AHI Question for Sleep study

Guest · Post by **Guest** » Sun Jul 23, 2006 9:51 am

I have an interesting question, I had a sleep study a while ago and was diagnosed with OSA, now my insurance company wants me to do another if they are to keep paying for equipment, has anyone else ever heard of this? Now my question is as a 100% compliant user, before I go for a non-cpap (baseline) study, does it make a difference in results if I do not sleep with cpap for a day or more before the study, or is it ok to sleep with cpap the night before the study. Just want to make sure I dont end up with a very low ahi as a result of compliant long term use.
Thanks

Guest · Post by **Guest** » Sun Jul 23, 2006 12:08 pm

Recently, I did an overnight pulse oximeter study at home. The nurse at the sleep lab told me that I had to be off of cpap for 2-3 days before doing the pulse ox. She said that the body "remembers" and the readings would be much different and innaccurate if I didn't wait.

I didn't ask a lot of questions so I'm not sure what it is that the body "remembers" or how that works. And I don't know if the same reasoning applies to getting a new diagnostic study.

It would be a good idea to call the sleep lab and ask them what they think you should do.

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 12:11 pm

Are you concerned that being compliant will lower your AHI possibly and make you not eligible for cpap therapy benefits if you use your machine the night before you go? I am not being sarcastic when I say, you should be so lucky. Using cpap doesn't prevent you from having events when you don't use it the following night. It shouldn't make any difference if you use it the night before you go for your new PSG. I wouldn't worry about that.

If I am following your rationale, you are thinking that perhaps since you used your machine the night before, it helps ward off any events for the next night and you won't get the "okay" to continue receiving benefits for your therapy. And unless I'm mistaken, the machine works while you use it and doesn't do anything to prevent future nights events.

Hope this is what you were referring to. That's how I understood your question. Good luck with your new study. But wouldn't it be nice if you really got the news back that you didn't need it???

rested gal · Post by **rested gal** » Sun Jul 23, 2006 2:52 pm

Guest, if I were you and thought there was any chance of the sleep study turning up an AHI that would cause the insurance company to say, "Nope, we're not gonna continue paying.", I would leave off the cpap for a couple, or three, nights before the study.

If snoring was a major symptom of your sleep apnea before you ever went on cpap, it's possible that your throat and palate were irritated to the point of perhaps being slightly swollen -- from heavy-duty snoring. CPAP treatment may have smoothed that out, and it might take some snoring again to get yourself back to pre-CPAP condition.

At the study, be sure to stay on your back as much as possible. Try not to sleep on your side at all. Apneas and hypopneas are most apt to happen when a person is "supine" (on your back.) If you can arrange the pillow under the back of your head so that your chin is tilted downward and inward, toward your chest, that will make things "worse", too.

Hey, that's what a sleep study is for, isn't it? To get a look at "worst case scenario."

You usually have a few beers just before you go to bed, don't you?

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 3:17 pm

I hate to disagree, but I feel the idea of a good sleep study is to simulate your normal sleeping conditions if at all possible and seeing what your AHI is. And if you're lucky enough to get an AHI that is under the criteria for needing therapy, that is a blessing that we would all strive for.

To do whatever you can to raise your AHI so that you can continue treatment doesn't make sense to me. If you normally sleep on your back and consume alcohol, which has been known to increase your likelihood for having events, hence a higher AHI, then so be it. Then you would be emulating a normal night and whatever the AHI turns out to be would be factual. But to intentionally try to make the AHI higher, I can't see why anyone would want to do that. I would think the best news you could hear is that your AHI falls below the criteria for needing therapy. I'd be kicking up my heels to get that news.

Guest · Post by **Guest** » Sun Jul 23, 2006 3:36 pm

I believe that what is being said is that if you go to the sleep study the night after using the cpap, then you may have 'better' ahi results for THAT night
not overall - as rested gal was saying - if your throat was swollen initially, causing apnea's, and now it's not, so fewer apneas ON THE CPAP - then you would still NEED the cpap -=
so if you go to the study after just getting off cpap the night before, your results may 'look' alot better, but then let's say ins. cuts off treatment and 2 weeks later with out the treatment, you are back to bad apnea as now snoring again and swollen throat and apneas all over the place
they are not saying make it look bad even if you don't have it, but are saying the way ins. co' soperate, the slightest 'improvement' may cut off insurance when it shouldnt' be cut off - I have heard this before as well

Goofproof · Post by **Goofproof** » Sun Jul 23, 2006 4:13 pm

She should call the Ins Co up and make a deal. They save the cost of the sleep study, and get her a APAP and software and You send them a report. Jim

Look out on that beer, they may not test drunks.

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 4:23 pm

Anonymous wrote:I have heard this before as well

I was under the impression (and I don't do impressions) that if you snore and it goes away, then that was not the same as apnea, which is absence of breath, not snoring. You can snore and not have OSA, but you can have OSA and snore.

I just recently was speaking to two different members on this site. One said if they don't use the machine for even one night, they feel miserable the next day. The other said it could even be for half a night. I have never heard of an AHI being normal from using a machine. That would mean it cures OSA. We wouldn't have to use machines nightly then. We could just use them every few days, which would be really nice.

