Using CPAP as a screening tool

Hello,

I was just diagnosed with sleep apnea and due to our healthcare system I had to secure a system through craigslist. I want my parents to be evaluated for sleep apnea. My mom snores midly and has a lot of swelling in her legs. She was told by her primary care doctor to be checked for sleep apnea, but she refused because she didn't want to sleep in a hospital- this was before home sleep tests. My Dad has had a mini stroke, has high blood pressure and thyroid issues (all linked to untreated sleep apnea) he snores like a broken truck and at time wakes up gasping which he attributes to "saliva going down his windpipe" -

I was wondering if I could set them up with my apap and look at their data to help convince them to go for a sleep study. I could set the pressure at 4 for minimal cpap assistance and look at their AHI or just let the APAP do it's thing and show them how much pressure it took to keep their airway open.

Is this something that could be done?

There are home tests that can be ordered online which will work better.

The problem with your idea is that 4cm is still treatment AND for many people it feels like they are choking with it. You also have the issues with fitting masks.

Yes, it could be done with the apap but understand that there are limitations by doing it that way.
It's not ideal but it's something that can be tried but when people are hell bent on denying the problem unless someone really understands what the results mean ...it can back fire on the person trying to help them.

I did it with my sister and her husband along with my own brother....she had the most symptoms of OSA but didn't seem to point to her having it and her husband who had mainly minor snoring probably for sure had it but he blew it off. My brother is a lost cause and I have just given up.

There's 2 ways of trying it...doing apap mode with the range and see if the pressure moves at all assuming if it moves then the machine is responding to something it doesn't like.
Or set it for minimal cpap mode setting and see what happens and might slip past the defenses with a minimal pressure..then point to whatever slipped past the defenses as "see here this is what you have showing up".
Problem being...even the minimum pressure setting has some therapy value so it's possible that 4 cm will effectively treat some people.
Problem being some people won't be comfortable at 4 cm and you will have to use a higher minimum which of course will have even more therapy value.

So while not ideal...it's certainly better than someone not at least trying something to maybe figure out what's going on.
A better choice would be an in depth home sleep study.

But after facing same problem with my own family members....plus my own brother who I have actually watched have apnea events (in the hospital) and he totally refuses therapy despite the proof I have in the reports from 2 nights of screening...not to mention the O2 alarms going off all night in the hospital when he went to sleep.....sometimes no amount of "proof" will wake a person up enough to be motivated enough to seek therapy.

no one wants to believe they have a condition. I was vaguely aware of it 6 years ago when my college room mate told me I was choking in my sleep. It wasn't until i was falling asleep at work and at the wheel that I sought out a sleep study. My parents are open to the idea, for my mom it was a matter or not wanting to do a hospital sleep study and for my dad, he just has a "nah, its fine" outlook. I think showing them some numbers will be just what they need to get a sleep study done.

There ARE home tests now that are quite reliable, and the basis for insurance coverage for treatment. They need referrals to a sleep doctor who will set them up for home testing. There are very sophisticated but unobtrusive devices, they strap to the wrist and have two finger probes. MUCH easier than an in lab sleep test, covered by Medicare and most other insurers if you work with a sleep medicine doctor.

Using an APAP machine is questionable to most professionals, and if you find they do have OSA (no big surprise) no doctor will back up your "findings" so your parents will still be free to ignore them. Without a clinical diagnosis and a stern warning from someone with an MD after their name, your parents are free to remain in denial and that doesn't bode well for success in the difficult CPAP adjustment period.

Pugsy wrote:Yes, it could be done with the apap but understand that there are limitations by doing it that way.
It's not ideal but it's something that can be tried but when people are hell bent on denying the problem unless someone really understands what the results mean ...it can back fire on the person trying to help them.

What Pugsy says, seems to me there is a HUGE likelihood of it backfiring, by which I mean that even if you get them to agree to it, if they use it and it's difficult, which is pretty much a certainty, now they'll object to being tested more than ever! Even for someone who accepts that they have apnea and wants treatment it can be a huge challenge to use cpap at first, getting someone who has not been diagnosed to wear it could result in the very opposite of what you are after.

You need to work on them to get a proper in-home test, so that they can be properly diagnosed and a doctor can explain how life changing treatment can be, only then should they be trying CPAP. And if they refuse to be tested, as painful as it is there is nothing you can do about it.

If you want to try and diagnose, for the purpose of trying to get them to agree to a proper study, I'd use a watch type oxygen meter, but that is problematic too, because it may or may not help to detect apnea. But at least it won't give them an excuse to say "oh hell no I'm never going to do this!".

Hundreds of people have diagnosed themselves at home with help from others and software! Your pessimistic viewpoint is not going to help anyone who for whatever reason can't do an inlab study but needs Cpap. You really need to do more reading and learning before making such sweeping assumptions.

Julie wrote:Hundreds of people have diagnosed themselves at home with help from others and software! Your pessimistic viewpoint is not going to help anyone who for whatever reason can't do an inlab study but needs Cpap. You really need to do more reading and learning before making such sweeping assumptions.

