A Fishy Diagnosis & Process

Hi there. I was kindly directed towards this group from another site and would appreciate any thoughts on my situation. I was feeling tired for many years and my doctor sent me in for a sleep test for apnea. They gave me a portable unit to use at home. The tech, a nice guy, told me that there were 3 possible outcomes: 1) I would be positive for apnea, 2) I would be negative and 3) It would be inconclusive. Since the machine itself was considered unreliable, results 2 & 3 would lead to a hospital stay study to get better data. Essentially, it seemed like I was just jumping through an insurance hoop in order to get to the next step (sorry, a little jaded when it comes to insurance companies). Anyway, I brought the box back in the next day and the person analyzed the data while I waited. I had figured that I would ge result # 3, since the machine seemed to be constantly warning me that one of the sensors wasn't recording. Also, I was on my back the whole night with it, which made me wonder if the experiment was flawed. The doctor said that I had 5.6 apnea events per hour. I had no idea if this was a little or a lot. He said that it was moderate. Does that sound right to you? Also, he went on to say that he'd be happy to order me a CPAP machine through my insurance and did I want to go ahead with that. I know very little about apneas & machines and asked to see a sleep doctor before making any decisions. I thought that it was odd that the next step was just to grab some rand machine. There seem to be so many out there with various features & masks. I had no idea how to use it. I called the sleep doctor and was told that I could make an appointment for a few months from now, but I had to have a month's worth of data before she'd see me. I'm left here with little information on what apneas are to start with machines and whether my test was even any good. My main question for this group is, does this sound right? Is this how things roll during an apnea diagnosis? I didn't want to be negative towards a system that's trying to help me, but I feel like I need to do some advocacy on my part before I start treatment. Does this make sense?

Many thanks for any insights,

Caseous

A lot depends on your country and your insurance.
Without that information, we can not say.

An AHI reading of 15-30 is considered Moderate. Your 5.6 is considered Mild. This means that you stopped breathing for at least 10 seconds or more an average of 5.6 times an hour. An ahi of less that 5 is normally not treated. It might be good to "trial" a machine for a month to see what it does for you.
The place that gives you the machine "should" familiarize you with the machine.

https://www.verywell.com/what-is-ahi-3015131

If you routinely sleep on your back, the number of events will be much higher, so at your already low result, if you can learn to sleep on your side (if this idea fits) you may well end up with little to no apneas at all...

My AHI was similar to yours. I felt tired all my life. Getting on CPAP was a very good idea for me!

With an AHI of 5, that's like someone poking you till you wake up every 12 minutes, all night long. No wonder you are feeling tired. With cpap, you work towards getting that AHI lower.

There usually are insurance and procedural hoops to jump through. If it were me, considering that you are symptomatic, I'd want to take it to the next step even if only for peace of mind. I would think they are going to give you an auto adjusting machine that will determine your pressure needs. The data from that machine may make it clearer how far you need to take this. For instance, if it reports that your pressure increases each night, then apparently it is responding to a need. Nothing is absolute here, but when in doubt, I'm thinking to err on the side of caution. Especially since you had some sensor errors during the study. What if without those errors you could have recorded more events?

Do be mindful that your symptoms could be caused by other things unrelated to sleep apnea. There are other sleep disorders too. Leg movements disturb sleep for some. Medication side effect is also to be considered, and several health conditions. Good luck with sorting through things. I suggest you do some fact-finding before you start. What exact machine will they dispense for the 30 days? What is that cost? After that time if you choose to continue with treatment, will you keep the same machine or get another one? Sometimes used machines are dispensed as loaners only. Two considerations here - will a 2nd machine be of the same caliber with treatment data capabilities (not just hours of use), and, if you keep the same machine make sure you aren't paying new prices for a used machine. Some insurances have a rental period before purchases. If you take some time to gather info, you can hopefully avoid buyer's remorse.

Thanks so much, everyone! I will take your advice and seek further information!

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The AHI is only one benchmark. There is a huge difference between not breathing for 10 seconds or not breathing for 30 seconds. There is also the Oxygen levels.

A cpap machine will ensure that your body & brain get the O2 it needs to function and repair itself.

Once you get on a machine, keep a detailed diary of how you feel physically, mentally and emotionally since it affects all of those things and some changes will be subtle but important.

Make sure you get a machine which will provide you data that records leak rates and AHI.

But remember it can take longer than a month. Body repair will take time. One of my symptoms was frequent night trips to the bathroom. The machine fixed that right away. That alone was enough for me to want to keep the machine.

It was some time later that I finally realized I could drive at night, or family events, people reminding me that I wasn't sawing logs in the corner.

Most of the changes are subtle and creep up on you just like when the apnea stole those abilities.

I probably would have not got the treatment I needed if not for reading/lurking at this group.

Read what you can. Make informed decisions. PAP (Positive Air Pressure) is the gold standard of treatment.

Join the forum!

Pesser wrote:My AHI was similar to yours. I felt tired all my life. Getting on CPAP was a very good idea for me!

Indeed. I had an average AHI of about 5 on my old machine yet had been suffering from poor sleep, nightmares, tiredness and increasingly severe morning headaches for over six months. A couple of weeks ago I bought a new blower and started using a chinstrap again. My average AHI is now around 2.5, the headaches have essentially gone, I'm waking up feeling refreshed and even the nightmares seem to be fewer and less gruesome.

Life is better when you're sleeping well, much better. Don't assume your AHI is good enough even if others tell you it is. Find out for yourself by going lower if at all possible (through experimentation) and seeing if it makes a difference to your quality of life. Make the effort - it's worth it.

I saw a sleep specialist on-post (I'm a military wife) and my process was pretty much like yours. I was given a machine to get home, two days later they told me I had 5.5 ahi which makes my apnea "mild" and was offered either a dental appliance or a cpap machine. I thought of the dental apliance but my dental insurance doesn't cover many things while the medical is awesome. Dr chose the machine she thought appropriate and sent me home. A few weeks later a hme company gave me my machine and I've been having fully awake days for three weeks now.
Home tests are used sometimes, I dont know why they told you they are "unreliable", I never heard such a thing and I definitely don't regret having my test that way, in the comfort of my own bed.

Caseous1 wrote:The doctor said that I had 5.6 apnea events per hour.

If you sleep 7 hours per night, that is about 40 awakenings each night. Do you think a person waking up 40 times per night can ever be healthy and feel energetic?

It's not that home tests are unreliable, but that there are other apnea related (and a couple more neuro related) conditions that home tests don't pick up on, and they can be important if you have them but aren't diagnosed, plus your choice of machine makes a big difference in such cases.