Results from sleep test from hell

This is follow-up from my "Sleep test from hell" upthread. I was the person where they lost the bed controller and had to move me in the middle of the night. Then they picked a bed with the wires on the right side instead of the left, so I had to sleep with the whole pile of wires under my head.

I don't understand any of it, and could use some clarity.

I have an AHI of 18. All from OSA. Moderate.

CMS AHI is 5, whatever that is.

Sleep efficiency is 74%. Minimum saturation at sleep is 85%.

Delayed REM at 166 minutes.

They evidently didn't notice I was punching the air in a goddawful nightmare about how they wouldn't listen. They didn't notice that I was awake for an hour in the morning, because they were supposed to come and get me and never did. They didn't notice a whole lot....

Recommendations? I had gone through these pre-test with the specialist. They were: clear my nose (there's nothing wrong with it, per the ENT), sleep on my side (I can't), don't use sleep meds (I don't and won't).

Other than that, no treatment. Of course, a North Korean nuke might take care of the problem....

Comments?

Zeds wrote: ...I have an AHI of 18. All from OSA. Moderate.

CMS AHI is 5, whatever that is.

Sleep efficiency is 74%. Minimum saturation at sleep is 85%.

Delayed REM at 166 minutes.

They evidently didn't notice I was punching the air in a goddawful nightmare about how they wouldn't listen. They didn't notice that I was awake for an hour in the morning, because they were supposed to come and get me and never did. They didn't notice a whole lot....

With an AHI of 18 and minimum saturation of 85% you have an official diagnosis for which the gold standard of treatment is CPAP. Did you get much REM sleep during the study? Just wondering what your REM AHI was. Due to the adverse accomodations during your study, we expected your sleep efficiency to be low and your REM to be delayed. While they didn't make mention of the data showing a nightmare, to be honest, I've never seen that be a part of a sleep study report. What a study shows is certain data during sleep. They don't generally report what happens during wake time, as it is not a wake study. I went through that in a couple studies when the things happening during my wake time were pertinent to what they were studying me for (limb movements). They told me they don't report on what happens during wake time, just that we are awake. Someone can correct me if I'm wrong, but I think the reports have an area where it shows the time of night and maybe the fact that you were awake shows up there. If I remember correctly you were concerned about your heart rate after the nightmare. What did your report say about your heartbeat? Any arrythmias? How can we be of assistance in your CPAP treatment?

kteague wrote: With an AHI of 18 and minimum saturation of 85% you have an official diagnosis for which the gold standard of treatment is CPAP. Did you get much REM sleep during the study? Just wondering what your REM AHI was. Due to the adversenaccomodations during your study, we expected your sleep efficiency to be low and your REM to be delayed. While they didn't make mention of the data showing a nightmare, to be honest, I've never seen that be a part of a sleep study report. What a study shows is certain data during sleep. They don't generally report what happens during wake time, as it is not a wake study. I went through that in a couple studies when the things happening during my wake time were pertinent to what they were studying me for (limb movements). They told me they don't report on what happens during wake time, just that we are awake. Someone can correct me if I'm wrong, but I think the reports have an area where it shows the time of night and maybe the fact that you were awake shows up there. If I remember correctly you were concerned about your heart rate after the nightmare. What did your report say about your heartbeat? Any arrythmias? How can we be of assistance in your CPAP treatment?

Thanks kteague. Since I wrote my note above, I did a little research, and it does seem that I qualify for Medicare treatment. The CMS AHI minimum is 5, and mine is 5. My overall AHI is 18.

The CMS AHI reflects a greater than or equal to 4% desaturation. Or some such thing.

When I had my nightmare, I was asleep. I went wild in my sleep. I was so wild, it woke me up. I don't understand why the sensors didn't go crazy.

The REM AHI is 23.9.

They didn't record for Bed #1; the study only reflected lights out to lights on in Bed #2.

The heart symptoms didn't get reflected in the EKG, as far as I can tell. This has happened before, though; my PCP already knows about it.

Maybe the doc is reading the Medicare guidelines incorrectly? This could require some diplomacy... Any ideas?

Thanks.

Your perception of going wild may not be much like what actually happened... sleep can do funny things to people who may still be more in a dream than otherwise when they do become conscious of surroundings, etc. and believe things to have been quite different, possibly more dramatic, than they actually were at a given time.

Your 02 desat of 85% is not bad compared to many who go much lower, but the time span needs to be checked (your report will show that).

And while 18% is just above a 'mild' diagnosis, you could have had a much worse one.

No one likes being tested, your having had to change beds must have been unpleasant, but all in all, I'd just be glad it's over and now you can go on to treatment. Things will make more sense as you go along.

