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Stymied . . . Starting Over . . . Undaunted Still . . .

I haven't started CPAP yet - have had a bad experience all the way around starting with the place I had my sleep center and then with the DME . . . have to start over again . . .

At my sleep center, on my 1st night, I was in an office with a Murphy bed and the left side of the bed contained a cabinet which apparently held supplies because the techs came into my room, turned on the light and sorted thru the closet throughout the night to find items they needed. Also there was no air circulation and it was too warm. After the tech opened the windows, it got cooler but still warm enough to sleep without any sheet or blanket on, and still no air circulation. On the 2nd night, I was in a smaller room with a smaller bed, but there was a fan and I had time to adjust the direction and speed while waiting for the tech, so even though the bed was smaller – especially with the equipment in it – the temperature and air circulation was better and the techs didn’t need to come in and out throughout the night to find supplies. BUT what bothered me the most was such a simple thing – in both rooms, the beds had plastic covering on the mattresses – but NO top sheet ! They had only a VERY thin piece of cotton material that was laid across the TOP of the mattress. It was the same size as the length and width of the mattress so it did not go down over the sides, top, bottom of the mattress. And so as soon as you sat on it for the tech to hook you up, the material started to bunch up and then as the tech placed the equipment under the pillow, the material pulled down from the top – and then as you laid down – well, that was it – the material just shriveled up under you ! So, throughout the night, your whole body, especially your arms and legs were partly on a damp plastic mattress or tangled up in a pile of crumpled up cotton fabric. (Since I had been reading the SG forum and thought it was important to find out ASAP out my OSA, I remained with the same sleep center for the 2nd test – but I wish I had thought to take a sheet from home for my 2nd night.) Needless to say, I didn’t sleep much either night for a whole assortment of reasons.

Also I was given vastly differing info between my 1st and 2nd sleep study tests regarding my condition and then after my 2nd test, I was contacted by a receptionist and told that I was to start using CPAP - but she would not provide me with any verbal or written info about my results and said that it was not their practice that I should speak with a doctor. However, since I wouldn't start CPAP without knowing something about my condition, the doctor asked that I come in, rather than talking with me on the phone, in order to explain my sleep study results and I had to wait another 3 weeks for that appointment.

I had thought, at both my initial consultation and at the visit afterwards with the doctor, that I received very good information. However, having learned an awful lot from the SG forum, I was able to read my sleep study results at home and found that the doctor had really slanted how she represented her findings at my follow-up meeting. Ultimately, the sleep study results do strongly show that I have severe sleep apnea, BUT I do need to have another sleep center conduct a reliable and complete sleep study in order to have the correct treatment plan determined for me by competent and qualified doctors who are in the field for health, rather than profit, motives. Someone else who I know who went to this sleep center got the impression that they were trying to fill some statistical quotas with their patients rather than providing a health service (and they also refused to provide her with her results). And I got the feeling that they had set up a unit within the hospital to make money in a niche market and to have a way to bill between the hospital, doctors and the DME.

However, after meeting with the doctor, since I think the diagnosis and mode of treatment is correct, only the "level" of treatment is in particular question and so I have felt comfortable getting started with CPAP even before going to a more competent sleep center for another study given how very much I have learned on SG and because the S8 Auto II will provide efficacy data including: pressure, leak rate, apnea / hypopnea index.

BUT - and now it only gets worse - at 1st, when I spoke with the DME that I was directed to contact, they seemed VERY helpful and cooperative and I wrote down everything they told me and I was SO VERY pleased that I had wound up with such a great DME after the horror stories that I had read about on SG. I was even going to post about them on SG but decided to wait until I had received my equipment to see that their excellent service followed thru with more than a phone call. But, then I got sick and had to go into the hospital and had to put off receiving my equipment for 2 weeks. And during that time, I had a chance to research the full line of ResMed equipment online and ask for recommendations from SG members.

