"please keep me updated about oximeters "
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The Sad State of Sleep Medicine
Mike,
I listened to the download version of your teleconference and couldn't
agree more with you regarding the sad state of sleep medicine. It's a
shambles; the sleep industry is a failure. Many sleep labs are failing
to do their jobs and putting patients at risk from misdiagnosis, no
diagnosis, lack of educating their patients, no followup, and the list
goes on. Medicare and insurance companies are aiding and abetting this
boondoggle.
The false negative rate of sleep studies, even in accredited sleep labs,
borders on the criminal (these patients go home thinking they don't
have a problem to suffer the catastrophic consequences of their
misdiagnosis). Something must be done to correct false negative tests.
One way to is to reduce the number of in-lab sleep studies. Forty
percent of sleep apneics do not need a sleep study because they have
already been diagnosed by a witness. A majority of others could have a
home study or go straight to an ACPAP with a smart card (diagnosis and
treatment all in one). The complicated patient (those with CHF, COPD,
etc.) can see a sleep doc (good luck).
All physicians should be able to diagnose and treat their OSA patients.
It's not rocket science, even surgeons can learn how to do it.
A patient should be able to buy his/her home sleep test and PAP machine
from Walmart or Sam's, etc., and if questions arise, see their
pharmacist, PA, or PCP for advice. Local support groups can fill in the
gaps. Once the populace becomes aware, even your grandmother could treat
OSA.
I listened to the download version of your teleconference and couldn't
agree more with you regarding the sad state of sleep medicine. It's a
shambles; the sleep industry is a failure. Many sleep labs are failing
to do their jobs and putting patients at risk from misdiagnosis, no
diagnosis, lack of educating their patients, no followup, and the list
goes on. Medicare and insurance companies are aiding and abetting this
boondoggle.
The false negative rate of sleep studies, even in accredited sleep labs,
borders on the criminal (these patients go home thinking they don't
have a problem to suffer the catastrophic consequences of their
misdiagnosis). Something must be done to correct false negative tests.
One way to is to reduce the number of in-lab sleep studies. Forty
percent of sleep apneics do not need a sleep study because they have
already been diagnosed by a witness. A majority of others could have a
home study or go straight to an ACPAP with a smart card (diagnosis and
treatment all in one). The complicated patient (those with CHF, COPD,
etc.) can see a sleep doc (good luck).
All physicians should be able to diagnose and treat their OSA patients.
It's not rocket science, even surgeons can learn how to do it.
A patient should be able to buy his/her home sleep test and PAP machine
from Walmart or Sam's, etc., and if questions arise, see their
pharmacist, PA, or PCP for advice. Local support groups can fill in the
gaps. Once the populace becomes aware, even your grandmother could treat
OSA.
Views: 91
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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I have never seen a false negative. There is no money for anyone in that. I believe the bigger scam is false positives.
I am done talking about this subject. I have put alot of time into my career, and work very hard for my patients. if you beleive that your grandmother, Walmart, or your local pharmacist can do a better job than someone like myself then I suggest that you invest your money with one of them.
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Permalink Reply by Mike on
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yeah, what he said. i totally, wholeheartedly agree.
j n k said:Rock,
I believe that most of us feel that the sleep techs are the only reliable part of the system right now. The system is flawed, but not because of the sleep techs.
Even if home testing takes off, I don't think the need for sleep techs would decline. I think it would increase, since hopefully more patients with more complicated sleep disorders would be identified and sent for overnight testing eventually anyway.
Where we buy the machines is about spending less money for a machine when we already know what we want and how to use it. I see that discussion as no bad reflection on sleep techs.
Overnight studies will always be needed for a number of the patients, regardless of where patients then go to get machines.
Rock Hinkle said:I have never seen a false negative. There is no money for anyone in that. I believe the bigger scam is false positives.
I am done talking about this subject. I have put alot of time into my career, and work very hard for my patients. if you beleive that your grandmother, Walmart, or your local pharmacist can do a better job than someone like myself then I suggest that you invest your money with one of them.
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I appreciate the air-cover, Dr. Jones. good to have backing of a physician on this controversial stance i've taken -- makes it harder to dismiss me as the crazy loon i no doubt am ;-)
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This discussion is not about the HST jnk, I am all for the HST. The HST gives me the ability to reach 25% more bad sleepers. If 100 people were asked if they would rather sleep at home or in a lab 100 of them would say at home. The HST I am all about. Just make one that truly evaluates sleep ...ie if you can't determine sleep vs awake, then you can't count the event. You can't determine sleep without measuring at least on EEG signal. You can't determine an event without measuring at least one point of respiratory effort. Without o2 or EKG then why not just do an overnight oximetry.
No this discussion is about the comlete deregulation of sleep. That is what is being proposed. The problem is not the prescription. This is pretty simple to get. The problem lies in education, support, and the powers that be. Dare I say Insurance on a public site? This why all of us are here. Including myself.
