Disappointing first follow-up

[linrey]

Visited my sleep Doc for the first time since receiving my CPAP. I've been extremely pleased with the benefits and have FABULOUS compliance. And, thanks to this board, I've overcome some difficulties.

But my Doc is not so sharp. I told her that I have 'lip flutter' and that I've been taping. So she says I need a chin strap. If I'd said I 'mouth breath', that might have been an appropriate response.

Before the CPAP, I'd fall asleep in about 5 minutes, easy as pie - it's in the records she has. I told her that the sound of the machine cycling, and the exhaust from the mask caused me to focus on my breathing, and delayed the onset of sleep. But I told her that listening to my iPod masks the noise and I was falling asleep faster now. So she gives me an insomniac's checklist of things to do, with the part highlighted for not watching TV or using the computer for 60 minutes before bed. Does she even listen at all?

Then I suggested that, after my straight CPAP machine was paid for, I'd like to try the APAP version. Well, she regailed me with all of the misinformation I've heard about from you fine folks, and I was so disheartened. Where do the doctors get this from? How can they think these machines don't stop apneas?

Have any of you managed to get a prescription for an APAP from your Primary Care physician?

Thanks for listening - and it won't even cost $229 (the sum billed to my insurance for the 5 or 6 minute visit).

[DP]

The reason why doctors are sometimes reluctant to order APAP is because current research does not support the need for an individual to be on an APAP all the time and in some cases showed to have a negative result as far as microarousals and desaturations go. Now I am not saying it does not work because I know a lot of people do use it successfully, I am just stating what the current literature states. You have to remember that in the U.S. doctors get sued all the time so they constantly have to watch their backs.

Lawyer: So doctor you prescribed an APAP to your patient who then died suddenly of a heart attack. Now you know sleep apnea can cause a heart attack and you are familiar with the current literature on the APAP. Why then, doctor, did you prescribe such a thing?

It is just the way medicine works sometimes.

[sleepingBear]

Linrey,

I suggest reading this thread.

viewtopic.php?t=17981

[tangents]

As disappointing as it is, I think DP is right. When I first started reading this board, I figured "why not APAP?" but more and more, I read the veterans cautioning to make small changes and wait about a week before making the next change. The APAP, if left wide open (4-20) will allow an apnea to start before bumping up the pressure - therefore you could have a microarousal and/or desaturation each time. I still want an APAP, but I'm glad that I've taken time to understand some of the complexities of OSA before I get one.

Here's a link that may give useful information about the medical guidelines (Practice Parameters) for the use of Auto's.
http://www.guideline.gov/summary/summar ... 1&nbr=2407

Do doctors listen? Many do, but I think many more do not. Sorry you got one of the drones who works on cruise control. But how exciting that you've teen able to reap some benefits from CPAP treatment! Keep up the good work!

Cathy

[rested gal]

Have any of you managed to get a prescription for an APAP from your Primary Care physician?

Yes.

A Rx from a PCP is the way I got started. I never had a "sleep doctor" at all.

I asked an old family doctor in town for a prescription for an "autopap" and told him what range of pressure I wanted on the Rx. He wrote it the way I wanted it. I ordered my first autopap from an online cpap supply store. I've done all my equipment shopping online ever since.

My story - why/how I started using "cpap":
viewtopic.php?p=5977#5977

I finally had a sleep study, after two years of using "autopap":
http://www.apneasupport.org/viewtopic.php?p=7956

[snoregirl]

I also get my prescriptions from my PCP. I never saw the "sleep doctor" who read the sleep study, wrote a boiler plate summary and charged $$$$$

I intend to stick to my family doc and manage my own care as many intelligent individuals are able to do.

Save your prescription as you can use a CPAP prescription to purchase APAP online cash if you wish at some point.