DIY Sleep Apnea Diagnosis

My 23 yo son is 5'10" and weighs 300 lbs. He was height-weight proportionate - a soccer player - until age 17 when he suddenly starting gaining weight. He eats like a bird and exercises regularly. His doctor says he's too young to have sleep apnea and won't prescribe a sleep study for him. But he just keeps on gaining weight. I'm thinking maybe he's a chip off the old block and the weight gain is the tip-off that he has early onset OSA.

So here's my plan and I'm wondering if you all see a problem with it. Well, I think my plan technically is illegal, but I mean a problem other than that.

I have a Respironics BiPAP Auto M with Bi-Flex. I'm thinking that I'll buy a new smartcard, load it up, program the machine with some sort of low starter setting like 7 IPAP/5 EPAP, leave it in "Auto" mode, then after training him in how to use the machine I'll let my son sleep with it for a week. I have an old Resmed machine that I can use while he's using my BiPAP.

At the end of the week, print out the results. If his AHI is like 10 or higher, suggest that he make an appointment with MY doc (a OSA specialist) and tell him to bring the printout with him to convince the doc to send him in for a sleep study. My son DOES have insurance and it DOES cover OSA so all we have to do is convince the doc to get him tested. On the other hand, if his AHI is low, well that would answer that question and we can start looking at other metabolic causes for his obesity.

What do you think? Am I nuts or what?

your doctor is a quack, I'd find another, OSA knows no age barrier. If you have been diagnosed with it, he will almost surely have it too, better to catch it as early as you can.

I would look up the symptoms and give him that epsworth test, should find one online.

You probably should set your auto up:

Mode=AutoBflex
IPAP Max=20
EPAP Min=6.5
PS Max=4
Flex=2

That is what I'd try for starters, when he turns on the machine IPAP will be at 8.5, EPAP at 6.5, they will then be free to move up as needed.

I wouldn't bother buying another SmartCard, just use yours, it will just be those days out of the report.

The Daily report is what you want to observe, tell him he has to keep his mouth shut, machine will log any events seen, if none are seen pressure will stay at the minimum.

I would keep his PS Max=4, you can go to 8 but it will come down much slower, you don't want him having to deal with too much pressure until you have an idea what he has.

Snoredog, I was gonna use 8 but you're right that's a little too much for his first time around the block. 4 it is! But why 6.5? Why not start lower and let the auto titrator do its thing?

[quote="DRONE"]Snoredog, I was gonna use 8 but you're right that's a little too much for his first time around the block. 4 it is! But why 6.5? Why not start lower and let the auto titrator do its thing?

DRONE wrote:His doctor says he's too young to have sleep apnea and won't prescribe a sleep study for him.

----

MY doc (a OSA specialist)

----

My son DOES have insurance and it DOES cover OSA so all we have to do is convince the doc to get him tested.

Drone, those are some things that jumped out at me in your post.

Why not simply ask YOUR doctor to refer your son for a sleep study? Your son could bypass his own doctor completely about the sleep study referral...use your doctor for the referral.

What Snoredog described doing would be if someone with no insurance and no way to get a sleep study were going to try to get TREATMENT on their own at home.

But if what you're wanting to do, Drone, is get results from the machine so your son can "prove" (via printouts showing a high AHI) that your son probably has sleep apnea, the last thing you'd want to do is set the machine to "treat" him.

If the purpose is to reveal a high AHI, you'd want to set the machine as low as possible to let the events happen.

Another way to get a glimpse of what's happening is to set it for "Split Night" with these settings:

min EPAP 4
max IPAP 20
max press sup 8

In "split night", the machine will use EPAP 4, IPAP 6 for however many hours (2 hrs, 3 hrs, or 4 hrs) you set for that. It will not move up at all until the time is up, but it will be recording events. Then it will switch to operating normally for the remainder of the night.

But here's the problem. For all you know, even very low settings might be "enough" to treat your son's probable OSA well enough to result in a low AHI. No matter how low you set the machine's pressure, it IS extra air being pushed.

Also, if your son's doctor is so pathetically ignorant about OSA that he thinks a young person can't have it, there's no guarantee that any kind of printout results from a "borrowed machine" for a "makeshift test" he didn't order would impress the dumb doctor in the least. Might even make him more stubborn about not ordering a sleep study.

Here's what I'd do: Since YOUR doctor is savvy about OSA and your son's doctor is not, I'd simply talk to your own doc about a sleep study referral for your son. Once you tell your doctor what your son's doctor said, I'll bet your doc will get the ball rolling.

While waiting to get in for the sleep study (that I'm betting your doctor will order for your son) your son can try out your machine if you two want to do that. Will be good "acclimatization" for him, but only if he's absolutely gung ho about using "cpap" and fully understands that it might take awhile to find the right mask and get past all the equipment related sleep disruptions that might happen while he gets used to such a strange way of trying to sleep.

This probably wouldn't apply to your son, Drone. He's probably a very determined smart young man. But I'm mentioning it for others who might be contemplating the same thing for one of their relatives or friends:

No matter how thorough your preparations, letting someone use a machine and mask if the person is not fully convinced they need "cpap", and is absolutely determined that they ARE going to use "cpap" no matter what it takes to get used to it, can backfire badly. It can very easily result in, "I've tried it. I just can't sleep wearing a mask. I already know I wouldn't be able to do this kind of thing no matter what... so there's no use in my going for a sleep study."

Good luck to you and your son in getting him that sleep study he needs. For shame on his doctor.

Drone,

I had to diagnose my own OSA. Here's how you can, too.

