DIY Home Sleep Study Tonight...

My Dad was never going to agree to go for a sleep study... but he has a hard time saying no to me so...
I packed up both S9 autosets, oximeter, Zeo, camera, laptop, hoses, masks, and O2 adapter, and I'm spending the night.
I didn't think to bring an extra slimline hose and didn't realize that the climateline won't work with O2 or without a humidifier. So he won't have the humidifier because I don't have a slimline to use on my S9.
I'm going with Auto 6-7 and a 15 minute ramp starting at 4 with EPR of 1.
He is 75, has COPD, is on O2 of 2L which he doesn't think he needs, and believes he sleeps fine.
I'm hoping the results will be enough for either me to leave him alone, or for his Doc to write a script without him going for a sleep study.
Anyone awake with any input? addditional suggestions?

Lizistired wrote:My Dad was never going to agree to go for a sleep study... but he has a hard time saying no to me so...
I packed up both S9 autosets, oximeter, Zeo, camera, laptop, hoses, masks, and O2 adapter, and I'm spending the night.
I didn't think to bring an extra slimline hose and didn't realize that the climateline won't work with O2 or without a humidifier. So he won't have the humidifier because I don't have a slimline to use on my S9.
I'm going with Auto 6-7 and a 15 minute ramp starting at 4 with EPR of 1.
He is 75, has COPD, is on O2 of 2L which he doesn't think he needs, and believes he sleeps fine.
I'm hoping the results will be enough for either me to leave him alone, or for his Doc to write a script without him going for a sleep study.
Anyone awake with any input? addditional suggestions?

Reply,

IMO, you could put him on the S9 Autoset and set it on 10 cmMax and 8 cm min with no ramp and no EPRS, and skip all the other stuff. Also prepare to give him 0.5 mg of Xanax (Alprasolam is the Generic) ) or 10 mg of Zolpidem before mounting the full face mask. But only once such dose each day. After 5 hours of sleep get the Resmed graphs to look at the 95% pressure if it needs to be raised one cm at a time. I am 6 years older than your dad and smoked a full pack daily from 60 years ago [corrected from 40 years] till 35 years ago [corrected from 20 years ] when I stopped smoking. I don't use oxygen supply (yet). Doing a recent chest X-Ray at a local "walk- in" clinic, the technician asked me if I have been smoking recently since there were some traces of COPD. But checking my lungs later at my internist by using a spirometer it was OK.

As I understand it, in COPD patients with acute respiratory failure you want to use externally applied PEEP on the expiratory pressure. This requires cooperation of a pulmonologist.

I removed the rest of the post as not relevant.

Good luck!

I don't want to eliminate all apneas, I want to document them. He is on Cymbalta and Remeron and I don't give anyone meds.
My concern now is that his mouth may be open in which case he will lose the O2 too. He is using my extra Swift LT.
Strange thing is that when I have gotten him to wear my oximeter overnight, his pulse is almost a flat line. Stays in the 60's all night with no spikes while his O2 is all over the place and seems to spike at regular intervals... like every 5 minutes. I'm guessing a med is keeping his heartrate flat.
I wish mine looked like that!

I did a home screening using my APAP a couple of years ago on my sister and her husband.
All I did was use the machine with a low minimum and a 10 cm maximum just to see if the pressure increased at all (assuming it would be trying to prevent some apneas) or have it score apneas at all.
When I attempted to use 4 cm minimum both complained immediately that they were suffocating and I ended up with 6 cm minimum before they were comfortable.
You dad may or may not feel the same way with that 4 cm ramp.

Results were surprising. My sister had the greater symptoms of OSA but had zero events and zero pressure increase up from the 6 cm. My brother in law only had minor snoring reported by my sister and he ended up with an AHI of 6 with pressure pegging out at 10 cm maximum for the bulk of the night. Obviously he had the problem but he chose to blow it off and is still floating along on the DeNile river.

Good luck with your dad. My mom won't even consider a home screening. She tells me it doesn't matter if she has OSA or not...she refuses to consider sleeping with the mask. So she says no sense in even doing the trial.

Does your dad have a pacemaker, by any chance?

Thanks Pugsy, I thought you had done this.
No Jan, no pacemaker.
He just told me tonight.. after whining about 5cmh2o when I put the mask on him... that he can't sleep on his back. I said yeah Dad I thought htat too until I videod myself. We're an hour in and he's still on his back! But every couple of minutes he raises his left knee for about a minute, then he lets it down. Looks similar to the O2 spikes. He probably has lots of arousals like I did and very little deep or Rem sleep. I hope the Zeo shows that if it is the case. I hear some mouth breathing but I would have been up for a drink by now!!

