Nephew hoses up one night, no insurance

[wlk]

My nephew visited us this weekend. We noticed a snoring pattern familiar to all of us with apnea. Loud snoring, followed by silence, followed by a resumption of snoring, repeating again and again. Apnea is very common in our family.
He does not have many of the "normal" issues such as excessive daytime sleepiness, headaches in the AM, and did not score particularly high on the Epworth scale. He does sleep very late whenever he is not disturbed. He is 41, moderately overweight, with a large neck.

He agreed to mask up for the last night at our house. I set him up with a spare mask and my M-Series Auto. The range of pressure was 9 to 15.(Lower than 9 caused discomfort)

He has no job or insurance so a real study is out of the question. My sister and I are willing to pool resources to buy him a machine if we deem it necessary. There is no way he can afford a study. He lives 1100 miles from us so further testing at my home is not possible.

Here is a screen cap from the Encore report. Since he was effectively being treated, hence the low AHI, I am not sure what this data tells me. Help??????

[Wulfman]

Sounds like you know what to get him for an early Christmas present.

Looks like the pressure is about right. If he didn't do any nasal cleansing, that would be an additional suggestion to lower the snore numbers. The snores and flow limitations are driving the pressure increases. A fixed pressure of about 9 or 10 should be good, I would think.

Good for you! There are far too many people with undiagnosed OSA that need this therapy.


Den

[DJ_Boxer]

I agree with wulfman: a setting of about 10 fixed pressure looks about right. Nasal Cleansing is a good thing to do, I use a NeilMed NetiPot with room temperature 8oz bottle of bottled water at night to clear stuff up(everything I have breathed in that day). Also after awhile on the machine he should start to lose weight: I started at 243.8 and am now at about 229.5 since starting in August(I no longer ate to increase energy and just ate to eat.

DJ

[harry33]

I agree with what you are doing although some who think the CPAP professionals welfare comes first would be horrified

you would need to buy him a CPAP in someone elses name, perhaps and to try several masks

[taberge]

The fact that he is still snoring seems to be a problem for me. How is he snoring? Does he need a chin strap? If he opens his mouth would this not skew the data?
For me I have had VS ticks only rarely now and I think they are mostly a result of the mask slipping because the pressure leak spikes at the same time.

[Guest]

If he was mouth breathing, wouldn't the leak line show it? That leak rate is fine for that mask.

[DreamOn]

Hello wlk,

Since your nephew does not have insurance, he may want to contact Awake in America, a nonprofit organization that helps individuals in need obtain diagnostic sleep studies and xPAP equipment. More information is available here: http://www.awakeinamerica.org/ (follow the links on the left side of the page to learn about their SleepStudy Relief and xPAP Donation & Relief programs). It is my understanding that the sleep study and the equipment are provided at no cost. It may be worthwhile to contact them to find out more.

~ DreamOn

[wlk]

Thanks! I was aware of the Awake organization but had not thought to contact them. I will do that. In the meantime, I am thinking about sending my nephew my Pro series machine, with mask and hose. I will order a spare card for him. Then he can rotate cards, mailing his to me for reports.

[DJ_Boxer]

I will order a spare card for him. Then he can rotate cards, mailing his to me for reports.

The extra card idea is a great one,(they don't cost much) I even wondered why my DME never provided a second one when I sent mine in so I could at-least record for the time that I would be waiting for my card to come back in post in case anything happened with my readings. When I got my software Encore Viewer/Pro and the reader, I purchased a second card as a backup card. I am now able to send my doctor the info from the card directly and still have the info on it because DME's when they read the card they have the software set-up to erase the data from it (I keep it on there and I always save the info in PDF automatically: this includes my dailies).

DJ

[Sleeprider]

I applaud your desire to help your nephew, and using the AWAKE resources sounds like an excellent idea. With regard to the data submitted above, there is nothing there that says he has sleep apnea, although he apparently snores. There are zero hyponeas and one single OA over the course of the night. As unpopular as this might be, I think you are jumping the gun attempting to diagnose and treat this on your own. You could create some dependency on CPAP, as I'm sure you have noticed, it's not easy to go back once you rely on pressurized air to maintain your airway.

Your adult nephew should be examined by qualified people who can evaluate the whole patient and consider these reported symptoms. Insurance or not, self-diagnostics and treatment can be harmful in overlooking health and physiological issues that are important, while fulfilling your pre-supposed expectation of finding OSA. As an aside, when was his last physical exam? A man with his risk factors in his 40s should have at least a cursory evaluation every few years. FWIW, insurance will be easier to get now, before he has any kind of confirmed diagnosis of a chronic condition.

