Best way to proceed?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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jmcsmomma
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Best way to proceed?

Post by jmcsmomma » Sun Feb 27, 2011 4:33 pm

Well, I've been using CPAP for two weeks now, and I KNOW that my husband has apnea as well, I can hear him stop snoring, and then do the gasping for air thing. My question is this- should he go to the sleep study, or would it be just as ok to buy an APAP from CPAP.com, and have him use it? What parameters would we use for titration? Don't get me wrong- I want the best for my husband(that we can afford, lol, we still have five kids at home) but if we could skip the study, SAFELY, we would.
Any input, much appreciated.

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HoseCrusher
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Re: Best way to proceed?

Post by HoseCrusher » Sun Feb 27, 2011 4:38 pm

You may want to consider a screening study using a recording pulse oximeter...

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Uncle_Bob
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Re: Best way to proceed?

Post by Uncle_Bob » Sun Feb 27, 2011 4:52 pm

jmcsmomma wrote:Well, I've been using CPAP for two weeks now, and I KNOW that my husband has apnea as well, I can hear him stop snoring, and then do the gasping for air thing. My question is this- should he go to the sleep study, or would it be just as ok to buy an APAP from CPAP.com, and have him use it? What parameters would we use for titration? Don't get me wrong- I want the best for my husband(that we can afford, lol, we still have five kids at home) but if we could skip the study, SAFELY, we would.
Any input, much appreciated.
Whats the cost to you for a study?
An oximeter study is a poor mans option. My levels are above 90% even though i have severe sleep apnea.

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Pugsy
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Re: Best way to proceed?

Post by Pugsy » Sun Feb 27, 2011 5:05 pm

I used my APAP to "screen" my sister and her husband.
Initially set the APAP from 4-10, all I wanted to see was if it tried to rise to treat anything.

They complained of "suffocating" with 4 min so went with 5.
Sister never scored any rises in pressure or events though she has some classic symptoms snores, nocturia, fatigue, morning headaches, etc.
BIL doesn't complain of symptoms other than snores. He had a nice little report showing the pressure went up to 8 and stayed there to treat events and he had an AHI of around 2. Duh....Guess who has sleep apnea? He refuses to do anything about it though. Won't even try.

Obviously the best thing to have is a formal sleep study but they had no money or insurance for it. A person does what they have to do to take care of themselves. Self treating is of course not ideal, but it can be done with someone who is really dedicated and has no other resources.

Rested gal self diagnosed and self treated for a long time before she had a formal sleep study.

An APAP and software is an absolute must though.

Regarding Oximeters. Would be helpful to give an indication of sleep apnea if there were desats showing but not everyone will have desats. So a negative Oximetry doesn't mean no OSA.

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mars
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Re: Best way to proceed?

Post by mars » Mon Feb 28, 2011 9:28 am

Pugsy wrote: Regarding Oximeters. Would be helpful to give an indication of sleep apnea if there were desats showing but not everyone will have desats. So a negative Oximetry doesn't mean no OSA.
Hi Pugsy

I am doing some experimenting with my oximeter and my recliner, and hoped you would be able to give the reasoning behind what you say above. Or perhaps a link that explains the ins and out.

Thanks

Mars
for an an easier, cheaper and travel-easy sleep apnea treatment :D

http://www.cpaptalk.com/viewtopic/t7020 ... rapy-.html

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Pugsy
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Re: Best way to proceed?

Post by Pugsy » Mon Feb 28, 2011 9:52 am

mars wrote:I am doing some experimenting with my oximeter and my recliner, and hoped you would be able to give the reasoning behind what you say above. Or perhaps a link that explains the ins and out.
Hi Mars,
No specific links come to mind as that information was from readings I had done when I first started my therapy.
I don't delve in great detail in "studies" like some people do. I just gather general information.

So my reasoning behind my statement is essentially not everyone who has OSA will experience significant oxygen drops. I think this is a common generally accepted premise.

So just using an oximeter for OSA screening and nothing else might give a false "negative" if the user happens to be one of those people whose oxygen does NOT drop.

