OSA? Yes? No? Maybe?

[TonySanDiego]

Hi all, I hope a few of you can offer some advice and insight.

I have a lady friend (past 55 is it proper to say girl friend?) who I have been seeing regularly for a while.

She had mentioned that she didn't sleep well, often woke up in the middle of the night, and had to read of do something on the computer before (sometimes) getting back to sleep. My thought was she had insomnia.

Last night I stayed over for the first time. Since I don't do well in unfamiliar environments and didn't have my CPAP either, I mostly stayed awake. I discovered that my friend snored, and often seemed to sort of "snort" as if she had a nasal blockage. (she has no nasal problems otherwise) And it seemed that she was doing exactly what I have heard described many times here and elsewhere. She would seem to come semi awake briefly, take a deep breath, and resume breathing. Quite soon, she would start snoring again, sort of "choke" and seem to shift to start breathing normally again. She acknowledged sometimes waking up gasping for air.

All I could think of was this very much resembled what I understand to be classic OSA.

My problem is this. She doesn't exhibit daytime OSA symptoms, at least to my untrained eye.

She says she has adequate energy during the day and doesn't fall asleep unexpectedly or feel the need to take naps. She does begin to fade by mid evening, 9 or so. I do not know if she is actually tired or not during the day. She is very active.

Obviously, a sleep study would be the best thing to get a definitive answer. But she doesn't have good insurance and it is doubtful that much, if any, of a sleep study would be covered. And sleep studies are expensive. She could, and I will encourage this, go see an ENT. (who will probably recommend a sleep study)

So my questions are:

1. Can a person have OSA and manage to function reasonably well during the day, not feel unreasonably tired, or feel like taking a nap during the day? Asymptomatic I guess would be the word.

2. Is it reasonable to expect an untrained person to be able to tell if someone is really suffering an apnea event? (If so, then I must stay over often for more observations, strictly for science you understand... )

3. If 2 is a yes, what would an untrained person, me, look for specifically?

4. I read the post about "why prescriptions". Should I just loan her my mask(s) and machine and do our own little sleep study? She sleeps, I observe. Has anyone ever done this? Results? She has no other health issues. She is ever so slightly "curvey", but certainly not remotely close to a heavyweight.

5. Am I over reacting to what might be benign signs?

My equipment:

Respironics M series Cflex. (set a 9cm constant right now)

Mirage Quattro FFM (I use this one, long live FFM)

Ultra Mirage II nasal mask

Comfort Classic nasal mask

Any thoughts, opinions, relating of similar experiences will be greatly appreciated.

Tony

[Georgio]

You may find the answer here:

http://www.resmed.com/en-us/clinicians/ ... 40x380.swf

[SharkBait]

My problem is this. She doesn't exhibit daytime OSA symptoms, at least to my untrained eye.

I didn't either. I've never been a "morning person", and I looooooove my coffee. So I'd get up, make some coffee, and go. I heard from two different sources over Christmas that it sounds like I'm stopping breathing. I went for a sleep study, turns out I had severe OSA (AHI of 74 with over 60 of those being apnea events).

We're adaptive beings and some tolerate things being wrong with us better than others. I never fall asleep at the wheel of the car, I don't require naps, nothing like that. My lab tech looked at the computer monitor showing my every minute clockwork like apnea events and stated, "I don't know how you function". I told her I didn't know any better than to just keep on going. At my annual check up my doctor always asks how I'm sleeping. This last visit I told him like I do every visit -- "Fine". For me, 74 AHI was "fine"...

[RipVW]

I'd say it is a definite maybe. My wife does the same, I really thought she was having apnea events, so she used one of my spare CPAP machines a few nights, yet the data showed no apnea events (she snores/snorts sometimes). And yes, you really do need to stay over for continued observations ;<)

[TonySanDiego]

Thanks Georgio,

I watched the ResMed movie. I guess it is going to be hard to ascertain exactly what is happening without instrumentation. I understand the differences in sleep disturbances better now. (Apnea is clearly the most severe, none of them are good)

And, as Sharkbait pointed out, some folks can function OK with OSA.

