Frustrated with recommendations by doctor

[Sleeprider]

If your doctor has an irrefutable prejudice against ASV you must change doctors. That position makes no medical sense and ensures a certain portion of his patients will be improperly or inadequately treated...that specifically includes you. I don't think I would do anything but get a copy of my records and transfer your care to a more open minded physician. I would not even ask for a referral as he is unlikely to appreciate the work of a physician that disagrees with his position on ASV.

[allanri]

I wouldn't ask the sleep doctor for a referral, but rather my GP.  In Ontario, I can't see a sleep specialist without a referral.

[sheepless]

rejecting asv because he doesn't like it is absurd. unconscionable. I can't speak for sleeprider but can tell you he helped me titrate my asv and I've read threads in which he helped others with same.

[jaswilliams]

Well, he’s already said he doesn’t like ASV machines, and wouldn’t recommend one. I will certainly try again.  I’m also going to ask to be referred to someone else for a 2nd opinion. 

The only thing I need a doctor for is to get a prescription for a new machine. Insurance is already maxed out for this kind of equipment.  And if I can get a machine (eg used) without a prescription, then I don’t have to deal with the doctor at all. Except for the settings... or do you think this is something that I can figure out with input from experienced apnea board member and trial and error?

The other possibility if your doc won’t recommend an ASV is a BiLevel with backup rate such as a Resmed Aircurve Vpap ST but they are not as comfortable as an ASV to use nor as effective

[Sleeprider]

Answering your question via PM in the thread...

[Cpapian]

I wouldn't ask the sleep doctor for a referral, but rather my GP.  In Ontario, I can't see a sleep specialist without a referral.

Hi allanri,

I am from Toronto.  A couple of things you have said puzzle me.

I am always about the money.  So first, the Ontario Government ADP program should have paid 75% of your CPAP.  That should have included everything to get you up and going, ie mask, hose, etc.  The prices are regulated by the Program.  A provider must be registered with the program and they should only charge you the 25%.  So it worries me that you say your insurance has maxed out.

Second, your sleep doctor  is no good.  Treated is considered an AHI of 5 and under here in Ontario also.   Your results are not acceptable.  (My untreated AHI was 39 - my treated AHI is 0 - 2 usually). If you are going to get another sleep doctor, there are some really good places to go.  Sunnybrook has a sleep lab.   A while back, I found a place that seemed quite comprehensive in their approach and where they stated they weren't happy until you were.   I'll try to refind their name if you want.       I'd imagine a sleep lab could work with the existing studies unless they felt there were shortcomings in the original ones.

I would definitely encourage you to get another sleep specialist and if you paid 100% of the cost of your machine, you should probably follow up on that also.

[allanri]

I am always about the money.  So first, the Ontario Government ADP program should have paid 75% of your CPAP.  That should have included everything to get you up and going, ie mask, hose, etc.  The prices are regulated by the Program.  A provider must be registered with the program and they should only charge you the 25%.  So it worries me that you say your insurance has maxed out.

Hi Cpapian - I wasn't clear, sorry. I did get the ADP coverage (though my mask and tubing wasn't included in what they submitted to the Ministry of Health ... I will ask about that).  The reason my insurance is maxed out (or close to) is because in my, er, enthusiasm to embrace CPAP, I also bought an AirMini travel machine, because I do travel a lot. My coverage through my extended health plan is only about $2000/year for respiratory equipment, and there are also limits on the # of CPAP devices you can buy in a five year period. 

So, when I say I'm not worried about the money, of course, I don't want to spend any more than I have to. But I'm prepared to spend what I need to if it will solve my issues.  

And thanks for the input re: what qualities as reasonable reductions in AHI in Ontario.  I am going to try to find another doctor; I will check out Sunnybrook.  If you do come across the name of someone there,  by all means PM me .. I'm anxious to move forward on this.

[allanri]

I looked in to the ADP details  (http://www.health.gov.on.ca/en/pro/progr...manual.pdf) ... ADP covers only a "basic" mask and tubing; I was given heated tubing, and I guess the mask I got (Respironics Dreamwear Nasal) was considered an upgrade, and therefore not eligible for coverage.

[allanri]

Answering your question via PM in the thread...

Thx!

[Cpapian]

I looked in to the ADP details  (http://www.health.gov.on.ca/en/pro/progr...manual.pdf) ... ADP covers only a "basic" mask and tubing; I was given heated tubing, and I guess the mask I got (Respironics Dreamwear Nasal) was considered an upgrade, and therefore not eligible for coverage.

Ya but ....... they should have given you the regular hose and regular mask.

I don't know anyone at Sunnybrook, but the clinic I was thinking of is Toronto Sleep Clinic.  It is run by a UoT professor.  They are at 790 Bay Street.  Their website had a lot of information, they have a number of different testing techniques over and above the polysomnography.  An interesting website if nothing else.