AHI Question for Sleep study

Goofproof · Post by **Goofproof** » Sun Jul 23, 2006 6:36 pm

That is where having a machine that records and shows you what your treatment is doing every night is important. You could even do a test run, by reducing your level of treatment and see if the Apnea is worse. Jim

rested gal · Post by **rested gal** » Sun Jul 23, 2006 6:39 pm

Sleepless on LI wrote:If all it took was one night to keep you going for a few nights, then we do we need therapy every night? We could just do it a few times a week and be fine. I don't think it works like that for most people.

I agree, Lori. I don't think it works like that for most people either. And that's not what this was about. The guest who started this topic said:

"Just want to make sure I dont end up with a very low ahi as a result of compliant long term use."

If it's true (and I don't know it to be, but makes sense) that what another poster said could happen:

"Recently, I did an overnight pulse oximeter study at home. The nurse at the sleep lab told me that I had to be off of cpap for 2-3 days before doing the pulse ox. She said that the body "remembers" and the readings would be much different and innaccurate if I didn't wait."

Then the hypopnea index could certainly be "artificially" low. I believe there has to be a certain percentage of dip in the O2 level during a limited flow it to be scored as a hypopnea and get added into the overall AHI. Maybe that wouldn't happen, but again...why take the chance of getting a skewed temporary "good" result that isn't going to last if the machine is yanked away?

Again, it comes down to this, as I see it...you can't make OSA be there if it isn't. But you sure can do things to lessen the number of events. In the case of the initial guest, he doesn't want to lessen the events and chance losing the machine that has been treating him well for so long.

If staying off the machine for a couple of nights before the study will present a better picture of the true AHI, that's what I'd do. And...I'd stay on my back as much as I could during the study. Salud!

Snoredog · Post by **Snoredog** » Sun Jul 23, 2006 6:50 pm

[quote="Sleepless on LI"]I hate to disagree, but I feel the idea of a good sleep study is to simulate your normal sleeping conditions if at all possible and seeing what your AHI is. And if you're lucky enough to get an AHI that is under the criteria for needing therapy, that is a blessing that we would all strive for.

To do whatever you can to raise your AHI so that you can continue treatment doesn't make sense to me. If you normally sleep on your back and consume alcohol, which has been known to increase your likelihood for having events, hence a higher AHI, then so be it. Then you would be emulating a normal night and whatever the AHI turns out to be would be factual. But to intentionally try to make the AHI higher, I can't see why anyone would want to do that. I would think the best news you could hear is that your AHI falls below the criteria for needing therapy. I'd be kicking up my heels to get that news.

wading thru the muck! · Post by **wading thru the muck!** » Sun Jul 23, 2006 6:51 pm

To provide my two cents regarding the initial questions...

Yes the insurance can require follow up sleep studies to verify the continued need for cpap... mine did. This is especially true for people with borderline AHIs. The key here is that if you have other concomitant conditions such as excesive daytime sleepiness or hypertension cpap can be the prescribed treatment even if your AHI is as low as 5.

I can understand RGs rationale regarding snoring irritating ones throat and causing inflammation which could contribute to obstruction, but on the other hand I have never heard of snoring being listed as a cause of OSA. For RGs supposition to be true snoring would be a cause of OSA... so I would have to say that ultimately this should not be a factor.

In the end if your untreated AHI was significantly more than 15, I would appeal to your insurance company that a second study would be wasteful. If you can't convince them, It will be up to you and your personal morals to decide whether or not to attempt to distort your AHI to give you a resulting higher AHI (there definitely are ways to do this.)

Tell us some more about your original sleep study and your answer may help in the commentary offered.

Wulfman · Post by **Wulfman** » Sun Jul 23, 2006 6:53 pm

Hi all.

Hope you don't mind if I jump in here with a few questions....

I'm curious about the situation as to why the insurance provider is requesting an additional sleep study AND what is their contractual obligation as to the rental or purchase of the machine being used. How long has this person been on the machine? Is the insurance provider on a "rent to own" or perpetual rental agreement? Has the user been compliant (or not)?

To borrow from one of Jim's posts, it would be a lot cheaper for the insurance provider to buy the equipment outright than to request additional sleep studies.

Also, are all the "guest" posts in this thread from the same person who started this thread?

Den

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 7:00 pm

One last thing I would like to add. I was told that if your AHI is low, but you are symptomatic, that is taken into consideration if treatment is to be prescribed. I had nowhere near 15 AHI (I was a 7). But because of desats classified as "moderate" along with severe fatigue, exhaustion, borderline hypertension and headaches, I was prescribed a machine. I didn't need the greater than 15 number.

My only rationale here is, I think if you have OSA, it will show regardless of what you do. If you are an apneac, and have a PSG that is done correctly, it should come out in the wash and you should have your machine. Maybe "should" is a key word here. I don't know. I just never thought as there being any type of "studying" or "homework" that one could do before taking this test to change the outcome. Opens up a whole new area for me to think about, I'll tell you.

wading thru the muck! · Post by **wading thru the muck!** » Sun Jul 23, 2006 7:11 pm

Sleepless on LI wrote:One last thing I would like to add. I was told that if your AHI is low, but you are symptomatic, that is taken into consideration if treatment is to be prescribed. I had nowhere near 15 AHI (I was a 7). But because of desats classified as "moderate" along with severe fatigue, exhaustion, borderline hypertension and headaches, I was prescribed a machine. I didn't need the greater than 15 number.

Lori,

You are absolutely right... This is also my situation and the reason I was required to do two sleep studies... IMO a huge waste of money but I was new to this at the time.

