Join Our Newsletter

New? Free Sign Up

Then check our Welcome Center to a Community Caring about Sleep Apnea diagnosis and Sleep Apnea treatment:

CPAP machines, Sleep Apnea surgery and dental appliances.

CPAP Supplies

Latest Activity

Steven B. Ronsen updated their profile
Mar 5
Dan Lyons updated their profile
Mar 7, 2022
99 replied to Mike's discussion SPO 7500 Users?
"please keep me updated about oximeters "
Dec 4, 2021
Stefan updated their profile
Sep 16, 2019
Profile IconBLev and bruce david joined SleepGuide
Aug 21, 2019
After a while on this site I have discovered that my eyes have been closed to the grass root auto treatment world. I find it hard to believe, That some of you folks would leave your health to a small tube, that would not be enough to provide air to the fish in a small fish tank! Thats how the auto-CPAP figures out what's an Apnea/ Hypopnea although it can't hear the snores, but oh well horseshoes and handgernades I guess, what the heck. Sleep technicians must not be as smart as those small air tubes, because we need 5-7 traces we analize every 30 seconds to see if a patient is breathing o.k. I guess I should start looking for a new job, Those darn little air tubes, how can we compete?

Views: 78

Reply to This

Replies to This Discussion

i wouldn't throw in the towel just yet, Duane. there's plenty of demand for good sleep techs out there, as you certainly have noticed.
Ach, Duane. You are being too too critical of APAPs. They have their use and their place in xPAP therapy and even Dx'ing.

There is absolutely NO DOUBT in my mind that an in-lab evaluation PSG and an in-lab titration PSG are the BEST way to go. There are more sleep problems than "just" OSA ... BUT - if a person has severe sleep problems that indicate the problem may be OSA AND no insurance and limited financial means a PROPERLY setup APAP trial is better than nothing at all.

If a person absolutely can NOT sleep in the lab sufficiently long to get a decent titration - better an APAP at home set somewhere near the best that could be titrated, if any titration at all was possible, in the lab again is better than no CPAP therapy and you can't just keep people coming in for titration after titration. Its just not economically feasible.

I only slept 42 minutes out of 6 hours bedtime for my first titration so they brought me in for a second titration. I only slept 98 minutes out of 6 hours bedtime the second titration. There were two additional "by guess and by gosh" pressure changes and then I INSISTED on a loaner APAP and we FINALLY found a pressure that worked for me.

It has NOTHING to do w/"dumb" sleep techs, or incompetent sleep techs. I make no secret of the fact that I'm not too impressed w/sleep doctors or local DME supplier RRTs or RTs and that I consider the RPSGTs the only true heroes in the sleep profession. But I still feel there is a place for APAPs in OSA therapy.
Judy at least you attempted a titration. I beleive that duane is going after the people and doctors that are foregoing these studies altogether. I have been paying close attention to quite a few self titration cases on sleep guide. They seem to be having twice as many problems as anyone else. Duane mentioned snoring as a drawback for these machines. I also believe that they do not take flow limitation into effect. Snoring has to be heard and flow limitation has to be seen in the respiratory waves. The machines can't do either. This does not make them bad. We just have to recognize their limitations. their use for self titrating is one of them. Your case was special.
Judy said:
Ach, Duane. You are being too too critical of APAPs. They have their use and their place in xPAP therapy and even Dx'ing.

There is absolutely NO DOUBT in my mind that an in-lab evaluation PSG and an in-lab titration PSG are the BEST way to go. There are more sleep problems than "just" OSA ... BUT - if a person has severe sleep problems that indicate the problem may be OSA AND no insurance and limited financial means a PROPERLY setup APAP trial is better than nothing at all.

If a person absolutely can NOT sleep in the lab sufficiently long to get a decent titration - better an APAP at home set somewhere near the best that could be titrated, if any titration at all was possible, in the lab again is better than no CPAP therapy and you can't just keep people coming in for titration after titration. Its just not economically feasible.

I only slept 42 minutes out of 6 hours bedtime for my first titration so they brought me in for a second titration. I only slept 98 minutes out of 6 hours bedtime the second titration. There were two additional "by guess and by gosh" pressure changes and then I INSISTED on a loaner APAP and we FINALLY found a pressure that worked for me.

