Re-diagnosis concerns

[Overflow]

Just got back from sleep doc, who had some 'Good news' for me.

He says that based on my study last month, I don't have OSA or any other physiological stuff happening like PLM. My apnea events were only 2.X and my oxygen saturation was above 90.

He thinks that what I have instead is insomnia or delayed sleep onset insomnia and has prescribed 2mg Circadin Melatonin with a lightbox regimen.

It just seems totally bizarre. Have had 3-4 previous sleep studies that pointed to OSA/UARS, and even my oximitry before the sleep study last month was showing below ideal oxygen and erratic heartrate (seems previous oximitry had mean of 97% actually).

He thinks my previous studies were mistaken and wants me to go off PAP and just try the pills and box for 4 weeks. I guess I will, but not feeling great about this shift. It would of course be great to be free of OSA, but insomnia alone? Perhaps I am too cynical.

[Julie]

At the very least, I'd want to see the full report (not just summary) myself, which of course is your legal right, and if you could post highlights here (via either a Photobucket or other link) others here can take a look and see what they think.

[zoocrewphoto]

I would ask for a recording oximeter to use during that time period to make sure you aren't having desaturations.

[49er]

Interesting Overflow. I had a similar type experience with a sleep doctor although fortunately, he didn't deny I had apnea.

Using a recording pulse oximeter is normally good advice but you can still have apnea even if you don't have any desaturations. I do agree about getting a copy of the sleep study and posting it on this site so the experts can verify that nothing was missed in the data.

I definitely understand your confusion as I felt the same way even though my apnea at least wasn't blown off.

49er

Just got back from sleep doc, who had some 'Good news' for me.

He says that based on my study last month, I don't have OSA or any other physiological stuff happening like PLM. My apnea events were only 2.X and my oxygen saturation was above 90.

He thinks that what I have instead is insomnia or delayed sleep onset insomnia and has prescribed 2mg Circadin Melatonin with a lightbox regimen.

It just seems totally bizarre. Have had 3-4 previous sleep studies that pointed to OSA/UARS, and even my oximitry before the sleep study last month was showing below ideal oxygen and erratic heartrate (seems previous oximitry had mean of 97% actually).

He thinks my previous studies were mistaken and wants me to go off PAP and just try the pills and box for 4 weeks. I guess I will, but not feeling great about this shift. It would of course be great to be free of OSA, but insomnia alone? Perhaps I am too cynical.

[kteague]

...He thinks my previous studies were mistaken...

#1 Wondering if previous studies and prescribed CPAP were done by same doctor.
#2 Wondering if he looked at the actual readings from previous studies and could point out exactly what parts were erroneously labeled outside diagnostic criteria.


EDIT: P.S. Since he diagnosed you with insomnia, could you perhaps have not slept enough to even get a significant picture of your issues?

[Overflow]

At the very least, I'd want to see the full report (not just summary) myself, which of course is your legal right, and if you could post highlights here (via either a Photobucket or other link) others here can take a look and see what they think.

Yes I will get the report from them I think. They did send me the oximitry report so shouldn't be too much trouble.

...He thinks my previous studies were mistaken...

#1 Wondering if previous studies and prescribed CPAP were done by same doctor.
#2 Wondering if he looked at the actual readings from previous studies and could point out exactly what parts were erroneously labeled outside diagnostic criteria.


EDIT: P.S. Since he diagnosed you with insomnia, could you perhaps have not slept enough to even get a significant picture of your issues?

Actually this was a completely new doctor who had never seen my previous tests. He was not blind to my previous treatment though as the referring doctor mentioned my history, and he knew I was using PAP. I started fresh with this clinic to see if they could give me any other ideas as PAP therapy has been very intermittent in helping alleviate symptoms. I did sleep through the study, for a good 5-6 hours I think. He got the idea of insomnia from my description of the average week and the amount of time it took to get asleep. I think the only physical thing that is definitely still off is the heart rate (too high) and he did note that sleep efficiency wasn't as good as it could be either.

I did do an A/B test with PAP on and off near the beginning of the year (oximeter) and it did seem to reduce the heart rate, although it was still higher than normal if I recall.

[BlackSpinner]

Maybe you could ask to do a few nights of a home study? That might give more information. Especially since some doctors believe that it takes a few nights (up to two weeks) off of cpap before you can get a real reading.

[JDS74]

Your equipment shows you using an S9 Autoset as well as a PR 550 auto cpap.
You can get good data from both of them.
What does the data look like? Are you seeing OSA events, CA events, etc.?

Even if you use the meds prescribed, the use of the auto CPAP machine won't do any harm but will provide recorded evidence of how well you are sleeping.

I'm unfamiliar with the ResScan reports from the Autoset but if you use Encore for the time on the 550, you can look at the wave data and see periods in which you are awake or aroused during the night. The shape of the wave data is different. When you are actually asleep, the wave data is more regular and smooth. When you are awake or aroused, the wave data shows more irregularity and higher flows. Its a little more difficult to see the same thing in SleepyHead because of the difference in the display of the wave data.

If you can get a CMS50F oximeter, then you have most of the equipment to do your own home sleep study (no real RERA data, no EEG data to see if you are actually asleep). You can see the heart rate data, the SpO2 data, and the apnea data.

[Day_Dreamer]

Just got back from sleep doc, who had some 'Good news' for me.

He says that based on my study last month, I don't have OSA or any other physiological stuff happening like PLM. My apnea events were only 2.X and my oxygen saturation was above 90.

He thinks that what I have instead is insomnia or delayed sleep onset insomnia and has prescribed 2mg Circadin Melatonin with a lightbox regimen.

It just seems totally bizarre. Have had 3-4 previous sleep studies that pointed to OSA/UARS, and even my oximitry before the sleep study last month was showing below ideal oxygen and erratic heartrate (seems previous oximitry had mean of 97% actually).

He thinks my previous studies were mistaken and wants me to go off PAP and just try the pills and box for 4 weeks. I guess I will, but not feeling great about this shift. It would of course be great to be free of OSA, but insomnia alone? Perhaps I am too cynical.

Can be 90 and still an issue if it drops more than 5%

[Overflow]

Well thought I'd try one more night as suggested. Here are results from Encore. It wasn't a very long night though, found it hard sleeping:

[kteague]

I would be very suspect of advice from a doctor who hadn't even seen the previous test results in detail before dismissing them. He should be able to tell you exactly what about those tests invalidated them in his professional opinion. Compare to this: If multiple tests had shown you to have a cardiac arrythmia for which you took medication, and a new doctor took one test that didn't capture the arrythmia so he took you off the medication, would you be willing to heed his advice? I try to not be too hard on doctors on here because I've had more good ones than bad, and know some excellent ones who are personal friends. In this case, I can't defend the doctor if they indeed did not even see the tests they dismissed. Sure hope you can get copies of the previous tests and post here for comparison.