Sleep apnea... without being tired (and questions)

Hi everybody,

I was diagnosed with sleep apnea and the study showed that I had 59 AHI. The sleep lab that performed the in lab study might have been shady.
Sleep apnea symptoms that I have:

• I've been caught gasping for air when I sleep a year ago (and I remember doing it the night of the study)
  ADD thats appears to be getting worse
  Slightly high blood pressure
  A recent anxiety attack

Sleep apnea symptoms/traits that I don't have:

• Not tired (even after the study)
  I don't snore
  I'm not severely obese (250 pounds at 6'4'')
  32 years old

My primary physician thinks that the lab that performed the test might have have the primary goal of just getting money (he even mentioned maybe insurance fraud). They required me to go see a specific sleep doctor in order to get a tritiation test performed. In a letter handed to me after the test, in all bold said -- "You MUST see Dr. [sleep] before you do anything else – Dr. [sleep] is board certified in Sleep Medicine which is the only credential that can order a CPAP titration study and the only credential that can order the CPAP machine be dispensed to you."

Following up with an ENT, he suggested that I do a take home. I asked the lab about that and the founder responded with, IMO, an unprofessional response (copied pasted into here):

We do offer potable studies; however, they are a dramatically more blunt instrument, especially for the demographic of [healthy city], younger, healthier, less obese than the general population for which these machines wok best.


ALSO

you have had a PSG which does everything the portable kits do PLUS the in-lab test like you had ALSO records EEG (for sleep staging and arousal detection), muscle tone (both for REM detection and Periodic Limb Movement and Restless Leg Syndrome)


The PSG remains the gold standard for diagnosing OSA and the CPAP titration is the gold standard for OSA treatment.


A home study would provide less information than the tests you have undergone

...

I am uncertain why your ENT suggested such a test when you already have the data, from a better testing instrument than your otolaryngologist suggested.

...

Again, I am puzzled by your ENT's recommendation - so maybe you might want to call me and help clarify this (or any other part of the process) - my Cell is listed below my signature.

My ENT's thoughts were that I would be more relaxed during a take home, and that the 59 AHI was suspicious since I'm not tired. He also saw no serious indications of OSA besides the report.

CPAP results:

Procedure:
The study was attended by a polysomnographic technologist and reviewed by a Diplomate of the
AASM sleep medicine specialist.
The follow biologic parameters were monitored during the recording: EEG, left and right
electrooculogram, submental and anterior, tibialis electromyogram, nasal/oral airflow, oxygen
saturation(SpO2), and respiratory effort.
Results:
Respiratory Parameters showed an overall apnea/hypopnea index was 59.1. REM apnea/hypopnea
index was 30. Supine respiratory disturbance index was 85.2. Baseline SpO2 was 91 with the lowest
recorded oxygen hemoglobin saturation at 85%. Average heart rate was 52.8 bpm. An EKG tracing
showed normal sinus rhythm. Sleep Efficiency was 68.5%. Sleep latency was 28.8 minutes. REM
latency was 254 minutes. Total sleep time was 291.5 minutes. Total recording time was 428 minutes.
Sleep architecture showed Stage N1, N2, N3 and REM sleep. The Arousal Index was 20.8 per hour of
sleep. PLM index was 0.
Interpretation:
Findings were consistent with Severe Obstructive Sleep Apnea (327.23)
Sleep architecture revealed short sleep latency, normal REM latency, all 4 stages of sleep, and sleep
fragmentation.

My questions are:
1. Is it possible that sleep labs could churn out bad results?
2. Why am I not tired with a 59 AHI?
3. When they say ADD like symptoms are caused by Sleep Apnea, would that be equivalent to one pulling an all nighter and trying to focus the next day?
4. Is it possible to have OSA and not snore or have other classic symptoms?
5. I took Clonazepam the night of both sleep studies, which is a benzo, with the nurses approval. I hear this makes OSA worse. How much worse could it make it?
6. How long before I start to notice an impact mentally? I'm really hoping I can get the ADD in check.

I have two options:
1. I can get a take home test tonight (Friday) and get results in two weeks ($120)
2. I can get a auto pap next week, Friday, and use something like sleepyhead or MyAir or whatever to determine how many events I have. (rental $42/ month, 7 months then I can purchase it)

Thanks for taking your time to read this. I'm not quite sure what to do. I'm leaning towards just getting the CPAP next week and hoping that I didn't get scammed out. At the same time, my ADD's getting worse, and the meds aren't working, so I hope that this could be the answer to that.

Sleep study with no cpap Sleep study with cpap Attached are my results from the study and my ENT appointment.

Are you sure you don't have AdHD? I was never sleepy either (and was definitely older than you) when my ex told me I quit breathing at night. I believe the HD may be at fault for not being sleepy (ever in my life in the early a.m. anyhow) and you should follow up with whatever is suggested. However you need to be very careful with meds for ADD etc as they can be counterproductive to Cpap. Your BP will lessen on Cpap as should your anxiety. Very many people with apnea don't snore (and probably even fewer would if they did not back-sleep). Do use Sleepyhead,, do not depend on Myair. Do get the auto and make sure it is data capable. Weight is no longer thought to cause apnea, but in fact apnea is thought to cause weight gain. Come back to this thread please with any follow up Q's or comments.
Clonazepam was not a good choice for your test... Ambien would have been much better.

Based on what I have read, and heard from my sleep doctor (a neurologist), in-lab studies are far more precise than a take home test.

The fact that you are gasping for air in your sleep would convince me that you do have sleep apnea that needs to be treated.

Julie makes some good points too. You don't have to be obese to have sleep apnea. If I understand ADD correctly, it can really mess with your ability to focus and remember, and I can say from experience that sleep apnea can do that to you too.

I have an AHI of 77 with a 2 night home sleep test. I didn't feel tired either, but am overweight/obese, have snored since I was a child/teen and have high blood pressure.

Dave

First, try to find others who have been tested in the same lab. The majority of these tested do test positive, but I believe that is because by the time one is approved for testing, those who don't have a sleep disorder aren't approved (along with many who do). Since Sleep Apnea is the most common sleep disorder (by a large margin), it will account for most of the diagnoses.

Than being said, maybe you can find others who were tested there, and see if they think they were diagnosed correctly. Also, check with the better business bureau, you state's Attoney General, the AMA, the ASAA, and the authority in your state that licenses medical facilities. If you're not in the US, check with your country's equivalents.

If your Dr distrusts the lab, why are you asking the lab? At home tests are at least reasonably reliable, and relatively inexpensive. Or, if your Dr decides to trust the lab, he can write a medical need letter to get an xPAP for you, the lab saying you have to consult with any particular Dr is BS. LAbs job is to administer the test and report the results to the ordering physician, not to specify who that physician must be.

TASmart wrote: ↑

Fri May 25, 2018 6:34 pm

If your Dr distrusts the lab, why are you asking the lab? At home tests are at least reasonably reliable, and relatively inexpensive. Or, if your Dr decides to trust the lab, he can write a medical need letter to get an xPAP for you, the lab saying you have to consult with any particular Dr is BS. LAbs job is to administer the test and report the results to the ordering physician, not to specify who that physician must be.

I asked the lab before I got the feedback from my primary physician that he thought it seemed sketch.