Pre Apnea diagnosis

[Bob6466]

My urologist and general practioner both think I have sleep apnea, (primarily because I am an hypertensive overweight guy that snores) but my MD for whatever reason is reluctant to consider a sleep study. He did test me with an oximeter and told me by SPO2 was below 80 60% of the time. After research this on the web, I became alarmed,and bought my own oximeter, and have ran it for two nights collecting data, and find I am my SPO2 is above 88% 96 percent of the time and generally hovwra around 91 or so. I have a couple of episodes where my SPO2 drops below 80 for 7 or 8 seconds then rebounds. I sent my conflicting results to my MD and haven't heard back.

Q1. Is an SPo2 of around 91 all night a problem?

Q2. Are 10 second drops below 88 serious (2-3) in seven hours of sleep?

Thanks.

Bob H

[Muse-Inc]

Welcome aboard! Great info & folks here.

If it were me, I'd demand a sleep study, a split-night study if possible that's where they wire you up, let you sleep and if you have apnea/hypopneas that meets the minimum for diagnosis, put a mask on you, let you go back to sleep, increase the air pressure to determine the ideal pressure (this is called titration), the one that eliminates events. The Medicare guideline for supplemental oxygen is readings of 88% or lower (can't remember for how long...sorry). Sleep apnea is too dangerous to go untreated and the only way to know if you do or do not have it is to have the study where they can gather all the diagnositic data and evaluate it.

In my case, my oxygen deprivation caused nightime hypertension so high, my body went nuts producing urine to drop my BP so I pee'd 8-10 times/night; then, the hypertension lasted so long that it became daytime hypertension too, very high (210/110)...it averages 130/70 now and I quit my nightime peeing my first night on CPAP therapy! I only dropped to 83% SaO2 and not very long. Do the drops in your SaO2 correspond to jumps in your pulse rate?

Good luck with this!

[Bob6466]

No jumps in pulse rate --pretty steady at 70 -- and I think I sleep pretty soundly except bathroom calls about every two hours. My BP is around 130/90 which doesn't sound all that high compared to yours...

[fadedgirl]

Get a new doctor.

Or, study up on the textbook symptoms of sleep apnea and tell the doc that you've got them & have a long time, you just didn't realize they were significant or related. Your current MD is an ignorant obstacle that is very easily hurdled in this manner. There isn't one on the planet that is going to take on the liability of not sending you to a sleep study if you report having 90% of the symptoms. And if you happen to have one that is, you really need to switch doctors immediately. All he/she is good for is the referral (meaning that they won't be involved in your treatment of this whatsoever in the future), so do what you need to do to get it. Once you get it, be honest with the sleep specialist about what is really going on with you, THAT is the doc that is educated and knowledgeable about sleep apnea and THAT is the place to tell it like it is.

Sorry if this sounds harsh, but I was put off by countless doctors for years because I wasn't overweight, didn't have morning headaches, never fell asleep driving or anywhere I didn't intend to, was too young, blah blah blah. Don't let the ignorance of the MD ruin your health/life. You will learn very quickly here that most MDs are completely clueless about sleep disorders. Just get the referral, because your life depends on it. Or get a new doc & get one that way.

I'm sure others will answer your questions about your oxygen levels, I'm not up to speed on that. Good luck & welcome!

[Julie]

One thing you will notice once you're on Cpap is that your bathroom wake-ups will disappear, or certainly lessen almost to none.

[Bob6466]

Thank you for the helpful replies, but to be fair I am skeptical myself. I do have many of the symptoms but I also think I sleep pretty soundly as long as I don't sleep on my back, so I am concerned about a false positive diagnosis. I am concerned as to how accurate a one night sleep study is, and given the $2500 or cost for the adventure, I don't see how you get a definitive diagnosis without having several, which isn't going to happen. Having said all of this, my MD said he would refer me for a full blown sleep study if that is what I want, but if my problems are cause by something other than sleep apnea, this is more likely to hinder a proper diagnosis than help it.

[Julie]

Without a sleep study, you won't know if you have other problems. PSG's diagnose not only OSA, but a lot of other sleep related disorders. They are quite accurate (hence the price tag!) as are the people who interpret them, though obviously nothing is going to be perfect, but we've all (thousands and thousands of us been there, done them and gone on from there. Problems arise not with the PSG's, but once therapy begins - getting the appropriate mask, the right size and fit, tweaking what pressure(s) are prescribed, what other (sleep or non-sleep related) problems you might have that need to be accommodated, etc. It's part of a journey that helps keep us alive, but is helped tremendously by a positive attitude going in. Those of us who've been there for years now feel naked without our Cpap's at night, and are so glad we have them, considering the alternative. There is no reason to have 'several' studies, though some of us, for various reasons not related to accuracy of the first one do end up having 1-2 more over the years - after all, things change physically as we get older, and sometimes a new 'look' is called for.

