So I'm having a disagreement with my doctor over my treatment of sleep apnea

[beer]

So basically I've had excess daytime sleepiness symptoms since i was in high school but they never got to be a big deal until "the real world" because I slept through half my college and high school classes. I did a sleep study and have moderate to severe sleep apnea. I am at about 8% body fat, 120/70 blood pressure, with nothing physiological about why I have this and the root cause is likely genetic.

So, bottom line is I have the documented paperwork that I have the condition and the condition is moderate to severe. However, he will only treat me with a CPAP machine and I prefer a treatment with both the CPAP machine and pills to alleviate the symptoms.

He won't prescribe the pills that are designed for these symptoms (provigil) because he is opposed to treatment with drugs at this time. I disagree with his approach because the EDS is affecting my quality of life and so on and so forth.

So, what do I do? I've already done the sleep study and have the diagnosed medical condition that these pills are designed to treat. I want a CPAP machine, but realistically it's not possible to use it even half the week considering my dating life and the party scene and, well, I still need to treat the symptoms.

The worry I have is that if I go to a new doctor to go over the sleep study, what I am trying to do will be identified as drug-seeking behavior, which it is not because I have the f-ing condition the pills are designed to treat. Has anyone else disagreed with their doctor and how did you resolve it? This is frustrating.

 

[Ryan]

Personally, I would seek another doctor if your current one does not want to consider a medicinal treatment - on a side note, have you considered surgical treatment?

 

[beer]

Originally posted by: Ryan
Why no consider surgical treatment?

Neither my doctor nor the interpreting MD think that I have even a moderate chance for success with the relatively highly invasive surgery. There's little that is physiologically wrong with me, certainly not to the severity to this extent, and the neurological component obviously can't be treated with surgery.

It's not on the radar.

 

[msarusac]

I'm a physician, and I know this is probably not what you want to hear or asked about, but I agree with him for now based of what you wrote. If you haven't had a chance to use the CPAP machine, it sounds like it might be worthwhile to give that a shot first, and see if that relieves your daytime sleepiness.

I think as you know, the reason why you're sleepy is because you constantly wake up in the middle of the night, but the CPAP should help you stay asleep throughout the night. So theoretically, once you start CPAP (even if not used daily), the daytime sleepiness might go away without meds.

Also, sometimes it's better to start 1 treatment at a time because if you do CPAP only and your daytime symptoms go away, then you know it's helping. If you started CPAP and the meds at the same time and feel better, then you don't really know if it was the machine or the meds.

With that said, even if you ask another doc for Provigil, I really doubt they're going to think you're drug seeking...we usually look for many more signs than just that =)

Obligatory disclaimer: please discuss all treatment options and questions about your care with your actual doctor, as I don't have the capacity to evaluate you or make medical decisions over the internet...this is only meant for additional information...best of luck!

 

[zach0624]

Originally posted by: msarusac
I'm a physician, and I know this is probably not what you want to hear or asked about, but I agree with him for now based of what you wrote. If you haven't had a chance to use the CPAP machine, it sounds like it might be worthwhile to give that a shot first, and see if that relieves your daytime sleepiness.

I think as you know, the reason why you're sleepy is because you constantly wake up in the middle of the night, but the CPAP should help you stay asleep throughout the night. So theoretically, once you start CPAP (even if not used daily), the daytime sleepiness might go away without meds.

Also, sometimes it's better to start 1 treatment at a time because if you do CPAP only and your daytime symptoms go away, then you know it's helping. If you started CPAP and the meds at the same time and feel better, then you don't really know if it was the machine or the meds.

With that said, even if you ask another doc for Provigil, I really doubt they're going to think you're drug seeking...we usually look for many more signs than just that =)

Obligatory disclaimer: please discuss all treatment options and questions about your care with your actual doctor, as I don't have the capacity to evaluate you or make medical decisions over the internet...this is only meant for additional information...best of luck!

my mom's a doc and my grandpa had pretty bad sleep apnea until he started to us his CPAP machine at night and now his able to stay awake 16hrs without dozing off(he used to go for 1 or 2). Also your doc knows what he is doing. If your symptoms don't go away using the CPAP go back to him to see if you can try the meds. If not then you can always get a second opinion.

And ditto on the disclaimer.

 

[dethman]

i'm also a physician and i have to agree with your doctor as well. CPAP only is initial standard of care for treatment of obstructive sleep apnea. modafinil (provigil) is a stimulant which has been shown by some studies to improve wakefulness and some studies to be ineffective. concern lies in the fact that you are not treating the source of the sleepiness (the actual OSA) and are only treating the symptoms. stimulants can lead to many long term side effects which can be detrimental to other aspects of your health which is reason enough not to start them as first line therapy.

first line therapy and standard of care is CPAP. period. your doctor may consider use of provigil in conjunction after CPAP fails. have you tried CPAP by itself?

i know you're probably young and don't want to use a cumbersome CPAP machine and would rather take a pill and have everything go away, as most of america would. but realize that drugs aren't always the best solution.


also i'm going to make the same disclaimer as the doc above.

 

[pyonir]

My dad uses a CPAP machine. He pulls it off in the middle of the night and doesn't realize it. This leads to him sleeping at least a couple of hours after he gets up and before he goes to work (he works 2nd shift). I can't sit and watch TV with him for more than 20-30 minutes without him dozing off.