From the notes I had taken, I realized that the DME was intending to provide me with the C-Series, the oldest CPAP machine and humidifier (combined) – and comparing that with the advice I received on SG, I knew that it is NOT a suitable machine – and that I must refuse it. - Also, SG members had provided me with info that my insurance would pay for any machine that I choose - that it was not up to the DME which machine I choose.

Given that the feature to receive efficacy data (leak rate, apnea / hypopnea index) is the critical feature to me, I called my DME (with whom I had previously spoken with 2 reps and a supervisor and with whom I thought I had an EXCELLENT relationship) to ask to have my order changed to substitute the S8 AutoSet II for the C-Series CPAP and, all of a sudden, the DME wasn't so cooperative anymore. They dug in their heels and said they would not do that without a specific RX from the doctor. I knew they didn’t have the right to do that but thought it was maybe the fastest and easiest thing to do without threatening them with contacting the NY State Dept. of Health, etc. So I called my doctor's office and left a message for her to please fax them a RX to the DME to issue me a S8 AutoSet II and detailed for the receptionist why I was requesting that: efficacy data, EPR - exhalation pressure relief and Ramp (which is only optional with the C-Series).

The next day, I called my DME to reschedule my appointment and thought that rather than threaten them with the NY State Dept of Health, that I could just tell them that I knew that the insurance would cover whichever CPAP I choose and that I wanted the S8, not the C-Series - and I explained the main efficacy data feature that I wanted. The rep said alright and changed my order and we planned that I would call back at the end of the week to set up my appointment for the rep to visit with me next week.

About an hour later I thought to call my doctor's office to tell them that my doctor did not have to take the time to fax a new RX to the DME because I had talked with them and they had already changed the order to the S8. The receptionist informed me that was not so because the DME had already called my doctor and they had decided that I was not to get the newer machine. Also, the receptionist said the doctor was not in and she is very busy with many things that she does with tests and patients and that she would get back to me when she could. I mentioned that I was a patient - to which I was told that that was so but that, as the doctor was very busy, as had been explained, she would get back to me when she could.

When the doctor called me she expressed her anger at my audacity in requesting particular equipment. I remained calm and explained to her the primary reason being that the unit I wanted provided the efficacy data for the doctor that the other unit did not - to which she said she did not believe me but she would check. To the 2nd reason - EPR - she said that did not matter in any way what-so-ever; however, just before we hung up, she told me after I got started with CPAP that she was going to be switching me to Bi-Level – yet she didn’t think EPR is important ! And, as to the fact that Ramp is optional with the C-Series on the Resmed website - she said that she was sure that I was absolutely wrong - but that under the circumstances that she would approve that I get the unit that I had specified. THEN she started yelling and screaming at me about how I should use CPAP and that she had spent a lot of time in the office with me . . . I wasn't sure as to what her point was . . . When she stopped ranting and there was a silent pause, and I said: Am I supposed to say something now? To which she made some sort of a grunting sound . . . I reminded her that I had not been able to start CPAP because I had been in the hospital due to an emergency - to which she spit out: Oh, yes, I hope you will be alright.

I was mystified at the bizarre episode. And, due to all that has occurred, I did not call the DME to set up an appointment for their rep to visit with me. I am COMPLETELY through with any further association with that sleep study center and that DME.

Very fortunately for me, I had made an appointment with another sleep study center and my consultation is for this coming Monday morning. So I will wait 'til after my Monday appointment to proceed with CPAP. I am going to take my full sleep study reports to my appointment and ask the new sleep study center for their DME recommendations to contact to get equipment.

The sleep study center that I am going to on Monday was recommended by members of SG and, rather than feeling defeated, I am feeling more confident in my search for help with OSA than I have been from the very onset of this process because I have more confidence in this sleep study center – and because I have learned so much from so many on SG and, thereby, learned that, while OSA is a serious condition, it does seem manageable with compliance, tenacity and the generous, on-going support and championing of so many great folks at SG .

