Frustrated - Two Failed Sleep Studies

[KKWinOK]

Hi, I’m new here and I need some suggestions. I’m convinced that I’m dealing with sleep apnea. My symptoms are: daytime fatigue, difficulty recovering from even light exercise, difficulty concentrating and memory recall, can sleep for 12 hours sometimes, not feeling refreshed upon waking, feelings of depression, etc. I just finished the second sleep study and was told that they didn’t get the required 40 events in 2 hours. In the first study, I could barely sleep. At home I have almost no problems falling asleep and staying asleep. On the contrary, I need more than what I get (in years past I normally need about 8 hours). For the second study, I was prescribed one generic Lunesta. I did absolutely nothing for me. Thankfully I brought my low dose melatonin and took it about 1 to 1.5 hours after the Lunesta and was able to fall asleep for a few hours but woke up and couldn’t go back to sleep. I took more but didn’t do anything. I told the tech that I couldn’t fall asleep again and the study was terminated 2 hours early. They got 6 hours of results. None of this makes any sense at all. I’m very frustrated because this is impacting my life in every way. I’ve exhausted my sick and annual leave from work due to tiredness. I’ve visited several physicians over the years and had lots of lab work with no diagnosis for my symptoms. My thyroid and adrenals are good too. So how am I supposed to get a good sleep study when I can’t fall asleep long enough to get results? Do you have any suggestions on where to go from here? I appreciate your help!

[realshelby]

6 hours of sleep is more than enough to get meaningful results. My sleep study barely passed 3 hours.

40 events in two hours? So you could have an AHI of 19 and they don't think that is a problem?

There is and always will be more than obstructive sleep apnea effecting how well you sleep. Without meaningful sleep study results there isn't much proof.

Do you snore? Do you know if you wake up with a rapid heart beat? Do you wake up gasping for a large breath? Not scientific, but certainly can be symptoms of obstructive sleep apnea.

If you have a choice, can you do an at home sleep study? I read your post like you were at a sleep center?

[Pugsy]

40 events in two hours? So you could have an AHI of 19 and they don't think that is a problem?

That sounds more like a sleep lab requirement for the person to be put on cpap during a split night sleep study.
My own sleep lab where I had my sleep study had a requirement of 15 AHI to be put on cpap....and I failed that part until I hit REM but unfortunately didn't get enough REM soon enough to be put on cpap and have the titration part of a split study. Up until REM hit, I was at around 12 per hour events despite oxygen levels going in the toilet (O2 levels weren't part of the criteria for a split study to start cpap in the middle of the night).

Either that or OP is in some part of the world that has a higher AHI standard for diagnosis criteria than the US but his ID name includes inOK which I assume might mean Oklahoma.

I think the OP needs to request the written results of this second sleep study and lets see exactly what it says. He/she may be simply misunderstanding what was found or not found during the sleep study.

[KKWinOK]

40 events in two hours? So you could have an AHI of 19 and they don't think that is a problem?

That sounds more like a sleep lab requirement for the person to be put on cpap during a split night sleep study.
My own sleep lab where I had my sleep study had a requirement of 15 AHI to be put on cpap....and I failed that part until I hit REM but unfortunately didn't get enough REM soon enough to be put on cpap and have the titration part of a split study. Up until REM hit, I was at around 12 per hour events despite oxygen levels going in the toilet (O2 levels weren't part of the criteria for a split study to start cpap in the middle of the night).

Either that or OP is in some part of the world that has a higher AHI standard for diagnosis criteria than the US but his ID name includes inOK which I assume might mean Oklahoma.

I think the OP needs to request the written results of this second sleep study and lets see exactly what it says. He/she may be simply misunderstanding what was found or not found during the sleep study.

Hi Pugsy, yes that's correct about the split study and a sleep lab requirement. So perhaps I overreacted because I didn't get to the CPAP portion of the study. I don't know this but it seems like most of the REM sleep I get is in the early hours of the morning...at least right now anyway. I don't think I reached REM during that 6 hour time.

Ha ha, yes I'm in Oklahoma.

I will find out more in probably 3 weeks or so. It takes a long time for doctor's interpretation...kind of frustrating on that part though. This gives me a bit of hope that maybe there's enough for the doctor to see that I do need CPAP.

I appreciate your input!

[KKWinOK]

6 hours of sleep is more than enough to get meaningful results. My sleep study barely passed 3 hours.

40 events in two hours? So you could have an AHI of 19 and they don't think that is a problem?

There is and always will be more than obstructive sleep apnea effecting how well you sleep. Without meaningful sleep study results there isn't much proof.

Do you snore? Do you know if you wake up with a rapid heart beat? Do you wake up gasping for a large breath? Not scientific, but certainly can be symptoms of obstructive sleep apnea.

If you have a choice, can you do an at home sleep study? I read your post like you were at a sleep center?