Now if a person does use an oximeter only as a screening for OSA and DOES experience a significant drop in the oxygen levels then of course that sure could be a "positive" finding for OSA. It could also mean other things but OSA would be the first suspect.

I am not saying "don't use the oximeter" because the findings aren't reliable. I am just saying that sometimes it might be misleading should the O2 levels not drop, the person could still have OSA and further "screening" might be in order.

I guess I am saying that it pays to be extra cautious when using oximeter as a screening tool, especially if there are no desats.

Now for those people who use the oximeter for monitoring therapy. Hey, I wish I had one and could do it to. It sure has its place for spotting problems or simply for validation of effective therapy.

My comments were intended to be directed to someone who wants to use an oximeter for screening only. If a person has symptoms of OSA and decides to do an overnight oximetry test to "screen" for OSA and has no desats, they might say "oh, no desats, not OSA" and never go on to investigate anything else when they very well could still have OSA or even something else. Just an extra caution for people with no desats to not be lulled into thinking all is well on the front and stop investigating the cause of symptoms.

Since you already know that you experienced desats with your events then your findings pertaining to naps in the recliner or overnight stuff can help you determine if you are getting effective therapy or if you even desat with naps in the recliner without the machine. You are using the oximeter to validate things. That is different from someone wanting to use the oximeter strictly as a screening tool. That's what I think anyway. I just prefer to be extra cautious when someone is wanting to base a diagnosis on a screening sample when there are other variables to be weighed.

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Lizistired
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Re: Best way to proceed?

Post by Lizistired » Mon Feb 28, 2011 10:08 am

You may not have desats, but you could have just enough apneas to interfere with getting sleep time in deeper, restful sleep stages.

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KatieW
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Re: Best way to proceed?

Post by KatieW » Mon Feb 28, 2011 10:51 am

jmcsmomma wrote:Well, I've been using CPAP for two weeks now, and I KNOW that my husband has apnea as well, I can hear him stop snoring, and then do the gasping for air thing. My question is this- should he go to the sleep study, or would it be just as ok to buy an APAP from CPAP.com, and have him use it? What parameters would we use for titration? Don't get me wrong- I want the best for my husband(that we can afford, lol, we still have five kids at home) but if we could skip the study, SAFELY, we would.
Any input, much appreciated.
Is he willing to do the sleep study? And, do you have money or insurance to cover it?

If the answers are yes, then I would recommend the sleep study, because it will give a more complete diagnosis. Most of us use a CPAP/APAP, but it could be (not probable, but possible) that he needs a BI-PAP.

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jbn3boys
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Re: Best way to proceed?

Post by jbn3boys » Mon Feb 28, 2011 11:47 am

I would suggest getting a sleep study. It's always better to know for sure just what you are dealing with.

I would agree that an oximeter cannot be used to rule out OSA. It can be a very useful tool, and can help to lead to an OSA diagnosis, but it should not be used solely to rule out OSA. I have had two sleep studies, and have never had my oxygen saturation lower than 90/92%. But I still have moderate OSA. If I were to have used an oximeter to rule out OSA, I would not have gotten treatment.

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mars
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Re: Best way to proceed?

Post by mars » Tue Mar 01, 2011 7:02 am

Sorry - jmcsmomma - for that little hijack there - it sometimes does happen

and what a beautiful baby you have as your avatar

Thanks Pugsy for getting back to me, and thanks also to Lizistired and jbn3boys.

I found this very interesting -

[quote jbn3boys]I would agree that an oximeter cannot be used to rule out OSA. It can be a very useful tool, and can help to lead to an OSA diagnosis, but it should not be used solely to rule out OSA. I have had two sleep studies, and have never had my oxygen saturation lower than 90/92%. But I still have moderate OSA. If I were to have used an oximeter to rule out OSA, I would not have gotten treatment. [/quote]

So from what everybody is saying I was wrong to think that lending my oximeter to someone would give a definite "no OSA" if there were no desats. And I can see why now.

But I still have a question - would not the SpO2 graph indicate drops when apnea's were occurring, even if those apnea's did not cause desaturation, or is that too fine a distinction to make.

cheers

Mars
for an an easier, cheaper and travel-easy sleep apnea treatment :D

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jmcsmomma
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Re: Best way to proceed?

Post by jmcsmomma » Tue Mar 01, 2011 8:26 am

Still trying to get used to using a forum... I keep looking for a "like" button, lol. Too much facebook, I suppose.
We do have insurance, but that lovely 500 dollar deductible is a stretch. No clue how much a sleep study is.Mark goes in on the 7th for a consult. I told him that when they do the titration (I KNOW he has apnea, I hear it happening) tell the DME that he wants the s9 autoset. That way, if he has a bad night at titration, we can tweak some at home.
Thanks, for the baby compliment, she is my 6 month old grand-daughter, Isabella:)
and Hijack away!!!

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Drowsy Dancer
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Re: Best way to proceed?

Post by Drowsy Dancer » Tue Mar 01, 2011 8:40 am

jmcsmomma wrote:<snip> No clue how much a sleep study is.<snip>
The bill for my sleep study less than one month ago was about $3,000 before insurance (teaching hospital in major metropolitan area if it matters). YMMV.

Drowsy Dancer

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jbn3boys
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Re: Best way to proceed?

Post by jbn3boys » Tue Mar 01, 2011 9:00 am

I've had two sleep studies in the last 6 months. Both were a little over $4,000 before insurance. The first one, my portion was a little under $800. The second one, I have not gotten the insurance information on yet.

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Pugsy
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Re: Best way to proceed?

Post by Pugsy » Tue Mar 01, 2011 9:15 am

mars wrote: But I still have a question - would not the SpO2 graph indicate drops when apnea's were occurring, even if those apnea's did not cause desaturation, or is that too fine a distinction to make.
I don't know Mars. There is such a fine line there. People can have a slight drop in O2 at night just because...it may vary from whatever. Other health issues? Central event that sometimes happen as people are transitioning to sleep?
We just can't tell enough from the oximetry report alone unless we can use it in conjunction with maybe xpap report and really nit pick on times that something odd occurs and see if we can line up the time lines on both reports. Even this way doesn't tell the whole story.

Should someone happen to use Oximeter as a screening tool and see only minute variations or drops in O2 we just don't know if they are for sure caused by an event or if it was simply a normal variation. Bad dream or whatever. I think this would be a good time to rely on the doctors to establish if the drop was significant enough to cause alarm.

Back when I first started cpap I was getting good numbers compared to before cpap. I was still having some monster headaches and still seeing "clusters" of events 3 or 4 times a night but the overall night was great so the AHI was ok.
I wondered if those clusters and the headaches meant that I was having destats enough to create the CO2O headache.
So I got the doctor to order overnight oximetery. Did it 3 nights. My reports still showed the clusters of events but the oximetry report didn't show any desats.... Everything was entirely normal. So I couldn't blame the headaches on the events. We ended up blaming my arthritic neck.

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tschultz
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Re: Best way to proceed?

Post by tschultz » Tue Mar 01, 2011 10:03 am

I thought I would grab a quick picture and show what my SaO2 levels looked like before I started treatment. With an AHI of 119 my oximiter data clearly showed major desats, I know my family doctor was VERY concerned when she saw the graphs and helped push getting my CPAP trial expedited. My oxygen levels and heart rate were on a continual roller coaster all night long, no wonder I felt so awful.

Image

I would suggest that if anyone sees something like this then there is definitely something wrong. I have been very lucky and although needing a high pressure now have very normal oxygen levels at 94-98% for the whole night and see no dips below 92%. In my case it was severe obstructive sleep apnea and treatment has resolved this, with my AHI now averaging 2.6 and has been below 4.3 for several weeks now.

I don't like to suggest that simply the oximiter data will allow a diagnosis what you have, or rule out what you don't have. But it can be a valuable tool when combined with other information such as data from the xPAP or sleep study information.

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