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Permalink Reply by Linda Birnbaum on July 19, 2010 at 4:19pm

What was the policy at the sleep center you were tested at? We have a lot of patients that undergo splits because of their severity. They will have an appointment within 2 weeks after their studies to go over their results and most likely be set up with their equipment depending on how good the insurance company is. And we like to closely monitor our severe patients for compliance and for therapy reasons. If it is not working we need to act sooner rather than later.

j n k said:

By the way, I really like this sleep-for-life policy:

"Patients who have been identified with significant sleep-disordered breathing (Apnea-Hypopnea Index > 40 events/hr of sleep; severe SaO2 desaturation events) on their first night of diagnostic testing will typically receive therapy for their sleep-disordered breathing on the same night (“split-night study”). . . . If the patient has severe sleep-disordered breathing, but there was not sufficient time to implement therapy during the first testing session (<4 hours remained for testing once severity was determined by the technologist), then a repeat sleep study with CPAP or bilevel therapy is indicated."

I very much wish that had been the policy where I was tested, a little further north in your state.


j n k said:

:-)

Linda Birnbaum said:

I will I promise. I might not make it back. But Mike will.

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Permalink Reply by Judy on July 19, 2010 at 4:42pm

Congratulations, Mike. And thank you, Linda.

Actually, my understanding is that DME RRTs have more leeway than we think when it comes to therapy settings - at least w/the more sophisticated PAPs such as bi-levels and their comfort features. The comfort features aren't considered "therapy" so much as "comfort". So options such as Rise Time, Triggering, Cycling, Sensitivity, usually aren't even included in the script by the doctor and the RRT has the opportunity to work w/the patient and adjust those settings to the patient's comfort level. The same holds true when advising on Ramp, Settling and Humidifier settings altho this is less clear if the doctor includes one or more of these settings in the script. When they don't is where sometimes it is more advantageous to talk to the testing RPSGT than to the sleep doctor.

It sure never hurts to stress the importance of the patient lying down and a CPAP set at their pressure or 10 cms whichever is higher when being PROPERLY fitted for a mask.

I sure don't think it would hurt to remind the RRTs, at least those that work for DME providers, that they SHOULD familiarize themselves w/the features and capabilities of the PAPs they provide to patients by retaining and reading from time to time the Providers Manual for the various PAP models instead of just relying on the Quick SetUp Guide. They SHOULD understand the features and capabilities of these PAPs, ESPECIALLY the more sophisticated models such as bi-levels and above.

And when and if they get a new patient who has obviously spent some time exploring CPAP therapy before coming in for their first PAP it would be nlice if they would do their best to provide that patient w/at least a fully data capable CPAP and just provide the entry level CPAPs to the patients who express no real interest in their therapy. It would also be nice if the RRTs would encourage, rather then discourage, patients who want to take an active part in their CPAP therapy. I'm not talking about the patient changing the therapy settings, such as pressure, themselves but I am talking about their understanding of the Leak, AHI and AI data and the validity of their questions on these matters.

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Permalink Reply by 99 on July 19, 2010 at 5:07pm

two flys on the wall which one is the bandit
the one nearest the border

are you crossing the county line

is the return fare increased to stop a returnee in thier tracks

you are needed mike

wear your kevlar vest just in case eggs are thrown

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