Pulmonary Clearance. Why?

[freddy 0]

Hi. I would love some insight and some advice from you guys.

I have hit a roadblock in my journey to Lap band. I went to the pulmonary specialist who sent me for a sleep study to determine if I have Sleep Apnea. The sleep test was awful. 7 hours of not being able to sleep with all of those wires and paste etc... It also came with a co pay of over $600.

I went back for the results and the doctor says I have sleep apnea. He tells me that I only slept for brief 10-15 minute intervals but it was enough to determine that I do have it. I wasnt surprised. I have always snored my whole life. The shocking news was the he wants me to go back to determine what type of Apnea I have???

I walked out of his office when he told me that. The test was 7 hours of misery and $600. Why do I need another test? Couldnt that have been accomplished with the first test? He said that after they determine what type kind apnea I have, I will then be advised which C pap machine I need. I need to use the machine and go back to him, so that might even mean a 3rd sleep center trip??

I called my surgeon and his assistant advised me I need the clearance and that having to go back to the pulmonologist was not unusual.

I dont understand this. The real cure for sleep apnea (in my case) is weight loss, not this machine that I wont be able to use because I move around a great deal while sleeping.

I dont understand this. Is pulmonary clearance required for other types of surgery? Why does a bariatric procedure require it? I have 2 friends that did the surgey in another state and they didnt need a sleep test. They went for a pulmonary exam and were cleared in the same day based on breathing exercises.

I feel like the doctors (who are businessmen, first and foremost) are miliking me and my insurance company. Were you guys required to take multiple sleep exams? Does anyone know what purpose these sleep exams provide?

I am already paying $1500 for a mandatory 6 month program that is required by the surgeon that really isnt much more then Weight Watchers meetings. Between the co pays and all these tests, it will be well over 3k for these required procedures that dont seem to be required by every surgeon.

My question is this-- Why is a Sleep Apnea test required for this procedure but not others? Ok, I have sleep apnea and I understand the dangers, but what's the point? It isnt going away without weight loss, so why do I need to go back to the sleep center? Again, I dont trust doctors. I feel the way I do when you get your car's oil changed and they tell you you should have some internal maintanance that is recommended by your manufacturer and it is only 89.99 this week.

Sorry for the long windedness but I am at the crossroads and I dont know what to do. Thanks for your time.

[RestlessMonkey 7]

I know you're frustrated, but sleep apnea is a bona fide problem for many, more than one "visit" isn't uncommon, and although I understand your anguish, not all docs are essentially businessmen first and foremost. There are some money grubbers in medicine as there are in anything on earth, unfortunately, and for all I know your surgeon is one, but if you think that's the big issue, find another. seriously!

I don't have sleep apnea but from reading here and another "weight loss board", and knowing a couple people who have it, the cpap can revolutionize your life. I hope some people w/apnea will post for you, but I can assure you that it takes getting the right mask, machine, setting etc to properly treat it.

If you want the band but don't trust your surgeon, switch docs. If you want the band and trust your surgeon but just are frustrated, then hopefully someone can post and help you deal. But your problem isn't an uncommon one. Many have to have several sleep apnea tests pre banding.

[freddy 0]

Thanks Monkey. I want the band, I think I trust the surgeon but I dont trust the pulmonary guy. I cant fathom sleeping with that machine strapped to my face.

I just dont see why they require me to be getting treated for the sleep apnea when it isnt going to get fixed without weight loss.

Kinda like getting braces for teeth that are going to get pulled anyway.

[RestlessMonkey 7]

I don't blame you. I don't think I'd want one either and people do have trouble adjusting...but say it is miraculous, the change in energy etc. Hate to tell you this but losing doesn't cure all apnea, either! Some

"normal weight" people have it. Hopefully yours will go away with weight loss. I guess if your surgeon vouches for the pulmonologist, you're kind of stuck. Good luck whichever you decide.

[phenry 0]

I was just diagnosed with apnea too. I had to go back for a second study in which they let me sleep with a c-pap and then they were able to compare test one without c-pap with test two with c-pap. It greatly increased my oxygen levels at night. Once it's determined you have it, they want you to bring the c-pap machine for surgery and they will put you on it so that you wake up from surgery breathing with it. At least that is how it was told to me. Maybe it is a liability issue with the doc. If they know you have apnea and don't take all the proper measures to make sure you have your c-pap for after surgery...maybe they could be risking something happening to you. I don't know about other surgeries since I have never had surgery before. Also maybe both tests are required in order for you to be able to get the machine from your insurance company.

[freddy 0]

I was just diagnosed with apnea too. I had to go back for a second study in which they let me sleep with a c-pap and then they were able to compare test one without c-pap with test two with c-pap. It greatly increased my oxygen levels at night. Once it's determined you have it, they want you to bring the c-pap machine for surgery and they will put you on it so that you wake up from surgery breathing with it. At least that is how it was told to me. Maybe it is a liability issue with the doc. If they know you have apnea and don't take all the proper measures to make sure you have your c-pap for after surgery...maybe they could be risking something happening to you. I don't know about other surgeries since I have never had surgery before. Also maybe both tests are required in order for you to be able to get the machine from your insurance company.

Have you slept with the machine on since the study? Do you feel any better? I cant imagine being able to sleep with that thing tethered to my face.

