"please keep me updated about oximeters "
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CPAP pressure changes
Here's an interesting study out a few months ago which showed that weather changes, particularly atmospheric pressure lowering can increase obstructive events. These results are similar to studies that where performed in high elevation.
It just goes to show that your effective xPAP pressure needs to be constantly changing, since the "real" AHI is also changing, depending on the weather, nasal allergies, nasal congestion issues, what and when you just ate, sleep position, etc. I've always been a little suspicious about eyeballing one constant pressure setting based on an entire night's reading. More reason to use autoPAPs more frequently, but that's another major discussion in itself.
It just goes to show that your effective xPAP pressure needs to be constantly changing, since the "real" AHI is also changing, depending on the weather, nasal allergies, nasal congestion issues, what and when you just ate, sleep position, etc. I've always been a little suspicious about eyeballing one constant pressure setting based on an entire night's reading. More reason to use autoPAPs more frequently, but that's another major discussion in itself.
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Permalink Reply by Mike on
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I'm all for the manufacturers' shareholders making a profit -- even an outstanding profit. that's what makes all of this outstanding innovation possible and accessible to you and me. not going anywhere with that other than to put that out there.
on your other point, I am with you -- I think the direction we're headed is what you describe -- fewer straight CPAPs/more APAPs with the ability to run in straight CPAP mode.
j n k said:Actually, since all APAPs can run as CPAPs, there is no reason to make CPAP-only machines at all, is there? If every machine made was an auto, the savings in manufacturing costs could be passed on.
But would they be?
No. That money would be passed on as added profits to the share-holders of the manufacturers.
Business is business. Medicine is medicine. It's a volatile mix. The question these days is whether the two should get a divorce on grounds of incompatibility. I have no answer, myself.
jeff
Mike said:well said. i think we might also shift some of the blame to the manufacturers as well as the insurance companies and DMEs --- i.e., there's enough blame to go around: the manufacturers could lower the prices they charge DMEs on the APAPs to the point that the APAPs are cheaper than the CPAPs. then we'd see a lot of changes. given economies of scale and how far they're coming with the automation technology in these units, I see that as a pretty realistic scenario. of course, i might get some push-back trying to get the CFO of Respironics to come around to that way of thinking ;-)
j n k said:That's my point exactly, Mike. If a doc goes ahead and writes the Rx for an APAP every time, why would insurance care? In fact, that should make insurance happier because of the potential savings. But most docs remember the old days when APAPs were cutting-edge technology and much more expensive than CPAPs, so most, if not all, assume they would get in trouble for writing APAP Rx's all day.
When I asked my sleep doc to write my Rx for an APAP, his answer was: "Insurance often won't pay for it." Why does he think that? I don't know. He wrote "patient may use an APAP" on the Rx. Why? I assume it is fear. Fear of whom? And again, why?
I think it must all be one big misunderstanding among all the parties in the "transaction." That's all I can figure.
I think that Dr. Park, by the way, is exactly right in every point he makes above, and he summarizes the primary issues perfectly. I am only using the subcontext of the statements to point out what I believe to be an industry-wide misunderstanding that is, as usual, about money. Dr. Park has obviously found some effective ways to get around those misunderstandings. And as Judy points out, more doctors need to learn the things Dr. Park has learned and is willing to say 'out loud' in a way that other doctor's should learn from.
jeff
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i get a lot of that.... which is fine with me ;-)
j n k said:No argument from me. Just pointing out the confusing conflicts of interest when questions of regulation and pricing are brought up.
Just testing you.
:-)
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