[secret agent girl]

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[Julie]

GP is short for general practitioner, a 'family' doctor, not a surgeon and not a 'specialist' in any particular medical field such as endocrinology or gastroenterology. An MD is a doctor of medicine, which means a graduate of medical school, in any specialty or none in particular, licensed to practice medicine (and prescribe, do surgery, psychiatry, etc. etc.). Every specialist, surgeon and GP is an MD, but only GP's have chosen to not go into surgery, or other specialty for which they would have taken more university courses to become experts in their fields, though a GP can pick up (informally if they chose to, at seminars, intensive 6 wk courses, etc.) subspecialties, such as sleep disorders, cosmetic surgery, etc. without necessarily doing full Univ. semester degrees.

[ozij]

My urologist and general practioner both think I have sleep apnea, (primarily because I am an hypertensive overweight guy that snores) but my MD for whatever reason is reluctant to consider a sleep study. He did test me with an oximeter and told me by SPO2 was below 80 60% of the time.

And what did your MD suggest you do, as a follow up to that dreadful oxygenation report?

After research this on the web, I became alarmed,

Rightly so. Your MD should have been alarmed as well. And if he wasn't, he better have a very good explanation. At minimum, he should have suggested a repeat of the measurement.

and bought my own oximeter,

Good for you.

and have ran it for two nights collecting data, and find I am my SPO2 is above 88% 96 percent of the time and generally hovwra around 91 or so.

In other words, your SPO2 is less than 88% for 4% of the time -- one more percent and you're eligible for supplementary oxygen all night long. If your machine has a 1% error....

I have a couple of episodes where my SPO2 drops below 80 for 7 or 8 seconds then rebounds. I sent my conflicting results to my MD and haven't heard back.

I don't like your MD.

I would insist on a repeat measurement with (I assume) the more professional device.

It sounds to me as if your MD might picking up on your reluctance and telling you what he/she senses you want to hear, or isn't but you're still hearing what you want to hear. Or, he/she could be biased for some reason.

I haven't heard of too many false positives. More likely, I would think, if you have mild OSA. If it's moderate to severe that's much less likely.

but if my problems are cause by something other than sleep apnea, this is more likely to hinder a proper diagnosis than help it.

How so? I'm curious about the reasoning behind this statement. In any case, why don't you get the other "rule out" testing first to find your problems cause(s), and consider the sleep study as a last resort.

[/quote]

Very god points. And if there's reason behind that statement, I'd love to hear it too.

[BlackSpinner]

[quote="Bob6466" Having said all of this, my MD said he would refer me for a full blown sleep study if that is what I want, but if my problems are cause by something other than sleep apnea, this is more likely to hinder a proper diagnosis than help it.[/quote]

He is an idiot. Sleep apnea causes amongst other things : high blood pressure, heart attacks, strokes, diabetes, obesity, depression, anxiety and other mental health issues, fatigue, and a host of other issues. It is the FIRST thing to eliminate in diagnosis because it is the underlying cause for so many things.

Thinking you sleep soundly is self deception. You don't know because when you have an apnea you don't wake up fully so you think you are sleeping fine but the oxymeter says differently.

[janeysmom]

I agree with others. Demand it. It took me a couple of years to get my sleep study but when I finally did, I was diagnosed with moderate sleep apnea. I just start with my CPAP machine last week and already have noticed a difference in my alertness and feel much better. I now know that because I demanded it and was diagnosed with what I thought I have, I am on the road to recovery. Good luck!

[roster]

After research this on the web, I became alarmed,and bought my own oximeter, and have ran it for two nights collecting data, and find I am my SPO2 is above 88% 96 percent of the time and generally hovwra around 91 or so. I have a couple of episodes where my SPO2 drops below 80 for 7 or 8 seconds then rebounds.

You left out something important. What were your levels before you fell asleep?

[Bob6466]

>You left out something important. What were your levels before you fell asleep?

During the day, they bounce around from 92-97 depending on what I am doing, closer to 92 or so when I am just sitting around.

BTW, I am scheduled for a sleep study tonight in a lab... Thank you for your continued feedback...

[roster]

BTW, I am scheduled for a sleep study tonight in a lab... Thank you for your continued feedback...

That was quick.