Today, I watched a video about fat shaming vs fat acceptance and it prompted me to comment but the comment was honestly too damn long so I wanted to bring it here. This post has to do with weight and health. I welcome your comments and interactions but let's try to be kind.
2) Those that had actual medical conditions and needed a CPAP for supplemental oxygen at night only.
3) DOT Licenses
I'm not knocking anyone. Everyone has their own reasons for needing a sleep study.
Let's talk about the 7 year old male patient.
The parents said they all sleep in the same bed and we had a bed large enough for them so that wasn't a problem. I didn't ask questions because we all have different living situations and they mentioned their son has night terrors. They were super kind to me and I with them so it was not really an issue.
Middle of the night, everyone was sleeping and one of the monitors goes offline. I was in the next room but we had a system where someone else about an hour away monitored all the techs in case they saw something we didn't. She called me and asked if I caught that, I told her I had and I was checking stuff in the office before I went in because we tried not to wake anyone. But I was quick because this wasn't just any monitor, this was his heart. I got in the room and it's dark except for the light from the hall so I grab his bedside monitor and start checking the leads quickly as I can. Within seconds, this little guy sits straight up in bed gasping for air and then lays back down and is still fast asleep. His parents are unmoving and still snoring, one in the bed and one on a chair in the room. All leads intact.
By morning this had happened a couple other times. I'm terrified. Legit, this baby might have a heart condition.
We, as techs, are not physicians and are not at all allowed to tell them how the test went because we don't "read" them but we see things. I wake everyone and the young man is ready to go to the bathroom so I ask the parents to chat with me for a moment while he went to get cleaned up (the leads are stuck on with tape or a paste so sometimes it takes a minute to get all that out). I asked them if the doctor had mentioned a reason for why he wanted the test. The dad starts getting upset, and by upset I mean southern hillbilly, irrationally upset, and cussing about the Asian doctor who was a jerk to him and to his family. He said, "I told him if I catch him in a dark alley, I'll kill him" were threats he tossed at the doctor and "he told my son he's "obese" and because my wife and I are diabetic that our kid is likely to be. We told him he just snores and wets the bed so he needs his tonsils out to fix the snoring and he sent us here because of insurance".
At the risk of losing my job and/or being punched in the face, I had to make a choice. Do I choose their feelings and say, "Wow, gosh, that is CRAZY! If you don't like your physician you should get a second opinion" or do I say "Um, actually..."
Keep in mind, I had been up all night in terror watching and running into the room for a 7 year old child, roughly the same as my own babies, gasping for air. This isn't "night terrors", this child has physically stopped letting air in and out of his lungs. There's potential his heart stopped and recorded information to verify it. I was in tears all night, on the phone with my backup gal, in case something happened and took the phone in with me every time I went in the room all night.
I took a risk.
"So before I tell you how the night went I want to first tell you that I am NOT in any way a physician. I can NOT tell you what any of this means to your son's health but if my baby were in here I would hope someone would be honest with me. First of all, Dr S (not his name) really isn't a bad guy. I'm sorry for your experience with him but he's sometimes brutally honest, from what I hear from his patients. Secondly, your son may be having night terrors but have you noticed he sits up in bed in the night? (They said yes, that's the nightmares and then he wets the bed.) I cannot tell you if he was having nightmares but in each instance he sat up in bed, we had trouble with some of the connections. There may be an underlying issue to speak with the doctor about. Third, please know that OUR own physician will go over this with a fine tooth comb and contact your doctor. I've already discussed with him this morning that we noticed the disconnections so either he or your doctor will reach out to you with more information. If you're not happy with your doctor, get another, but please know that he's just trying to look out for your and your son's best interests even if he doesn't he doesn't have a filter. And lastly, there are things that can help a person's sleep and we call those Major Life Changes such as losing weight, going on a healthier diet, medication changes, quitting smoking, etc so if your doctor suggested he should lose weight he may well have just been saying that if those changes are made he may not need the study."
Mom and dad agreed to try to be nicer to the doctor because they'd rather have honesty than someone kiss their ass but whether they did or not, I don't know. You see, that was a Night 1 Patient. Generally, I would have a Night 1 Patient for a standard test and on Night 2 they'd be prepped with a mask and CPAP to see if the settings worked for them. If they didn't come back 9x out of 10, they didn't test in a manner that required a CPAP. I know he didn't fall in the "doesn't need it" position but he didn't return for night 2. I asked the scheduler if he was on with someone else but she said no. I could have asked our physician (reader of the tests) but that truly isn't my business and would likely violate HIPAA.