My main point was, I just don't understand why anyone would try to force their AHI to be higher by drinking or doing things that they don't ordinarily do just so they could continue on therapy even if they may not need it. I would think the best thing to hear after having a PSG done is, "Mr./Mrs. Jones, your AHI is normal and you don't need therapy." To deliberately pull out all the stops that you normally wouldn't do nightly just to raise your AHI so you could continue on therapy sounds a bit odd to me.

roster · Post by **roster** » Sun Jul 23, 2006 4:26 pm

[quote="Anonymous"]I have an interesting question, I had a sleep study a while ago and was diagnosed with OSA, now my insurance company wants me to do another if they are to keep paying for equipment, has anyone else ever heard of this?
Thanks

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 4:29 pm

rooster wrote:
Anonymous wrote:I do not want to sleep another night without cpap and then feel horrible for a day or more. A friend told me he skipped one night and it took four weeks to "get straightened out."

That is exactly what I was saying. If all it took was one night to keep you going for a few nights, then we do we need therapy every night? We could just do it a few times a week and be fine. I don't think it works like that for most people.

roster · Post by **roster** » Sun Jul 23, 2006 4:36 pm

Do insurance companies required patients diagnosed with sleep apnea to do another test without cpap?

rested gal · Post by **rested gal** » Sun Jul 23, 2006 6:19 pm

Sleepless on LI wrote:I feel the idea of a good sleep study is to simulate your normal sleeping conditions if at all possible and seeing what your AHI is.

Even sleep techs have differences of opinion about whether a sleep study should be looking at a person's normal sleep habits (or as normal as can be emulated with wires attached all over and in a strange environment) or whether the test should be conducted in certain ways. Lurk-reading on a message board for sleep techs, I've found it most interesting to see them discuss different approaches to how to run the study and the reasons behind sometimes completely opposite ideas.

Some of the techs say, let them keep the tv on to fall asleep if that's what they do at home; others say the tv should be turned off at "lights out." Some say let the person sleep in any position even if they never turn onto their back. Others say, we need to see worst case scenario -- supine/REM --because even if the person customarily sleeps ONLY on their side at home, they might end up having to sleep on their back at some point in life (hospital stay, rehab facility, nursing home.) And so on, about other sleeping habits.

Both views have merit, imho -- emulate home habits and sleep position as much as possible, or conduct as thorough a test as possible to uncover OSA. But bottom line is that if the person just plain does not have OSA, they are not going to have a high AHI, even if they sleep all night in a position known to be conducive to having apneas/hypopneas.

Sleepless on LI wrote:But to intentionally try to make the AHI higher, I can't see why anyone would want to do that. I would think the best news you could hear is that your AHI falls below the criteria for needing therapy. I'd be kicking up my heels to get that news.

If it were a "for real" below the criteria to need treatment...great news! Sure! But I think the second Guest nailed a "why" in this situation. A person who has been doing so well ON cpap for a long time that he/she doesn't want to take any chance on an insurance company taking his machine away...based on a possibly very temporary low AHI in a close call:

Guest wrote:so if you go to the study after just getting off cpap the night before, your results may 'look' alot better, but then let's say ins. cuts off treatment and 2 weeks later with out the treatment, you are back to bad apnea as now snoring again and swollen throat and apneas all over the place

Guest · Post by **Guest** » Sun Jul 23, 2006 6:25 pm

and also, if you no longer have osa, then you no longer have it and 'any' type of inducement of raising your ahi level should not, then, work right?
the point is, if there is a small chance that their insurance could be pulled from them, then I think that making the ahi as 'accurate' as it would be comletely off the treatment is best - we certainly can agree to disagree!!!!

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 6:26 pm

rested gal wrote:But I think the second Guest nailed a "why" in this situation. A person who has been doing so well ON cpap for a long time that he/she doesn't want to take any chance on an insurance company taking his machine away...based on a possibly very temporary low AHI in a close call

Then that reinforces how I'm thinking. I think it should be determined if this person REALLY needs the machine to feel well or if they're just struggling with the pitfalls of xpap therapy when it's really not necessary. I can't think of anyone who would rather use the mask if they really don't need it to feel well. And speaking personally, I sure would want to know if I really needed to use it so I don't have to endure unnecessary inconvenience in my life for nothing, and for the rest of my life at that.

If an AHI is going to be above the criteria if it's really needed regardless, there should be no need to "push the envelope" to make it happen. It should just happen, one would think. Or at least that's how I'm thinking.

Sleepless on LI · Post by **Sleepless on LI** » Sun Jul 23, 2006 6:28 pm

Anonymous wrote:and also, if you no longer have osa, then you no longer have it and 'any' type of inducement of raising your ahi level should not, then, work right?
the point is, if there is a small chance that their insurance could be pulled from them, then I think that making the ahi as 'accurate' as it would be comletely off the treatment is best - we certainly can agree to disagree!!!!

Then case in point...why bother drinking a beer or doing anything else? If it will show up regardless, there you go. Wasn't that what I was saying?

AHI Question for Sleep study

AHI Question for Sleep study

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