[Pugsy]

With regard to the data submitted above, there is nothing there that says he has sleep apnea, although he apparently snores.

I tend to sort of agree with Sleeprider here. We don't know if there were no events because of the pressure or no events to speak of because there simply weren't any.

I loaned my auto machine to my sister and her husband because they both had some markers for OSA but didn't want to do the sleep study thing. I used the auto with 5 cm min and 6 cm max so that I could see if any events were occurring then I would worry about pressure needed for treatment. I really wanted to use 4 cm min and max but that low of pressure felt too stifling for them to comfortably breathe. My sister wasn't really diagnostic though she did report and absence of usual morning headache and much more energy that day. She has elected not to pursue using the machine. My brother in law was a different story. He had an AHI of 8.8 (mostly AI) at the 5-6 cm pressure range that dropped to 1.0 AHI with a minimum pressure increase to 8 cm. So he pretty much for sure has OSA but he also is still in denial and has not done anything about it. Over Thanksgiving he and his sister's husband (confirmed severe OSA with sleep study) whined about using the machine and pretty much neither wants to face the facts yet.

If you can get your nephew to try the machine at a minimal pressure setting it might or might not show some events. Obviously not ideal way of doing things but sometimes you gotta do what you gotta do to get in the game. If it were me I would want to see something going on at a 4-5 cm pressure setting that needed treatment before I would accept the 9 minimum pressure setting. Just my opinion for what little it is worth. Remember, even a minimal pressure of 5 cm can be adequate for some people's needs. Your nephew may only need a lower pressure or may not even need any pressure.

[rested gal]

I think the fact that the machine did raise the pressure for significant amounts of time, it's a pretty safe bet that the user did, indeed, need to use CPAP to get the airway well and truly open.

If the pressure had stayed at the minimum all night, then yes, one could say the jury's out as to whether the minimum pressure was preventing events, or...was there no OSA in the first place, thus no reason for pressure to go up.

wlk, I think you did the right thing for your nephew, and I don't think there's any need for him to go through the A.W.A.K.E. program unless he wants to. Sometimes it's better not to have an "official" diagnosis of "OSA."

If I were him, I'd elect to just self treat, with your good help -- and without bringing an official diagnosis into it.

Link to a Powerpoint presentation by board certified pulmonolgist/sleep doctor (Dr. Barbara Phillips) at a meeting of the American Lung Association of the Central Coast - November 2004:
"Not Every Patient Needs to Go to the Sleep Lab"
http://www.alaccoast.org/pdf/Phillips_0830.pdf

Looks like you chose a good range to use. I agree with the others that if he were going to use straight CPAP, 10 probably would be an effective single pressure.

[Hawthorne]

I think your nephew does have sleep apnea. As Rested Gal said, that's why the pressure rose several times during the night - to deal with or prevent an event.

It was noted, in the thread, that he had only 1 apnea and no hypopneas. There certainly were flow limitations. This report is "with cpap therapy". That suggests, to me, that the machine at those settings, really worked quite well in controlling his apnea.

A sleep study without machine would probably show a lot more apneas and probably some hypopneas. A titration study would probably put his pressure at 10 or 11 cm. Your auto settings seem quite effective then. A straight cpap pressure of 10 or 11 cm would also be a good therapy setting for him.

With the extra card, and you monitoring his reports with the software, he will probably do quite well at managing his sleep apnea. He seems to have tolerated the mask for a good number of hours, given it was his first time on the machine.

[Guest]

I was diagnosed with sleep apnea and have no insurance, no job either. I applied for reduced/free healthcare through my state DHS. It is normally called (your state)Care. They took care of my sleep study after a lot of getting referrals and waiting but they did not cover the machine. Awake in America can help you there but you must have a prescription to apply for a machine through them. The local DMS here alerted me to a church that had a medical supply "closet" but there was no promise of a machine being available. I ended up finding one on Craigslist for $100.

[Gerald]

I agree with Rested Gal......she's always the "voice of reason and logic"......

If you want to check your diagnosis, purchase a SPO-7500 Recording Oximeter....a little over $400....it includes good software......and check his O2 levels while sleeping without the CPAP machine. That'll confirm your opinion.

Purchase the SPO-7500 from turnermedical.com

Gerald