REM Only Sleep Apnea -- Doctor Doesn't get it...

[Guest]

So I had my follow up after my sleep study today. The doctor, well, I'm just not sure about him...

He said that both of my sleep tests came back normal, including the Multi-Latency. However, how is this normal? In REM sleep in the first study by RDI jumped up to 37 when events didn't occur elsewhere, and in the second study, it was at 34. Now, mind you, my amount of REM sleep was only 7% on the first test and down to 4% on the second test. So within about a 12 minute period he said there was about 16 events. But this won't make me tired? How so? He also said that we can go entirely without REM sleep. I didn't think that was the case. The studies I have always heard of demonstrated that after a few days with none of it people start to show symptoms of psychiatric disorders such as hallucinations, and when rats were deprived of it after a few weeks they died.

Finally I handed him my group of abstracts from medical journals on REM only sleep apnea and he said I made a good case about it, and using the scale they used in one study my numbers are off the chart for being high. Yet he insists insurance won't cover it, and he won't even try and get it through, although mine tends to be fairly agreeable. UGH! Doctors...

I feel miserable and just can't get someone to see this problem as something that's actually wrong. Okay, I get that the standard is to look at the numbers across the whole night, but obviously new research is demonstrating that that might not always work for some people. I feel like I'm banging my head against the wall... Any advice on getting a CPAP or anyone with a similar clinical problem?

[chunkyfrog]

--and you would be in an HMO?
You need to involve some insurance regulator, perhaps.

[Guest]

Yeah, HMO. The stupid thing is my insurance is saying they will probably cover it if he would just submit it but nope...

[Goofproof]

Or get a script and get a APAP and the software out of pocket, spending a few bucks is cheap compared to lose of your health. Jim

[Guest]

That's what I was thinking, but I'm having issues getting anyone to write me a script.... Them and they're stupid indexes! Okay, I get that GENERALLY it's averaged over the whole night, but people are different... I figured out my AHI index. Seems a little weird, but the AHI is 52 for the first one, and 48 for the second one when you look only at REM which is where it is only occurring. I understand that is where most people see it the worst, but I even backed up how my results go along with what new research is finding about REM only and still no where... UGH!

[Pugsy]

My sleep study showed AHI in REM 53
and Non REM was only 12 AHI...barely diagnostic.
My doctor based the diagnosis on the REM AHI and I got "severe obstructive sleep apnea".
My oxygen levels dropped to 73%.

And yes, untreated you don't get much REM because the events snap you out of REM sleep and yes, you feel horrible.

If you can't find anyone to give you a RX and you want to get a machine anyway and you have the funds to purchase a machine out of pocket...there are ways to get a machine. Are you willing to self treat with a machine you buy on your own?

[Guest]

That's what I told him he needs to do, is base it off the REM indexes but he won't. He insists that won't work. Won't even check...

I just need to feel better... I'm 22 a senior in college and about to fail classes because I feel so bad. I might try one more thing to get one then I'm out of ideas.

[RocketGirl]

If you don't already have it, make sure you get a complete copy of your sleep study results. Make a copy to keep and one to give. Then ask around and find a different doctor who can read them. There is nothing to say that you can't ask for a second opinion from a different physician - especially as your HMO seems to be on board in principle.

[BlackSpinner]

That's what I told him he needs to do, is base it off the REM indexes but he won't. He insists that won't work. Won't even check...

I just need to feel better... I'm 22 a senior in college and about to fail classes because I feel so bad. I might try one more thing to get one then I'm out of ideas.

Get your dentist to write the prescription or walk into any other doctors office with you sleep study, pay cash and get a prescription. You are a student, do some networking to find a medic who will write what ever you want them too.

[SleepingUgly]

In one of my sleep studies, my REM RDI was 58 and my NREM RDI was 4. But because I had a normal amount of REM, in contrast to you, that led to an overall RDI of 12-13, so it was considered significant. In my last one it was still something like 50 and 6, respectively.

I have a very hard time with sleep doctors using the mean as a measure of central tendency in the presence of outliers. To say my RDI is 13 neither represents my NREM or my REM sleep well. I think doctors could use a statistics course before they are allowed to become physicians...

[Guest]

That's the truth. I'm sort of wondering about their ability to figure the RDI and AHI.

In my first study, the REM RDI was 37 and overall was only a 4. In the second, REM RDI was 34 and overall was 2.1. Now when I figured the AHI it was much higher than the RDI number. I know they each figure in different things, though.

[SleepingUgly]

Go into google scholar and look REM-dependent OSA. Give the articles to your doctor, and get him to write the Rx. If that doesn't work, take it to another doctor.

I read somewhere that REM-dependent OSA is more common among women.

[Guest]

Actually I did just that... and he still won't and won't even try to get approval from insurance. I'm giving him one more chance tomorrow when I call and then I'm done and finding someone else...

[SleepingUgly]

Did you find this one, with it's oh-so-relevant recommendations?

http://www.aasmnet.org/JCSM/Articles/020115.pdf

[Guest]

No I hadn't. Thank you so much! As much support as I can get is greatly appreciated! I need as much info as possible...