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Could be UARS too. I don't know whether most sleep labs diagnose that these days, or if it's still restricted to a few.

How long did she sleep?
91% SP02 is still low... and while the average of 97% is still OK, if she spent a lot of time at < 97% she could still be feeling the effects of the desaturations.

With an RDI of 5.7, (and what was the average duration?) I don't see why they can't approve or at least trial CPAP therapy??

Time for a 2nd opinion?

Post the full study if you can.

echo wrote:Could be UARS too. I don't know whether most sleep labs diagnose that these days, or if it's still restricted to a few.

How long did she sleep?
91% SP02 is still low... and while the average of 97% is still OK, if she spent a lot of time at < 97% she could still be feeling the effects of the desaturations.

With an RDI of 5.7, (and what was the average duration?) I don't see why they can't approve or at least trial CPAP therapy??

Time for a 2nd opinion?

Post the full study if you can.

She slept for 390 minutes out of 420 minutes. I can't find the average duration of RDI... But I just noticed that she spent zero minutes in supine position! I think this might be the key... She might have more problems when she sleeps on her back...

Knee-jerk reaction.. or maybe just jerk , then again subconsciously thinking she should try a mask!

echo wrote:91% SP02 is still low...

91% is too low? Mine was 92%... Is that not good? (sorry to hijack...you can PM me if I'm hijacking)

SleepingUgly wrote:

echo wrote:91% SP02 is still low...

91% is too low? Mine was 92%... Is that not good? (sorry to hijack...you can PM me if I'm hijacking)

Well again I'm not a doctor. During my psg my oxygen desats never went below 91% and my baseline (awake) SP02 was around 97%. I had mostly hypopnea's. I still had wrecked sleep, though that could be from arousals as well. So I think what's important there is comparing with your baseline SP02. If it's 99% when you're awake and you go to 91% at night, I'd say that's not good. As far as I can gather most healthy people are in the upper 90s. Again, i'm no doctor, just going from what I've observed around here.

The question is this:
Suppose you could convince to doc to give her a 2-3 week trial of an APAP at home.
And suppose she felt much much better with APAP therapy. And the doctor agreed to Rx a CPAP (APAP) and then insurance refused to pay.

Would you pay for an APAP out of pocket?

Getting an Rx, and getting insurance to pay are 2 very different things, and it helps to consider them separately.

O.

ozij wrote:The question is this:
Suppose you could convince to doc to give her a 2-3 week trial of an APAP at home.
And suppose she felt much much better with APAP therapy. And the doctor agreed to Rx a CPAP (APAP) and then insurance refused to pay.

Would you pay for an APAP out of pocket?

Getting an Rx, and getting insurance to pay are 2 very different things, and it helps to consider them separately.

O.

First for what you wrote to happen, a mini miracle has to take place -- my girlfriend wanting to try APAP

Joking aside, yes I would definitely pay for APAP out of poccket. Actually, I think we can also pay that with "flex" dollars.

I started posting in this forum regarding UARS.

viewtopic.php?f=1&t=52027&st=0&sk=t&sd=a

If she gets re-studied and sleeps on her back (supine) she will most likely have more significant sleep apnea as you have witnessed. Some would say if you can have a low AHI on your side then why not do it? The real question is...how does she sleep and feel now? Not very well from what you described. Most people with "positional sleep" apnea have obvious respiratory events while supine and flow limitations while lateral (side). Flow limitations by definition do not meet AASM criteria to be included in the AHI and AHI is what most insurance companies use to determine CPAP need. Probably instinctively she sleeps on her side much of the time and still feels poorly. This is typical of the UARS patient.

I just got a machine for my partner, look online, used machines are there.
Actually, the machine I found was better than my System-One 450, it's an Remstar Auto with humidifier.

Her results are better than mine, it took me 3 weeks to get used to the (non-auto ) machine.
She's already sleeping through the night and is in much better mood (and a bit friskier
just a week into it.

Now I need to find a good sleep Dr for both of us, my insurance-appointed DR and DME are
pretty much useless. I could not get my sleep study results, they just said 'severe' but would
not give me numbers or charts when I asked. The DME would not show me the data report
from my 450, all they care about is the compliance data so they can get paid.
And with all that, I've still had to pay $500 out of pocket for my machine, I only paid $385 for hers.
I'm only renting mine at this point, the DME charges over what insurance will pay, I've had it since March '10.
If I can find another nice Auto machine, my System-One's going back to the DME.

Big Daddy RRT,RPSGT wrote:If she gets re-studied and sleeps on her back (supine) she will most likely have more significant sleep apnea as you have witnessed. Some would say if you can have a low AHI on your side then why not do it? The real question is...how does she sleep and feel now? Not very well from what you described. Most people with "positional sleep" apnea have obvious respiratory events while supine and flow limitations while lateral (side). Flow limitations by definition do not meet AASM criteria to be included in the AHI and AHI is what most insurance companies use to determine CPAP need. Probably instinctively she sleeps on her side much of the time and still feels poorly. This is typical of the UARS patient.

I agree! I am not sure how we are going to convince the doctor about this. He told her that she has "shallow breathing" but only recommended sleep hygiene type behavior changes...

Some updates... My girlfriend saw her sleep doctor again and also had an appointment with an ENT specialist. The ENT specialist didn't see any physical abnormalities... Her sleep doctor suggested her about the possibility of UARS and, as expected, the insurance is not going to cover CPAP expenses. He told her that she can try CPAP and he can give her potential pressure ranges to use. I was little bit surprised about this since it sounded like he would prescribe her a CPAP without a titration sleep study. Anyway, she has an appointment coming up with the sleep doctor in about a month -- we'll know more then. I am hoping that at least she can get a loner CPAP/APAP to try for couple of weeks at home.

With my APAP, I can at least see AHI stats and tweak the pressure accordingly. I am wondering what kind of CPAP machine will be best to use with UARS patients in terms of monitoring the effectiveness of pressure/therapy . There are new machines in the market with different algorithms. Is there anything out there with "UARS" mode?

Thanks!

I must give you some explanation as to why your g/f might be "positional sleeping" during the study as this was explained to me by my respirologist.

He said to my g/f that I was sleeping mostly on my side and with a crooked neck, along with excessive restlessness because my body was trying to adjust position during sleep (the little bit I got) in its own attempt to correct/improve my breathing. Its like a fight or flight response to not breathing adequately. The human body is quite adept at adjusting or altering itself as its needs change.

A significant drop in O2 levels between awake & asleep is cause for concern and 91% is not that good that being said its not horrible either, I've seen many reports from other users showing levels in the 80's.

I would suggest you or she try to convince the doctors to trial a machine or possibly trial her your machine for a few hours during the day(while napping) with those potential pressure ranges you speak of. If she uses your machine try to be home to observe her and make notes.

I definitely notice that she's fighting for air once in a while. No surprise that she's always so tired. It amazes me though the doctor is taking the situation kind of lightly since it's not a well defined case of OSA.

If we can't get a loner, we'll experiment with my APAP. We just need to get a mask that fits her.

My AHI was only 5 and lowest 02 sat was 88%. It was sleep disturbance, measured by EEG, that got me the diagnosis. Even the infrequent apneas were causing me to shift out of sleep mode, and I never completed a full sleep cycle the entire night at the sleep lab. Maybe she needs a more knowledgeable doc??