Pro & Con of keeping follow-up Sleep Dr appts

[JayDee]

BLUF: Just had my first follow-up appt with my sleep doc, it was mostly a routine check for how I was feeling and I'm leaning towards not making my next follow-up appt. Or should I make that appt?

He's a nice enough guy and I appreciate the sleep study and RX that got my on APAP therapy. When I went in yesterday, he checked compliance (as expected) and asked if I had any complaints or issues (I have none). He reviewed the "tiredness score sheet" I filled out when I checked in and asked how I was feeling. I told him that I have my pressure pretty much dialed in, that I'm working on mouth-leaks and getting better with them and that my apnea is well under control with APAP therapy. As far as the apnea issues, my better-half says I no longer snore nor have I awakened her with loud gasps like I did pre-APAP. Also, I can tell from Sleepyhead that for the periods during the night when I'm sleeping, I'm sleeping pretty steady. I still wake up periodically throughout the night due to chronic back pain from an old back injury and that is my only remaining sleep issue.

And that was it. No other discussion. We shook hands and parted with a "See you in 6 months".

I've nothing against the guy and I appreciate him, I'm hesitant to make that next follow-up appt IF I have no issues and all he's doing otherwise is checking compliance, which he can do online at his leisure. Presuming I won't have met my high deductible (I rarely do), that's $250-ish per appt I'd rather keep in my HSA account.

Now if I do happen to develop any issues that I just I can't sort out on my own over the next 6 months, I can always make a normal appt.

I didn't ask what happens if I don't make that appointment, but perhaps there is something I'm missing. I already have the machine. I get my own supplies and don't use the DME. Using insurance is typically the most expensive option, whereas I can buy my own supplies up to and including a replacement machine much less expensively from any of the sources that don't require a RX with my HSA funds as needed.

Is there something else I should consider? Something I'm missing? Any other pro/con?

Thanks,
-JD

[Pugsy]

I vote for this

Now if I do happen to develop any issues that I just I can't sort out on my own over the next 6 months, I can always make a normal appt.

I started cpap therapy last of May 2009. Saw him/her for roughly 90 day follow up in early August 2009. Left with a "see ya in 6 month" thing and I never made the appointment nor have I had the need to go back.

[LSAT]

Compliance is only for 90 days....after that ...if you are sleeping well and your AHI is low...you don't need the doctor (Unless you have $250 burning a hole in your pocket).

[jnk...]

Some people want and need follow-up with their sleep doc. Others don't. I filed myself under "don't."

My situation is somewhat unique, but my coordinating primary's office was willing to forward my printouts of my first ResScan report as proof of compliance and efficacy to the sleep doc for his records as a courtesy to him. My primary "took responsibility" for managing my care from there. He knew he didn't know much about CPAP, so he had asked me if I was comfortable managing my own OSA treatment. I said yes. Now at my annual physical my primary asks if everything is going OK with CPAP. And occasionally he says that if I ever want to give him another report for him to put in my file that would be fine.

I don't discourage people from regularly seeing a sleep doc, though, because if they don't get help from an online forum like this one or from an exceptionally educated DME employee, the sleep doc's office may be all they've got for help if they continue to have sleep issues.

[nanwilson]

Been at this for almost 9 years, saw the sleep specialist just before I received my equipment and NOT SINCE. My pulmonologist (asthma) told me months ago I needed another sleep study..... told him no I didn't and if he wanted one I would bring in my sleepyhead stats and he could see that all was okay. He hasn't mentioned it since I am my own advocate with this therapy... except for those here that freely give out correct information and help if any, when I have needed it. Save your $$$$$$$$$$$$ for more important stuff.
Cheers
Nan

[JayDee]

Appreciate the sanity check. I'll just skip the appt.

