Overnight oximetry criteria for justifying a PSG

[colomom]

My son recently underwent a titration study, because he is pediatric I had to spend the night in the room with him. The morning after the study the sleep tech told me the mic was picking me up all night long and she recommended I convince my doctor to order a sleep study for me. I thought I could increase the chances of my doc ordering a sleep study if I presented some evidence so I downloaded Snorelab. I knew that I snore, but I was shocked when I listened to the Snorelab recordings. My snore score generally is in the 70's, most concerning is that much of my snoring is not a the typical vibratory snoring sound I expected to hear; most of my snoring sounds like I'm gasping for air. A typical night is a long period of gasping snoring, then a loud snort or gasp, followed by what sounds like an awakening (I assume I wake up because I can hear myself move around a bunch). I presented my case to my doc, and while she was concerned when she heard my snorelab recordings she said the best she could do at this point was to order overnight oximetry.

As a 115 lbs 44 year old female, I hope I don't have sleep apnea but worry that I might be to easily dismissed. I have a recording oximeter that I have used on myself and it has shown that my O2 desats fall into the mild category (13.6 desats an hour).

Which brings me to my question...
What criteria need to be met on overnight oximetry to justify a sleep study?

[Filigree3]

Can you ask your primary care physician or an ear, nose, and throat doc for an at-home sleep study? My ent ordered one for me just based on my health questionnaire and the fact that I was asking about a deviated septum. My insurance would not pay for the in-lab study, so I did the at-home version. And I did test as severe obstructive sleep apnea. I just started an APAP machine a few nights ago.

[raisedfist]

What specific oxygen saturation do you desaturate too? If it's below 88%, and not an artifact of data, odds are very high that you have some type of sleep disordered breathing that needs follow up.

[palerider]

the sleep tech told me the mic was picking me up all night long ... I knew that I snore,.. most of my snoring sounds like I'm gasping for air. A typical night is a long period of gasping snoring, then a loud snort or gasp, followed by what sounds like an awakening (I assume I wake up because I can hear myself move around a bunch).
... I hope I don't have sleep apnea

Oh, I think you do, either push for a doctor study, get a home study, or just get a machine and start treating yourself.

If not for yourself, then for the other people in the household, so THEY can sleep without the racket

[colomom]

Thanks Filigree3, an ENT is a great suggestion!

Thanks raised fist.
My average O2 was 93, but I live at 7,000 feet so 93 isn’t horrible. My lowest O2 sat was 85, and I was under 88 for only about 2 minutes. I’ve used my trusty oximeter many times on my son, mother, and brother (who all have sleep apnea) none of my readings appear to be artifact to me.

Thanks Palerider! Fortunately my husband can apperanty sleep thru just about anything, and my son’s bedroom is on the other side of the house
If it comes down to it I will self treat, but I pay an arm and a leg for health insurance so I hope they will cover it.

[palerider]

Thanks Palerider! Fortunately my husband can apperanty sleep thru just about anything, and my son’s bedroom is on the other side of the house

Then at least have some consideration for the neighbors!! they need sleep too!

[bwexler]

If it comes down to it I will self treat, but I pay an arm and a leg for health insurance so I hope they will cover it.

This brings me to my favorite topic.

If I can't train my doctors to do things my way, I can hire new doctors until I find one who will do things my way,

I would sit my PCP down and have a stern conversation about what I want and why. With a not so subtle THREAT that I will get the treatment I believe I need and Hope this PCP will continue to be part of the team that makes it happen.

I don't want to spend money frivolously, not mine or my insurance companies. I don't mind skipping Specialists I don't need, but won't skip treatment that I do need.

[HoseCrusher]

Oximetry usually records O2 levels and heart rate.

When you dropped low in O2, what did your heart rate show?

A "typical" problem shows a gradual to rapid decline in O2 followed by a spike in heart rate. If you suddenly drop in O2 saturation, it is most likely an artifact. If you have no change in heart rate, it is most likely an artifact.

To find your particular pattern you can run a test. Sit down and spend 5 minutes relaxing and clearing your mind. Put on your oximeter and start recording. Spend a couple of minutes shallow breathing then at the end of an exhale stop breathing. Hold on as long as you can. This will be uncomfortable.

What you should see is a gradual drop in O2, then your heart rate will accelerate in response. This will correspond to your heart racing while holding your breath.

If you hyperventilate, you will find it very difficult to register a drop in O2 levels.

Once you have a "map" of what a desaturation looks like, you can use that to review your overnight data.

[Julie]

Just a caution - ENT's are paid for surgery, and tend to suggest many procedures (like UPPPs - relatively radical - for starters) as the only way to fix apnea, but the majority of them, except for e.g. nasal turbinate operations, do not do the job beyond a few months and even turbinectomies cannot fix narrow throat obstructions, even if they do help nasal or sinus issues), so definitely stay in touch here if they are recommended before signing on to have things removed or altered that then cannot be reversed.

[colomom]

Thank you for the input everyone!
The oximetry does show an increase in heart rate following desats, I don't believe I'm seeing artifact.

I decided to try an experiment last night and I redid the oximetry and tried to sleep on my back as much as I could. I was surprised at how much worse my oximetry report looks simply because I spent a portion of the night on my back. My desat index from last night was 25.9, basal O2 90.7, low O2 77, and my O2 was under 88 for 42 minutes. Hopefully when I get the overnight oximeter from the DME if I make an effort to sleep on my back it'll give the doctor enough to justify ordering a sleep study.