On both of my sleep tests, it was three or four weeks before the doctor notified me that I had severe SA. It was then another two weeks before I was scheduled form a bipap titration.

Julie wrote:
And while 18% is just above a 'mild' diagnosis, you could have had a much worse one.

No one likes being tested, your having had to change beds must have been unpleasant, but all in all, I'd just be glad it's over and now you can go on to treatment. Things will make more sense as you go along.

Actually, they've said "no treatment", except 3 things, none of which apply, and which I told them were irrelevant during the interview before the sleep study. Sleep on my side (I can't without ending up in the ER), deal with my nose (there's nothing wrong with it, per ENT), and don't take sleep meds (which I don't and won't).

They placed the AHI 18 in the "moderate" category and attributed it to OSA.

I am super-frustrated, and exhausted as hell...

AHI of 18 earns a machine with Medicare...where are they coming up with "no treatment"?
AHI of 5 to 15 can earn a machine if certain other co morbid factors exist. Do you have any of the other co morbid factors (I forget exactly what they are but they are shown at the Medicare web site)?

The CMS AHI minimum is 5, and mine is 5. My overall AHI is 18.

Is the AHI of 18 based on the looser not so many desats? More like a RDI number maybe?

The AHI of 5 is based on actual desats less than 4 % thing??

Who is advising "no treatment" except for the 3 options which aren't suitable options for you?

Finally...if worse comes to worse and Medicare won't cover a cpap machine do you want to go the DIY route? It can be done.

Pugsy wrote:AHI of 18 earns a machine with Medicare...where are they coming up with "no treatment"?
AHI of 5 to 15 can earn a machine if certain other co morbid factors exist. Do you have any of the other co morbid factors (I forget exactly what they are but they are shown at the Medicare web site)?

The CMS AHI minimum is 5, and mine is 5. My overall AHI is 18.

Is the AHI of 18 based on the looser not so many desats? More like a RDI number maybe?

The AHI of 5 is based on actual desats less than 4 % thing??

Who is advising "no treatment" except for the 3 options which aren't suitable options for you?

Finally...if worse comes to worse and Medicare won't cover a cpap machine do you want to go the DIY route? It can be done.

Thanks for weighing in,

The sleep study MD did the analysis and made the recommendations.

The "CMS AHI" as you surmised, evidently refers to the equal or over 4% desat. My CMS AHI was 5. I am learning the lingo...

I have all of the "behavioral" co-morbid factors (like exhaustion, falling asleep all the time, snorting/choking, cognitive issues). They are the reason I was referred to the sleep study in the first place. They have been long-term and well-documented. I have none of the co-morbid factors in the "chronic conditions" category (e.g. Hypertension).

I'm trying to figure out what to do. DIY is not in the budget, and I'm not sure I could practically get away with it, since another of my slew of MD's might object on the grounds that going around doctors' orders may account for the pear-shaped bruise on my pes anserine, or some such ridiculousness.

(Natch, I could probably eliminate half of those specialists if they had considered sleep issues, rather than ordering obscure blood tests for one-in-a-billion cancers).

Frustrated...

I've sent the sleep doctor the Medicare specs. Let's hope this gets sorted out.

FWIW there's a poster on this thread who's on my Ignore list. I don't read or respond to posters who get gratuitously belligerent.

I understand.
Exhaust all your options regarding cpap and Medicare and your doctors and then decide if you want to quietly go the DIY route if that is the remaining option.
Sounds like you are well versed on the actual documentation needed and prepared to fight that battle so I won't elaborate on that aspect.
I thought that excessive sleepiness was enough of a co morbid thing to get Medicare on board but maybe it isn't...I would be talking directly to Medicare though because the doctors don't always understand the fine points and/or get tunnel vision.

Should you decide at some point (if all else fails)...and you want to try the DIY route....get with me. Sometimes we can pull off some miracles but you have to be comfortable going the DIY route yourself first. I can't do that for you.

I'm not sure what CMS is, exactly, as that wasn't a term used on my sleep study (although in the 10.5 years it's been since my study that could have easily been added).

On my report, the sleep doc actually wrote in AHI 4.7 and RDI 19. (RDI being respiratory disturbance index, which takes into account all respiratory disturbances, not just anpeas and hypopneas.)

Again, my study was over 10 years ago, and I had high blood pressure successfully treated with meds, but my doctor said I definitely needed a machine and I had no trouble getting one.

I sure hope you can get this sorted out because, like others, I just don't understand how they could say that no treatment is needed.

So, I can not advise on interpretation issues. Still learning. But I have some thoughts on prioritizing the quality of our lives.