I guess you won't be needing cpap yourself tonight. Looks like you will be awake watching him. What a lucky dad. It is so nice of you to take care of him like this. I am sure he wouldn't get this kind of attention at a sleep centre.

I have no input as far as helping but do hope you get some rest.

Thanks Elle, I'm still monitoring but I think I will get some sleep soon. He has a dr appt in the am so I have plenty of work to do before that. He got up to go to the bathroom and was quite obediant about getting his gear back on. He's used to having a woman tell him what to do, I'm just not used to doing it and don't really want to get there.

I'm in the process of having to do something like this on my dad. He has allways snored heavily, stopped breathing and gasped for air in his sleep. A couple of years ago at age 60, he had to have a tripple bypass, changed out most of his aorta due to an aneurysm and got a mechanical heart valve replacement. I wonder how much of his heart issues could have been avoided, if he had gotten his sleep taken care of long ago. My grandfather died from a similar condition in the '70's, so the big question now is if I'll "dodge the bullet" starting CPAP now, in my early 40's.

I wonder why you choose to use a Cpap machine in your DIY sleepstudy? A CPAP will prevent most apneas and only document what it can't prevent or have to adjust the pressure to resolve. I'd use an automatic CPAP for titration, not documentation. I think you'll get much better documentation of his sleep using only your oximeter and Zeo. At least that's what I plan on using on my dad.

I wish you and your dad the best of luck and hope your DIY study will work out well. If needed, you can do as I plan to do, get him a CPAP using my own RX

Good luck, Liz. I know it is difficult caring for a parent. We'll be interested in the outcome.

Jay

Liz, I'd like to share my experience with cymbalta. I took it for about 4 months. I found it to be a very powerful stimulant like drug which greatly reduced daytime fatigue. However, I found it to have adverse effects on sleep causing many more awakenings and even further reducing my deep sleep. I felt it was only covering up the effects of my poor sleep by daytime stimulation which I felt must have detrimental effects on my health so I stopped it. Shortly after stopping, I had an upper GI done and a small ulcer was found. I have no direct proof, but I'm sure the ulcer was caused by the cymbalta.

Jay

Pugsy wrote:Not everyone will have significant desats with OSA. So oximeter alone doesn't always tell the full story.

For purposes of screening only...APAP or cpap is fine. Use a minimal pressure just to see what happens. We aren't trying to treat the events....just prove they exist to a person that is probably in denial and needs some tangible proof that they are stopping breathing at night.

Worry about auto titration and treating the events once the person admits to the need. If we use APAP with a wide range and the machine does its job...and not many events get scored...the person in denial will say "see...nothing happened very much...I don't need this machine...get it out of here" even though we know that nothing happened because the machine did its job.

Sometimes we have to use the 2 X 4 to get their attention first. I wish now I had used a small range on my brother in law. More events would have shown up and maybe he would realize the risk. I used 6 to 10 and the machine stayed at 10 and the number of events weren't hugely eye catching. I bet it would have been a different story if I had limited the pressure to 7 max. He couldn't grasp the fact that since he needed the 10 cm most of the time that there was a significant problem.

Now someone who isn't in denial and welcomes the diagnosis...yeah...open up that range and let the machine do its thing. That person will welcome the pressure changes and understands the need. Those people in denial..they won't want to listen.

I was not suggesting to only use the oximeter, but when using it togeather with a Zeo, I think you'll get the best screening possible, outside of a sleeplab. A healthy amount of time spent in each sleep phase + no undue arousals + no O2 drops = no sleep apnea. Anything that warrants further study by pro's will be recorded, either on the Zeo or oximeter, most likely on both.
I could easily get my dad to sleep with a Zeo and oximeter every night for say a week, giving me very good data over time to base any conclusion on. I'd get him to try the CPAP for one night, but probably no more, unless the data captured showed a GOOD cause for further tests.

Using me as an example, I have many nights where I don't need more than 7 cm H2O to keep my airways open. If you had tried to "diagnose" me with a CPAP set at 5-7 (I'd consider streight CPAP mode at lowest possible pressure best for this as any variation in pressure is therapy, (really, any pressure at all is therapy,) and will further reduce findings), chances are good that I would have had a good nights sleep with a low AHI and my sleepapnea would not have been discovered. Even worse, it might have been falsely ruled out completely.

In my opinion, a CPAP is a treatment device, not a diagnostic device.

I can tell you that the oximetry reports that I selfdiagnosed on was just as effective as a 2X4 for me, even for my doc, who wrote me a RX with no questions asked

I think I would like to disagree too... Can I do that?

The pulse oximeter measures two things. Oxygen saturation and pulse rate.

