Disastrous Sleep Study

First sleep study was 10 years ago. Since then I became disabled and am no longer able to work. Sleep has been even more disrupted with the condition I have. My machine was way old and needed replaced - 10 years. Resmed S9 APAP. I have been wondering if undertreated sleep apnea or additional sleep problems weren't making my condition worse. I also have been wondering if a bilevel machine wouldn't treat my issues better. To get insurance to cover that it required an in person sleep study. I think if I just needed a new APAP I could have proven that with a home study.

For multiple reasons I waited a long time for this second sleep study when I probably needed it 5 years ago. Unfortunately, the study last night was a disaster IMO. I couldn't get confirmed how much I slept but I think it was only 45 minutes at the most. I completely forgot some things until circumstances in the study reminded me. Hindsight is 20/20 I wish I had done some things differently last night.

The masks: My biggest issue last night initially were with the masks. I had forgotten how difficult it was for me to find a mask that worked for me. I use a Swift FX nasal pillow mask. It took me a while to realize that the only way that I could make it comfortable was to make sure it was barely tight enough to make a seal but no tighter. I had forgotten how uncomfortable the masks with the protruding nasal cushions can be. I don't know if it is my nose.. I don't know if it is a problem with the masks but they end up feeling like they are really digging into the skin inside my nose if they are too tight. Unfortunately the mask that was tried initially wasn't adjustable enough. The band is a bit adjustable but it doesn't have velcro. It was a Resmed Airfit P10 nasal pillows. It really was digging into my nose. Tried the xs, small, and medium pillows. But between my pain condition and it feeling like it was digging into my nose and all the other sleep study challenges it kept me from falling asleep. I did get to take all the masks home. Through testing I think if I had stretched the heck out of the strap I could have made got it comfortable enough. I now wish I had made a point to do that. I tried some at various points but it wasn't enough.

Also tried the Resmed Airfit F10 full face mask. That one is way too tight as well even more so than the P10. I think I might be able to make it comfortable by also stretching the heck out of the straps, but I'm really unsure about that.

After hours of struggling and failing to get to sleep the tech went to see if other masks were available. She came back with a Resmed AirFit N30i nasal cradle mask. Because it had velcro straps and there was no actual pillows I was able to get it to be fairly comfortable. Though honestly I'm worried about leaks with that mask. Unfortunately it was really too late at that point. I was exhausted but wired and stressed. The longer it was taking me to get to sleep the more stressed I was getting.

I really wish I had brought my own Swift FX mask in. I didn't think of doing it.. I thought there would be masks that would work for me forgetting how much I had struggled with masks in the past. I'm not positive I would have been able to sleep with all the other factors (unfamiliar place, pain, less comfortable bed, all the wires, being away from my husband and animals, etc..), but I would have had a much better chance. They also didn't use a climate line hose in the Resmed machine which ironically I think was the same machine I have at home but newer. It looked like a ResMed S9.

Will see the specialists on Monday afternoon but I'm pretty sure she is going to want another study. I'll have to wait and see.

RenW wrote: ↑

Sat May 14, 2022 9:59 am

Will see the specialists on Monday afternoon but I'm pretty sure she is going to want another study. I'll have to wait and see.

Being patient until your visit is a good idea. You may have slept more than you think. Humans are bad judges of their sleep minutes. Your study may have enough minutes to see what the doc needs to know.

Yes, it is good to take a mask you know works for your sleep study.

It would help to understand what the aim of the study was. Apparently not to gauge your level of sleep apnea, given that you were supposed to be sleeping with a machine. And apparently not to see whether you'd benefit from a bi-level machine, since there apparently wasn't one there to be used on you. And apparently not to induce your insurance company to cover a new machine, again because the test wasn't going to tell you what your current untreated level of sleep apnea is.

So I'd request clarification before doing another test.

RenW wrote: ↑

Sat May 14, 2022 9:59 am

. . . the only way that I could make it comfortable was to make sure it was barely tight enough to make a seal but no tighter. . . .

I consider that to be true of all modern masks.

RenW wrote: ↑

Sat May 14, 2022 9:59 am

I have been wondering if undertreated sleep apnea or additional sleep problems weren't making my condition worse.