It has NOTHING to do w/"dumb" sleep techs, or incompetent sleep techs. I make no secret of the fact that I'm not too impressed w/sleep doctors or local DME supplier RRTs or RTs and that I consider the RPSGTs the only true heroes in the sleep profession. But I still feel there is a place for APAPs in OSA therapy.
I know that I was scheduled for a split night study -- but alas only slept approximately 2 hours the whole night of my sleep study. It did pick up that I had 217 leg movements during that time. For you techs out there what does that mean? The doctor wanted me to take Requip and gave me some samples that are still sitting in my cabinet (sleep study done in August of 2007). Had to go back for a titration study. Did sleep longer, but still not nearly the whole night (approximately 4 hours if I remember correctly).

I am like Judy, sleep studies are the best -- BUT there are exceptions and using an auto machine is better than nothing. If one has a sleep study and then if it is going to be months before the titration study I would rather see someone try with an auto machine in the mean time.
Carol, 217 leg movements means that you probably have RLS, PLMD, or both. Do you still have frequent arousals with your CPAP? How are your iron levels?
Ah, but there again, Rock Hinkle, WHAT was the pressure range of those started out on an auto who were having the most problems?? Wide open? 4 cms to 20 cms? Ridiculous! I have COPD which my sleep pulmo/critical care doctor was well aware of and even so when I received the loaner auto it was set at 4 cms to 20 cms. Sheesh! Did he not know any better or did he leave it up to the local DME's RT to set the range or did the local DME's RT take it upon herself to set it at that range?? DUMB! I had had an in-lab titration. True it was an insufficient one (thru NO fault of the tech or lab or doctor) but nonetheless they had SOME idea of pressure to work with. Even w/NO previous in-lab titration I would have thought a pressure range of 6 cms to 15 cms would have been a wiser choice.
It would have. I personally would have gone with 8/9-15. It still does not change the fact that these machines are not a replacement for proper titrations.
Judy said:
Ah, but there again, Rock Hinkle, WHAT was the pressure range of those started out on an auto who were having the most problems?? Wide open? 4 cms to 20 cms? Ridiculous! I have COPD which my sleep pulmo/critical care doctor was well aware of and even so when I received the loaner auto it was set at 4 cms to 20 cms. Sheesh! Did he not know any better or did he leave it up to the local DME's RT to set the range or did the local DME's RT take it upon herself to set it at that range?? DUMB! I had had an in-lab titration. True it was an insufficient one (thru NO fault of the tech or lab or doctor) but nonetheless they had SOME idea of pressure to work with. Even w/NO previous in-lab titration I would have thought a pressure range of 6 cms to 15 cms would have been a wiser choice.
I agree w/you there. But - even Medicare has bowed to the inevitable and is now paying for 3 months of xPAP w/o an in-lab PSG evaluation OR in-lab titration. AT least on a trial basis is some areas. Pure economics, unfortunately.

You are most likely right about the 8/9-15 cms, especially if A- or C-Flex or EPR is going to be turned on. Hey, I'm just a patient taking a wild guess that "I" would have been comfortable trying rather than the assinie 4 cms to 20 cms. I wasn't comfortable suggesting any higher than 6 cms starting pressure.

Personally, I want a in-lab titration and I would not even be agreeable to a split-night study.
I think that as medicare learns that an AHI of even 1 over an extended time can be detrimental to your health that they are going to change their minds. Right now they are back pedaling due to the sleep care audit. In the long run I believe we are going to see an increase in repeat studies because of these new auto-titration rules. Take yourself or someone with CHF how many apneas a night are ok? 20 years ago the goal was an AHI<15 now it is <5 in another 5 years it will be even lower due to the medical risks. If we are talking simple economics we have to look at the cost difference between open heart sugery and a full sleep evaluation and treatment, or the cost to rehabilitate someone back into the work force after a stroke if they can be put back to work. How much does disability cost? The government is looking for quick solutions to long term problems. In the long run it is cheaper to treat apnea the right way than any of the long term effects. Think of how much overhead would be saved if they just tested everyone at 40. Colonoscopy and a sleep test. This is the number one killer among us. Eventually they will figure it out.
I suspect that because those of us of the "Now" generation, i.e. the teens of the 60s, make up most of government and business, there are very few in "power", i.e. the government who have any idea of HOW to look beyond today. Certainly, those in "power" on Wall Street and thus big business don't know how to look beyond today. And look where it has gotten us.
Hopefully history won't repeat in this case.
I don't know. It seems like the medical profession is usually a generation behind the rest of us. The states and the Fed had to legislate a patient's rights to their medical records before the medical profession would lighten up and allow us some access. Even now some of the fossils and control freaks find it hard to give up control and release our records to us when we request them.

Reply to Discussion

RSS

© 2024   Created by The SleepGuide Crew.   Powered by

Badges  |  Report an Issue  |  Terms of Service