Second opinion on a sleep study

[spudhorse]

Made some progress so let me document it for "those who come after."

I eventually found a sleep doctor who was just fine with giving a second opinion on my sleep study. It was still a bit of a struggle since all the office manager knew how to say was "so, you want to establish yourself as a patient and make an appointment?" She eventually got frustrated and sent me to her boss who said "no problem as long as you fill out all the paperwork so you're officially a patient and we can bill your insurance." Paperwork I can do! No issue at all with doing a telehealth visit.

She was the first person to say "I completely understand why you'd want a second opinion on the equipment you were supplied and we're happy to do that for you."

She confirmed I had the sleep study and knew how to download the report from myAir.com and we're good to go.

She did mention that having a prescription for new equipment filled might be an issue having to do with what is and what is not able to be done via telehealth after the expiration of some of the Covid relaxation rules by Medicare but we'll cross that bridge when we come to it (and it might not apply at all because my Medicare Advantage plan has its own rules in this regard.)

[Sleeprider]

Good luck Spudhorse. I have a strong prejudice against ST machines as I think they are an obsolete technology using fixed pressure and square-wave pressure transitions modified only by rise time. These devices have no "smart" technology, so not respond to changes in respiratory volume and simply trigger IPAP based on spontaneous respiration or timed breaths per minute. Compared to either ASV or iVAPS it is crude, uncomfortable and generally ineffective, however they are frequently used in COPD patients and improperly in central apnea patients. For individuals with good spontaneous respiratory effort and an need for bilevel pressure the Vauto is the best of the best, with effective and responsive auto titration, comfortable IPAP/EPAP pressure transitions, and trigger and time of inspiration controls that can further optimize results and comfort. Hope that makes some sense. If you feel you need a stronger background on these devices and their intended use, read the Resmed Clinical Titration Guide. https://document.resmed.com/en-us/docume...er_eng.pdf Good luck with the new doctor.

[spudhorse]

Well, I've failed.

Finally had a telehealth visit with an actual sleep doctor. In summary:


Stop looking at all the numbers and stop looking at OSCAR. You're AHI is below 5 . A 1 isn't any better than a 5 because they're both in the normal range. Stop looking at your O2Ring data or it will make you crazy.

As far as having the correct piece of hardware (Resmed AirCurve ST):

Since you're below 5, it's doing what it needs to do. And you can leave it with the back up breathing turned off because -- did I mention you're below 5?

When I mentioned that I don't feel rested and sometimes feel really tired when I wake up:

Why don't you come up here for a 2 day sleep study to rule out narcolepsy?

Today's lesson learned: Never tell a doctor that you will take a nap when you feel tired! It was obviously clear to him that it couldn't be the therapy because -- . . . 

I told him if it was a choice between 5 minutes of waterboarding or another sleep study, I'd take the waterboarding. I don't think he found it very humorous. 

Ironically, after telling me to stop looking at the O2ring, he wanted to do an overnight with an 'approved' pulse oximeter. I said OK.

So I'm at the end of dealing with sleep doctors and their minions.

[Deborah K.]

I wanted to move from a ResMed AirSense 10 Autoset to a ResMed AirCurv10 Vauto. I went to my REGULAR doctor and explained why I believed I needed the Vauto, and he prescribed it! I had to provide the DME with a copy of my old sleep study, which did NOT show the need for a Vauto. My insurance paid for it and now I have my new machine. You can do this too!

[spudhorse]

Thanks Deborah K. but as they say "been there, done that." My regular doctor wanted nothing to do with the conversation and the physicians assistant who wrote the prescription isn't about to do something that's outside what the guy who signed the sleep study wanted. The sleep doctor who signed the sleep study wouldn't talk with me unless it was face-to-face which is about a 200 mile roundtrip drive. Hence, why I went looking for a second opinion.

By the way, moved from Longmont in 2019. Days like today here in Idaho make me really miss the bright blue Colorado skies!

[SarcasticDave94]

Ah yes, the old if you're looking at the numbers you're feeling bad trick.

I dunno, I think you're at the brick wall with these Dr. Quacks. If me I'd go somewhere else. Fire and replace.

Keep your sleep reports because you should be able to reuse with someone willing to actually help instead of patronizing. Pretty incompetent group it seems.

[Deborah K.]

I'd look up regular doctors online or talk to folks you know about their doctors and find one who the patients like very well and who actually listens to them, and hire him or her.  It's not like you have to stay with your present doctor, or that he has to be your only doctor.  It is worth the effort!

Boy, do I sound like a cheerleader!  

[spudhorse]

I can't really be mad at the regular doctor since she wouldn't know a CPAP machine if it . . .  and the process is for her to refer to the sleep lab and then have a physicians assistant handle all the follow-up. Any doctor in the small healthcare system I'm in will do the same thing.

Thanks for the cheerleading but I'm going to try to live with what I have for the moment. This entire adventure is sucking way too much joy from my life.

[SarcasticDave94]

Had a thought for you. I don't know of a supplier by name, but I recall something about if you can give them a copy of the sleep diagnostic, they have a reviewing doctor that will script the machine. Maybe they would get what you need.

It's been a while so forgive my poor memory. Your report indicated whatever machine you're after that's not the current one? I see in the earlier posts on this thread I mention ASV, Sleeprider has mentioned some others. Maybe worth a shot, give them the complaint of poor treatment despite getting to AHI 5 or less.