Thanks to All !
Renee

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Dear Renee, I am so sorry you have had callous treatment from the medical staff. It was good that you stood your ground. The 1st physician I went to 6 years ago did not believe I needed a sleep study, but had me on Lunesta and 2 anti-depressants for 5 years. My sleep was so poor last March I ended up going to the hospital. Within a matter of days I had a sleep study done, was found to have severe apnea, and thus a new CPAP machine.
Do not give up with your machine. It can change your life and give you back a more normal and healthy life.
Brad
Good for you for being so proactive!!

Be sure to get a copy of your script. Do not be surprised if many in the professional community, outside the forum, scoff at you for wanting to be proactive. WE know it is important, just be firm.
Wow Renee......I empathize with you. I too had very horrible experiences with both my DME and Sleep Study Ctr. I too, am in the middle of trying to get set-up with another DME. So, So frustrating......even more stressful!
DAMN, girl!, you are the poster child for assertive self-care!!!!!!!!! I'm totally impressed with your courage and your level of research to say nothing of your willingness to buck "the system" (or whatever you wanta call crap like that). You're my new hero!!

Seriously, Renee, you've had a rough ride so far and I admire your tenacity more than I can say. You're gonna be so glad you stood your ground once you get into treatment--the APPROPRIATE treatment--hopefully before long you'll be feeling better. It can take awhile but you're gonna succeed. I have no doubt about it. Haven't looked at your Profile yet--where do you live? Was this lab you went to, by any chance a private lab? or was it affiliated with a hospital? I cannot believe they treated you so poorly. ALL of 'em. Just goes to show what some, not all, but some medical practitioners really think about patients. Makes me wonder why they're in the business of caring for people in the first place.....

And by the way, I'm certain you already have gathered this: they CANNOT refuse to give you ANY of your medical records. It's totally against the law. I'm withholding all the language I'd like to spew right now!!!!!!!!!! I'd lol if it weren't SO not funny.

Honestly, if I had a flag I'd be raising it in your honor. Just keep up the good work and let us know how things are going. You make me proud to be a woman and, frankly, proud to be a successfully-in-treatment apnea patient. Never thought I'd be saying THAT, but it's true......

Susan McCord :-)
Renee, now I see that you're in New York City. Are you aware of The Manhattan Apnea Support Group associated with SleepGuide? It's a very strong group that meets monthly, run by our SleepGuide webmaster, Mike. If you haven't seen it yet, I'd encourage you to click "Groups" at the top of your Page and check it out. Would be a good resource for you, IF you need anything local that some of us may not know about. Just a thought. It IS good that you're in the city and not a small area where there are fewer options available.....

Susan McCord :-)
Am I understanding you correctly, Renee???

... And I got the feeling that they had set up a unit within the hospital to make money in a niche market and to have a way to bill between the hospital, doctors and the DME. ...

This sleep lab was in a hospital??? Wow! There are all kinds of legal complaints that can AND SHOULD BE filed!!! Do you feel up to filing those complaints?

Congratulations on standing your ground and GOOD LUCK, you are definitely on the right track now!!! I certainly wish you much success, heaven knows you've certainly earned it!
Hi Renee

Sorry to hear of your bad experiences. But, sadly, not surprised.

Many doctors have bought into the "I am god" concept, many are uninformed, and many just don't care. Unfortunately it sounds like you found one with all three problems!

Good for you to do the research! Good for you to be persistent!

Now, though, it sounds like you'll be on the right track.

In spite of all of their attempts to convince you otherwise, you are in control of your care, treatment, and who will provide it.

Until somebody comes up with an alternative, we are going to be on CPAP for the duration. The doctors will come and go, the DME people will come and go, but you'll be dealing with this for (hopefully!) a very long time.

So, keep the assertiveness, lose the providers you have, and find the ones that will help.

