Newbie, Mild OSA/Severe Symptoms, at-home 'vs' in-lab

Thanks in advance for your responses. I've searched and read many other newbie posts, I'll post data soon as I'm only a few nights into APAP-ing, but I'm here for a little big picture help. I also hate being that guy who has nothing to give to a community, and shows up only because he's in need, so the only thing I can offer, if you need National Park travel advice, especially Yellowstone, I'm happy to help. Find me on insta @PictureYellowstone

I'll try and give as many relevant details before I ask for some opinions.

I had an "episode" about 14 months ago, first time ever, I felt super dizzy and disoriented. Took lots of deep breaths to stop the world from spinning. As a result, I experienced weeks of brain fog, fatigue, mild headaches, light headed/dizziness. Like being constantly hungover without drinking. Did lots of tests, even had an CT-scan, and in the end was treated for high blood pressure, everything else looked fine.

Not sure if I ever made it back to baseline brain function, but got on with life until this past march, and the brain fog/fatigue started setting in again. Regular blood tests showed nothing. I did an overnight oximetry test which showed showed my 02 levels did dip below normal. Bought my own pulse oximeter. Most nights I hang out mid-low 90s, but I do dip into the 80s most nights. I don't think it's too severe.

The Dr. suggested I do an in-lab sleep study, but as I'm uninsured....I opted for the cheaper at-home study. Result: 509 recording time, 63 events. 16 ostructive apneas, 0 central, 47 hypopneas. That particular night average oxygen saturation was 95%, lowest was 89%. 288 snoring episodes, total duration 79 minutes, 16% of duration. Respiratory disurbance index 7.4 Findings: Mild OSA. I should note here I'm not overweight, and I don't believe I snore loudly ever, I'm 37.

Got a script for an APAP 6-20. Opted for a Breas Z2 auto as I travel a lot for work and fun, in fact most years I sleep away from home more than in my own bed.

I'm 5 nights in sleeping with it and the ResMed P10 nasal pillow.

I will also say the week leading up to my first night with the APAP anxiety set in on top of worsening brain fog and fatigue.

And 5 nights in, I think I feel worse, more dizzy, more fog, more anxiety. Consecutive AH count per night has been 12, 9, 2, 2, and last night was 1.

Just a few questions...

1.) would the in-lab study tell me more about the quality of my sleep? Ie could it diagnose something other than what's already been diagnosed by the in-home study? Just don't know if I can justify ~$1000 more of testing (out of pocket) Is brain monitoring and visual monitoring the only difference from an at home study?

2.) I do drink a fair amount of caffeine...but I'm not sleepy during the day. No yawning. I've always slept pretty solidly through the night. I feel fatigued, and brain fog, but if I sit down I can binge watch 8 hours of whatever without feeling like I'm going to need a nap. So...not sleepy during the day, no loud snoring...could mild sleep apnea really make me feel this crappy? (Or should I spend the $1000 on lots of other testing...)

That's all for now. Again, thanks in advance.

Hello and welcome to the forum.

I’ll leave the apena questions to the experts, but I can help answer question about a lab study as I have had 1 at home and 3 lab tests done. The lab tests can definitely reveal other issues besides apnea there are many sensors connected to your scalp to monitor brain waves and other sensors connected to your muscles in your legs and jaws to monitor for bruxism (jaw clenching) and things like PLMD (periodic limb movement disorder).

I think an in lab study is a great way to go if you suspect something other than apnea. Even if only apnea was suspected, the EEG that’s monitoring your brain waves can tell if you’re awake or asleep, and how much of the different stages of sleep you’re getting.

As you are uninsured I understand the cost is large concern. Even insured the cost is a lot. You may want to continue the CPAP therapy to become more accustomed to the machine and see if you start feeling better before spending the money on the lab study. I’ve heard it can take quite awhile for some to start feeling better with therapy, months up to a year possibly.

I’ll add that a benefit of a home study is the costs and mainly being able to sleep in your own bed. During the lab study, don’t be surprised if you sleep worse than usual. It’s hard sleeping in an unfamiliar environment with lots of wires plugged up to you.

Welcome to the forum.

Sounds like your home study was either a type 3 or 4 sleep study with nothing to monitor sleep stages.
Bet they didn't tell you that a type 2 study did sleep stages as well. I know a place that does the type 2 for about $500.

How many hours of real sleep are you getting?
How many times do you think you wake up during the night?
Do you take any medications of any kind? If so, what?

Thanks Doce. That helps my next steps. I will say I can sleep anywhere these days. Give me 68 degrees and some noise, preferably a box fan, and I can sleep

Pugsy, no, I was not told there were multiple options for at-home sleep studies. Mine was the 95806 (not sure if that code is specific to my center or universal). Base price $465, cash discount brought it down to $279.

I'm usually asleep 7-9 hours. Before APAP I would sleep through most nights, maybe wake up once to pee. Some nights I wake up and if my mind has something it would like to think about, sometimes it'll take me awhile to fall back asleep. But normally I can fall back asleep in minutes. Even last night, woke up 4-5 times, and as soon as I realized APAP was still on my face and working, I fell back asleep quickly. I will say past couple nights, I'm starting to remember my dreams...that a good thing?

No medications at the moment. But every other night I've tried melatonin to see if that helps me stay asleep while APAPing, and see if it increases deep sleep. It's so hard to tell if it's 'working,' like many supplements and vitamins.

Thanks for any input.

I think it's a little premature to be considering an in lab sleep study. It's not unusual for sleep to be more disturbed for a short time at the beginning while you are getting used to the mask and machine and dialing in your optimal pressure settings. I'm not familiar with your machine and what kind of data you can (or can't) get from it. But I think you need to give it a few months to see if you can optimize your therapy (particularly with data to guide you) before you decide that you have more than run of the mill OSA that needs assessment. If you are still having symptoms down the road a little way, then an in lab sleep study will give you more data to go on. That will give you some time to save up for it, and find a good quality and economical in lab sleep study center.