowing air.

It's a lot of extra work to look at the data and make pressure adjustments. It falls on you to monitor your data and, since you don't want to risk making adjustments yourself during your first year lest you violate some insurance regulation, you will have to bother your equipment provider or doctor about it.

It's very likely that no adjustments are needed, but if you show us your data we can help you with suggestions for changes. Once you understand the reasoning behind those suggestions you can present them to your care providers, get their responses, and go from there.


Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#8
It's your machine, it's your therapy, it's your life, and it's on you. Download sleepy head, get to know what you're looking at, educate yourself, and adjust the machine to get the best results. "They" only care if you're using it 7 hours a night, whether you're getting the best results is of seemingly little interest to any of them, for as far as they're concerned as long as you use it you'll get "results". To get the BEST RESULTS you have to do some leg work. Do it, do it now, you'll be happy you did. No better resources than the people here to get you the very finest results. Had it not been for the people here I'd still be getting moderate to crappy results based on what the Dr recommended and set my pressure to. Don't let people tell you it isn't your machine, it is, they may be footing the bill but it's yours, adjust it as needed to get the very best results.
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#9
Funny you should ask, I had my 6 month follow up today with my sleep doctor. He reviewed the data on my card and ask me how things were going. I explained how I had tamed the leaks and adjust my settings to get my AHI down to 1.5 to 3.5 regularly. He said that sounded good and asked what my plans were. I said I was running my pressure at 15-19 now, and I felt that was the reason I primarily have CI's a HI's, and I was planning on slowly lowering the pressure to see if I could find a spot to lower those a little. He said, that sounded like a plan, asked if I had any questions, and said to make an appointment for a 6 months followup next year and wished me well.

I really like my sleep doctor, he has always encouraged me and worked with me.

Frank
I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
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#10
(11-11-2016, 09:28 PM)FrankNichols Wrote: Funny you should ask, I had my 6 month follow up today with my sleep doctor. He reviewed the data on my card and ask me how things were going. I explained how I had tamed the leaks and adjust my settings to get my AHI down to 1.5 to 3.5 regularly. He said that sounded good and asked what my plans were. I said I was running my pressure at 15-19 now, and I felt that was the reason I primarily have CI's a HI's, and I was planning on slowly lowering the pressure to see if I could find a spot to lower those a little. He said, that sounded like a plan, asked if I had any questions, and said to make an appointment for a 6 months followup next year and wished me well.

I really like my sleep doctor, he has always encouraged me and worked with me.

Frank

Great to hear this! That's a model conversation.

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