I do have have a few questions though. The HST at it's present best only measures for OSA accurately(according to CMS not personal). What % of sleep patients do you think have another sleep disorder on top of this? My educated guess is somewhere around 40%. Let us say that my number is high and go 30%. There are 4,615 members on sleepuide. We all get Dx via the HST or buy at Sears. At 30% 1384.5 still end up sleepy due to undiagnosed problems. Dr. Mack these people will most likely still be at risk fo Alhzeimer's, Parkinson's, or some other neurolical disorder. My money is that this is more tired people in theory than in reality on this site. Don't dismiss the arousal for it is the true problem. Jnk ealrlier you posted of insomnia. How does having a 16 year old boy in a blue vest help someone find the source of their insomnia? How can the HST help with a Dx of insomnia if it does not record sleep?
!300 out of 5000 for the god of sleep seems fair. You get your PAP and get to change your pressure at HSN prices. If all america were to get tested or buy at 7/11 90M people would potentially fall through the cracks. That is alot of people just so you can buy a PAP and a lottery ticket.
j n k said:Rock,
I believe that most of us feel that the sleep techs are the only reliable part of the system right now. The system is flawed, but not because of the sleep techs.
Even if home testing takes off, I don't think the need for sleep techs would decline. I think it would increase, since hopefully more patients with more complicated sleep disorders would be identified and sent for overnight testing eventually anyway.
Where we buy the machines is about spending less money for a machine when we already know what we want and how to use it. I see that discussion as no bad reflection on sleep techs.
Overnight studies will always be needed for a number of the patients, regardless of where patients then go to get machines.
Rock Hinkle said:I have never seen a false negative. There is no money for anyone in that. Ihan the desat. believe the bigger scam is false positives.
I am done talking about this subject. I have put alot of time into my career, and work very hard for my patients. if you beleive that your grandmother, Walmart, or your local pharmacist can do a better job than someone like myself then I suggest that you invest your money with one of them.
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Permalink Reply by Mary Z on
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Let's not let the problems with underdiagnosis with sleep medicine lead us to believe it is not a highly complex field, and as any complex field in medicine mistakes will be made. Let's put our energy into demanding the best sleep medicine has to offer and then to giving 100% in return by our feedback, compliance, remaining educated and compliant. When we have techs as highly qualified as Rock Hinkle we should all be writing his boss about the support he gives here and his dedication to the patient and their education. I have never once heard him step over the line into malpractice by giving medical advice or a prescription, but only offer his expertise and experience. I'm sure certain threads have made him feel less than appreciated. He deserves our unreserved support and this applies to more than one discussion lately.
I want a DME and Doc to get me started, to help continue my education, and hands on support, and the support I receive from the well educated regular posters here to give me new insight, perhaps to tweak settings (and not give to the complete newby the secret handshake) and solve problems with masks and such. I don't believe CPAP Machines should be available in every Walmart, or Costco, but I would like to see more targeted educational material- perhaps on TV and radio as well as in appropriate dental, psychiatrists/counseling, internal medicine and cardiac specialist's offices ( to name but a few as well letters as to the editor of our newspapers).
The short written tests when taken by someone who is aware they may have a problem and is encouraged to follow through are important.
If Blood Pressure and cholesterol medicine reducing drugs were avalable OTC I don't believe we would see a lessening of these problems-more than the initial outlay of cash, education and follow through is necessary, as well as dedication to health, and healthy living. I have heard some extremely intelligent comments from respected posters regarding the importance of weight control and healhty diet and lifestyle. As 99 often says, we are responsible for our health.
As far as the general medical pratitioners and even specialists who pooh pooh the idea of sleep apnea in an identifiable individual, when possible (and I know not always possible due to lack of alternative resourses) find another doctor, get more documentation. Go in armed with the Epsworth Sleepiness scale, and the info of a person willing to stay up and watch you sleep during the night, the anecdodotal evidence of falling asleep at work or behind the wheel.
An association has been made with the availability of glucose testing meters and diabetics. What has not been addressed in this case is the dedication to overall health a person using these meters need to demonstrate. Too many people use them outside of titration guidlines to have a little extra cake and take a little extra insulin. They work for people dedicated to their health, not cheating the system.
Until we get the global public through education by word of mouth, tv, magazines and more educated physicians (hit our medical schools hard) to care about this problem and seek admittedly sometimes difficult, time consuming, and costly treatment I don't believe we will accomplish much. And I believe that once in the system the patient is best served by an experienced RPSGT, or experienced HST expert.
I believe EDUCATION and proactivity on our point is the key to success in this fleld.
hem.
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Permalink Reply by Banyon on
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Absolutely agree with you Dr. Jones and thank you for speaking out frankly and openly.
My eleven years of experience with sleep apnea, multiple sleep doctors, and three studies in certified sleep labs is consistent with the description, "sad state of affairs".
Without patient forums, I doubt I would be alive today.
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