That job wasn't for me. I stayed on for a few more weeks but my heart wasn't in it anymore. I loved helping people and I loved getting notes from work saying someone left a really great call or message that I had truly helped someone feel at ease and worked with them to make sure they got what they needed.
Also, side note, of those that had their tonsils and adenoids removed, it did not always mean you will not be on a CPAP. I had about 40% of my patients that had theirs removed and still had sleep apnea. Not all were weight related either. Toward the end of my Sleep Technician days, more of my patients were in because of the DOT issue so I want to hit on this one really quickly.
The Department of Transportation states truckers have to renew their licenses more often than regular drivers. Truly, I'm not sure why they do it but I'm assuming it has to do with safety and making sure they are checked out and tested by a physician regularly. A driver who sleeps better and adheres to log regulations is less likely to fall asleep at the wheel and be in an accident. Not all of them know they do not sleep well because a partner, who is not always one that travels with them, often notices the issue where the driver does not. I've had many drivers say "I don't snore but my wife said I do" so then you snore bro. Not sorry.
Honesty Hour.
Driver : "This is all made up by the government and ya'll are sitting on fat stacks of cash."
No. Just ... no. We had a deal with a major trucking company and were expanding (this was almost 15 years ago now). Drivers would go into their physician for a physical. If they failed certain criteria that has in the past or could potentially in the future cause a driver to fall asleep at the wheel of his truck then yes, you might have to take a sleep study. You should do that with or without DOT certification issues from the physician.
Your physician gets paid by your insurance and get a fraction of what you think they get. They send you to do a study and get zero kickbacks from the sleep facility. They're looking out for you. Your company does not gain from taking you off the road for two days for a sleep study, and if they're paying for 1/2 then they're also losing out. While we had a deal with a trucking company, there were no kickbacks. We did the studies and it was charged to insurance. As a tech in about 2007-2008 I made $100 for Patient 1 and $10 more if there was a 2nd patient. I worked 7 nights a week for six months until I put my foot down. I washed all laundry from patients sleeping in the beds, cleaned leads and did follow up calls. We were barely making it as a family of 4 in a small house. Our office furniture was sub par except for what was needed for the test equipment and things to make the patient comfortable. My chair hurt like hell, the pc was patched together and we only had one scanner that barely worked to scan patient documents. Your sleep facilities are not Elon Musking it in the back rooms. They do this to provide a service and they want people to be healthy.
I, personally, believe truck drivers (long haul) should all be tested every 5 years. It doesn't just improve your sleep but your way of life. You have no idea how many drivers I later worked with that thanked me because they didn't realize how worn out they got just doing every day tasks that now they can do more of. Insurance usually will pay for a new one every two years. If you feel that's too much, at least have a card in your CPAP and take that in every six months to get a print out of how you're doing and how it can be tweaked to better help you.
If a driver could cause the death of themselves, the death of anyone else, destruction of a very expensive truck, damaging customer goods, paying out to the families of the lives lost, buying a new truck, paying out for the goods ruined ... OR you could shut up for 1-2 nights and get a sleep study done to see if you even need it, isn't it worth it?
If you're a trucking company, be honest with your drivers about why you want them to get checked.
If you're a physician, be honest with your patients as to why you want them to be seen. It's just best.
If you're a driver, please be courteous. This isn't against you, it's for you. I promise.
If you're a general patient, ask questions. Ask your doctor why they want to do it, are there options to avoid it, do what you can do to be PROACTIVE in your own health.
Be honest about your symptoms, ask for honesty from your physician and then don't be a baby when you get that honesty. You don't want them to save your feelings and tell you that you look great and you have a coronary on their front steps.
For anyone who has a CPAP and they hate it, before you pitch it, try another mask. Not every mask is perfect for every patient. You generally have a Full Face mask, Nasal Mask and Canula type mask/Nasal Pillows. Ask about them. Talk to your insurance if they say they won't pay for another yet. Get the prescription info for your CPAP and order masks online if you have to. Keep your mask, hoses clean and filters so you don't get pneumonia. If you have questions, call a tech. They'd rather you ask.
