Possible false reading on itamar watch pat200? If not, advic

So, I have had some sleep issues for as long as I can remember. I have always had insomnia issues and I have always tossed and turned.

I recently went into the doctor because I was having issues with my stomach, throwing up very frequently, and at the same time my sleep has gotten much worse. As I've always tossed and turned, it's not unusual for me to wake up in a somewhat uncomfortable position, however it used to be that when this happened I could adjust myself and pass right back out, now if I wake up, I can't fall back asleep, sometimes for hours. I have also started waking up with night sweats (confirmed not menopause) sometimes so bad my hair is basically matted to my neck.

The dr suggested the sleep apnea test, and though I was highly doubtful I was at a point between the lack of sleep and being physically ill all the time I was so exhausted I would do anything they asked of me as long as they find a way for me to sleep.

They sent me home with the watch test I listed in the title. In all the posts or articles I could find looking for possibilities of false positives things like chest straps and some sort of nose tubing were used as well, not just something on your fingers like I was given.

They originally told me that my results were inconclusive as I only slept 4 hours that night, which at this point is the normal for me. A few days later they called and said the dr looked at those 4 hours and I was diagnosed with severe, obstructive sleep apnea.

I brought home a loaner cpap machine for 1 week which included an over nose mask that strapped around the back of my head as well as around my forehead. I then went back in and received my permanent machine as well as nose pillow masks which I used for about a week. We are currently in an argument which I will get to below, but first my questions about the possible false positive.

My reasons for originally doubting that sleep apnea was the issue were these. My symptoms of tossing and turning and waking up throughout the night have always existed, it is only since I have lost my ability to fall back asleep that I have stopped feeling rested. I have never felt short of breath upon weakening. When I could sleep more than 5 hours max a night, I did feel rested. I do not snore. I am overweight however my neck circumference is below 16 inches. My cousin had an ex who had sleep apnea and she would always hear him stop breathing, her and I have shared a bed on many, many occasions and she has never heard anything like that from me.

What lead me to create this post however was an appointment I had with my dentist recently. He said my airway looked very open for someone diagnosed with obstructive sleep apnea. He also asked if they did any sort of digital imaging and where they thought the obstruction was, they did not and they did not tell me where they think the obstruction is. So my question is, is it possible that the positive reading was false, and if it wasn't completely false is it possible it was false about the obstructive part and that I have central sleep apnea instead?

Now, if there's little to no chance that the reading was false, or if my best/only option is still a cpap machine regardless of it being obstructive or central, me and my machine may need some couples counseling to get this relationship to work.

The issue is that though the dr says the machine is keeping me breathing, this has done absolutely nothing to stop my bodies mission of destroying my bed as I sleep. I still toss and turn constantly. With the full over the nose around the forehead mask one of the biggest issues I had was I get headaches, and having something strapped around my forehead not only seemed to increase their frequency but also the pressure to my forehead caused more pain. Aside from that, the tossing and turning has created issues with both types of masks I've used. With the first, over the nose mask, I would wake up because I had turned my head down mostly on my pillow and pushed it weird and now had air blowing into my eye or other various situations like that where my tossing and turning pushed it into my face in a way that woke me up. With the nose pillows I am simply not keeping them on. I have woken up with it down around my neck like a necklace, wrapped around my arm, and entirely underneath me. My dr's suggestion to waking up with it off you is to set alarms throughout the night to put it back on.

The issue here I'm having is that the mask itself, and the solution to my taking the mask off in my sleep, both exacerbate the original issue I came in for, which is that I am waking up, and then unable to fall back asleep. If I can't fall back asleep after waking up to pull my arm out from under myself in some weird position, I certainly can't fall back asleep after waking up to an alarm, untangling myself from a bunch of tubing and re-adjusting my mask. At that point I may as well get up and go make myself a cup of coffee because sleep is out the window.

Any advice for trying to keep the mask on and actually sleep through the night with it would be greatly appreciated, while I have my doubts about having sleep apnea I am still desperate enough to keep trying anything.




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rainydaichick,

In my humble opinion, the Itamar WatchPAT sleep study that diagnosed you with severe sleep apnea has almost NO chance of being a "false positive." In other words, the WatchPAT is a reliable diagnostic tool, and if it says you have severe OSA, then you do indeed have OSA. And you need to be on CPAP.

rainydaichick wrote:So, I have had some sleep issues for as long as I can remember. I have always had insomnia issues and I have always tossed and turned.

Untreated OSA can cause insomnia. It can also aggravate insomnia issues. And untreated OSA tends to get worse as we get older. It may be that you always had some mild OSA, even as a kid, but that through the years, the OSA has grown worse.