Good luck!
Renee, Judy's absolutely right. They'll lose their credentialing if JCAHO finds out what lousy, unprofessional practice is happening there. And they NEED to lose it, to protect others from going through what you have......

Susan McCord :-)

Judy said:
Am I understanding you correctly, Renee???

... And I got the feeling that they had set up a unit within the hospital to make money in a niche market and to have a way to bill between the hospital, doctors and the DME. ...

This sleep lab was in a hospital??? Wow! There are all kinds of legal complaints that can AND SHOULD BE filed!!! Do you feel up to filing those complaints?

Congratulations on standing your ground and GOOD LUCK, you are definitely on the right track now!!! I certainly wish you much success, heaven knows you've certainly earned it!
Wow!
On the subject of getting your Medical Records, get a Release of Information Form and fill it out specifying the information you want, e.g. sleep lab reports, Doctors Dictation, and put your name and address down so they send it to you. A lot of times they won't send anything out until the doctor signs off on it. In this case it pays to talk to the receptionist. You might have to follow up on it, but luckily you seem to have no trouble doing that. The Release of Information form makes your request for records official and if you get a copy of the ROI all the better to keep track of when you asked.

Good Luck and Brava!

Mary Zimlich
Hello Brad ~

First off - WOW ! I got up this morning and first thing I thought to check out the discussions to see how folks were doing this morning. I hadn't expected to receive replies to my posting especially because after I'd sent it I thought that I had been so long-winded and voiced so many complaints that it would be a downer and folks would think: Oh, this is a problem person. And, not wanted to be seen as a "problem person", is why I hadn't voiced my difficulties all along. Yet, to my surprise, I received many really kind and supportive replies !

I am so sorry to hear that you didn’t receive treatment for several years and that it took you to the point of having to go into the hospital to get help. I can only say that thank goodness someone thought sufficiently there to order a sleep study. It is amazing that the SO many in the medical field remain unaware of OSA.

Since you mention about the poor and INcorrect medical treat you had to endured for so long, I'll share with you that, not having known about sleep apnea, I was searching for the cause of my problem with regular medical doctors for a year or two and they all told me that I was fine, nothing wrong with me. Finally some GI problems were diagnosed and an abdomen ultrasound was ordered. An abnormality was found during the exam and the doctor took over from the tech and the test was extended and the doctor told me that because of where my pain was located and because of what she was seeing that I had an inflamed gall bladder but she was not sending me to the emergency room because she did not think I was toxic. But then when my Internist called me with the report, he told me that the lab report told him that I had pain diffused throughout my abdomen and that there was no problem with my gall bladder and that no follow-up was needed and that I was fine. I, of course, told him that was not what had occurred at my test. He told me that the doctor was a very good doctor and that doctors knew what patients did not know and that I was wrong. After a few days, someone from his office called me again and asked me to go to the hospital - not the lab - and have an advanced gall bladder test. I wanted to know why - since the doctor had berated me and told me in no uncertain terms that I was absolutely fine - but he would not speak with me. However, since I would not go for the test without speaking with him, he did call me back and he told me that he had talked to the lab doctor and that she said that maybe I had a little more pain in the area of my gall bladder but that she stood by her report. However, he was thinking that even though she was still right, that he would order another test. I had already decided to leave his service but knew that the other test was just the test that the next doctor was going to order and the sooner I got it the better, so I used his RX to get it. After 3 weeks, when I had not heard back, I called my Internist and he finally called me back. The phone call was VERY short. He had only 3 things to tell me: 1) that it was the lab's error that they had gotten back to him with the results and that in the future if I don't hear back in a week I should call him because results shouldn't take that long (so I was again at fault). And - 2) lo and behold, the test results revealed that my gall bladder was not only inflamed - but not working at all ! So much for my gall bladder working just fine. And - 3) that I should have an operation ASAP to have my gall bladder removed. End of phone call. No apology, no suggestion of a surgeon or way to proceed, no support of any kind. I also never heard from my GI doctor who works in conjunction with him, who I am supposing he forwarded my rest results onto.

