Sounds to me like you know you have sleep apnea, and don’t want to admit it to yourself. Go ahead and delude yourself if you like, but don’t expect anything we say to clear up that nagging fear in the back of your head. There is no way to make this whole thing just go away.
In general, to qualify to have your insurance pay for a portion of a CPAP, your blood oxygen level has to drop below 50% at least three times during the night. I was down to 53% for 90% of the night. The doctor called and asked if they were nuts when they tried disallowing it. They didn’t try to hold out.
So all you have to do is keep your blood oxygen level above 50% the whole night, while you sleep.
If he hasn’t specifically said that he’ll cut them off, then he probably won’t. Does he think that the pain is related to apnea somehow?
Why would your doctor be that interested in getting you tested? You say you’re not complaining of symptoms. You say your husband isn’t interested in the results, so I’m guessing he’s not complaining of snoring.
Anyway, if you don’t stop breathing while you sleep, you’ll pass just fine.
An intermediate test might be to do a home study with a pulse oximeter. If your O2 saturation level stays over 90% all night I wouldn’t worry about sleep apnea. It’s a much less expensive test that only requires clipping a sensor to a fingertip and can be done in your own bed without any attendants.
True, but I’m not as sure it applies as other posters in this thread. It may, but this is exactly the kind of grey area that drives me nuts, and I’ll learn better how to navigate it as I gain more experience, I hope. It’s not a violation of HIPAA, as far as I understand it, to ASK a spouse (or a child or a roommate, even) questions about a patient’s symptoms or behavior. For example, it’s exceedingly common for doctors to ask the sleeping partner if the patient snores, or if they’ve observed them stop breathing at night, as part of the information gathering phase of diagnosing sleep apnea. The patient may or may not have this information, and the partner can provide it, and the doctor isn’t sharing information about the patient’s medical history or diagnosis or treatment, she’s asking a question.
Now, yes, legally the OP could say, “I don’t want you to talk to my husband about my health concerns, period,” and that would make questioning the husband a violation of professional ethics and probably stop the doctor from doing so. However…remember that these are real people, not hypothetical ethical constructs; it’s quite likely that the doctor may forget the request and slip up, and such a request is going to strain the OP’s already strained relationship with her doctor. I’d suggest that a more realistic course of action would be to find another doctor, one that she doesn’t share with her husband and who will respect her right to refuse and tests and treatments she doesn’t want.
However, this:
REALLY concerns me, and is not a grey area at all. If a doctor actually did this (withheld pain medication to force the OP to consent to the test), it’s highly unethical, it’s assault and it’s illegal. Not in a HIPAA violation sense, in a criminal law sense. It could very easily result in at least a reprimand from the medical board which holds his license, if not a suspension or even revocation of his medical license. So it’s exceedingly unlikely that a doctor would actually do it, and if it happens, the OP needs to take action, report him to the medical board and file a police report for assault. Then she needs to take her case to his superior, who should take over the case himself, and take disciplinary action against the doctor to protect the practice from legal action.
I’m not saying the doctor absolutely won’t do this; doctors *do *play games like this sometimes. But it’s wrong, and it’s illegal, and it’s very easy to switch doctors if it happens - the other doctors in his practice will fall over one another to resolve the issue and prevent a lawsuit. If he even hints at it (and most of the time, hints are as far as it goes) the OP needs to stand up for her rights, look him dead in the eye and say, “I know you couldn’t possibly be suggesting that you will withhold my pain medication if I don’t submit to this test, because that would be assault and medical malpractice, right?”
If she’s not brave enough to do this, then she should talk to one of the nurses in the practice. Nurses are trained to be patient advocates and run interference if things like this happen, to ensure that the patient’s rights are not violated and that their choices in healthcare decisions are respected.
Thank you, that always makes me twitch irrationally.
Get a new doctor if you’re sick of the nagging, or tell the doctor that you refuse.
I’ll spare you the lecture since you’re obviously not interested in what your breathing - or lack thereof - during the night may or may not be doing to your health, life, husband’s sleep quality, etc. Yes, sleep apnea and disturbed sleep as a result can screw with a bed partner’s quality of sleep.
