Slightly Nervous but Determined Newbie Intro-Study Results

[mint0101]

Hello,

I'm newly diagnosed with OSA and have been lurking around this board for a few days, awaiting my sleep study results. I'm a mid-30's female, I guess I am an "atypical" OSA patient as I am female, young and BMI slightly under 20. My mother has OSA, as well as her mother, so I can thank them for my genetics....

Since I am very new to this, I'd like to share my split night sleep study results--below.

Although my OSA is considered "moderate", as many of you can attest--my daytime sleepiness and exhaustion has been quite draining, and I'm finally thrilled to get my diagnosis so I can start to feel better!

Diagnostic Portion
Total Sleep Time (TST) (min): 159.5
Sleep Efficiency: 83.5%
Sleep Latency (min): 8.5
Stage REM Latency (min): 144.5
Wake after sleep onset (WASO) (min): 23.0

Stage N1 Sleep (min, % of TST): 7.5 (4.7%)
Stage N2 Sleep (min, % of TST): 108.0 (67.7%)
Stage N3 Sleep (min, % of TST): 24.0 (15.0%)
Stage R Sleep (min, % of TST): 20.0 (12.5%)
Supine Sleep (min): 91.5
Arousals (index, #): 37.6 (100)

RESPIRATORY ANALYSIS: (index = #/hr)
Apnea/Hypopnea Index (AHI): 15.4
NREM AHI: 10.3
REM AHI: 51.0
Non-Supine AHI: 27.4
Supine AHI: 6.6

Respiratory Disturbance Index (RDI): 16.9
NREM RDI: 12.0
REM RDI: 51.0

Apneas (index, #): 0.0 (0)
Obstructive Apneas (index, #): 0.0 (0)
Mixed Apneas (index, #): 0.0 (0)
Central Apneas (index, #): 0.0 (0)
Hypopneas (index, #): 15.4 (41)
RERAs (index, #): 1.5 (4)

Mean Awake SpO2: 97%
Mean Sleep SpO2: 96%
Minimum Sleep SpO2: 86%
Sleep Time with SpO2 < 88% (min, % of TST): 0.3 (0.2%)

CARDIAC ANALYSIS:
Mean Awake HR: 71
Mean Sleep HR: 71

Bradycardia: No
Asystole: No
Sinus tachycardia: No
Narrow Complex Tachycardia: No
Wide Complex Tachycardia: No
Atrial Fibrillation: No
Other: None

LIMB MOVEMENT ANALYSIS:
Periodic Limb Movements of sleep (PLMS) (index, #): 0.0 (0)
PLMS with arousals (index, #): 0.0 (0)

Specifically--my question is, even when my AHI is around 16, what contributes to my high number of arousals per hour? (37) What else besides my hypoapneas might be causing the arousals? Your insight would be greatly appreciated.

My next challenge is with Apria, my DME...on Monday...I'm praying for a successful visit but having read some of your struggles with DMEs, I feel I am as best prepared as I can be....I've already spoken with my insurance (HealthNet HMO) who informed me that they don't require CPAP rentals prior to purchase, but Apria has told me that my insurance requires 3 months rental & compliance before purchase...I'll be calling my insurance early on Monday morn to clarify this...

Thank you very very much! I look forward to sharing my journey with you--as well as participating in yours.

[Janknitz]

Rule of thumb: NEVER, NEVER, NEVER, ever, ever, ever, take the DMEs word for anything.

Get a copy of the prescription in your hand, and if Crapria tells you something different than your insurer, insist on a conference call with the insurer to clarify purchase vs rental. Be sure to read "What you need to know BEFORE you meet your DME" in my signature below. Refuse to accept anything other than what you want-don't let them wear you down because they won't let you return it. You're the one who has to sleep with it every night.

[mint0101]

Janknitz--I want to thank you for your blog entries on DMEs...it's been very very helpful. Do I call Apria and insist on a three way convo with my insurer? Or do I call my insurer?

I know for sure my insurance clearly told me that they do not require rentals. So how do you think is best to remedy this? My appointment at Crapria is in early afternoon on Monday...

[avi123]

Hi, I am looking at following data and can't guess what could be wrong with you b/c there is nothing out of the ordinary than the REM AHI of 51. The REM RDI is also 51 meaning that you don't have Upper Airway Resistance syndrome(UARs).

Do you have any underlying medical condition besides the OSA?

I'm a mid-30's female

BMI slightly under 20

RESPIRATORY ANALYSIS: (index = #/hr)
Apnea/Hypopnea Index (AHI): 15.4
NREM AHI: 10.3
REM AHI: 51.0
Non-Supine AHI: 27.4
Supine AHI: 6.6


Respiratory Disturbance Index (RDI): 16.9
NREM RDI: 12.0
REM RDI: 51.0

Minimum Sleep SpO2: 86%


p.s. you may see that we talk here a lot about Silicone with E at the end which is different than Silicon.

[mint0101]

Hi, I am looking at following data and can't guess what could be wrong with you b/c there is nothing out of the ordinary than the REM AHI of 51. The REM RDI is also 51 meaning that you don't have Upper Airway Resistance syndrome(UARs).

Do you have any underlying medical condition besides the OSA?

Avi--I don't have any other health conditions other than migraine headaches, which I believe may stem from my now diagnosed sleep apnea. 'Tis a mystery!

[Janknitz]

Mint, if you are going to Crapria to pick up your equipment, you stand your ground right there. Refuse to accept the machine as a rental or sign any papers to that effect. Tell them to get your insurer on the phone so that you can both hear, at the same time, whether a rental is required or not.

And refuse to sign anything or walk out without a fully data capable machine. NOTHING with "Escape" in the name (ResMed) or and for Respironics turn it over and look at the model number--650 or 660 only. It's also a good idea to learn how to check run hours on both machines, so you don't get stuck with a used one.

