He has no money for a sleep study, so why not --- ?

[Physician]

Okay. He tried an S9 last night. Only complaint was frequent awakenings with a dry mouth. (No water in chamber).

Pressure set 6-12 auto set, sleep 7.1 hours, AHI = 4.1

Is this useful ?

Anyone have a link to the oximeter ?

[purple]

If the fellow is depressed, then what is the harm of treating it first. It does fly in the face that if he has Sleep Apnea, then depression might be in some way connected to that. Personally, many of us who have Sleep Apnea also have Diabetes, which can make one sleepy when we eat much in the way of carbs, and the check for Diabetes is a lot cheaper than all the things folks have mentioned.

I am not a subscriber to the theory that a machine set on auto can be used to titrate a person, or diagnose a person. What can be occurring can be far more complicated, and a sleep lab can find issues that an at home sleep study is not as likely to find. Then again, a lot of sleep labs do not find the obvious either.
However, a machine that one gets off, wherever, and set to auto can work well for some here. No doubt a machine set to auto that it has saved people who could never afford a sleep study.

I think many sleep labs actually reserve time slots for people who can not afford to pay. However I bet your friend might still have some of the parts of his previous good earning years. Really nice house, luxury cars, which would make the charity part not usable.

Keep in mind that half the people who have a sleep study, and a titration, get a machine, will not follow through with treatment, even if the DME is willing to help (and sometimes DME's are of no help). It is harder to do a self titration with a machine set to auto than the route of getting a full sleep study.

How high did the pressure get? What were the leaks like? more than minimal leaks says the data is not valid. However, the best standard would be, how did he feel? Did the patient dream, when they had not been dreaming in the recent past?

[hyperlexis]

One of my best friends (age 34) made some unwise investments and has very little money. For the past year he often yawns, feels intensely sleepy, and can go to sleep within five seconds if he lies down. He'll then sleep for 30 minutes to four hours. He denies snoring.

It seems his problem is depression and a lack of exercise.

He asked if there's an inexpensive way to diagnose or exclude sleep apnea.

Disregarding that these devices are prescription only (for a full unit, not components), what would be wrong about his trying an auto set CPAP machine, such as the S9 ? If his AHI = 0, would not this exclude sleep apnea ?

Um, if he's broke why doesn't he sign up for an obamacare plan or Medicaid? They will cover a test.

There is no easy or free way to do this. Without a diagnostic test you wont truly be able to determine if it's 'sleep disordered breathing' which could be obstructive apnea or a host of other problems. And then without a follow-up 'titration' study you wont truly be able to ascertain any settings needed on x-machine. Skip one of the testing steps and its making educated guesses as a layman, at best. Even with an 'auto' machine. There are lower cost home tests available on the internet but they don't work as well as a standard, multi-lead lab test, and they don't titrate pressures as well. And, they do cost a few hundred dollars anyway.

There are also charitable organizations that can help with providing machines for apnea patients.

But, ideally, he should get insurance. That will help resolve this.

[Pesser]

Most people that I am in touch don’t have a sleep study or test (I'm in Canada where the waiting list is very long and sleep studies are free). The doctor prescribes a “CPAP Trial”. The machine is set a strait CPAP (not auto); at the lowest minimum pressure that can be tolerated by the person. The results are read after three days or so. The insurance companies accept this and they go by the AHI; and that’s it.

[49er]

Um, if he's broke why doesn't he sign up for an obamacare plan or Medicaid? They will cover a test.

Deadline to sign up was March 31 of this year. Enrollment won't reopen until 11/15/14.

http://obamacarefacts.com/missed-deadline-obamacare.php

There are exceptions to the rule and if you don't qualify under those, there are options outside of Obama Care. But how much they would cost is another issue.

49er

[Luthie2006]