(Not quite the same, but my husband snores. I may someday snap and repeatedly beat him over the head with my pillow. I spent last night on the couch. His next doctor’s visit, he will talk to his doctor about this and see if there’s anything to be done.)
While in theory your doctor could take a stand and say that if you refuse to get the sleep study he’ll discharge you from his practice and you will have to start seeing another doctor for your pain meds, it is unlikely it will come to that. I promise you that you are not the only patient he has who loves narcotics and refuses to use CPAP. In fact, that’s the norm, not the exception, in primary care.
My guess is that he just keeps bringing it up so he can document that he talked to you about it to make sure that if you do die from something related to sleep apnea then your survivors can’t bitch about how you never were warned about the danger and now they’re gonna sue.
If I were you I’d just tell him that you understand the risks of refusing the test, ** including that you might die from something related to untreated sleep apnea** (it’s important to emphasize that you really do get that part), and that in spite of that you are choosing not to do it. I think most docs would be satisfied with that unless they were some super idealistic person who actually really cares about trying to save every patient from themselves.
Refuse to take the test. And then find another doctor to keep supplying you with meds.
It could be a violation if the question inherently reveals information about the diagnosis or treatment. “Does your husband snore?” is one thing, “Is your wife using the CPAP machine I have prescribed for her?” seems like quite another. Obviously if the husband knows she’s been prescribed it then the question isn’t an issue, but presumably then the husband could either lie or refuse to discuss it and it wouldn’t be a problem.
Is this true even if sleep apnea contraindicates the pain meds? Because a cursory look on google seems to suggest that opioids can make sleep apnea worse to the point of putting the patient’s life at risk. In that case, I can’t possibly see an ethical conflict in a doctor refusing to prescribe a certain set of meds without assurance that the patient doesn’t have a problem that makes those meds extremely risky.
You cannot cheat the test. The electrodes and monitors will allow those who administer the test to tell, exactly, when you fell asleep and when you woke up, and how many times.
You’d have better luck cheating on a polygraph.
In such a case, he should be working to find a more appropriate pain treatment, not withdrawing pain medication entirely. If he can’t rule out sleep apnea with a test, then yes, he should assume she has it (if she has other clinical signs and symptoms, which she denies) and prescribe a safe pain treatment with that assumption in mind, but having sleep apnea is not a reason to deny pain medication altogether.
Which may very well be what he will do. Remember, we’re not dealing with a real situation, but something the patient is *afraid *he’ll do.
…besides, she isn’t afraid he’ll yank the pain meds if her test shows that she has sleep apnea, so I think maybe we’re overthinking it here. She’s under the opinion that he’s strong arming her into the test, using the pain medication as a tool of force, not that sleep apnea would mean she can’t have her pain medication.
I don’t know who told you this, but they are very, very wrong. (Unless they were speaking of some particular insurance plan that is WAY outside the norm.)
I work for a company that runs a number of sleep testing facilities, and it’s my job to send PAP orders out to DME companies to fill. The vast majority (Medicare/Medicaid, Anthem, UHC, Aetna, Med Mutual, etc.) of insurance companies make their determinations based on the Apnea Hypopnea Index (AHI - or the number of times per hour that the patient stops breathing) as follows:
AHI < 5: Generally no coverage.
5 <= AHI < 15: Coverage if the patient has a secondary diagnosis (hypertension, diabetes, ischemic heart disease, and a few others) for a condition that can be caused or exacerbated by sleep apnea. (Note: severely low O2 sats can be used here, but I’d have to check my guidelines for the specifics.)
AHI >= 15: Coverage regardless of existence of other diagnoses.
Oxygen levels can be one way to help get you qualified for a machine if you are in that middle range, but it’s not the stand-alone measure for most insurance companies.
Seriously? You must not get around much. While what you say is a pretty huge problem on the Dope, it’s not really happening here. Okay, there’s the one person calling you an addict, but, other than that, everyone is just trying to give you advice because you will not be able to fake the test.