That applies only to people who WANT to have help.

This is just as likely to backfire because of the sensation of the mask on the face.

I think the APAP would be a bad idea especially since you would have to get them adjusted to the wearing the mask. Why not try a pluse-oximeter. At least it should show you if apneas are occurring. I know in my case the SpO2 plots correlate very well to the apneas showing on the flow plots. The type that you wear on your wrist with a soft finger probe is very easy to sleep with and valuable tool to have in monitoring your sleep apnea.

The problem with relying on a pulse oximeter alone is that not everyone will have significant desats with apnea events. Sleep apnea could be severe and not experience much of a drop in O2. I have a friend who has severe OSA with 60 plus events per hour and her O2 levels never dropped below 95%. I saw the report and was dumbfounded but it was there in black and white.

So while a pulse oximeter can be useful...it isn't without its limitations also.

I have a friend who was having severe fatigue issues. She had a sleep study years ago, which was apparently negative. She had a huge work up for the fatigue and they decided she had narcolepsy and gave her Provigil- a stimulant.

Even with the Provigil she felt like crap and was using caffeine pills too. I got my CPAP and came here and read about UARS and how not all sleep studies test for it. Given her slim build, I wondered if that's what she had. I told her to look into another sleep study that would look at that specifically.

In the meantime, I offered to let her borrow my Autoset for Her CPAP, to see if she felt better. She used it for a little over a week with wide open settings and felt dramatically better. I looked at her data on Sleepyhead and was surprised to see the machine titrating her to higher pressures than I needed- and flagging many events- especially on her first night: OA's, CA's, and RERA's. I told her now I definitely suspected her fatigue issues were related to some form of sleep disordered breathing. I suspected she would get a diagnosis not as Plain Jane as good ol' OSA at this point.

So back she went armed with this anecdotal data asking for another sleep study. She called around finding a sleep center that would look for UARS. Her doctor gladly ordered a new sleep study.

The results showed moderate OSA. I was glad for her that she got a straightforward diagnosis this time, so she would have no problem getting a machine. Her primary then sent her for a titration study, and she was titrated to a pressure of 6. Then her primary care said he didn't think she needed a CPAP at that low pressure! Thank goodness for this board, once again. And I was able to pull out the Sleepyhead data again and remind her she was routinely being titrated by the Autoset up to 12. I encouraged her to ask for an Autoset, given that information- plus the likely hood that sleep studies have limited REM or supine sleep. So she did. At this point her primary bowed out and sent her to a sleep specialist- who gladly prescribed the Autoset.

And now she uses it nightly and feels much better. So there's my happily ever CPAP as a screening (not diagnostic) tool.

Interesting! That's great that you were able to help her figure it out. I think the distinction of cpap as a screening (not diagnostic!) tool is very important. I don't expect that this will take place of a sleep study for my parents, just that if there is an issue this is going to give them a swift kick in the behind to get things squared away. They aren't resistant or unwilling, they just don't quite have the motivation to spend a lot of money in doctor's visits and tests for something that may or may not exist. If they see data that shows there is likely an issue, that will be sufficient for them to pursue it further.

No one is suggesting to rely on a oximeter to rule out apneas, only Polysomnography could do that and in this case that is clearly not going to happen. The oximeter is a simple and inexpensive tool that can show that apneas are probably occurring. Of course it can't determine that they aren't occurring.

Julie wrote:Hundreds of people have diagnosed themselves at home with help from others and software!

Julie, please reread my post. I only advised against using CPAP as a testing tool, in no way did I say not to help them get a diagnosis at home.

Your pessimistic viewpoint...

It's not a pessimistic viewpoint, it's a viewpoint that is based on having a good understanding of human nature, and his description of the situation. It's easy when you are emotionally involved to want to push to help, but it's a fine line that can backfire so caution is required. I've been there and done that and dealt with multiple people that would prefer denial to seeing a doctor and dealing with an issue. My viewpoint is actually optimistic in the sense that I'm advising him to try a strategy that is more likely to succeed - an oximeter (which is imperfect) as a first step, and then preferably an in-house test.

is not going to help anyone who for whatever reason can't do an inlab study but needs Cpap. You really need to do more reading and learning before making such sweeping assumptions.

And you really need to read what I actually said and not project things I didn't say onto it. I didn't say anywhere that they needed an in lab study, I just said it would be better to use an oximeter and to press them to get a proper test. Based on his description about his Mom saying she would never sleep in a hospital, as well as his Dad's reaction, it clearly seems like an home study is the solution they are more likely to agree to, and that certainly qualifies as a proper test.

Thatgirl story is great, but I want to point out there is a huge difference - she had someone actively seeking help for a situation she had been trying to solve.

Jimsp1, I could be entirely wrong on my fear of cpap backfiring and best of luck whichever path you push for. Just to clarify one last time, all I am saying is I would try an oximeter (imperfect as it is) first. Of the the watch variety or they may also object to wearing that all night, as the finger only ones can be uncomfortable. Then push for an in-home lab test. I'd use the cpap as the last option.

Good luck!