Your present machine (or use of OSCAR) should report to you your AHI, so that would be the best way to know whether your OSA is undertreated night-to-night, instead of relying on one night of data from a lab/center.

But the data from your most recent study using PAP may give the doc an opportunity to discern whether there are additional sleep problems that are being unmasked during PAP use.

RenW wrote: ↑

Sat May 14, 2022 9:59 am

. . . been wondering if a bilevel machine wouldn't treat my issues better. . . .

In my case, I was originally prescribed bilevel, probably because I strongly hinted to the tech that's what I wanted him to "discover" I needed. However, I now use a ResMed APAP, not a bilevel or autobilevel, since I have found that for me the available 3cm of delta (the pressure relief on a ResMed is virtually bilevel) is enough for me to sleep comfortably with low AHI.

Miss Emerita wrote: ↑

Sat May 14, 2022 10:54 am

It would help to understand what the aim of the study was. Apparently not to gauge your level of sleep apnea, given that you were supposed to be sleeping with a machine. And apparently not to see whether you'd benefit from a bi-level machine, since there apparently wasn't one there to be used on you. And apparently not to induce your insurance company to cover a new machine, again because the test wasn't going to tell you what your current untreated level of sleep apnea is.

So I'd request clarification before doing another test.

This is a good point. I assumed that the study was going to be very similar to my original study. I thought I would spend the beginning of the night sleeping without a mask or attempting to like my original study. If I had known that I would have to wear a strange mask the entire night I would have really thought about how I needed a broken in mask in the style that I use. This is reminding me how hard it was to find a mask to use that was even remotely comfortable. How the mask I use now (Swift FX nasal) wasn't comfortable for me at all at first. I'm remembering the nights when I try a new mask how the vast majority of the trials have end in me taking it off and putting my old mask back on in the middle of the night.

I didn't start with a bilevel machine, but I'm not sure that one wouldn't have been available if they had gotten enough data on the APAP machine. Though I only saw one machine in the drawer this morning. I am curious why they didn't want to gauge my sleep without a machine..

lazarus wrote: ↑

Sat May 14, 2022 12:17 pm

In my case, I was originally prescribed bilevel, probably because I strongly hinted to the tech that's what I wanted him to "discover" I needed. However, I now use a ResMed APAP, not a bilevel or autobilevel, since I have found that for me the available 3cm of delta (the pressure relief on a ResMed is virtually bilevel) is enough for me to sleep comfortably with low AHI.

Could you explain what you mean by "3cm of delta"? Did you find that you slept best with a bilevel machine but that you realized that you didn't need it? Is there are reason you switched to an APAP machine from a bilevel if you don't mind answering.

Good point about the AHI. I just have assumed that the data from a CPAP machine pales in comparison to what can be gathered in an in lab sleep study. I have my most recent data that I can review. I just need a refresher on the AHI that is considered poorly treated sleep apnea.

With as disabled I am right now, I have wanted to make sure that I'm trying to treat any sleep issue I have as thoroughly as possible. I need every little bit of help I can get. In fact, one expert specialist on one of my main conditions has indicated she views Fibromyalgia as primarily a sleep disorder. That she finds without improving the sleep of her patients she is unable to see other important significant improvements in symptoms.

RenW wrote: ↑

Sat May 14, 2022 2:40 pm

what you mean by "3cm of delta"?

I set my APAP's pressure relief on 3. So that is very close to a bilevel machine with pressure support (PS) of 3.

RenW wrote: ↑

Sat May 14, 2022 2:40 pm

. . . realized that you didn't need it? Is there are reason you switched to an APAP machine from a bilevel if you don't mind answering.

At the time, all my medical expenses were being reimbursed by a third party, so I wanted to switch to APAP if I could in order to save that party some money. I tried APAP for a while first, to make sure it would treat me well according to home-machine-reported AHI, to test
my theory, then I had my primary at the time write me an APAP Rx. But I'm glad I used bilevel to get used to PAP therapy in my earlier days.

Technically, according to official treatment definitions, it isn't "bilevel treatment" unless there is a 4 cmH2O or more difference between breathe-in pressure and breathe-out pressure (or, "delta"). But ResMed's comfort feature goes up to 3 cmH2O, and it turns out that is close enough to bilevel for me.