I recently went into the doctor because I was having issues with my stomach, throwing up very frequently, and at the same time my sleep has gotten much worse.

Untreated severe OSA can cause the lower esophageal sphincter to open which allows regurgitation. And that would explain the stomach issues: As your untreated OSA grew worse, the apnea events increased the frequency of the number of times the lower esophageal sphincter opened during the night, aggravating the stomach problems. And the combination of the stomach problems and the worsening OSA caused the quality of your sleep to go down even more, which in turn created more insomnia.

As I've always tossed and turned, it's not unusual for me to wake up in a somewhat uncomfortable position, however it used to be that when this happened I could adjust myself and pass right back out, now if I wake up, I can't fall back asleep, sometimes for hours. I have also started waking up with night sweats (confirmed not menopause) sometimes so bad my hair is basically matted to my neck.

Night sweats can be a symptom of untreated OSA.

They sent me home with the watch test I listed in the title. In all the posts or articles I could find looking for possibilities of false positives things like chest straps and some sort of nose tubing were used as well, not just something on your fingers like I was given.

The WatchPAT is relatively new, but it has been extensively tested in order to win FDA approval. You can find out how the WatchPAT works by visiting http://www.muchdigitaldev.com/watchpat-main/

In controlled studies the WatchPAT has been shown to be reasonably reliable when compared to the gold standard of an in-lab PSG. In other words, it's one of the more accurate commonly used home sleep tests.

They originally told me that my results were inconclusive as I only slept 4 hours that night, which at this point is the normal for me. A few days later they called and said the dr looked at those 4 hours and I was diagnosed with severe, obstructive sleep apnea.

In a PSG, they only need two hours of fragmented sleep in order to diagnose OSA. If the watchPAT data showed you got 4 hours of sleep, then that's more evidence that test is accurate.

My reasons for originally doubting that sleep apnea was the issue were these. My symptoms of tossing and turning and waking up throughout the night have always existed, it is only since I have lost my ability to fall back asleep that I have stopped feeling rested.

Untreated OSA grows worse through the years and because untreated OSA can make insomnia worse. The fact that you are no longer able to fall back asleep and no longer wake up feeling rested points to the idea that your OSA has finally gotten severe enough that your body can no longer cope with it.

I have never felt short of breath upon weakening.

Not everybody with OSA wakes up feeling short of breath. I never did, for example. Moreover, unless you happen to wake up during a particularly bad event, your body will have the chance to get the O2 level up before you wake up.

When I could sleep more than 5 hours max a night, I did feel rested. I do not snore.

Not everybody with OSA snores. And not everybody who snores has OSA. Yes, there's a correlation between snoring and OSA, but the lack of snoring does not mean it's impossible to have OSA.

I am overweight however my neck circumference is below 16 inches.

The stereotype that all OSA sufferers are overweight and have a large neck is a stereotype. Plenty of skinny people with small necks have OSA. I'm 5'1'' and 110 lbs and I've got a tiny neck. But I've also got moderate OSA and I need a CPAP.

My cousin had an ex who had sleep apnea and she would always hear him stop breathing, her and I have shared a bed on many, many occasions and she has never heard anything like that from me.

Not all apnea episodes result in an obvious cessation of breathing with loud gasping noises at the end of the event. You can have severe OSA and have the vast majority of your events be something called a "hypopnea with arousal." In a hypopnea with arousal, the breathing never fully ceases, it just becomes shallow enough where your brain realizes something is wrong and the brain arouses just enough to open the partially collapsed airway back up. It's possible for the recovery breaths after a hypopnea with arousal to sound like pretty normal breathing to a bed partner.

What lead me to create this post however was an appointment I had with my dentist recently. He said my airway looked very open for someone diagnosed with obstructive sleep apnea. He also asked if they did any sort of digital imaging and where they thought the obstruction was, they did not and they did not tell me where they think the obstruction is. So my question is, is it possible that the positive reading was false, and if it wasn't completely false is it possible it was false about the obstructive part and that I have central sleep apnea instead?

It appears that your dentist was saying that you've got a rather low Mallampati score. While high Mallampati scores are correlated with OSA, there are people who have low Mallampati scores and still have OSA. The problem is that there are multiple places where the upper airway can become partially or fully obstructed when the muscles hat control it relax too much during sleep. It could be that your tongue simply relaxes way too much and falls back into the airway. That can block the airway enough to cause a hypopnea even if the upper palate and uvula are not too large.

As for imaging: The problem is the airway only becomes obstructed in sleep: And so it is possible that the airway can look normal when you are awake, but once the muscles relax too much, some part of the upper airway becomes partially or fully blocked.

Now, if there's little to no chance that the reading was false, or if my best/only option is still a cpap machine regardless of it being obstructive or central, me and my machine may need some couples counseling to get this relationship to work.

In my humble opinion there is little or no chance that the WatchPAP reading is a false positive.

And if you need counseling to make your new relationship with the CPAP work, then get it. I say that as someone who did have to get some counseling to get over my own irrational anger at both my OSA diagnosis and my anger towards my CPAP.

The issue is that though the dr says the machine is keeping me breathing, this has done absolutely nothing to stop my bodies mission of destroying my bed as I sleep. I still toss and turn constantly.

I have a great deal of empathy for what you are going through. After starting PAP therapy, my insomnia exploded in a fashion that neither I nor my sleep doc expected. It took 6 months of cognitive behavior therapy for insomnia (CBT-Insomnia) to rein the insomnia monster in. And more counseling to deal with the anger issues. And until I had that insomnia monster reined in, things did not get better. Even now I have to be pretty vigilant about my insomnia issues. When the insomnia is under control, I wake up feeling pretty decent. When the insomnia is not under control, I feel pretty lousy.

The moral is: CPAP fixes sleep disordered breathing, but CPAP does not (by itself) fix bad sleep.

To put it another way:

For a person with severe OSA, CPAP is necessary for a good night's sleep.
For a person with severe OSA, CPAP is NOT sufficient to guarantee a good night's sleep.

With the full over the nose around the forehead mask one of the biggest issues I had was I get headaches, and having something strapped around my forehead not only seemed to increase their frequency but also the pressure to my forehead caused more pain.

So you have mask issues. There are nasal masks that do not have forehead supports. You might want to try one of them.

Aside from that, the tossing and turning has created issues with both types of masks I've used. With the first, over the nose mask, I would wake up because I had turned my head down mostly on my pillow and pushed it weird and now had air blowing into my eye or other various situations like that where my tossing and turning pushed it into my face in a way that woke me up.

Consider using a CPAP pillow with cutouts for the mask. For the air blowing into the eyes problem, try adding a simple eyemask of the sort that airlines hand out to passengers on redeyes. Or even just drape a hanky across the eyes.

With the nose pillows I am simply not keeping them on. I have woken up with it down around my neck like a necklace, wrapped around my arm, and entirely underneath me.

Which nasal pillows mask? Some of them are a lot more stable than others.

My dr's suggestion to waking up with it off you is to set alarms throughout the night to put it back on.

This is a STUPID idea!

My suggestion: If you wake up and the mask is not in the right position, then put it back on before you go back to sleep. Do NOT worry about the fact that it came off in your sleep and do NOT try to figure out why it came off in the middle of the night. You do the probem solving in the daytime.

Two other things:

1) Do NOT allow yourself to consciously remove the mask and then go back to sleep without the mask on.
2) If you wake up without the mask on, do not consciously allow yourself to go back to sleep without the mask on.

The issue here I'm having is that the mask itself, and the solution to my taking the mask off in my sleep, both exacerbate the original issue I came in for, which is that I am waking up, and then unable to fall back asleep.

This is indeed a tough problem. Unfortunately the real, long term fix is time---as in it takes a lot of time to learn how to sleep well with the mask on, and when your body doesn't actually know how to sleep well in the first place, it can take even longer.

If you are not opposed to the idea, sometimes a short course of sleeping medication like Ambien can get you over the hump. If the problem continues for several months, you may need to talk to the sleep doc about long term use of sleeping pills. It took me a very long time (and a switch of sleep docs) to realize that I am better off taking Belsomra everynight and sleeping well with my PAP than I am not takig the Belsomra and fighting for sleep all night long.

If I can't fall back asleep after waking up to pull my arm out from under myself in some weird position, I certainly can't fall back asleep after waking up to an alarm, untangling myself from a bunch of tubing and re-adjusting my mask. At that point I may as well get up and go make myself a cup of coffee because sleep is out the window.

Sounds like you need a hose management system. Have you tried hanging the hose over the head of the bed? It may also be worth investing in an actual hose hanger.

Rainy, are you a Kaiser patient?

You should ask for a copy of the full sleep report as I think that may be very helpful for you to see the data the WatchPat provides. Mine was hair raising as a vertical graph with blue lines showed periods of apnea. I was in one of Kaiser's groups (ugh!) and a few others showed their graphs with mostly white and a few blue lines. Mine was nearly solid blue! Denial didn't have a chance against that!

You may have a restless leg component that the WatchPat cannot pick up. One member here, Kaiasgram, successfully pushed for an in lab test to ferret out issues the WatchPat couldn't. It's great for fun of the mill OSA, but you may be dealing with other issues.

In any case, Sleeping with a good data capturing APAP will see if you have any improvements, and if not, further testing is in order. Stop fighting this. They are trying to help.

Finally, there are two under appreciated causes of middle of the night wakenings you should have assessed. One is GERD, which often goes hand in hand with sleep apnea because each exacerbates the other, and the other is insulin resistance which can disrupt sleep because your body sends a surge of cortisol when blood sugar drops in deep sleep. If you are kaiser, btw, their typical diagnostic and treatment approaches to both issues STINK.

Yes, I am a Kaiser member.

To clarify I am less so doubting that the sleep apnea diagnosis was wrong and more so wondering if it's possible that it's central sleep apnea and not obstructive, can the watch actually tell the difference between the two?

My bed doesn't have a headboard and I have no idea what a hose hanger is. As I've said, my dr's advice was to set alarms throughout the night which I agree sounds like a terrible, terrible idea. I will look into a nose hanger, thank you.

The nose pillow mask they gave me has one strap coming from either side that splits into two in the back, it's not very supportive and I'm not sure what exactly would be that doesn't involve a forehead strap but I am open to suggestions.

I am completely open to sleep meds, however the Dr's at Kaiser have been reluctant to prescribe them to me. Which is why I've basically shown up here desperate, if this will help I desperately want to make it work but I am not getting much help from my dr and the advice they are giving me are things like set alarms not advice on better equipment. I am at a point where I am obviously very frustrated.

My stomach issues were finally diagnosed. While I'm sure the sleep apnea doesn't help things I was diagnosed with something called gastroparesis. It is a completely unrelated battle I get to fight with this one apparently. I'm at a point where I don't know whether to laugh or cry.




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rainydaichick wrote:Yes, I am a Kaiser member.

Janknitz can give you some great info about how Kaiser does things.

To clarify I am less so doubting that the sleep apnea diagnosis was wrong and more so wondering if it's possible that it's central sleep apnea and not obstructive, can the watch actually tell the difference between the two?

I will admit that I don't know the answer to this question. However, CPAP/APAP is the first thing they try for CSA, although for many people with severe idiopathic CSA, a CPAP/APAP machine often does not fix the problem. After establishing that CPAP/APAP is not working for a patient with CSA, the next step is to try the person on a bilevel machine with a timed backup rate. If that machine also does not adequately fix the problem, the patient is then moved to an ASV machine. Most insurance companies insist the cheaper CPAP/APAP and bilevel machines be tried first before authorizing moving a CSA patient to an ASV machine. It's worth noting that learning to sleep with an ASV can be more difficult for a newbie than learning to sleep with a CPAP.

My bed doesn't have a headboard and I have no idea what a hose hanger is.

A hose hanger is nothing more than a way to hang the hose overhead. Our host has two for sale:

https://www.cpap.com/productpage/arden- ... ystem.html
https://www.cpap.com/productpage/HoseBu ... ystem.html

Many people rig up their own homemade version of a hose hanger by attaching a hook of some kind to the wall above the bed and using a loop of material to hold the hose up. If you search the forum you will find instructions and pictures of some people's homemade hose hangers.

The nose pillow mask they gave me has one strap coming from either side that splits into two in the back, it's not very supportive and I'm not sure what exactly would be that doesn't involve a forehead strap but I am open to suggestions.

You are using a Resmed AirFit P10 nasal pillows mask. You are right: the headgear is not particularly supportive. For many people (including me) that's not a big issue: The mask is designed to be worn quite loose. But other people never really manage to get the thing to securely seal and the fact that there are no easy adjustments can be an issue.

You might try other nasal pillows masks: The slightly older, but still widely available Resmed Swift FX nasal pillows mask may be a better match. It has two straps that are both adjustable. But it also has a jet stream of an exhaust flow. The PR Nuance nasal pillows mask may be worth investigating. Or the F&P Pilaro or the older F&P Opus nasal pillows masks.

It's also worth pointing out that a lot of the newer nasal masks are now being designed without a forehead strap. You might find the Resmed Swift FX Nano or the Resmed AirFit N10 masks might be more stable than the P10 and neither of them has a forehead strap. It's also worth considering the PR Wisp nasal mask and the very new PR DreamWear nasal mask. These masks also have no forehead straps. There are several other nasal masks made by PR, Resmed, and F&P that do not have forehead straps. You can do a search on CPAP.com to see what they look at.

I am completely open to sleep meds, however the Dr's at Kaiser have been reluctant to prescribe them to me. Which is why I've basically shown up here desperate, if this will help I desperately want to make it work but I am not getting much help from my dr and the advice they are giving me are things like set alarms not advice on better equipment. I am at a point where I am obviously very frustrated.

It's sad when dealing with the doc is also stressful. Been there, done that and have the scars to prove it.

My advice is to document everything you can about how bad things are when you are trying to sleep. You can do that with a sleep log AND plenty of calls to the sleep doc's office with your complaints.

In the sleep log keep track of the following things:

• Time you go to bed
• Estimate of how long it takes you to get to sleep
• Estimate of how many wakes you had during the night. You do NOT need to track when the wakes occurred or how long they were.
• Time you get out of bed in the morning.
• Estimate of how long you think you slept during the night
• A simple 0-5 rating of how awful you feel when you get up in the morning where 0=AWFUL and 5=AWESOME.
• A few notes about how much you had to fight with the mask and/or machine during the night. Or even a simple 0-5 scale for how much time and frustration you had fighting the mask where 0=Way too much time and/or VERY frustrated and 5=No frustration at all.

As for the "taking the mask off" problem, I'd not worry too much talking to this idiot of a doc about that problem. His suggestion of using alarms to check the mask when you are already not sleeping very well is just plain silly. The fix for the "take the mask off" problem is a combination of:

• the right mask. (I think you need to change masks myself)
• making yourself put the mask back on when you wake up with the mask off
• not allowing yourself to consciously go back to sleep without the mask on your nose
• time

The problem gets better with time as long as you always put the mask back on when you wake up with it off your nose.

As I mentioned before, I think it is also worth turning the Auto On/Off feature OFF so that when the mask slips completely off your face the blowing air has a chance to wake you up so that you can put the mask back on. On a Resmed the Auto On/Off is called SmartStart if I recall correctly.

My stomach issues were finally diagnosed. While I'm sure the sleep apnea doesn't help things I was diagnosed with something called gastroparesis. It is a completely unrelated battle I get to fight with this one apparently. I'm at a point where I don't know whether to laugh or cry.

I am sorry to hear this. You have my sympathy. Unfortunately the interaction between your gastroparesis and your OSA probably mean that until both conditions are well controlled you're not going to feel much better.

Out of curiosity do the doctors know the cause of your gastroparesis? I was recently diagnosed with sleep apnea and my doctors are investigating gastroparesis as the possible cause of my stomach issues. Off the top of my head I can think of at least two underlying medical conditions that can raise your risk for both apnea and gastroparesis. Just wondering if there's any others out there.

I don't have diabetes and I am not on any medication that would cause it, which are my understanding are the two major known causes, so no. They theorized my vomiting may be from silent reflux which I know can correlate with sleep apnea but the gastrointestinal specialist did not say he saw any signs of it during my endoscopy. Gastroparesis was not a theory anyone had or anything I had heard of but they did an endoscopy suspecting ulcers from the suspected silent reflux and instead found food in my stomach from eating 15 hours earlier. I actually left understanding very little about it, they told me that I had this issue but that they didn't find what was causing my nausea, only for me to look it up for dietary recommendations and find that nausea and vomiting are the number one symptoms. Between both these experiences I am planning on switching insurance once I can so I can find someone other than Kaiser to deal with for all of this.

I appreciate all the advice on equipment, and I will definitely start keeping a sleep journal. If nothing else it will be a good resource once I find a new dr.


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This book has a good explanation of gastroparesis and it's correlation to sleep apnea, to GERD, and to insulin resistance (which is an earlier stage long before they will ever diagnose you with diabetes) and even asthma: https://www.amazon.com/Why-Stomach-Acid ... omach+acid Very important to read because the standard treatments don't necessarily address the underlying causes--when you only treat symptoms it can get worse and the medications they tend to use have serious side effects. There are dietary things you can do to help this condition. This book was the best resource for the "whole picture" I've seen.

My experience with my local Kaiser is that if the mask is not working well I call the sleep lab. They have sample masks and they will let you try there and then KEEP them so you can try them at home under your own sleeping conditions. Their "formulary" is somewhat limited, but they have most of the more popular masks. Call and ask them to do a mask fitting to find something that works better for you. There's no charge or co-pay, even if your plan doesn't have DME coverage. They will also want to see your data and may be able to help you tweak your treatment at the same appointment.

The data from your machine will help sort out if you have run of the mill OSA or CA or mixed apnea. Kaisgram had to proceed on to an in lab sleep test because the data showed that she had more than just OSA. So she can tell you more about how Kaiser works that.