[Treatment] How is CPAP data used to get better sleep and reduce apneas

[chuck taylor]

After having been issued a non data CPAP and having returned it, I'll be returning to sleep doctor Monday to request RX for a ResMed S9 Auto Set machine.
My Sleep Study indicated severe OSA, which I would like to get under control.
I am preparing comments to Dr. to support need for data capability.
My thoughts are:
1. I need to see what my mask Leak rates are so that I may effectively adjust head gear, choose better masks etc.
2. Reduce apneas by changing eating habits, caffein, bedtimes, etc.
Any other ideas to support why I need a data capable machine.
3. If he is a doctor that wants to improve my condition wouldn't he want to see the data?
Any other reasons to have data capability? suggestions?

Also, I may ask for a pulse oximeter to ensure O2 is not going low also.
Is there a brand that either ResScan or the sleepyhead software reads and correlates event times?

Thank You

[retired_guy]

Sounds like you have a pretty good handle on it Chuck.

Only thing I'd do differently is:

Instead of Numbers 1 through 3,

1. "Hey Doc, would you please specify that I receive a Resmed S9 Auto Set? Thanks a bunch."

(I don't know about the pulse oximeter though.. That might be overkill.)

Mr. Doctor Guy doesn't really care what brand or model you have as long as you use it.

[zonk]

S9 Elite would gives you a good therapy but nice to have the AutoSet
S9 AutoSet can be used in CPAP mode as well as auto mode (two machines in one)

[Peter_C]

Better still, wouldn't the Doc want *YOU* to care about and watch your own data? Like mine pointed out to me, data is not everything, remember the goal is not numbers, the goal is better sleep for you. In other words, yes, watch the data, but don't try to chase perfect numbers, as good sleep, less wake-ups, steady O2 at night are the goals.

[me50]

what zonk and Peter_C said

[zonk]

Like mine pointed out to me, data is not everything, remember the goal is not numbers, the goal is better sleep for you.

My doc told the same story, I think the goal is both good numbers and good sleep

Lousy numbers means that the therapy is far from optimal so the good doc have some tweaking on his hands

If numbers good and sleep is lousy tells the doc that the problem is not CPAP related so he have put his thinking cap on and look elsewhere

[herbm]

Data is not everything but it is objective and automatically available AND recorded on a data capable machine.

Without the data, it is impossible to know if you are being treated, with minimal data it isn't possible to pinpoint HOW the events are occurring. (E.g., an isolated, short event once per hour is NOT the same as a cluster of 4 long events interrupting your sleep twice per night.)

Without the data, one can't distinguish easily between Apnea, Hypopnea, and CAs.

With the full data, one can see if the (automatic) machine's pressure is corresponding to CAs or OSAs.

Yes it is about how you feel, but most people report that to feel better requires WEEKS or MONTHS (or sometimes even longer) of EFFECTIVE THERAPY before BEGINNING to feel significantly better.

Data is MOTIVATING; those with data and who monitor the data, are more likely to continue treatment and to use the equipment EVERY TIME THEY SLEEP.

The Doc look at it instead of getting a bare snapshot one every few months or even as long as once per year.

It costs the insurance company nothing as they pay the same for a crappy device; it costs the doc nothing, so no one is going to complain to the doc about the data capable machine.


Also, JUST ASKING for what you want is usually enough (except in the case of narcotics but that is only because docs have been TRAINED to resist the drug seeking patient.)

Ask nicely, ignore the word no and ask again if you don't hear "Yes". Just pretend like you didn't hear the doc.

Another effect: Once you ask for something medical, the doctors better judgement will tend to err on the side of MORE AND BETTER treatment.

This is both human nature and to protect against law suits. If you ask for it and don't get it, then your law suit case is easier if it turns out you NEEDED that treatment.

Also, lots of docs don't even understand what the 'rules' are so the moment you show them the 'better' alternative they have no reason to say 'no'.

[retired_guy]

Ok, you've got a lot of good "ammunition" to use in order to win your case for an s9 auto set. But I would like to say one more time that the first words out of your mouth should be:

"Hey Doc, would you please specify that I receive a Resmed S9 Auto Set? Thanks a bunch."

I'll bet that if you do that, his first words will be "sure."

Why? Because it's no skin off his back if you have the top end machine or not, in fact as Herb pointed out he's got lot's of reasons to keep you happy on this. So relax, enjoy your evening, and look forward to receiving your spiffy new Resmed S9 Auto Set.

[Sleepster]

My Sleep Study indicated severe OSA, which I would like to get under control.

Hi Chuck. Welcome to the forum. I'm so glad you're committed to making it work. That can be the first hurdle for us. Did you tolerate the CPAP machine well during your sleep study? Any excess gas the next day?

I am preparing comments to Dr. to support need for data capability.
My thoughts are:
1. I need to see what my mask Leak rates are so that I may effectively adjust head gear, choose better masks etc.

Excellent. Getting the leak rate under control is fundamental. Without it the machine can't exert enough pressure to keep your airway from collapsing.

The other reason, and perhaps a more important one, is the ability to see the AHI (and its three components). AHI is the number of events per hour. To be diagnosed with severe apnea you had an AHI of 30 or more during your sleep study.

2. Reduce apneas by changing eating habits, caffein, bedtimes, etc.

That's not going to help your argument. There are lots of reasons you need to reduce apneas, and none of those things will help you do that. The only thing that'll help is CPAP therapy.

Any other ideas to support why I need a data capable machine.
3. If he is a doctor that wants to improve my condition wouldn't he want to see the data?

No. He may be convinced that data capability makes no difference. If that's the case he's a bone head and you'll be pointing it out.

The real reason you need a data capable machine is that you want to monitor the effectiveness of your therapy. It's important because the consequences of ineffective therapy are a decreased quality of life and an increased risk of dying early of a heart attack or stroke.

If the doctor doesn't understand this then he's the not the right doctor for you. Chances are, he doesn't need to write a prescription for you to get this capability. You just need to present your existing prescription to a different durable medical equipment (DME) provider, or simply threaten your current DME that you will be doing that.

But you want something more, you want an auto CPAP machine. That's the same prescription code, so you won't have a problem there. It's just that your insurance company may not be willing to pay the few extra dollars for the upgrade. The DME will get paid the same amount by the insurance company either way, so you'll be asking him to cut into his profits. You may have to shop around to get a DME that's willing to do that.

[me50]

one thing I would like to point out is that you can have a machine and your data is great...low AHI, leaks, etc., but still not sleep well. It could be because you cannot tolerate the pressure, even if you are using an auto set. that is why some people are switched to a vpap/bipap because they can get more relief on epap than with a cpap or cpap auto. if all else fails, then the doc and the patient will have to do some further investigating. JMHO