As far as the homework... I would think an evening of screaming for your favorite team at the ballpark would inflame your throat much more than a little snoring. LOL! In the end if you DO have OSA it will be apparent during a quality PSG without any extra efforts on your part.

different guest · Post by **different guest** » Sun Jul 23, 2006 7:45 pm

They made me lie on my back in the sleep study. I told them I never sleep on my back. They said I had to for the test. It was uncomfortable and I took forever to fall asleep. It would seem like they were trying to skew the results in favor of a diagnosis of OSA. Why do they do that? If my results were borderline does that mean I probably don't really have OSA because I don't normally sleep on my back? Have I been suffering with this thing on my face every night for no reason?

Guest · Post by **Guest** » Sun Jul 23, 2006 9:50 pm

me again - woozle = I was 'original' guest on here with additions and my internet doesn't let me log on long enough - sorry wasn't saying who I was, kept forgetting~!

Anyway, first off, I think RG's example of snoring was just that, an example, I don't believe she was saying snoring 'causes' apnea - additionally, my ENT told me, and I have been trying to study the heck out of all this, ie, anatomy of apnea - due to my sinus problems - am in the process of deconstructin the hybrid so I can use if without the nasal apparatus - anyway, I digress!
My ent adivsed that many times, not all, but many times, one may have apnea due to the soft palate and muscles not being strong enough, or collapsing during sleep - so on this subject of having the sleep study AFTER having been on treatment for a time, there is such a thing called muscle memory? Not sure if any of you play (ed) sports but I did and for most all of them, muscle memory like shooting baskets or golf swing, etc. comes down to the more you practice, the more your muscle (s) remember how to perform the sequence of what you want so that it doesn't even really take thought, it's muscle memory - It is my understanding, and I could be wrong, that the throat muscel, albeit much much weaker than say forearm, could have a short term muscle memory where it would, just fo rthe next night, or just for a few hours, who knows, after being on cpap successfully, could have muscle memory, and that would be the 'problem' if you go in to sleep study and you have a much lower ahi than you did prior to the treatment - I am sure if I am way off, I will be advised, but new and correct info is always appreciated!!
I think that with new information, such as weight loss etc, that you would still get a much more accurate picture by being off the treatment for one night prior to the study

and when I went to the ent, they had some brochures on these 'implants' that they can put into the soft pallate of your throat, supposed to toughen it up, so that you may not have to do cpap if/when it toughens up - my doc didn't even ask me to try it and so I asked him about it, and he said it's really new, and that it wouldn't work for someone with severe osa like I have

wading thru the muck! · Post by **wading thru the muck!** » Mon Jul 24, 2006 5:38 am

Anonymous wrote: ...for someone with severe osa like I have.

If you have "Severe" apnea why are you worried about boosting your AHI during your second sleep study???

As far as "Muscle Memory" it appears your muscle have long forgotten how to keep your throat open (considering your "Severe" apnea)

I doubt that a short refresher course on cpap has brought those muscles back to there younger days. LOL!

original poster · Post by **original poster** » Mon Jul 24, 2006 5:50 am

First off I am the "original guest" who posted this. I was told originally when I was diagnosed that a lot of my upper airway structures were swollen (ie uvuela, epiglottis) from turbulent airflow as a result of restriction caused by osa, I was diagnosed as *moderate*. I was afraid with xpap use, this swelling would go down, and I would turn up a very low AHI, and if I discontinued xpap use, it would start all over again, may take several days/weeks for the damage to recur. Apparently due to a lot of recent diagnoses, my ins co decided to change (read raised) their criteria for paying for osa related equipment, and is requiring a follow up sleep study (under the threat of being required to return our "rented" equipment, or be billed for it). This will be a mostly moot point soon anyways, since I plan on buying a apap, but it will be nice to have them pay for consumables, after all I send them approx 15% of my salary every week anyways, its the least they could do right? .

rested gal · Post by **rested gal** » Mon Jul 24, 2006 5:57 am

Hi woozle,

I think Wader is right...a previous diagnosis of "severe" SA is going to easily keep you in "OSA diagnosis" territory no matter how many sleep study hoops your insurance company makes you jump through periodically. You'll get to keep your machine coverage.

Just relax about the upcoming study.

And stay on your back there.

Let us know how it goes!

wading thru the muck! · Post by **wading thru the muck!** » Mon Jul 24, 2006 6:23 am

original poster wrote:First off I am the "original guest" who posted this. I was told originally when I was diagnosed that a lot of my upper airway structures were swollen (ie uvuela, epiglottis) from turbulent airflow as a result of restriction caused by osa

original guest,

The key is that the swelling was caused by the OSA and not the OSA caused by the swelling.

When you say "moderate" ...do you have an AHI number?

Sleepless on LI · Post by **Sleepless on LI** » Mon Jul 24, 2006 7:52 am

wading thru the muck! wrote:The key is that the swelling was caused by the OSA and not the OSA caused by the swelling.

Wader nailed it with that one. That was my original post about not worrying about the snoring because you can snore with OSA but you don't necessarily have to have OSA if you snore.

SnoozeHunter · Post by **SnoozeHunter** » Mon Jul 24, 2006 7:52 am

Wulfman wrote: Also, are all the "guest" posts in this thread from the same person who started this thread?

Den

Den,

Not all are from the same guest. The second post is mine, the one about being advised to stay off the cpap for 2-3 days before doing an overnight pulse ox.

I thought I was logged in when I posted that and when I realized I wasn't, it didn't seem like a big enough deal to post another just to identify myself. Sorry 'bout that.

SnoozeHunter

AHI Question for Sleep study

Re: AHI Question for Sleep study