How Important is the Sleep Study? Self-treat user looking for opinions

I ignored obvious symptoms of sleep apnea for a few years after significant weight gain. In the last few months, I was starting to develop significant anxiety as bedtime approached, and I would wake up frequently feeling like I just went through some kind of horrible stress test. I'm 27 and was waking up to urinate 3-4 times in the early morning, and would have a sore throat, headache, and just generally distressed feeling. I had a an impromptu habit of doing breathing exercises in the mirror every morning as I felt oxygen starved when waking up. Others have often commented on how extreme the noises I made while sleeping were.

I tried to schedule a sleep study, and just the consultation with the doctor (not the study itself) was 3 weeks out. It's still scheduled at the moment, but out of desperation I went out and bought a Phillips Respironics Dreamstation Auto CPAP new in box (Model: DSX500T11, which has the full data and the heated tube) and a Amara View full face mask for a total of $350 out of pocket after a bit of research on this site. I set the mode to Auto and changed the pressure range to 6.5 - 20. I've been using it for three nights and the improvements have been dramatic to the point that coworkers noticed a change in my energy and mood after the first night. I feel a lot better even on 5 hours with this machine than I have in years.

My AHI with the machine is right around 5 the last three nights. The pressure ramps up as high as 15 for short periods during the night.

With the way these automated machines work, does this pretty much give a definitive confirmation of sleep apnea? If yes, what incremental value from a health perspective will be added by actually completing the sleep study at this point? The cost to me even with insurance is likely to be around $1000+ to carry it out. Furthermore, if I did decide to do the study, should I even tell them that I have self-treated in this manner? Might they do the study with the CPAP involved?

I'm curious to see if anyone else here has gone the self-treatment route and even moreso what additional benefits members who have had the study done got above simply being prescribed the CPAP equipment. Thank you in advance for the resources that this forum has provided.

Welcome to the forum.

Please post one of your typical night's reports using SleepyHead software so we can see the details and the event category breakdown.

viewtopic/t158560/How-to-post-images-for-review.html

and if you don't know about SleepyHead
https://sleep.tnet.com/equipment

Yes, we have several forum members who have gone the DIY route and never even seen a sleep doctor much less have any sort of sleep study.
It can be done with some hard work and education on your part and as long as there are no complicating factors popping up.

And yes...if the machine went to 15 for part of the night then it had a really good reason to do so and that's fairly definitive for OSA. It won't increase the pressure without obstructive apnea events of some sort happening and that amount of increase is significant.

Pugsy wrote: ↑

Sun Jul 22, 2018 8:43 pm

Welcome to the forum.

Please post one of your typical night's reports using SleepyHead software so we can see the details and the event category breakdown.

viewtopic/t158560/How-to-post-images-for-review.html

and if you don't know about SleepyHead
https://sleep.tnet.com/equipment

Yes, we have several forum members who have gone the DIY route and never even seen a sleep doctor much less have any sort of sleep study.
It can be done with some hard work and education on your part and as long as there are no complicating factors popping up.

And yes...if the machine went to 15 for part of the night then it had a really good reason to do so and that's fairly definitive for OSA. It won't increase the pressure without obstructive apnea events of some sort happening and that amount of increase is significant.

Thank you for the prompt and helpful response. I believe I followed your Sleepyhead instructions appropriately, but please let me know if there is anything further I should do to make it easier to read. Also I found this "Intentional Leak Rate" chart for quick reference in case that is helpful (I'm using Amara View and have set the mask type to 1 as specified by Respironics if that matters): https://www.continuedcare.com/wp-conten ... -ports.pdf

Some people want to know "what they had"... and for that, the sleep study provides some .... information, (I won't say "usefulness"...)

Some people say sleep studies are essential and important *glances at our new sleep tech member*.

I've never had a sleep study, and I'm doing fine. I sleep so much better with the machine, it's like (near)death and life... I *know* I had bad apnea? how bad? hopefully, I'll never know, because that would mean sleeping without the machine, and I haven't missed a single night since I got it, nine years ago.

You may not end up with a prescription to make buying masks easier, doing it the DIY way, but I've gotten all my masks off of ebay/amazon anyway (and all the other supplies I've needed).

That cluster you had around 7:30 to 8:10 AM....were you awake or asleep?
I assume you were awake immediately before that time since there's a break in therapy.

I think things will clean up a bit more with a little more minimum pressure. Maybe around 8 or 9 cm...or in between.

That's the only thing I would do...increase that minimum just a little and if 8 is too uncomfortable..split the difference and work up slowly.
With the increases in pressure shown...pretty safe bet to say you have OSA. Now how bad...no way to know and how bad you want to know goes along with how bad you want to spend the money for a sleep study.

It kind of depends on whether you had a good sleep test or a bad one. A good sleep test will identify which parameters are causing you to sleep poorly. It isn't always as simple as classic obstructive sleep apnea; there are other conditions that might be present, and a sleep study conducted and reviewed by a competent specialist can set you on the right track from the beginning. And a sleep study can save you a lot of time and lost sleep by dialing in your pressure in a single night.

In my case, my titration study produced good data, which produced a recommended pressure of 10.5. When I got my S9 Autoset, I set it up with minimum and maximum pressures bracketing that value. And after a few months, I reviewed the accumulated data, and it showed the machine averaged around 10.4. So the machine arrived at about the same pressure as the sleep study revealed was necessary to keep me breathing freely.

I went back to the sleep doc several times and brought with me the ResScan data for a week's worth of nights each time. The doc went over the data with me and said everything was fine and there was nothing he would recommend changing. I haven't seen him in several years, now. But if anything changes, I'd not hesitate to go back.

Pugsy wrote: ↑

Sun Jul 22, 2018 9:32 pm

That cluster you had around 7:30 to 8:10 AM....were you awake or asleep?
I assume you were awake immediately before that time since there's a break in therapy.

I think things will clean up a bit more with a little more minimum pressure. Maybe around 8 or 9 cm...or in between.

That's the only thing I would do...increase that minimum just a little and if 8 is too uncomfortable..split the difference and work up slowly.
With the increases in pressure shown...pretty safe bet to say you have OSA. Now how bad...no way to know and how bad you want to know goes along with how bad you want to spend the money for a sleep study.

I don't recall, but I was probably awake. I have been waking a lot while trying to get used to the pressure ramping up. Is the Sleepy head data meaningful at all when awake, or would events while awake be false positives?

My leaks issues with the Amaraview got substantially worse each night. I think i need to try the medium cushion because my nose keeps entering the large one when it rides up at high pressure and it wakes me up.

I purchased the Dreamwear nasal pillows and hope to get a longer session of data with the higher minimum pressure to see if I can get below 5 AHI. Last night was over 8 AHI even with the minimum bumped up to 8, but perhaps that was due to the leaks when I needed the pressure the most. Will post more data soon. Thanks

palerider wrote: ↑

Sun Jul 22, 2018 9:12 pm

Some people want to know "what they had"... and for that, the sleep study provides some .... information, (I won't say "usefulness"...)

Some people say sleep studies are essential and important *glances at our new sleep tech member*.

I've never had a sleep study, and I'm doing fine. I sleep so much better with the machine, it's like (near)death and life... I *know* I had bad apnea? how bad? hopefully, I'll never know, because that would mean sleeping without the machine, and I haven't missed a single night since I got it, nine years ago.

You may not end up with a prescription to make buying masks easier, doing it the DIY way, but I've gotten all my masks off of ebay/amazon anyway (and all the other supplies I've needed).

This is pretty much exactly what I wanted to hear lol. I am comfortable estimating just how bad it was based on symptoms, and am leaning towards doing this without the study. Thanks for the Amazon recommendation, I didn't even think to look there and thought I was pretty much limited to Craigslist. It looks like you can build mostly any mask from the individual replacement pieces.

Awake events don't count.
Consider them false positives if it helps you wrap your head around them.
Our awake breathing is very irregular compared to asleep breathing and these machine only measure air flow and they can and will mistake awake irregular breathing for some sort of apnea event. They have to be mentally removed from the evaluation process.
For the event to be a real sleep apnea event we have to be asleep for it to matter.

Slightly better. Let me know if you think I should keep creeping up on the minimum pressure until the cluster events stop, or if I should leave it for a few more nights. This is the lowest AHI I've gotten so far. Every single Obstructive event was below 13cm pressure except one single non-cluster event.

You've got other flags that also mean the airway is trying to collapse and the current pressure just can't prevent it well enough and they aren't part of the AHI.
FLs and RERAs and snores....and while I will let a little of those slide by if the AHI is really low...with your not as low as I would like AHI along with the number of these not included in AHI events (which I often call clutter)...I wouldn't wait long before trying a little more minimum pressure.

I would try 0.5 tonight if it were me...wouldn't wait.

Oh...when sharing reports please include how you think you slept and feel. It's actually more important than the numbers.
I see one break in therapy where you turned the machine off and back on again...so I know at least one wake up...
did you have others??? Did you have trouble falling asleep and spend much time awake with mask on?

Pugsy wrote: ↑

Tue Jul 24, 2018 6:38 am

You've got other flags that also mean the airway is trying to collapse and the current pressure just can't prevent it well enough and they aren't part of the AHI.
FLs and RERAs and snores....and while I will let a little of those slide by if the AHI is really low...with your not as low as I would like AHI along with the number of these not included in AHI events (which I often call clutter)...I wouldn't wait long before trying a little more minimum pressure.