Anyway...if you haven't tried the machine yet, do that. My dad isn't on any medication for it at all, i'm not even sure he knows there is such a thing. I might mention it to him and my mom tomorrow.

 

[brxndxn]

You have hypothyroidism.

 

[Coquito]

I too had excess daytime sleepiness symptoms since I was in high school. Turns out I had mono. On & off. For about two years.

I don't currently have mono though, now I'm just tired. Turns out I'm just always bored, & I find cubicles to just be a little too comfy.

 

[JEDIYoda]

Originally posted by: brxndxn
You have hypothyroidism.

don`t you just love search engines???

 

[Azraele]

So you've basically said you won't use the CPAP because of your dating/party habits.

Change your habits. :/

 

[brxndxn]

Originally posted by: JEDIYoda

Originally posted by: brxndxn
You have hypothyroidism.

don`t you just love search engines???

I have hypothyroidism.. He describes a situation that sounds just like me in college.

 

[meltdown75]

My wife just started with the CPAP machine last week. It doesn't seem like that much of a fuss, other than she looks like she is sleeping with a snorkel attached to her face.

Give it a try, FWIW she has already mentioned that less sleep feels more restful - and she only has minor sleep apnea.

Just think how hard you will be able to party with better quality sleep the night before. Take it from a partying expert

 

[Chryso]

Originally posted by: Azraele
So you've basically said you won't use the CPAP because of your dating/party habits.

Change your habits. :/

DINGDINGDINGDING!
Best answer.

 

[Viper GTS]

want a CPAP machine, but realistically it's not possible to use it even half the week considering my dating life and the party scene and, well, I still need to treat the symptoms.

I'm not going to be nice like the rest, you're just an idiot. Your doctor is doing exactly what he should. Use the damn CPAP, and use it every night. They aren't going to give you drugs just because the CPAP decreases your sex appeal.

Besides, once you're used to sleeping with a CPAP you won't WANT to sleep without it. If I even fall asleep on the couch I wake up wishing I'd used it.

Viper GTS

 

[AlienCraft]

This is why hyper-consumerism is not necessarily a "good thing", imo.
It elevates consumerism to a rank equal to that of years of medical school and the gleanings of decades, centuries even, of research and study.

I'm all for asking questions and even seeking multiple professional opinions, but to countermand a diagnosis on the basis of an inconvenient social impact is absolutely ludicrous.
But hey! If your insurance covers it or you can afford it, more power to you. isgust;

 

[Viper GTS]

Originally posted by: AlienCraft
This is why hyper-consumerism is not necessarily a "good thing", imo.
It elevates consumerism to a rank equal to that of years of medical school and the gleanings of decades, centuries even, of research and study.

This really got out of hand when they let those godawful prescription drug ads on TV. I'm all for being informed but do we really need everybody trying to decide what they need?

Viper GTS

 

[AlienCraft]

Originally posted by: Viper GTS

Originally posted by: AlienCraft
This is why hyper-consumerism is not necessarily a "good thing", imo.
It elevates consumerism to a rank equal to that of years of medical school and the gleanings of decades, centuries even, of research and study.

This really got out of hand when they let those godawful prescription drug ads on TV. I'm all for being informed but do we really need everybody trying to decide what they need?

Viper GTS

Thank you.

 

[dirtboy]

My father has had every surgery for sleep apnea in existence and has been treated by the best sleep apnea doctor's in the world.

I can tell you for fact, there is no pill that cures sleep apnea.

The only pill I can think you'd need, is a diet pill if you are fat, as sleep apnea is most common in overweight people.

 

[Jugernot]

Dude, it's called a second opinion.... everyone is entitled to one. Go get your pills!

 

[glutenberg]

Originally posted by: Jugernot
Dude, it's called a second opinion.... everyone is entitled to one. Go get your pills!

He doesn't want a second opinion. He wants an opinion that matches his. In fact, he's had 4 supplemental opinions from doctors just in this thread.

 

[torpid]

Excessive drinking also contributes to sleep problems pretty noticeably, BTW.

Get the CPAP machine only. The drug is not intended as a substitute for a CPAP machine. The drug's not going to treat the potentially long-term serious health risks that sleep apnea can cause. And it even says on the website for the drug that it should be used in addition to the CPAP when the CPAP alone is not effective in reducing sleepiness.

 

[Fullmetal Chocobo]

My doc gave me a bunch of Provigil to see if it might diagnose sleep apnea. It didn't do anything at all, so I just have insomnia.

 

[FiLeZz]

Get the CPAP and take it with you to your friends house, they will apperciate it in the long run because your snoring will not keep them awake any longer.

I am on CPAP and take it with me when I go anywhere overnight, the differance in sleeping with it and without it is amazing.

 

[OutHouse]

Originally posted by: Viper GTS

want a CPAP machine, but realistically it's not possible to use it even half the week considering my dating life and the party scene and, well, I still need to treat the symptoms.

I'm not going to be nice like the rest, you're just an idiot. Your doctor is doing exactly what he should. Use the damn CPAP, and use it every night. They aren't going to give you drugs just because the CPAP decreases your sex appeal.

Besides, once you're used to sleeping with a CPAP you won't WANT to sleep without it. If I even fall asleep on the couch I wake up wishing I'd used it.

Viper GTS

:thumbsup: