Can't get AHI below 38

Also forgot to say there is a deviated septum. I don't know if it matters, but it is the main reason for mouth breathing.
I'm beginning to think a sleep study is in order. What is the best way to find the best dr./ clinic?

Do you have insurance? If so, best to check with them first and to ask what your options are.

It appears that you may have some complex apnea issues so a specialized sleep doctor who can arrange for a real sleep lab study would be best for you. This could save you a lot of trial and error, if you have the option. Unfortunately, if not covered by insurance, the costs can be prohibitive.

Either way, the good folks here will do what they can to help you.

yaconsult, wouldn't it be better for my dr to get the insurance approval, or me?

Is the insurance Medicare or something else?

Ar least, in my case, it was my Dr. who told me how much my insurance would cover and how much I would pay. He was correct. Guess many Drs. these days are quite familiar with the more common insurances.

clearyt wrote:yaconsult, wouldn't it be better for my dr to get the insurance approval, or me?

Yes, the doctor has to get coverage approval for the sleep study. But I thought you were interested in checking out other sleep doctors since the current one hasn't done much for you?

Does your medical provider have a website that you can research? So much depends on your local provider and what options they have available for you. For example, this one provides phone numbers and address for the sleep lab locations in their area: http://www.pamf.org/sleep/

Is your current doctor a sleep specialist or a GP? Because you've tried the usual, simple treatment approach already, someone with a real specialization in sleep medicine is required.

The dr who ordered the at home sleep study is a pulmonologist, who also does with sleep apnea. He is the one who diagnosed the chronic bronchitis, etc. Like him very much, but it seems that the main thing they look at on the card when we visit is whether the number of hours is reached, I guess for insurance purposes. And of course the AHI average. Insurance is Medicare advantage through State Merit United Healthcare- retired educator. I'm going to spmention this to the cardiologist Thursday on a regular visit. He has suggested for years that this might be an issue, but no snoring.

Give me just a little bit of time and I am going to generate an Encore report for you to print off and take with you Thursday to the cardiologist. I will send it to your private email address as attachment.
It should be enough to get his attention and help get you started on seeing a doctor that deals with this type of stuff on a regular basis.

OK, so got the goods.

I guess we can all agree that

every single one of the obstructive apneas is central.

These are all loooonnnng cycle, too.

Did you find out about the EF?

How about the home test (see my image previously posted)? I'm also thinking the HST missed it all too.

How can we tell that all Apneas are central? Not sure how to read.

I understand your situation. I've got a great cardiologist that is the main reason I am still alive. But doctors today have become so specialized that they need to work together with other specialists. And it appears that you may have more going on than "plain old" obstructive sleep apnea.

Hell, I have two cariologists that specialize in different aspects of the heart.

You couldn't be in better hands than Pugsy and Morbius.

Morbius wrote:OK, so got the goods.

I guess we can all agree that

every single one of the obstructive apneas is central.

These are all loooonnnng cycle, too.

Did you find out about the EF?

How about the home test (see my image previously posted)? I'm also thinking the HST missed it all too.

EF = ejection fraction?

So glad you're on this.

clearyt wrote:How can we tell that all Apneas are central? Not sure how to read.

That's the thing -- I don't think you're expected to be able to determine that apneas flagged as obstructive are actually centrals. I know Morbius will explain what he's seeing.

clearyt wrote:How can we tell that all Apneas are central? Not sure how to read.

There's no flow limitation, snoring, or resuscitive burst.

kaiasgram wrote: EF = ejection fraction?

Right. If the diagnostic is also all centrals, but the EF is <45%, we might have an issue trying to get an ASV.