I have not bought a card reader and software yet. I seem to be doing well so I didn't bother. Oops, seems like it would come in handy right now. RipVW, would the encore software show clear apnea events if they were there? How about hypopneas?

Hmmmmmmm.... clearly more research is needed.

Tony

[RipVW]

RipVW, would the encore software show clear apnea events if they were there? How about hypopneas?

Yes, Encore reports do show apnea and hypopnea events.

[Wulfman]

Tony,

I didn't see where you mentioned which specific model of CPAP you have. It would help to have a data-capable one if you're going to let her try it. It would have to be at least the M Series Pro to get data. All of the Autos/APAPs are data-capable.

It could be that she's in the earlier stages of when it's more detectable and may become progressively worse if left untreated.

Yeah......more "research" needed.

Den

[TonySanDiego]

Sorry, I forgot to say it is an APAP M series w Cflex.

Data capable but as I noted, I have not gotten the card reader and software. Tonight I will do so. I should have it anyway. I probably need to see what is happening with me also.

Tony

[old64mb]

She acknowledged sometimes waking up gasping for air.

Along with snoring and trouble getting going in the morning, excessive daytime sleepiness is what PCPs and others are trained to screen for...which is one reason I think that the number of people missed is so high. I went through 30 years and 15+ medical providers and no one ever considered it since the only thing of those three I did of was to snore. Mildly. (Now realize that I did have both of the others, just not in disabling capacities.)

Of course, now that I know all the other comorbidities with OSA and UARS, different story. I shake my head that someone hadn't even asked about them, but only sleep doctors will tend to pick those up, and when I went to one...voila, she did, almost immediately.

If your ladyfriend wakes up gasping for air, that's as good a sign as any that she needs to be checked out, and I'm glad she's willing to doing so. On your end, I wouldn't do anything until after you get a recommendation from the ENT, since you don't know enough about her situation to know when titration might be dangerous. However, that said, you could offer the ENT to try to autotitrate her post-PSG/hometest (saving a second trip), try to find a cheaper home test, or buy a pulse oximeter. I'm not sure what they'd agree to, because frankly, she sounds like she really does need a PSG at some point...but maybe if there's insurance down the road they could work out a compromise on bridge therapy for a few months....

Edit: spelling correction, clarification

[TonySanDiego]

you could offer the ENT to try to titrate her, try to find a cheaper home test, or buy a pulse oximeter. I'm not sure what they'd agree to, because frankly, she sounds like she really does need a PSG at some point...


Does anyone know of home tests? I know the VA had something at one time, but I am not very sure it was effective.

Anyone know where and how might I find a pulse oximeter? I believe a pulse oximeter would at least show that there was a problem, and give some indication of how bad. Can you rent one of these things?

Sure sounds like a PSG is in the cards somewhere. Has anyone had any success beating them down off their high prices if you pay cash?

Thanks for all the help.

Tony

[old64mb]

Sure sounds like a PSG is in the cards somewhere.

Yeah, Tony, I'm looking at my post and realized my brainstorming might have misled you - but if you got that part about the PSG in store at least part of my post may have been not in vain.

Here's your issue. You don't know what, if anything, she has. This means some sort of diagnostic work with a professional is going to be in order, since one of the loudest and most legitimate complaints among doctors is that the advent of the Internet has allowed someone to look up symptoms and diagnose themselves or others with all sorts of horrible maladies that someone with clinical experience can rule out in about 5 seconds. In turn, where patients have a legitimate complaint on diagnostics is that some doctors will improperly rule out that horrible malady because the patient dared to challenge them by bringing it up, even at times when they don't have the expertise to treat it themselves. My experience has been that the best practitioners end up doing something else, which is explaining, "Here's why that's pretty unlikely, but if this keeps up for time period x, let's run this inexpensive test first and try this treatment, and if that doesn't work, then we'll try slightly more expensive test/treatment y, and if that still doesn't work then we'll go gold standard and refer you to someone who is really good."