I would try 0.5 tonight if it were me...wouldn't wait.

Oh...when sharing reports please include how you think you slept and feel. It's actually more important than the numbers.
I see one break in therapy where you turned the machine off and back on again...so I know at least one wake up...
did you have others??? Did you have trouble falling asleep and spend much time awake with mask on?

I woke up drowsy and with an unusual desire to sleep for a few more hours, but otherwise feeling good. I attribute the morning drowsiness to it being my first night having taken 10mg Melatonin supplement before sleeping. Once fully awake, I have felt very good today, probably the best results yet.

The pressure ramping up to 19 definitely woke me up. I turned the machine off and immediately back on to reset it back to a reasonable level, since I was no longer asleep. If my numbers were better or required pressures trending lower, I would strongly contemplate lowering the maximum, as pressures that high are just going to wake me up. Maybe I will get more used to that level over time, but anything over 16 is just a bit ridiculous to wake up to right now.

The other wake up (the one large leak event), I took the mask off shortly to drink water. Probably a bit of unintended mouth breathing, as this was the first night with the Dreamwear Gel Pillows. I don't think I'll be going back to the Amaraview however unless something changes, as the gel pillows were way more comfortable and less leaky. It's funny that everyone says that you can't use high pressure on pillows, because the subjective feeling of the pressure is way less extreme with the pillows than with the full face mask, and leaks way less.

I will increase the pressure again tonight by at least .5 as suggested. I don't have any issues tolerating the 10cm current minimum setting. I even thought I had taken the mask off momentarily upon waking up because it was so subtle. Of course, when the mask is taken off first thing in the morning I feel like I'm barely breathing any air at all.

You know just because the machine might want to go higher doesn't mean that we just absolutely have to let it go higher if the going higher creates more problems in terms of sleep quality than whatever the machine was trying to kill.

Limit the max for now...see just how often it wants to go higher and watch for clustering of events happening when it can't go higher. Re-evaluate the higher pressure max needs later.

If anything over 16 creates a problem in terms of sleep quality or wakes you up...limit the max to 15 or 16 for now and let's evaluate in a week or two just how often it wanted to go higher and did limiting it actually let too many events slip past the defenses. Your AHI might not even change and you might sleep better. Worth trying.

Plus...often when the minimum is more optimally set the machine will stop wanting to go so high so often.

Like someone said on here previously it all depends on how good of a sleep study you get. I have had two of them done and both times I did horribly. Both times I layed there not being able to sleep and when I did I barely even hit REM. They basically told me that I have sleep apnea but without a better study then they couldn't fully dial it in. They actually wanted me to do a third. lol.

But basically I think with the auto cpaps of today and all the data / sleepyhead info one can see without having a sleep study if you are suffering from apnea or not and go from there. Now back about 20 years ago when cpap machines were basically bricks then I would say a sleep study was definitely needed but now a days I think you can go the DIY route if needed.

Pugsy wrote: ↑

Tue Jul 24, 2018 2:19 pm

You know just because the machine might want to go higher doesn't mean that we just absolutely have to let it go higher if the going higher creates more problems in terms of sleep quality than whatever the machine was trying to kill.

Limit the max for now...see just how often it wants to go higher and watch for clustering of events happening when it can't go higher. Re-evaluate the higher pressure max needs later.

If anything over 16 creates a problem in terms of sleep quality or wakes you up...limit the max to 15 or 16 for now and let's evaluate in a week or two just how often it wanted to go higher and did limiting it actually let too many events slip past the defenses. Your AHI might not even change and you might sleep better. Worth trying.

Plus...often when the minimum is more optimally set the machine will stop wanting to go so high so often.

I'll give this a try as it seems to be practical advice, and remain open to increasing the max again if it seems like I am limiting the machine in a detrimental way and causing obstructions. I'll also increase the minimum to compensate as recommended.

I have a quick side question regarding "essential oils" used in aromatherapy. Prior to beginning with the APAP, I used one of those diffusers every night with some peppermint/lavender drops. I would never put the drops directly in the APAP or anything like that, but do you think it would be harmless to run the diffuser on the night stand next to the APAP?

I put the essential oil on a little cotton ball on a little tray and stick it right next to the air intake at the back of the machine.

I see no problem with using a diffuser on the side table next to the machine. I have one but my table is so small and the diffuser is fragile and I have the cats from hell and I am afraid they will end up knocking the diffuser off the table and breaking it. That's why I use the cotton ball trick. They can't hurt a cotton ball or the tiny tray it is on.