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

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 ?

Physician wrote:If his AHI = 0, would not this exclude sleep apnea ?

No. Not necessarily. Even if the minimum pressure of 4 cm is used all night with no increases there is still therapy value at 4 cm and all that could be determined with that AHI 0.0 with any certainty would be no events slipped past the defenses.
We don't know if they didn't occur at all or if that 4 cm pressure was sufficient to keep them away.
Plus a lot of people simply aren't comfortable with 4 cm....they will want to use more pressure so they don't feel like they are suffocating and that gives more therapy value.

What you are suggesting is still a viable option as long as you understand the limitations.
What I did for my sister and her husband was a nice 6 to 10 range...and just see what the machine wanted to do.
Prove the need first and then worry about sufficient pressure if needed.
Her pressure line never moved off 6....hubby's went to 10 and stayed there. He for sure has OSA...she I am not so sure about because I understand that 6 (she couldn't do less) has a lot of therapy value.

That would tell him he's not having apneae WITH CPAP. He still won't know what happens without.

It certainly wouldn't exclude sleep disorders like Upper Airway Resistance Syndrome, alpha intrusions, restless leg syndrome, sleep architecture issues, etc.--all of which can be just as detrimental to sleep and not register in a high AHI score even in their most severe forms.

If he's got insurance to go to a GP, he's got insurance that will cover a sleep study if it's a referral from the GP.

Ideally, someone would need to observe him sleeping.
Preferably with video on. Then show the scary parts to a doctor, PA ,or nurse.

Start with screening:

http://umm.edu/programs/sleep/health/qu ... leep-apnea

http://www.sleepapnea.org/treat/test-yourself.html

And then video tape a night (this can be very effective). There are many very low light or cameras or cameras with an IR light source that can work well for this. Be sure to get the best audio that you can. Many of them are computer cameras (web cams - skype cams...).

Physician wrote: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 ?

Reply,

Yes, if his 95% percentile AHIs would be below 5 for the full 8 hours or so of sleep then for sure the Auto CPAP helped. But most sleep docs in the U.S. don't prescribe Auto CPAPs b/c they don't know how to set it and also since the Am. Academy for Sleep Medicine does not cover it in their guided instructions the docs don't want to assume the responsibility. Their insurance policies say not to touch it. Over the rest of the world Auto CPAPs are used extensively to diagnose OSA.

For about $250, he can get a home sleep study.
If I had a friend with an apparently serious sleep disorder and literally no money, I'd spring for the $250 and at least get that much done.

But that's just me.

JDS74 wrote:For about $250, he can get a home sleep study.
If I had a friend with an apparently serious sleep disorder and literally no money, I'd spring for the $250 and at least get that much done.

But that's just me.

Exactly what is a home study? I ask this because I am interested!!!!

Pugsy wrote:

Physician wrote:If his AHI = 0, would not this exclude sleep apnea ?

No. Not necessarily. Even if the minimum pressure of 4 cm is used all night with no increases there is still therapy value at 4 cm and all that could be determined with that AHI 0.0 with any certainty would be no events slipped past the defenses.
We don't know if they didn't occur at all or if that 4 cm pressure was sufficient to keep them away.
Plus a lot of people simply aren't comfortable with 4 cm....they will want to use more pressure so they don't feel like they are suffocating and that gives more therapy value.

What you are suggesting is still a viable option as long as you understand the limitations.
What I did for my sister and her husband was a nice 6 to 10 range...and just see what the machine wanted to do.
Prove the need first and then worry about sufficient pressure if needed.
Her pressure line never moved off 6....hubby's went to 10 and stayed there. He for sure has OSA...she I am not so sure about because I understand that 6 (she couldn't do less) has a lot of therapy value.

One of my first posts was to get someone to confirm what you have just asserted. I responded so well to the machine that my score never went much above 4. The tech told me that since there is no insurance company involved I should go by the increase in pressure. My pressure went from 4 to 8; and stayed at eight. Every night for two weeks my pressure would start at 4 and then move to 8 for the rest of the night. I always felt better with treatment. So that’s really all I ever had to go by. I purchased my machine on that basis because I could not get a sleep study. The waiting list here is very long! I have always believed that in a sleep lab I would have scored above 10. Do you agree with my reasoning? If you agree with my logic then he could at least know whether he feels better, what the AHI at treatment is, and what the machine needs at pressure to avoid events!

Hi Pugsy:

I just re-read your post. That is what you are saying!!! Thanks for your post!

Pesser wrote:Exactly what is a home study? I ask this because I am interested!!!!

It is a smaller version of a sleep lab study.
You go home with a set of sensors that measure your blood oxygen level, breathing rate, respiratory effort, and some other things.
These are all recorded and when the equipment is returned, the data is evaluated.
Not as good as a sleep center study but good enough to identify a range of problems.
Some managed care/insurance groups do it this way and then finish with a follow-on using an auto-titrating CPAP machine to determine pressure levels needed, etc.

There are a few on-line DME companies who provide this service. I presume a doctor's Rx is needed to get this done but the costs are very much lower than the sleep center approach.

JDS74 wrote:

Pesser wrote:Exactly what is a home study? I ask this because I am interested!!!!

It is a smaller version of a sleep lab study.
You go home with a set of sensors that measure your blood oxygen level, breathing rate, respiratory effort, and some other things.
These are all recorded and when the equipment is returned, the data is evaluated.
Not as good as a sleep center study but good enough to identify a range of problems.
Some managed care/insurance groups do it this way and then finish with a follow-on using an auto-titrating CPAP machine to determine pressure levels needed, etc.

There are a few on-line DME companies who provide this service. I presume a doctor's Rx is needed to get this done but the costs are very much lower than the sleep center approach.

Hey....Thank Man!!

Physician wrote: 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 ?

I'd say the *cheapest* way to find out is to buy a cms50d+ oxymeter, and wear it a few nights.

download the data, and check it, if you don't see any o2 desats, and you don't see any big spikes in heart rate that correspond, then it's unlikely that they're having significant breathing problems.

if you see some, then pick up an autoset model somewhere (I've had luck with craigslist) and see what it does, you can often get decent used masks there too.

Pesser wrote:

JDS74 wrote:For about $250, he can get a home sleep study.
If I had a friend with an apparently serious sleep disorder and literally no money, I'd spring for the $250 and at least get that much done.

But that's just me.

Exactly what is a home study? I ask this because I am interested!!!!

This is the home unit which firmly diagnosed my OSA: http://www.watermarkmedical.com/physician-videos.php

It was $300 and easy to use. I do not like sleeping anywhere except home, and did not want strangers or a video cam watching me. The insurance company covered this 100%. I didn't care about my EEG or Restless Legs Syndrome, et. al.