That's why getting her to an ENT is a good first step, since she's going to a professional who hopefully has seen enough sleep patients to get a pretty good gauge on if the gasping and insomnia mean something. Preferably, they're board certified in sleep medicine, because if they're not there's no guarantee they've seen enough patients - otherwise it may be better to just find someone who is, regardless of their primary specialty. (The AASM has 5 specialties that currently offer board certification in sleep medicine.)

The problem is that once they've determined there's good reason to be tested, the specialist has only two real choices - home test, or gold standard, which is a PSG. A pulse oximeter - here's a review on one viewtopic.php?f=1&t=34394& - will run a couple hundred bucks, but all that will tell you is if she's experiencing oxygen desats. Won't tell you why (it can be other things, some are even more dangerous than OSA), you'll need a script for it (although you can probably bypass that by Ebaying one from China), and it will totally miss other SDB problems like UARS. Some home tests have issues as well - viewtopic.php?f=1&t=35541&p=305353 gives you some of the ideas, but that's a great question for a sleep doctor as to why it may or may not be appropriate. And using your own APAP only makes sense for a post-sleep study titration; before that, you don't know what comorbid stuff might be hanging around.

As far as bargaining with a lab on cash payment price, might work. The original, non-AASM certified lab that I was referred to got desperate once I didn't call them back to set an appointment, and their incentive to win me over to them was to leave me a voicemail offering a certificate for a steak dinner for 2 if I were to patronize them. (Seriously.) It's one of the several reasons I was very glad to go someplace else. Just make sure whatever deal you get is put in writing up front.

Let's hope the specialist you get her to rules out everything. That's the best case.

[MoneyGal]

Tony - to answer one of your original questions: yes you can have OSA, even severe OSA, without having daytime sleepiness. I wouldn't say you can have "asymptomatic" OSA, but that you can have OSA where the symptoms don't show up except in their absence, after treatment begins.

I have severe OSA (AHI over 90 per hour) and I don't show any of the "classic" symptoms - no daytime sleepiness. Before my diagnosis (and after!) I was training for a black belt in karate. I did full-out, very intense cardio workouts several times per week. While working full-time. And raising two small kids.

The difference is that now I enjoy those workouts, and they don't leave me totally depleted. I keep saying to my spouse that I feel as though I am on crack; I have so much energy for life. My only symptom would have been the same one you described, which is "going to bed early." But I obviously racked that up to my workout and life schedule, not to sleep disturbances.

[TonySanDiego]

Thanks all,

Moneygal, how did you come to be diagnosed? What was it that tipped you and your doctor that you had a problem?

Tony

[MoneyGal]

I was "tired all the time." Finally went to the doctor in mid-January 2009 when I was on my second week of simply not being able to get out of bed - I was sleeping up to 20h per day (and I felt HORRIBLE - weak and intensely headachey). My 02 saturation was low and my heart rate was high (my doc gave me an oximeter to wear for a day).

My lung function was fine (I did some kind of blowing test, plus they had a lung specialist listen to my lungs), and my heart was fine (EKG), so they started considering other possible diagnoses. They booked a sleep test for me on an emergency basis because the lung specialist said she wanted to know how I was sleeping; and it was clear I was actually quite sick.

So, the diagnosis came from the sleep study. I think my O2 levels were getting so low during sleep that my body finally couldn't compensate when I was awake.

[WearyOne]

My friend works for a company that provides a test for use at home. They work in conjunction with local hospitals who screen patients for OSA during pre-adminision testing for surgeries. If the screening through the kiosk shows possible OSA, they're sent to my friend's office located at the hospital as part of the pre-admission stuff. She explains things to them, and if they're interested, they are given the Snapp at-home test. http://www.snapdiagnostics.com/

After the tests are returned, the recorded sleep data is sent to Snapp, who then sends the results to my friend's company. The patient's doctor also receives the results.

Not as good as a PSG, obviously, but way cheaper, and could be beneficial for those who can't afford an expensive PSG.

Pam