[phthaloblue 0]

Sorry you're having to go through all of this, at your own expense (literally). My understanding is that they want you to have the CPAP machine for when you come out of anesthesia. They want to make sure that you're able to breathe properly when you're waking, and that there are no breathing complications post-op. They're not trying to treat your apnea on a long-term basis, it's simply for the day of surgery.

My insurance required a pulmonary screening, and the pulmonologist ordered a sleep study. It turned out I had very mild sleep apnea, and so I had to schedule a second study with CPAP. The next week I got the CPAP machine and I have to use it until and immediately after my surgery. It turns out that I'm barely eligible for it (being that my apnea is so mild) but they're doing it just to be safe. I'll also have to stay overnight in the hospital because of the CPAP - I wouldn't if I didn't have it. The whole thing is very frustrating, and I totally get where you're coming from!

My only advice is to just get it over with. If it's important enough to your doctor, and you trust your doctor, then jump through the hoops. It sucks, but what can you do? Maybe you'll find that you sleep better, and it was a blessing in disguise.

I hope this helps, and good luck on your journey!

[ParrotheadCathy 0]

I had to do a thing at home ..... some recording thingie. Showed nothing. But they decided I needed to do the sleep study. I had told them from the start that I was pretty darned certain I didn't have apnea because I always slept well, never awoke tired, etc. But I did it. My pulmonary guy gives you a sleeping pill (Ambien). It came out negative, not one event of apnea (I told them so, LOL). But what I was told is that if I had shown apnea in the test, I would have been prescribed a CPAP machine and been required to be on it for 2 weeks before they would do the surgery. Apnea doesn't just go away the day after surgery. If you have it and they put you on a CPAP, it will help you a great deal. More than you can imagine. The couple of people I know who use the machine have been amazed at how much better they feel.

[BillOh 13]

Most people have a hard time understanding how something called a sleep study can be stressful. I've had 5 and I am hoping will never have one again. On the bright side, I was considered to have SEVERE sleep apnea with over 200 "episodes" an hour and my blood oxygen level slipped to 79%. I revisited my sleep doctor after losing 50 pounds and did an overnight test where you just wear an oxygen monitor on your finger and it has improved dramatically. I am going to repeat the test when I hit 200 pounds.

[BillOh 13]

Thanks Monkey. I want the band, I think I trust the surgeon but I dont trust the pulmonary guy. I cant fathom sleeping with that machine strapped to my face.

I just dont see why they require me to be getting treated for the sleep apnea when it isnt going to get fixed without weight loss.

Kinda like getting braces for teeth that are going to get pulled anyway.

The main thing is sleep apnea can be fatal, and they want to make sure you are being treated. I am 6 months post surgery and am almost cured of my apnea, but if you don't get treated, the additional stress from surgery can be bad. It would be possible to die in the weeks after WLS because of sleep apea. If you are being treated for it, your recovery will go smoother.

That said, my being banded was primarily because I wasn't using my CPAP machine, I just couldn't stand it. I was supposed to bring it with me on surgery day. I didn't, but I was on oxygen that night and my level never dropped.

Edited May 26, 2009 by BillOh

[phenry 0]

I am still waiting to get my machine! My last study was on May 7th. On the first test my oxygen dropped to 70%. With the bi-pap machine I was at 90%. Someone is dragging their heels and I really would like to get used to the darn thing before surgery. I didn't mind the sleep study at all and I get insomnia really bad. They gave me an Ambien and it was good night nurse!

[Cleo's Mom 257]

Freddy: I don't understand why they couldn't tell you what kind of sleep apnea you had after one night. That is what the first night's study is for. To make a diagnosis. You either have obstructive sleep apnea or another kind called central apnea something. Most have OSA. Then the second night, they try different cpap masks to see which one works and you tolerate. The anestesiologist needs to know about your sleep apnea in the event that you need to use it after surgery. Others who were on the machine before surgery were told by their surgeons not to use it immediately after surgery due to it blowing too much air into the stomach area.

I was diagnosed with mild/moderate sleep apnea and could not tolerate the cpap but before my surgery I just had to go to a pulmonologist who did a breathing study and said I was good to go. The original doctor who did the sleep study was a bit of an alarmist. A new set of eyes provided, what to me, was a more rational look at my results. Anyway, you might need to use the cpap before the surgery and have another test down the road to see if your apnea is improved. But I totally agree with you about those sleep studies. I've had two 2 night ones and the last time I had to take xanax to get through it. So, good luck. I hope you get this resolved.

[losinit 0]

My surgeon said my lungs sounded fine and he himself would not require me to have a Pulmo consult. However, my INSURANCE requires I have it, along with the 3 months of dietician visits, a Cardiologist clearance and the psych eval. I have had sleep apnea for a few years. The first study is the diagnosis, you may want to call and question the office again, they should have sat down with you and all the reading, They check how many times you stop breathing, how often your brain wakes, your 02 levels and restless legs. The second visit is just to see if you do better on CPAP or BiPAP and wether or not you sleep better with a nose mask, mose plug mask or a full face. You always have to stay over twice but there should be no testing the second time, just the measurements and tweaking of pressures etc. I am sure you will get this sraightened out.