Get an oximeter. Borrow one from a DME, rent one, or buy one which has memory so that it can keep a record of oxygen saturation throughout the night. Wearing the little fingerclip overnight for the oximeter is no big deal. Wearing an OSA mask would be a big deal. Keep the APAP plan as a back-up. If the oximeter data shows desats, then you'll know definitely.

I agree with Snoredog. Fire that damned physician. Not only that, file a complaint against him with the state licensing board. Show no mercy. He deserves to be harshly reprimanded.

Regards,
Bill

At home use Oximeters are available now too. Get one and use it too. If it shows significant desats through the night, that should be a good piece of evidence to convince any doc something is wrong.

I'm no expert but if it were me and my son I would go the Oximeter route as well. It certainly is less intrusive and frankly I think a doctor would be more convinced by these readings than by printouts from you trying your own home study. Not that you aren't capable of setting your son up properly but I just get the sense that doctors understand the importance of blood O2 concentrations more than AHI numbers. And I am generalizing here. This scenario would especially apply to your son's doctor in case your own doctor is somehow hamstrung in referring your son for a sleep test.

Drone,

I completely agree with Rested Gal. As usual, she states just what I'm thinking, but much more elegantly.

My first thought, however, was exactly the same as NightHawkeye's. Do the oximeter test. Its SO much less invasive than a sleep study, and (I believe) will diagnose a breathing problem. And fire that doctor.

Have you had his thyroid tested?

Good luck
Cathy

I agree that his thyroid could have alot to do with his weight gain. Please have that tested. In my area, the primary care Dr's like to do nocturnal oximetries to "prove" to patients that they need a sleep study. Also, I would have your son find a sleep specialist and call and make an appointment. Most will accept a patient without a physician referral. It is sad that some Dr's still believe that sleep apnea can't happen to younger people.

Drone,

I am assumming your son's doctor is not a complete idoit and has already done a Throid Test, but if he hasn't get one done.

The term that immediately comes to mind is "heredity/genetics". Part of my discussion with my doctor about why I should have a sleep study was the fact that my father suffers my some symptoms as I do, and sleep disorders are hereditary. A little research on the web should give him the ammo he needs to show the doctor not everyone "fits the mold". That is if he intends to keep (or has to keep) his current doctor.

A call to your doctor may be all it takes to get the ball rolling, you might not even have to go to "plan B", in which case I'd also go for the oximeter.

Your son's doctor must not know about the prevalence of OSA among children--yes, there are plenty of kids on CPAP.

In addition to the oxymeter I'd recommend you have your son fill out and score the Berlin Questionnaire. It consists of 10 questions and you score it yourself. It is highly predictive of sleep apnea--if he scores at high risk there's an 89% chance he has OSA.

Here's a link to a thread with a link to the Questionnaire.

viewtopic.php?t=29216

Fill it out and take it to a doctor and ask for an oxymeter test (that his insurance should pay for).

> At the end of the week, print out the results.

Yes, use a separate card. It's only $10 from cpap.com and simplifies things for you. But print it out daily (and then format). This would alert you to any serious problem. But I wouldn't make any changes based on daily results, unless they were serious.

Independent of what you do about xpap, your son really needs to get a new doctor. It's clear that the currrent one doesn't have a clue. And maybe doesn't care. With that kind of weight gain it doesn't take a rocket scientist to figure out that something else is happening.

If you want to do some self-testing, find someone you know who is a diebetic and have them use their blood glucose monitor to test him. Two hours after eating. It's just a quick prick on the finger, a drop of blood on the strip, and the monitor displays the number. Quick and simple.

And help him find a new doctor.

Thanks, everybody. I like the idea about the oximeter and had no idea you could get one for home use. Really, great idea for all the reasons stated above! Forums are great for learning new stuff, aren't they?

I called my local DME supplier and they said that they have two oximeters that they send out for overnight use -- free -- no charge. Take it out, use it for a night, bring it back in, and they'll download the data and print it out for you. It was funny -- the woman said to me, "What do you want it for? Like to diagnose for sleep apnea or something?" I said yes, and she said "Oh yeah, we do that all the time!" Only thing is that they do require a script from the doctor, even though it's diagnostic not therapeutic equipment (seems silly to me).

I think my son's doctor was reluctant to order a sleep study because around here they cost like $6000 and I bet the insurance companies ask the doc's to not give out scripts like candy for sleep studies because of the expense. But I'm sure we could get him to write up a script for a FREE test. Then I'm thinking, if my son's SO2 levels are low, I should ask my son to come home to see my doc. It's like a 2-hour drive. But I know my doc will take him seriously.

As for non-OSA reasons for obesity, including metabolic abnormalities, I'm pretty much up to speed on that stuff and can advise and guide my son in his dealings with the medical community. But I'm one of those folks who thinks that metabolic disturbances are closely tied to OSA, sort of a chicken-egg conundrum if you know what I mean. Like for instance let's say his TP3 and TP4 levels are below normal. He COULD start taking Synthroid, or he could get treatment for his OSA and discover that his hormone levels "magically" fix themselves.

One thing I want to discourage him from considering is lap band surgery or something like that. I know it's all the rage but I think it's crazy. He's too young. Let's exhaust all the other possibilities first.

Thanks again. I'm not a regular on this forum but I'll try to revisit this thread at some future date to let you guys know what happened.

one other thing you should be aware of, sometimes getting that official OSA diagnosis is not such a good idea if you are young, it could have career ending consequences such as if he had goals of becoming a pilot or even a surgeon, can't have either one of those having OSA, should anything go wrong they will use it as an excuse to sue.

Then it can impact medical & life insurance costs and even preclude you from obtaining it.

Sometimes if the treatment is the same you may be better going straight to the treatment and never getting that official diagnosis they just seem to use it against you.