[Captain_Midnight]

New poster Mint writes...I'm newly diagnosed with OSA and have been lurking around this board for a few days, awaiting my sleep study results. I'm a mid-30's female, I guess I am an "atypical" OSA patient as I am female, young and BMI slightly under 20. My mother has OSA, as well as her mother, so I can thank them for my genetics....

Ah, genetics and upper airway architecture. I can thank also them for OSA (since childhood according to pulmonologist), even though I am also within normal weight limits. I'm pretty sure that both parents had it, as do both brothers. I mention this because I tend to think that those who have had OSA for years, since childhood, might tend to be more sensitive to the inflammatory and stress hormonal effects (due to years of involuntary "practice".) I also suspect that we might be more inclined toward hypopneas, because we have somehow developed this as a mechanism to keep us out of total OSA occlusions.

As far as AHI, the divisions between mild (ha!), moderate, and severe are arbitrary, and there are OSA patients who read their nightly data that tell you that they can feel noticeably icky with AHIs even below mild. (I can usually tell the difference if I have an evening AHI above 1.0, as an example).

You mention two things that will serve you well, and I believe that these might also help the newly diagnosed who read this at a later time.

You describe yourself as (1) "determined" and (2) "...finally thrilled to get my diagnosis so I can start to feel better!" . Good on ya. Determination, optimism (and a sense of humor) will take you the distance. There will, of course, be some speed bumps along the way, but a humorous approach to inevitable "surprises"and "issues", determination (and a resistance to any self pity or ranting) are the some of the keys to success.
Anything else? Just make sure that your unit is fully data capable, so you can use the nightly data as feedback to assess your therapy.

Hope to read your "success stories" at a subsequent posting.

.

[Bill44133]

Since you are new I would strongly recommend that you take a few minutes out to review this video:

http://www.resmed.com/us/multimedia/und ... 40x380.swf

The video helped me to understand what exactly was wrong, and I used it to explain to family and friends what was wrong with me.
it put everything into perspective for me. i hope that it helps you also.

Welcome to the forum! You are in a good place.

I wish you well!

[mint0101]

Mint, if you are going to Crapria to pick up your equipment, you stand your ground right there. Refuse to accept the machine as a rental or sign any papers to that effect. Tell them to get your insurer on the phone so that you can both hear, at the same time, whether a rental is required or not.

And refuse to sign anything or walk out without a fully data capable machine. NOTHING with "Escape" in the name (ResMed) or and for Respironics turn it over and look at the model number--650 or 660 only. It's also a good idea to learn how to check run hours on both machines, so you don't get stuck with a used one.

Janknitz, this is great advice--THANK YOU. I will do exactly as you say. The Apria person on the phone who called me to let me know that insurance has authorized the CPAP--also wanted my credit card info. I refused to give it to her. She was very upset, and I asked her if they accept checks or cash. She said no--credit card only, because then they can charge any recurring charges directly to my card.

That sounds REALLY fishy, I am going to talk to my insurance to try to sway them to accept another DME instead...Apria is listed as the only "Preferred" DME according to my insurance, but they will accept any DME my doctor puts on the prescription. The co-pay/deductible will be the same.

My physician prescribed me the ResMed S9 Autoset, I will not accept any other machine, I'm hearing great things about it from this board. So I"ll stick to my guns for sure!

And to Captain Midnight and Bill--thank you for your kind words, I look forward to hopefully sharing some positive updates soon Hopefully I'll be more rested...once I wrassle with my DME first....

[Pugsy]

In the Respironics machine lines...model number 450 or higher are the full data models.

Not 660 or 650..those are bipap machine model numbers. Unlikely that your RX called for bipap.

the 50 part of the number means 50 series model
60 part of the number means 60 series which is the latest model and has a heated hose option.
Not many 50 series being dispensed now unless used or sitting on the shelf a long time.

Model 450/460 PR System One Pro....single fixed cpap machine..
Model 550/560.. PR System One Auto CPAP...auto adjusting pressure machine..has APAP mode as well as cpap mode.

Model 650/660....PR System One Pro BiPap....dual pressure machine
Model 750/760...PR System One Auto BiPap....has auto adjusting dual pressure

Anything below model 450 doesn't offer any data other than hours of use.

[mint0101]

Thanks for the info, Pugsy--my doc prescribed the ResMEd S9 Autoset, which --guessing from the posts on this board--is a really good machine.

[Pugsy]

my doc prescribed the ResMEd S9 Autoset, which --guessing from the posts on this board--is a really good machine.

Yep, great machine. Just make sure that is what you get.
ResMed makes the Escape Auto which functions just like the AutoSet but the data it collects for therapy evaluation is severely limited
Model names for Resmed S9 machines are easy to see...on the top of the machine by the LCD screen..plainly shown.
The Respironics machine names aren't so easy to tell the models unless someone is really familiar with terminology and that's why it is easier to tell newbies to look for model number on the Respironics machines.

You will want a copy of the clinical/provider manual. You can download it here.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf

[mint0101]

Rule of thumb: NEVER, NEVER, NEVER, ever, ever, ever, take the DMEs word for anything.

Get a copy of the prescription in your hand, and if Crapria tells you something different than your insurer, insist on a conference call with the insurer to clarify purchase vs rental. Be sure to read "What you need to know BEFORE you meet your DME" in my signature below. Refuse to accept anything other than what you want-don't let them wear you down because they won't let you return it. You're the one who has to sleep with it every night.

Janknitz--after dealing with Apri for approx 10 minutes--I've decided to drop them as my DME...I can't trust them.

I'm considering other DME options, or even prefer to go Out of Network for my CPAP...but thank you for your help!!