Was my OSA misdiagnosed?

Pugsy · Post by **Pugsy** » Tue Jul 16, 2013 1:48 pm

There's a stereotype for Sleep apnea patients and it is just plain wrong.

We aren't all fat with massive necks. We don't all snore like freight trains either. It doesn't just happen to old people nor primarily the male of the species.

There are people who snore who don't have sleep apnea..they just snore.
There are people who do have sleep apnea but don't snore.
Not everyone will have oxygen level drops associated with their sleep apnea.
It's more than an AHI...it's a quality of sleep issue. Ask anyone with insomnia that doesn't have sleep apnea if they feel good the next day...they won't.

My sister has every symptom in the book for OSA and she also has the body size to go along with it...but doesn't have sleep apnea.
Once we figured that out she looked at her meds for possible complicating factors and discovered her blood pressure meds were known to cause fatigue...changed her meds and felt immediately better.
Her husband...doesn't have any typical sleep apnea symptoms except for very minor snoring...he has sleep apnea but blew it off.
There are simply no hard fast rules when it comes to this diagnosis.

laserjobs · Post by **laserjobs** » Tue Jul 16, 2013 10:20 pm

Well I am going to try straight CPAP at 8 and see if there is any different results. I am really wondering if the doctors are barking up the wrong tree at this point.

laserjobs · Post by **laserjobs** » Wed Jul 17, 2013 7:56 am

Last night at a straight pressure of 8 as prescribed by my pulmonary doctor. This is looking a lot worse IMHO and I am not feeling any better. Min 8 Max 8 – AHI 2.5 NRI 0.50 EPI 1

HoseCrusher · Post by **HoseCrusher** » Wed Jul 17, 2013 10:11 am

Let's look at your data numbers.

Before you had a basal SpO2 of 93.4% and an average pulse of 66.6 bpm.

Last night you had a basal SpO2 of 92.7% and an average pulse of 69.3 bpm.

Not a lot of change...

Looking at the distribution graphs it appears that it took you longer to get to sleep last night when compared with your before graphs.

The problem is that you are not feeling better. I don't see anything that shouts out relative to your oxygen saturation or heart rate so it may be time to look elsewhere.

The positive side of this is that your heart is beating and your blood is carrying adequate oxygen... Isn't that wonderful news?

laserjobs · Post by **laserjobs** » Wed Jul 17, 2013 12:20 pm

HoseCrusher wrote:Let's look at your data numbers.

Before you had a basal SpO2 of 93.4% and an average pulse of 66.6 bpm.

Last night you had a basal SpO2 of 92.7% and an average pulse of 69.3 bpm.

Not a lot of change...

Looking at the distribution graphs it appears that it took you longer to get to sleep last night when compared with your before graphs.

The problem is that you are not feeling better. I don't see anything that shouts out relative to your oxygen saturation or heart rate so it may be time to look elsewhere.

The positive side of this is that your heart is beating and your blood is carrying adequate oxygen... Isn't that wonderful news?

LOL! Yes that is good news. Now only if the Doctor could have figured this out since my out of pocket costs are now reaching the $3000 mark without a resolution to my polycythemia or testosterone levels. I am going to try an APAP setting of 4 to 8 for a few weeks and see if there is any improvement in my blood tests. The titration of 4.5 might be enough to keep my O2 levels from dropping below 88 from time to time.

For the record I had an appointment today with what I thought was with the doctor. Nope, it was for a CPAP follow-up with his assistant and the doctor was not even in the office. So another $100 out the door for absolutely no service provided. Here is the kicker, she did not even know how to read the codes off the machine!

I really appreciate all the help and advice as well as allowing me to vent. Thanks for saving my sanity!

laserjobs · Post by **laserjobs** » Thu Jul 18, 2013 8:18 am

The wife said that she could hear the APAP ramp up last night several times.

95th Percentile Pressure 4.5
90th Percentile Pressure 4.5
AHI 1.0
Pressure Plateau Time 0%
High Leak Flow Time 0%
NRI 0.25
EPI 1

Probably best if i stop worrying about it, set it on auto from 4-10 and test my O2 levels overnight every month.

laserjobs · Post by **laserjobs** » Fri Jul 26, 2013 2:17 pm

Spoke with my doctor today and got the results of my overnight titration study. 8 was prescribed but he saw good results at 6. So the doctor said to set it up with a min and max of 6 and see how that works. He also thinks I would be a good candidate for an oral appliance instead of the CPAP.

laserjobs · Post by **laserjobs** » Mon Sep 23, 2013 8:06 am

So here is an update:

SpO2 reports are pretty well the same with or without the CPAP.
SpO2 AHI is always below 5 and O2 levels not dropping below 88.

The doctor measured me up at around 15 AHI and an O2 low of 82 that I can not duplicate.

The main thing is the CPAP is not noticeably increasing my quality of life and from what I have read should be doing a little bit at least.

All in all I have spent around $2500 for this diagnosis and equipment.

It does not seem all in vain as I was able to help my father test his AHI that came out to 28 and his O2 levels were dropping down to 60 at night. He has since gone to a doctor and is currently trying out an APAP. So it looks like I will just give him my APAP.

chunkyfrog · Post by **chunkyfrog** » Mon Sep 23, 2013 8:30 am

IMHO, you gave up too soon. For many people, it may take months just to get used to the equipment.
It took around 4-5 months for me to feel a little more energy.
For me, the apnea was giving me severe insomnia--I wasn't getting enough sleep.
That got better right away, even though the mask was the wrong one, causing nose sores and tooth movement.
I finally have a mask that fits well enough I don't have to trade around to let my nose heal.

oak · Post by **oak** » Mon Sep 23, 2013 8:32 am

how many hours per night are you using your APAP? how many hours per night do you sleep?

i am not in your shoes, with mild apnea, but i still don't think i would be bringing that machine over to the relatives house just yet.

laserjobs · Post by **laserjobs** » Mon Sep 23, 2013 8:58 am

Here is the thing, my APAP has only adjusted upwards a half point from 4.5 to 5 and at 5 it never moves upwards according to the reports. I have tried it at 6 (as my doctor suggested) for a month with no improvement noticed. I have been very consistent with using it nightly and sleep 7-8 hours with it on. It has been the last week I have been going without and measuring the results. The SpO2 reports look virtually no different with or without CPAP. There is no compliance issues as the mask fits fine, no leaks and is comfortable. My thoughts were if the AHI is under 5 and the O2 levels are not dropping below 88 then there is nothing to correct.

chunkyfrog · Post by **chunkyfrog** » Mon Sep 23, 2013 9:05 am

Maybe I'm a delicate flower, but my diagnosed AHI of 13 was ruining my life.
Treatment keeps it at or below 1 most of the time.
If it pops above 2, I usually feel like cr@p. Five would not do it for me--and many others here.

HoseCrusher · Post by **HoseCrusher** » Mon Sep 23, 2013 1:19 pm

I think you gave it a good shot. Now you can take what you learned from this exercise and move on to discover how to maximize your health.

Was my OSA misdiagnosed?

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