I know when I got a new roof, I did not need a 40 yr guarantee. I wish they would reduce the price to reflect my reasonable length of life left. That said, when I think of budgetary items and if and when I want the foolishness of insurance companies and medical providers to not get the most money on my nickel of health, I started comparing the apples and oranges.

With the information available here, we can get educated enough to exercise some preventative medicine. We don't have to be the worse of the worse. If it peeps like a duck, then maybe its a baby duck that will just grow into an adult duck.

There are many ways to procure equipment and masks. There are the usual channels where they have all these rules and requirements and its on a schedule of where your paperwork might be in the pile. Or if the clerk is on vacation. The wait could be for all kinds of reasons, some really dumb.

We can decide just how much we can afford in budget compared to not feeling well. It does become an mathematical equation at some point. Only you know your numbers but for me I learned I don't want to always wait for others to decide when I can have or do things. If I can make it happen, I will research other ways (like Pugsy said DIY or trades or buying used)

Pugsy wrote:I understand.
Exhaust all your options regarding cpap and Medicare and your doctors and then decide if you want to quietly go the DIY route if that is the remaining option.
Sounds like you are well versed on the actual documentation needed and prepared to fight that battle so I won't elaborate on that aspect.
I thought that excessive sleepiness was enough of a co morbid thing to get Medicare on board but maybe it isn't...I would be talking directly to Medicare though because the doctors don't always understand the fine points and/or get tunnel vision.

Should you decide at some point (if all else fails)...and you want to try the DIY route....get with me. Sometimes we can pull off some miracles but you have to be comfortable going the DIY route yourself first. I can't do that for you.

Thanks so much for putting that out there. I'll let you know if I decide to go DIY. I have a feeling the sleep doc has misread the Medicare specs. I think maybe I'll look up her credentials. It's possible she's a new resident.

WearyOne wrote:I'm not sure what CMS is, exactly, as that wasn't a term used on my sleep study (although in the 10.5 years it's been since my study that could have easily been added).

On my report, the sleep doc actually wrote in AHI 4.7 and RDI 19. (RDI being respiratory disturbance index, which takes into account all respiratory disturbances, not just anpeas and hypopneas.)

Again, my study was over 10 years ago, and I had high blood pressure successfully treated with meds, but my doctor said I definitely needed a machine and I had no trouble getting one.

I sure hope you can get this sorted out because, like others, I just don't understand how they could say that no treatment is needed.

It turns out CMS is the agency that handles Medicare paperwork. It's not a medical term. Took me a bit to figure that out. CMS AHI is evidently the number of AHI's that meet the CMS specs (there's a required desaturation level).

I averaged 18 AHI's, but 5 CMS AHI's. I assume this means I wasn't breathing quite a bit, but managed to more or less maintain enough oxygen. Interesting, since it looks like at one point I didn't breathe for a minute and a half.

Zeds wrote:

WearyOne wrote:I'm not sure what CMS is, exactly, as that wasn't a term used on my sleep study (although in the 10.5 years it's been since my study that could have easily been added).

On my report, the sleep doc actually wrote in AHI 4.7 and RDI 19. (RDI being respiratory disturbance index, which takes into account all respiratory disturbances, not just anpeas and hypopneas.)

Again, my study was over 10 years ago, and I had high blood pressure successfully treated with meds, but my doctor said I definitely needed a machine and I had no trouble getting one.

I sure hope you can get this sorted out because, like others, I just don't understand how they could say that no treatment is needed.

It turns out CMS is the agency that handles Medicare paperwork. It's not a medical term. Took me a bit to figure that out. CMS AHI is evidently the number of AHI's that meet the CMS specs (there's a required desaturation level).

I averaged 18 AHI's, but 5 CMS AHI's. I assume this means I wasn't breathing quite a bit, but managed to more or less maintain enough oxygen. Interesting, since it looks like at one point I didn't breathe for a minute and a half.

Ah, gotcha. So CMS has certain type of breathing problems they will "count" toward their AHI criteria and others they won't. Your number for THEIR criteria was 5. Still doesn't mean you don't need the machine, so hope you are able to get it one way or another. Even if certain breathing disturbances are not classed as an apnea or hypopnea and don't reduce O2 to a dangerous level doesn't mean those disruptions don't cause a major problem with getting restorative sleep.

Zeds wrote: Thanks so much for putting that out there. I'll let you know if I decide to go DIY. I have a feeling the sleep doc has misread the Medicare specs. I think maybe I'll look up her credentials. It's possible she's a new resident.

Later...Dang if the Doc hasn't had 20 years' experience. I'll bet she just got a tech to do the write up...