Tips for getting an AutoBiPap from your sleep doctor
Summary: I started on CPAP @ 12cm 35 days ago using a ResMed Airsense 10 Autoset for Her and went in for my compliance appointment with my sleep doctor today.
While my apneas were technically controlled (average AHI 2), I had bad RERAs, flow limitations, and snoring; so 8 days ago I switched to APAP mode and over 3 days ended increasing it to 12 - 20cm, and suddenly my flow limitations and snoring dropped dramatically. I posted my charts and Bonjour and Sleeprider recommended an AutoBilevel device since my pressure was so high.
So I printed out (in color) all my Sleepyhead Charts and also printed out detailed charts from ResScan (in case the doc preferred that). And I printed out a dummy-proof bar chart showing how increasing the pressure nearly extinguished the RERAs, flow limitations, and snoring.
PROBLEM 1: I got to my appointment, gave them the SDCard, and the AirView compliance report only had 8 days of data on it. All three staff people couldn't understand why this was the case and, after numerous requests to have the card back, failed to produce anything more than the 8 day report. Apparently each time you change the settings on the machine, AirView groups the data with those settings, and it isn't intuitively evident how to print a report for more than one group of settings. Luckily I had printed a 30 day compliance report from ResScan, and apparently even that didn't matter because I was told only the DME cares about the compliance report.
PROBLEM 2: I see the doctor and he REFUSES to look at any paperwork other than what his staff provided him (the 8 day report). He says, you are doing great, feeling fine, and now I want to talk to you about seeing a dietician to lose some weight. I asked him if we were going to discuss how my therapy is going, and he seemed surprised because the apneas are controlled - case closed. I show him the pretty multicolor bar graph showing how I increased the pressure and the non-apneas went down dramatically. He didn't care.
SOLUTION: So at the point, I went a little batsh*t crazy and started ranting about how difficult this journey had been, how I wasn't really sleeping at night and did not feel better! I told him how I was in great pain, anxious, and near psychological crisis. I told him I had quit smoking, and didn't appreciate his disinterest and lack of enthusiasm for the obstacles I had overcome. And told him I expected him to address not only my apneas but my sleep quality (a risky move, I admit, to confront a doctor). So as he tried to listen to me, but he kept looking at the clock and saying, this is so odd that we're not on the same page. I told him I WAS grateful that my AHI went from 50 to 2, but now that I'm not dying from hypoxia, could we please do something about the sleep quality. So, he finally throws up his hands and says: just tell me what you want me to do!
So I tell him, please prescribe me a ResMed AirCurve 10 VAuto, since my pressure range is so high, and I need more support than EPR3. So he says fine (humph) and starts writing my a 4-25cm prescription. So I ask him, can you please specify the ResMed AirCurve 10 VAuto? And it is clear, he has NO IDEA what models ResMed makes, so he just scribbles ResMed on the prescription. So then I ask, can you please write out: ResMed AirCurve 10 VAuto, and he scribbles VAuto in the corner, and I guess that was the best I could do, so he hands me the prescription and shoves me out the door.
TLDR: sometimes the wheel needs to do more than squeak, it needs to come a little unhinged.
Stay tuned for the next episode: when we find out what the DME dispenses, and whether they become unhinged when they find out I adjusted my own settings (which by the way, the doctor had no problem with).
While my apneas were technically controlled (average AHI 2), I had bad RERAs, flow limitations, and snoring; so 8 days ago I switched to APAP mode and over 3 days ended increasing it to 12 - 20cm, and suddenly my flow limitations and snoring dropped dramatically. I posted my charts and Bonjour and Sleeprider recommended an AutoBilevel device since my pressure was so high.
So I printed out (in color) all my Sleepyhead Charts and also printed out detailed charts from ResScan (in case the doc preferred that). And I printed out a dummy-proof bar chart showing how increasing the pressure nearly extinguished the RERAs, flow limitations, and snoring.
PROBLEM 1: I got to my appointment, gave them the SDCard, and the AirView compliance report only had 8 days of data on it. All three staff people couldn't understand why this was the case and, after numerous requests to have the card back, failed to produce anything more than the 8 day report. Apparently each time you change the settings on the machine, AirView groups the data with those settings, and it isn't intuitively evident how to print a report for more than one group of settings. Luckily I had printed a 30 day compliance report from ResScan, and apparently even that didn't matter because I was told only the DME cares about the compliance report.
PROBLEM 2: I see the doctor and he REFUSES to look at any paperwork other than what his staff provided him (the 8 day report). He says, you are doing great, feeling fine, and now I want to talk to you about seeing a dietician to lose some weight. I asked him if we were going to discuss how my therapy is going, and he seemed surprised because the apneas are controlled - case closed. I show him the pretty multicolor bar graph showing how I increased the pressure and the non-apneas went down dramatically. He didn't care.
SOLUTION: So at the point, I went a little batsh*t crazy and started ranting about how difficult this journey had been, how I wasn't really sleeping at night and did not feel better! I told him how I was in great pain, anxious, and near psychological crisis. I told him I had quit smoking, and didn't appreciate his disinterest and lack of enthusiasm for the obstacles I had overcome. And told him I expected him to address not only my apneas but my sleep quality (a risky move, I admit, to confront a doctor). So as he tried to listen to me, but he kept looking at the clock and saying, this is so odd that we're not on the same page. I told him I WAS grateful that my AHI went from 50 to 2, but now that I'm not dying from hypoxia, could we please do something about the sleep quality. So, he finally throws up his hands and says: just tell me what you want me to do!
So I tell him, please prescribe me a ResMed AirCurve 10 VAuto, since my pressure range is so high, and I need more support than EPR3. So he says fine (humph) and starts writing my a 4-25cm prescription. So I ask him, can you please specify the ResMed AirCurve 10 VAuto? And it is clear, he has NO IDEA what models ResMed makes, so he just scribbles ResMed on the prescription. So then I ask, can you please write out: ResMed AirCurve 10 VAuto, and he scribbles VAuto in the corner, and I guess that was the best I could do, so he hands me the prescription and shoves me out the door.
TLDR: sometimes the wheel needs to do more than squeak, it needs to come a little unhinged.
Stay tuned for the next episode: when we find out what the DME dispenses, and whether they become unhinged when they find out I adjusted my own settings (which by the way, the doctor had no problem with).
