Latest on Husband

[Janknitz]

So hubby got the results of his most recent home sleep test (Itamar Watch Pat). His AHI was 4, BUT his O2 level went down to 85% for a good part of the night. The doctor told him that "CPAP might help" but left the option up to my husband, particularly since we no longer have coverage for CPAP.

The night of the sleep study was miserable. All we are talking about is a thing on the wrist and two fingers, not a big sleep study in lab. He tossed and turned and kvetched from just that little bit of intrusion, then finally got up and took Trazadone to sleep, even when the instructions said not to. And has made several complaints since about how "miserable" he was that night (me too, because his mini-temper tantrums had him pulling the covers off me and waking me several times that night).

Geez, that's just from a little thing on his hand!!!!

He's really not willing to try CPAP. I have my old PRS1 and a bunch of masks we could try with him (he has a moustache, so this is going to be challenging), but I'm not really looking forward to him trying to sleep with CPAP with his poor tolerance of the Watch Pat. Boy is he going to toss and turn and kvetch! Meaning my already ragged sleep will be worse.

But 85% O2???? Why??? That worries me.

I need to ask him to get the full printout of his sleep study. My guess is that he may desat in REM, and that's probably where any apneas cluster. So it might average out to 4 AHI but all be during that deep sleep. Otherwise I can't see why his O2 would go down like that.

[sewsleepy]

Wow, it's amazing how resistant some people are to the whole idea of cpap. My son sleeps terrible but won't go in for a sleep study. I love my cpap, it changed my whole life!

I will say my night in the sleep lab was the most uncomfortable night of my entire life. And no one warned me it was going to be freezing in there, either.

[Okie bipap]

I could never convince my wife to get tested for SA. When we had annual physical, I just happened to mention to the doctor that she was snoring a lot at night, and she would quit breathing when she slept. Our doctor scheduled her for a sleep study. My wife was very upset with me at first, but now that she has been using the machine for about nine months, she is glad she had the sleep study done. She has a lot more energy now, and generally feels better.

[Goofproof]

Despite the Word of the unguided banned who Shall not be named, Most Non-Lab Home sleep tests don't hold water. I'd sooner trust a cracked Magic Eight Ball for a sleep apnea test or a hat with paper slips in it. Sorry to hear his problems, sounds like help will be a uphill problem, I wish you good luck, for both of you. Jim

[prodigyplace]

Despite the Work of the banned Shall not be named, Most Non-Lab Home sleep tests don't hold water. I'd sooner trust a cracked Magic Eight Ball for a sleep apnea test or a hat with paper slips in it. Sorry to hear his problems, sounds like help will be a uphill problem, I wish you good luck, for both of you. Jim

That sounds good, except my insurance insisted on a home study because it is cheaper for them. I had specifically asked for a Lab study but the insurance would not do that.
For some reason, the rubber oxygen sensor on my finger was very bcomsprtable, disturbing my sleep.

[Goofproof]

Despite the Work of the banned Shall not be named, Most Non-Lab Home sleep tests don't hold water. I'd sooner trust a cracked Magic Eight Ball for a sleep apnea test or a hat with paper slips in it. Sorry to hear his problems, sounds like help will be a uphill problem, I wish you good luck, for both of you. Jim

That sounds good, except my insurance insisted on a home study because it is cheaper for them. I had specifically asked for a Lab study but the insurance would not do that.
For some reason, the rubber oxygen sensor on my finger was very bcomsprtable, disturbing my sleep.

And why would they be concerned in your health, their concern is profit today, and they are making it off of you. Jim

[sewsleepy]

My SIL was forced to do the at-home test, too (HMO). When it showed he had sleep apnea, they told him to sew a tennis ball into the back of his pajama top so he doesn't sleep on his back. Seriously.

[Janknitz]

Actually the Home tests are validated and have a pretty good accuracy for OSA. What they may not be as good at diagnosing is other forms of sleep apnea and sleep disorders.

Nobody—and I mean NOBODY—was more resistant to testing and treatment than I. But my sweet, usually patient husband spent two years investing in fleece fuzzy pj’s and sleeping on the couch because my snores could wake the dead, and I finally agreed to testing for him. When I saw the results were very severe I know I couldn’t live in denial any more. My O2 sats were in the low 70’s and my AHI was in the high 70’s. They show you a bar graph that represents minutes in or out of apnea. My Bar graph was nearly solid blue (apnea) from the moment I fell asleep to the moment I got up. I knew I wasn’t going to live long without diapers if I didn’t do something about it.

I had a terrible 3-4 month ordeal getting used to the mask (some of you literally helped save my life by telling me to put on my big girl panties and just do it—I’m forever grateful!).

The challenge with my husband is that he might think that low AHI is a get out of jail free card, but he brought it up himself today and even joked about how one of us is going to have to sleep in the “guest room” (finally medical school kid only visits now) if he had to learn to sleep with CPAP. We’re not sure which of us. He has emailed his doctor for more discussion.

Fingers crossed.

[jnk...]