Thanks all,
-JD

[jhuckabyjr]

I've been on CPAP for 3 years. First year was with a brick. Had the initial sleep study, then titration. Was issued a machine and never given a followup appointment. My insurance has a high deductible, so all supplies have been out of pocket. I began to lurk on this site and one other, trying to learn as much as I could about settings, masks, machines, and so forth. I felt okay the first year, but so many issues with mask leaks, and I absolutely hated the full face mask. By the second year, I purchased an APAP, and experimented with different masks....nasal masks, pillows, and finally found the right combination of mask and machine settings. I see my primary typically every 6 months, and take a current printout from Sleepyhead. We discuss, and he says as long as I am comfortable managing my therapy, he sees no reason to waste the money on a pulmonologist visit when my typical AHI is less than 1. In hindsight, I wish I had all the information I have now back when this journey began. To add, I've also considered the SoClean machine, but decided after reading comments on here, that I'm better off saving the money. I wash hose, mask, and water chamber with soap and water once a week. I use unscented baby wipes on the mask daily. Keeps the grime off, germs off. Nothing more is needed for clean equipment other than regular filter changes.

[Muse-Inc]

Saw sleep doc 6 weeks after picking up equipment, he showed me the brain waves...yikes, scary! Saw him again after 12 months of CPAP therapy as my blood tests seemed to have stabilized as he predicted. About 6 months later with the mentoring of folks here, I had become a mouth breather and intolerant of straight pressure, so back to sleep doc. He loaned me an APAP and overnight recording oximeter for 4 nights. Wow what a difference in my sleep quality! Ended up having to buy an APAP and hybrid mask out of pocket thanks to our profit-making insurance. Thereafter, for next several years, I used to visit annually hauling all my devices for them to ensure each was blowing the right pressure. Then, dropped by insurance and that stopped my appointments.

[purple22]

Does your insurance require that you see the sleep doc how often for them to keep giving you supplies? Such as masks, hoses, cushions filters. Or even for them to keep making payments on the machine itself. I suspect it is the insurance requirements which is what will make you go to see the doc how often, for what.

[Okie bipap]

I continue to see the nurse practitioner at the sleep clinic every six months. I also see my primary physician every six months. This schedule works out to where I see one or the other every three months. I have other breathing problems (asthma and occasional bronchitis attacks), so I don't mind having my lungs and heart checked four times a year.

[chunkyfrog]

I see the sleep doc every year.
It keeps Medicare happy.
Do I need it?
Only for the financial support--a no-brainer in my case.

[SewTired]

Here's where you have to learn to be your own advocate. Why 6 months? Why not 1 year? Don't limit this just to your sleep doctor. Ask all your medical people including dentist, eye doc. etc. So few people do question the frequency of follow-up that medical professionals are often surprised when you ask the question. Some doctors actually hold you hostage by only setting the refills for your necessary prescription to 6 months (or 4 months or whatever frequency they want). There should be a reason for it.

So, my suggestion is to contact your doctor's office and tell them that the doc suggested a 6 month review and you are thinking a year unless there are problems. Is there any reason why this isn't feasible? I think I had one 6 month follow up and then it went to a year. However, I had a secondary problem (RLS). If you don't, then maybe an annual is all you need. My supply line is now through my primary, so no need to see the sleep specialist for another 2-3 years.

[SewTired]

Thereafter, for next several years, I used to visit annually hauling all my devices for them to ensure each was blowing the right pressure. Then, dropped by insurance and that stopped my appointments.

Qualified people that actually check the PRESSURE, not the setting, are generally not located in the doctor's office. Just thought you should know that. If I want to have the pressure checked on a machine, I have to go to the building that does the repairs (cpap, wheelchairs, walkers) as the DME office doesn't have the capability. At Lincare, most of the RTs didn't even know what a manometer was. They would just check the settings on the machine and declare it fine.

[klm49]

I see the sleep doc every year.
It keeps Medicare happy.
Do I need it?
Only for the financial support--a no-brainer in my case.

Same here, My DME requires it.

[Muse-Inc]

Qualified people that actually check the PRESSURE, not the setting, are generally not located in the doctor's office...

My sleep doc is the director who runs the sleep lab, is a ResMed equipment junkie, his office acts as DME (though I buy my own equipment elsewhere after first device and mask), his RTs run the sleep studies as well as issue and service the equipment (handled replacement of one machine under warranty for me even tho purchased elsewhere, charged me $50 for the overnighting), and educate patients.

Thanks for the reply, many don't know that most DMEs and their staff are clueless ,