But hey, I ain't exactly normal. As people here know.

lazarus wrote: ↑

Sat May 14, 2022 4:08 pm

But hey, I ain't exactly normal. As people here know.

which is exactly WHY you're here, of course!

...Resmed machine which ironically I think was the same machine I have at home but newer. It looked like a ResMed S9.

It was most likely the S9 TX. https://www.resmed.com/en-us/healthcare ... ab-system/ This system can emulate every other type of Resmed machine (CPAP, Autoset, bilevel, ASV), so the single machine can test all sorts of options for you.

RenW wrote: ↑

Sat May 14, 2022 9:59 am

To get insurance to cover that [BiPap?] it required an in person sleep study.

Unfortunately, the study [in-lab ?] last night was a disaster IMO. I couldn't get confirmed how much I slept but I think it was only 45 minutes at the most.
Will see the specialists on Monday afternoon but I'm pretty sure she is going to want another study.

Whether or not she wants another study, you are entitled to get the full sleep study report, graphs, event plotting and notes . These are your medical records.
That report will provide information on your sleep architecture.

Respirator99 wrote: ↑

Sat May 14, 2022 9:52 pm

...Resmed machine which ironically I think was the same machine I have at home but newer. It looked like a ResMed S9.

It was most likely the S9 TX. https://www.resmed.com/en-us/healthcare ... ab-system/ This system can emulate every other type of Resmed machine (CPAP, Autoset, bilevel, ASV), so the single machine can test all sorts of options for you.

Ah! This would answer one of my questions. And if they’re just trying to figure out which kind of machine you need, and not WHETHER you need one,that would basically answer all my questions.

It was better than I feared. Thankfully I did sleep at least 90 minutes during the night. Enough for them to determine that I did still have sleep apnea and that I responded well to the pressure of the machine. Unfortunately I did not go into REM because I wasn't asleep long enough at one time. The important thing for me at this point is that they got enough data to prove the I do need an APAP machine. The sleep doc did not recommend a Bilevel machine based on data from the study and my current Resmed S9 machine. She is writing a prescription for a ResMed 11 APAP.

RenW wrote: ↑

Mon May 16, 2022 6:11 pm

She is writing a prescription for a ResMed 11 APAP.

All's well . . .

Disastrous Sleep Study

I am reminded of the words of Mr. Twain:

I've lived through some terrible things in my life, some of which actually happened.

Thanks for passing that good news on to us!

So glad you will get what you wanted and have piece of mind. I love a happy ending.

Just so you know your not alone in your experience, sleep labs and myself don't get along very well. If I'm not heavily medicated I don't sleep. I've had 5 nights in the lab now. Two of those nights I had no medication and dozed off for around a half hour the entire night. Both of those had to be done over. The other three nights I was medicated with 10mg of ambien and was able to sleep but not well. From my experience a night in the lab is completely different than a night at home. They can glean some information about your sleep but it's likely different than your typical night at home, sometimes much different. It often makes me contemplate how well they are doing with diagnoses when there are so many things disturbing your sleep in the lab. At least if they can get an idea of what is going on some improvements can be made.

RenW wrote: ↑

Mon May 16, 2022 6:11 pm

It was better than I feared. Thankfully I did sleep at least 90 minutes during the night. Enough for them to determine that I did still have sleep apnea and that I responded well to the pressure of the machine.

Toad u sew.

ChicagoGranny wrote: ↑

Sat May 14, 2022 10:50 am

Being patient until your visit is a good idea. You may have slept more than you think. Humans are bad judges of their sleep minutes. Your study may have enough minutes to see what the doc needs to know.

RenW wrote: ↑

Mon May 16, 2022 6:11 pm

She is writing a prescription for a ResMed 11 APAP.

Get a copy of the summary of your study and a copy of the prescription. Put them in a permanent file. You never know what will come up down the road that makes this very important. What are the pressure settings on your script?

RenW wrote: ↑

Mon May 16, 2022 6:11 pm

I did not go into REM because I wasn't asleep long enough at one time.

Airway muscles are in their state of greatest relaxation during REM sleep. Patients' pressure requirements tend to be higher in REM. Let's see what settings are on the script. If your AHI is unacceptable, members can help you tweak the therapy.

It's good to hear things worked well and you are moving forward.