Home tests are very good at proving someone has OSA, but home tests are totally incapable of proving someone doesn't have OSA. They give a reliable positive and a reliable question mark, but cannot provide a true negative, which is why an inconclusive home test should always earn someone a lab/center test, according to present accepted practice. The lab/center test is not done to verify the finding of the home test, since in this case the home test provided no finding. When a home test provides no finding, but there were indications of the need for the home test, there is no argument left for payers to make for denying a lab/center test. They rolled the dice on saving money with a home test. Their gamble did not pay off. It is time for them to pay up or else they do not belong in the game.

Low O2 without high AHI may, in my opinion, indicate the possibility of a need to jump straight to bilevel, depending on habitus and medical history.

[Janknitz]

Home tests are very good at proving someone has OSA, but home tests are totally incapable of proving someone doesn't have OSA. They give a reliable positive and a reliable question mark, but cannot provide a true negative, which is why an inconclusive home test should always earn someone a lab/center test, according to present accepted practice. The lab/center test is not done to verify the finding of the home test, since in this case the home test provided no finding. When a home test provides no finding, but there were indications of the need for the home test, there is no argument left for payers to make for denying a lab/center test. They rolled the dice on saving money with a home test. Their gamble did not pay off. It is time for them to pay up or else they do not belong in the game.

Low O2 without high AHI may, in my opinion, indicate the possibility of a need to jump straight to bilevel, depending on habitus and medical history.

Kaiser does things their own way and they don't do lab testing as a general rule. They really do play the numbers, but in an interesting way. They are the providers, the insurer, and the DME (Crapria is merely their supplier). So if the home test they use overdiagnosed, they used to pay for the treatment too. Seems to me they always do everything possible not to spend a penny they don't have to.

But their approach has changed. Now the cost of treatment is on the non-Medicare patient. What the doctor told my husband when he first saw him about sleep issues this time is "why do you want a test because we don't cover the CPAP and it's too expensive for you to pay out of pocket?" Interesting. Kaiser used to be about preventing the downstream illnesses to save money in the long term by spending in the short term. Now they just seem to be going through the motions. Something they have to offer.

I've always had issues with Kaiser but now it's getting really crazy My daughter and I were due for physical exams. We were offered the option of doing both of them through telephone appointments. What part of "physical exam" is unclear??? Sheesh! And this doctor was new to my daughter, so it was important to establish a relationship with her new provider. Not a voice on a telephone. Fortunately this time we were offered the option of an office visit, too. I'm guessing it won't be long before that's no longer an option.

[luvsbluberries]

But 85% O2???? Why??? That worries me.

From what you've described of his night, I would bet that the device wasn't able to stay in position and it probably isn't an accurate reading... especially since his AHI was so low.

[Lucyhere]

I've always had issues with Kaiser but now it's getting really crazy My daughter and I were due for physical exams. We were offered the option of doing both of them through telephone appointments. What part of "physical exam" is unclear??? Sheesh! And this doctor was new to my daughter, so it was important to establish a relationship with her new provider. Not a voice on a telephone. Fortunately this time we were offered the option of an office visit, too. I'm guessing it won't be long before that's no longer an option.

I think that's true on many levels, and not only with Kaiser. I've used the same PCP since 2009 and always had the assurance that if I went into the hospital that she would immediately be notified. I recently found out that is no longer the case. I think it's just the beginning of things to come.

[Janknitz]

I think that's true on many levels, and not only with Kaiser. I've used the same PCP since 2009 and always had the assurance that if I went into the hospital that she would immediately be notified. I recently found out that is no longer the case. I think it's just the beginning of things to come.

Yes, now when you are admitted to a hospital, you are no longer "attended to" by your primary care physician. You are assigned to a "hospitalist" and AFAIK you don't seem to be able to choose your hospitalist (even outside of Kaiser). The excuse is that hospital care has become so technical that primary care physicians can't keep up--kind of like you don't choose an ER doctor, but I really hate the idea of someone who knows NOTHING about me except my medical history in my chart and may not have a good relationship established with me making decisions about my care.

The only solution is to stay the hell OUT of hospitals!!!

[Lucyhere]

I think that's true on many levels, and not only with Kaiser. I've used the same PCP since 2009 and always had the assurance that if I went into the hospital that she would immediately be notified. I recently found out that is no longer the case. I think it's just the beginning of things to come.

Yes, now when you are admitted to a hospital, you are no longer "attended to" by your primary care physician. You are assigned to a "hospitalist" and AFAIK you don't seem to be able to choose your hospitalist (even outside of Kaiser). The excuse is that hospital care has become so technical that primary care physicians can't keep up--kind of like you don't choose an ER doctor, but I really hate the idea of someone who knows NOTHING about me except my medical history in my chart and may not have a good relationship established with me making decisions about my care.

The only solution is to stay the hell OUT of hospitals!!!

Understatement of 2018!

I also hate the idea of someone not knowing me except for my medical history making decisions about my care. That's where an advocate comes in. It's simply imperative! Someone needs to be around to make decisions if you are no longer able.