So I left the service of those 2 doctors and started my search for a new Internist and that's how I found about sleep apnea. I had gotten so tired of telling each doctor that I saw that I was suffering from terrible tiredness / fatigue to only be told that I was fine, nothing wrong, it was normal or psychological. But the new Internist took my tiredness / fatigue as seriously, if not more so, than I did. She did not waste time on blood tests. She wrote out instructions for just 2 things: go for a sleep apnea study and go to her recommended GI specialist - and then get back to see her within 6 months ! The GI specialist has determined that we can wait and maybe avoid the surgery all together and he found other GI issues that needed immediate treatment. And, of course, the OSA saga began . . .

So, the battles began even prior to the sleep study center and I found it all tiring and difficult including having to change doctors while ill. But it was even more difficult navigating the world of OSA care providers because I was in a space where I came to know the potential dangers of OSA but I didn't know the medical language or how to navigate the landscape.

BUT THEN - I discovered The Manhattan Apnea Support Group of SleepGuide online and SG may actually have saved my life. So, even with my trials and tribulations, I have had the resources of SG to guide me through and I have not felt at a loss . . . OK, frustrated, sometimes angry and temporarily sidetracked . . . but I have been fortified with the knowledge that I need to get the health care that I have to have. And I don’t feel insecure. I have a great deal of confidence in the sleep study center that I am going to on Monday and have full expectations of moving right ahead with success. In fact all of this turmoil has distracted me from the apprehension and sense of discontent that I was anticipating in using CPAP – now I am actually looking forward to it without trepidation ! – Using CPAP now seems like it’ll be a piece of cake !

At closing, let me say that I am really sorry for how much you must have gone through and how alone you must have felt alone during those years while working as hard as you could just to try to be well. And I appreciate after all that you had to go through by yourself that you have been so generous to offer such support to me.

My Best,
Renee

Bradley Dean Moffatt said:
Dear Renee, I am so sorry you have had callous treatment from the medical staff. It was good that you stood your ground. The 1st physician I went to 6 years ago did not believe I needed a sleep study, but had me on Lunesta and 2 anti-depressants for 5 years. My sleep was so poor last March I ended up going to the hospital. Within a matter of days I had a sleep study done, was found to have severe apnea, and thus a new CPAP machine.
Do not give up with your machine. It can change your life and give you back a more normal and healthy life.
Brad
Hello sleepycarol ~

When I got up today, I thought to check out the SG discussions to see how folks were doing this morning. I hadn't expected to receive replies to my posting especially because after I'd sent it I thought that I had been so long-winded and voiced so many complaints – and then to my great surprise ! – I found that I had received many really kind and supportive replies !!! The folks at SG are really something else !

Thanks for the mention to get a copy of my script. The first sleep center that I went to was already being so uncooperative and, since having asked, I knew the doctor had written an open ended script, with no limitations, ordering only a CPAP unit, I decided not to press the issue and request a copy. But I appreciate the mention because I will ask for the script from the next center that I go to – and I am expecting that the next place will provide it because I have full expectation that they are going to be as cooperative as the first place was combative.

Thank you for your support about this. I was actually surprised to be treated in such a combative manner by health care providers in the very field who know about OSA.

And I must say that if I had not had the very good fortune of having discovered The Manhattan Apnea Support Group of SleepGuide online, I would not be in the good place that I am now.

Thank you so very much for taking time to respond and for your valuable advice and support !

My Best,
Renee

sleepycarol said:
Good for you for being so proactive!!

Be sure to get a copy of your script. Do not be surprised if many in the professional community, outside the forum, scoff at you for wanting to be proactive. WE know it is important, just be firm.
Renee, just FYI, if you ever travel by air, you'll need a copy of your script for security anyway, so it's a good thing to have.

Susan McCord :-)

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