Now you can argue that some people are being rather rude with that advice, but that’s something else. I just hope they haven’t been rude enough for you to no longer check out this thread, as the advice on how to handle the underlying situation is good.
Though I must admit that, if you are taking narcotics, doctors will be very wary unless you have a good reason to be shopping around. It sucks, but many doctors are so prejudiced against druggies that they will harm not only them but people who legitimately need pain medication.
It was Anthem Blue Cross and the initial letter denying payment said exactly that they required three episodes of desatting below 50% and that I didn’t qualify. I had already seen the test report and although I don’t remember any Apnea Hypopnea Index numbers, I remember the graph showing that I was at 53% for the majority of the night. It might have been a mistake on a clerk’s part or a passing phase they were going through, but that’s the letter I received. It’s good to know that there’s actually a more flexible criteria. They did not deny the second submission.
I think a lot of people with chronic pain would consider taking away all opiates and trying an alternate pain treatment plan to be “taking away my pain medication”. Outside of the dependency stuff, there’s also something almost superstitious about people with severe pain and their opiates: for a decade or so my husband had frequent reoccurring tooth abscesses, and he hoarded meds throughout those years: he wasn’t dependent at all, but the thought that the pain could come back at any minute and he wouldn’t be able to do anything about it horrified him. Opiates are a magical charm against that sort of thing in a way that nothing else is.
Ahhh, OP sounds like me. I took the damn test over my objections, the tech woke me up half a dozen times to adjust the sticky crap on my head, and then told me at 5 am to wake up, the test was over. I flunked because I had too much leg movement ???. They put me on a CPAP, and over a summer I tried at least six different styles that tortured me to no end. I would wake up with pounding headaches every night I used it. The doctor would not listen to me that of course I move a lot at night – I have RA and fibromyalgia, not to mention cancer, and I’m in a fricken boat load of pain 24/7!!! My breathing at night has nothing to do with it. Ahem. Sorry about that…a lot of frustration has built up over that thing. Carry on.
+1 on this. Heck, the second night of the sleep test, where I wore the mask for them to measure the difference, was the best night’s sleep I had had in decades.
Well, they’ll know you’ve stayed awake - they’ve got electrodes glued onto your scalp (with a mixture of Krazy Glue and elephant snot), so at best that would show inconclusive results.
But really - why fight it? 1) You might not have apnea, 2) you might, and depending on the nature of it you might find something like a jaw-repositioning guard might help, 3) apnea, untreated, is pretty dangerous on a NUMBER of levels, and 4), you might find the scuba apparatus is more tolerable than you’d expected (I did).
Of course, on rereading I see you mentioned the bite guard: I too had trouble wearing one of those for the longest time, but as my tooth pain got worse I managed and now I have trouble sleeping without it.
Oh - and even if you do turn out to have apnea, it’s not like they send storm troopers to your house to force you to acquire and use the CPAP equipment.
Regarding “passing” the test (or failing it, depending on the definition): Sleep apnea is typically worst when lying on your back - so if you can see to it that you sleep on one side for the test (bring extra pillows if need be), you’re less likely to show apneas.
Also, from my own experience, it can be tough to sleep well enough at these places to get a decent reading; wasn’t until my 4th study (yeah, FOUR of them; I have other sleep-related issues) that they caught enough apnea. So that might “help”.
That said: why is the doctor so insistent? You report that you have no trouble functioning during the day; does your husband report that you’re snoring or quitting breathing? Or does he want to get data on whether the narcotics are suppressing your breathing too much?
+1. Even though you’re married, it’s a HIPAA violation to discuss one spouse’s condition with the other, unless you’ve signed something giving them explicit permission.
Now, the reality is probably that this would get ignored, or the doc wouldn’t check the paperwork to see if he could talk about you with your husband…
Anyway - for what it’s worth, I’m sure it’s possible to snore without having apnea. Supposedly my father-in-law is one such: nfamously loud snoring, meets all the criteria for having apnea i.e. male, older, and profoundly obese, low energy, naps every day… My mother-in-law swears he’s had a sleep study that shows no apnea.