Hi realshelby, I think I snore. I wake up sometimes and I can hear that I was snoring and then fall back asleep again. I sometimes wake up with a racing heart. I haven't noticed it so much lately but it has happened before. There have been times it was so bad that it took quite a while for my heart to calm down so I could go back to sleep. I don't ever recall waking up gasping for air but I do wake up sometimes and it seems like I stopped breathing. So, I believe I am dealing with sleep apnea. I don't know either if I can do the study at home if there wasn't enough evidence this time.

[Pugsy]

Ahhhh....like me...you were disappointed they didn't slap a mask on your face in the middle of the night and you thought you failed totally.

You want an answer to your problems so you can fix it and you want it right NOW. Trust me....been there and done that.

6 hours of sleep is more than enough to establish a diagnosis or not...so lets wait and see what the report shows before going into panic mode.
I had to wait too....but eventually got the call that while I didn't meet the criteria to slap the mask on...I met the criteria to still need cpap and went in for the titration part of the study about a month later.

[Pugsy]

OH....FWIW....my AHI during non REM sleep was just 12 but once I hit REM it went to 53 per hour. Rocking and rolling for sure.
Problem being I never could stay in REM long enough to meet the criteria because the apnea events would wake me up.
Quite common for OSA to be worse in REM. No big deal but if that is the case for you...make sure that any machine you get is a machine capable of auto adjusting the pressures. You might also need much higher pressures during REM and if you get a fixed cpap pressure machine you will have to maybe use much higher pressures all night just to deal with the 20% of the night in REM. Not much fun to use 15cm all night when 7 does a great job the other 80% of the night.

[KKWinOK]

Ahhhh....like me...you were disappointed they didn't slap a mask on your face in the middle of the night and you thought you failed totally.

You want an answer to your problems so you can fix it and you want it right NOW. Trust me....been there and done that.

6 hours of sleep is more than enough to establish a diagnosis or not...so lets wait and see what the report shows before going into panic mode.
I had to wait too....but eventually got the call that while I didn't meet the criteria to slap the mask on...I met the criteria to still need cpap and went in for the titration part of the study about a month later.

Hi, yes that’s it exactly. Thanks for the explanation...that helps me understand better now. I usually don’t get bent out of shape like this so I apologize.

I think they use they typically prescribe the Resmed 10 if I recall correctly.

[Pugsy]

I think they use they typically prescribe the Resmed 10 if I recall correctly.

Be careful....if they typically are using ResMed they probably start with AirSense 10 models and there are 4 of them

AirSense 10 CPAP....avoid at all costs...fixed pressure only and extremely limited efficacy data collection
AirSense 10 Elite....full efficacy data but only has fixed pressure mode available...I would still try to avoid it
AirSense 10 AutoSet....this is the apap model...the model with the mode where the machine can auto adjust the pressures as it senses a need. It has 2 modes available...fixed cpap pressure mode and the auto adjusting mode.
AirSense 10 AutoSet for Her...same as the regular Autoset except it has a 3rd mode available that is also an auto adjusting mode target marketed towards women but there's no reason in the world why some men might not also benefit from that mode. I think everyone should get this model if at all possible. There's no down side to it since they cost the same as the regular apap model and we never know who might actually benefit from that special apap mode. Better to have something and not need it than need it and not have it.

All the above models use the same HCPCS billing code that insurance uses...so insurance pays the same amount for all these models.
The only person who really benefits from the dispensing of the AirSense 10 CPAP half assed brick is the DME who gets a higher profit margin.

[KKWinOK]

I think they use they typically prescribe the Resmed 10 if I recall correctly.

Be careful....if they typically are using ResMed they probably start with AirSense 10 models and there are 4 of them

AirSense 10 CPAP....avoid at all costs...fixed pressure only and extremely limited efficacy data collection
AirSense 10 Elite....full efficacy data but only has fixed pressure mode available...I would still try to avoid it
AirSense 10 AutoSet....this is the apap model...the model with the mode where the machine can auto adjust the pressures as it senses a need. It has 2 modes available...fixed cpap pressure mode and the auto adjusting mode.
AirSense 10 AutoSet for Her...same as the regular Autoset except it has a 3rd mode available that is also an auto adjusting mode target marketed towards women but there's no reason in the world why some men might not also benefit from that mode. I think everyone should get this model if at all possible. There's no down side to it since they cost the same as the regular apap model and we never know who might actually benefit from that special apap mode. Better to have something and not need it than need it and not have it.

All the above models use the same HCPCS billing code that insurance uses...so insurance pays the same amount for all these models.
The only person who really benefits from the dispensing of the AirSense 10 CPAP half assed brick is the DME who gets a higher profit margin.

Wow, I had no idea! Thanks for sharing that! I will have to ask about this then...or get a script for the auto set one.