Problem with doctor

[Mouchet]

I know that I am posting a lot but this is a completely bizarre matter .

 Five years ago I was prescribed a CPAP machine. It was set to nine .    I felt the CPAP machine was not really doing all it could do .

 I went and saw an ENT doctor and he said to try out an auto Pap machine where you get multiple settings throughout the night . I had a home sleep study and the settings were from 4 to 12 .

 My current sleep doctor said that was extremely wrong to do that .  he said he thought I was still on the original CPAP machine . 

 He also said that BiPAP and auto Pap should be used for no more than a month .  He said it should only be CPAP, and that is all he deals with.   Which is better and why? 

I am having problems right now with mask weeks and he said the CPAP should help with that problem. Does that make any sense?

 I am having problems right now with mask weeks and he said the CPAP should help without problem. Does that make any sense?  He did request a sleep study, my current doctor, and I scheduled it because I’m pretty desperate right now. 

 However I have a new doctors appointment on 20 August and they cannot do anything earlier .   should I get the sleep study and then go see the new doctor or should I just wait or what can you recommend or should I change it back to nine I’m willing to try anything .  

 I apologize for posting so much but my health is in severe decline . Everything from severe anxiety depression insomnia and even anger related issues are happening now. 

 Last I am trying to win off an antidepressant and I’ve been told that that would be a mistake to do a sleep study when that is happening . Does anyone know anything about that 

Last he said he knew nothing about Gabapentime and only would recommend Mirapex.  I get the feeling he doesn’t know what he’s talking about but can I really afford to wait and will my Nother doctor know anything anyways

[sheepless]

it's too easy from this distance to dis your sleep doc. the way you tell it, it sure sounds like he is incompetent. IDK. the important thing is whether you are comfortable and satisfied with the attention you receive; and it sounds like you are not. if you are not, it is in your own best interest to find another sleep doctor, clinic, whatever you need to get sorted out, asap. it's up to you how you proceed and how quickly. if you haven't already, you can look to your general practioner to help with anxiety, depression, anger, etc. and Rx questions while you line up a new sleep professional.

[S.L. Ping Beauty]

Other more learned members will chime in, but I can add this:

I complained to my GP that after almost a year on the machine that I am not anymore rested and in fact I felt MORE tired in the mornings. She suggested to me that we try the AutoPAP option to see it there would be any improvement. The Auto settings worked wonders for me and we never looked back as I am still on the Auto.

I do not know why Auto would be wrong so I am curious to what others will comments on this be.

[OpalRose]

Mouchet,
You apparently don’t have confidence in your current sleep doctor, so it is time to make a change.  

Is this new doctor that you have an appointment with in August a Sleep Specialist or a regular GP?  It would be ideal to have one doctor that would handle your medical issues and your Sleep Apnea, but usually that is not the case.

Why don’t you stick with the ENT doctor?  He sounds like he would prescribe an Apap.

I have no idea why your current doctor will only prescribe a Cpap, but many doctors feel that way.  Either they don’t understand how to set pressures on an Apap, or they don’t want to be bothered.

At least with an Apap, you can use the machine in Cpap or Apap mode. With a Cpap, you are limited to one pressure.

As far as anxiety and insomnia, discuss this with you GP.  

I hope you can get this all sorted out.

[Sleeprider]

Needless to say, I disagree strongly with your doctor and think you should part ways. Here is a good article in our Wiki that says your doctor is clueless. http://www.apneaboard.com/wiki/index.php..._and_BiPAP

[Mouchet]

Thank you all

I will most likely get the sleep study here and then switch doctors.

 My biggest concern is that if the machine is doing the breathing for me could screw up my breathing patterns ?

 I really need to check my sleepyhead data from 4-5 years ago to see what it looks like if it’s much better than where it’s at now I definitely think I’m gonna go back to just CPAP if this is the case

do you think pressure changes could be causing mask leak ?  Tree months ago I had 90 percent leak. It is a matter o instant sleep study or waiting-

[dmeRT]

a cpap does not breathe for you...it will not change your breathing pattern.

[Stom]

Sounds like your doctor seems to think that autosetting PAP machines are just for diagnostics and determining what single, constant pressure level you should use. That sounds like old-school thinking. These days APAP machines work with you, watching your breathing to give you just the settings you need at the time you need them. A CPAP is a one size fits all approach to your night's breathing, potentially giving you more pressure than you need at some times and not enough at others. There might be some specific reason you should have a single pressure setting, but your doctor sure hasn't articulated it from what you've said, and his general dismissal of APAPs as long term care is odd sounding. Definitely worth getting a second opinion.

APAPs change pressure levels while you are sleeping. That can aggravate leaks. But an APAP can also keep you from needing to be at higher levels for as long, thus reducing leaks overall. He sounds determined to stick you with the older technology he's comfortable with. I have no idea if it is for sound reasons that really fit your needs or if he's just not up with current technology.

[Stom]

Thank you all

I will most likely get the sleep study here and then switch doctors.

 My biggest concern is that if the machine is doing the breathing for me could screw up my breathing patterns ?

Neither a CPAP nor an APAP breathe for you. They just provide extra pressure to help prop open your airways. They don't have a ventilation feature that will breath in and out for you.

do you think pressure changes could be causing mask leak ?  Tree months ago I had 90 percent leak. It is a matter o instant sleep study or waiting-

Pressure changes can cause some leaks, especially if you fit the mask for low pressure and don't test it at a higher pressure. But you may also have a mask that is worn and needs replacement with a new cushion or you may need a different mask. It may not be so much a function of an auto setting machine's changing levels, but that you sometimes need higher pressures your CPAP was not set to provide you with.

[sheepless]

dmert, I believe you would distinguish cpap from asv which does provide breathing support. and while I'm pretty sure this isn't what you meant, cpap does in fact change breathing patterns by driving through obstructive apnea. so I think the question is does cpap change your breathing pattern when not using cpap. while I can't defend this or point to an authority at the moment, I believe I remember reading at least the implication that over time we can become "dependent" on cpap; that it can weaken respiratory drive or anatomy. I subjectively believe that the few times I've fallen asleep without apap, when I was using that modality, my breathing and apnea seemed much worse than before apap. could be perception but one wonders...