I work at a hospital and have fairly good insurance. However, I went to a sleep hospital lab, and had a very sweet tech who was very reassuring. I just could not sleep for the life of me knowing I was being watched on video surveillance. I was afraid I would have gas and hear it on the microphone taped on my neck and I could not sleep with the belt around under my chest. My sleep was for 90 minutes maximum, and this stupid sleep doctor (neurologist) actually said based on the 90 minutes sleep out of 8 hours that I actually did NOT have sleep apnea or snoring seen. She dismissed me for 1 more year and said I did not have sleep apnea but I had all the symptoms. I went to a new hospital (not the one I work at unfortunately) but still in our network, and I went to a new doctor. Right away, he suggested me to have a home-sleep study because of my history of the prior in-hospital test. My insurance fortunately did cover this with a ton of deductibles, but at least it went towards the deductibles. It does show less than an in-hospital test, but it definitely showed apnea and heavy snoring.
The only problem we are having now, me as a newbie (I waited a year to get treated) is that I had no CPAP titration at home. So they have no idea what numbers to get my air pressure to. I know it is a maybe of hit and miss with pressure numbers, but we are working on it, and I am working very closely with the other hospital's sleep clinician. I keep getting throw back, "well we have no CPAP titration on you." But at any rate, please look into maybe having your friend rent a home sleep study test and send out the results to a doctor. I know they have some online. I got a very good hospital version which the name escapes me but they are out there. An in-home sleep study test is better than nothing and very hepful.

[hyperlexis]

Um, if he's broke why doesn't he sign up for an obamacare plan or Medicaid? They will cover a test.

Deadline to sign up was March 31 of this year. Enrollment won't reopen until 11/15/14.

http://obamacarefacts.com/missed-deadline-obamacare.php

There are exceptions to the rule and if you don't qualify under those, there are options outside of Obama Care. But how much they would cost is another issue.

49er

You can still get in if there are certain 'qualifying events' in your life. Divorce, drop in income, unemployment, off parents' plan, childbirth, etc. You can, actually, still buy any of the plans on the open market directly from the insurance carriers, but you wont qualify for the subsidies available from buying on the exchange. If the guy lost income or became even worse off financially as time went on, I bet it would count as a 'qualifying event' and he could get back onto the exchange to either get a highly-subsidized plan, or even onto Medicaid, even now that regular open enrollment has ended for the year. He should at least try. Good luck to him.

[Physician]

Thanks everybody. He does NOT qualify for Obamacare as his monthly income is under $1,200. He doesn't qualify for Med-i-cal because he is from China and not a "resident" by their definition.

Leak was 4.8 L/minute.

It was ranged at 9 - 15 and his pressure automatically was 10.4.

Sure seems that SA is present. Would a normal person generate 10.4 ?

[Pugsy]

Sure seems that SA is present. Would a normal person generate 10.4 ?

Well, something drove the pressure up and the S9 doesn't normally increase the pressure unless it thinks it needs to.
If it had set on the minimum of 6 all night with no increases at all then most likely might be a different story.

I know in an ideal world we all get a full in lab sleep study to cover all the bases but it's not an ideal world for people who fall through the cracks. I know first hand how the system doesn't always work like it is supposed to. I have a family member who can't afford any Obamacare premiums even with a subsidy (which he can't get anyway) and Medicaid has denied coverage. Contrary to popular belief...it doesn't cover all the rest of the people who have zero money.

People can successfully self diagnose and self treat when they are dealing with plain jane vanilla OSA with no complicating factors and that sure beats no treatment. Is it "ideal"? Of course not but it isn't an ideal world out there.

A few more nights is really needed to confirm though.

The pulse oximeter thing....not everyone desats significantly with their sleep apnea. So if it didn't show much in the way of desats that doesn't 100% mean no sleep apnea. It's a good screening tool for people with significant desats but has its limitations when desats aren't significant. I have a friend whose O2 levels never dropped below 94% from baseline of 97% but her AHI was over 60 per sleep lab sleep study.

[Physician]

Can one draw any conclusion from this data ?



CPAP set 9-15, EPR = 3

Leak = 12-14

Pressure: Median 7.8, 95th%ile 10.4

Apnea index = 3.4, obstructive = 0.7, central = 2.6

7 hours sleep

======================================================

He might have a Sleep Clinic visit in the next two weeks.

[cflame1]

Really needs a test instead of a guess when you see that most of the ahi are centrals

[Physician]

Really needs a test instead of a guess when you see that most of the ahi are centrals

Using this same machine and mask, I have never had any centrals and my AHI average over three years is 0.1 . This certainly implies something. If and when he gets a formal test, even a home study, will post the results in this thread.

[palerider]

Anyone have a link to the oximeter ?

amazon, cms50d plus

[Physician]

Anyone have a link to the oximeter ?

amazon, cms50d plus

Thank you.

[archangle]

I work at a hospital and have fairly good insurance. However, I went to a sleep hospital lab, and had a very sweet tech who was very reassuring. I just could not sleep for the life of me knowing I was being watched on video surveillance.

Any doctor who sends a patient for a sleep test without an optional sleep aid in case the patient can't get to sleep in the lab deserves a good horse whippin.