If your airway becomes obstructed and your oxygen levels drop and your pulse rate shoots up, you have obstructive sleep apnea.

The reaction of your heart to a loss of oxygen causes a lot of stress on your body each time that happens. In addition to disrupting your sleep, the stress on the body is high.

This obstructive sleep apnea responds very well to xPAP therapy.

If you have no desaturations and no pulse spikes it is my understanding that you most likely didn't experience obstructive sleep apnea.

Unfortunately, sleep disorder breathing problems involve more than obstructive sleep apnea.

I think that obstructive events that cause oxygen desaturation and pulse spikes are very serious. On the other hand a lack of sleep from frequent arrousals is also serious, but not as serious as the combination desaturation and pulse spike.

With obstructions you are doing structural damage to your cardiovascular system. With the other sleep disorder breathing issues you don't get restful and regenerating sleep. Either way you are doomed to poor health.

A trained person can gather a lot from the pulse oximeter and the Zeo, but I agree with Pugsy that the additional information from a sleep study is the best way to go.

As it turns out, EVERYBODY IS RIGHT! Thanks for all the input.
Well, It was somewhat of a failure. I learned alot but not what I was hoping for. The data wasn't conclusive enough to try to convince his doc so I didn't go there, but we did discuss it. He has sleep apnea and understands both the seriousness and the difficulty in adjusting to therapy if the patient doesn't want it.
Dad insisted that he only gets up once a night and doesn't ever/cannot sleep on his back. So he got up 5 times and slept on his back twice for an hour each.
He was a trooper though. He put the mask back on each time he got back in bed, but had alot of leaks. Most of which were probably mouth breathing. The pressure did bother him, so I set the ramp but everytime he got up the ramp started over. Then the pressure stayed mostly at the top until he got up again.
O2 is an issue for him because he has has COPD and is on 2L. His O2 stayed higher than I have seen it but that could be lack of deep sleep. The Zeo showed him awake almost the entire night. I think once when he was putting the mask back on, he took the Zeo off.

Jay, He kicks like you do! He was still twice for no more than 10 minutes the entire night. Thanks for sharing your experience with Cymbalta. That makes sense because at his first follow up after starting it, the doc added Remeron to help him sleep. He insists he sleeps fine and says he doesn't fall asleep watching tv(I don't believe him) or nap during the day. Is that when your problems with deep sleep started?? This is a whole new can of worms!
Oddly, He was more engaged today than I have seen him in a year. Then found out he quit taking Flomax 3 weeks ago. They put him on it a year ago when he was in rehab for a broken back. My brother also commented that he has noticed a difference in the last 2 weeks. I hate Big Pharma.

I should have planned to stay awake and monitor him all night.
I should have probably tried Burke's method first. Since Dad says he wouldn't have gotten up that many times if he hadn't had all that stuff on, he said to bring my camera back and video him sleeping as he normally does. I said Ok, if he will wear the oximeter. I think he will go along with the Zeo too without too much of a fight.
He still loves me.
I'm the one that needs the sleep now. I got about 4 fragmented hours last night and I know this doesn't make much sense. Sorry.

HoseCrusher wrote:I think I would like to disagree too... Can I do that?

The pulse oximeter measures two things. Oxygen saturation and pulse rate.

If your airway becomes obstructed and your oxygen levels drop and your pulse rate shoots up, you have obstructive sleep apnea.

The reaction of your heart to a loss of oxygen causes a lot of stress on your body each time that happens. In addition to disrupting your sleep, the stress on the body is high.

This obstructive sleep apnea responds very well to xPAP therapy.

If you have no desaturations and no pulse spikes it is my understanding that you most likely didn't experience obstructive sleep apnea.

Unfortunately, sleep disorder breathing problems involve more than obstructive sleep apnea.

I think that obstructive events that cause oxygen desaturation and pulse spikes are very serious. On the other hand a lack of sleep from frequent arrousals is also serious, but not as serious as the combination desaturation and pulse spike.

With obstructions you are doing structural damage to your cardiovascular system. With the other sleep disorder breathing issues you don't get restful and regenerating sleep. Either way you are doomed to poor health.

A trained person can gather a lot from the pulse oximeter and the Zeo, but I agree with Pugsy that the additional information from a sleis desat ep study is the best way to go.

Quesion to Crusher,


when you use a pulse oximeter on your hand's finger and read a desat of lets say 10% down to 85% saturation. Where in your opinion this desat is occuring? If it's in the finger- blood or hand palm then does it mean that it is also in your brain or heart? If not and the desat is only in the palm of your hand with the finger holding the oximeter then would it not wake you up and then the desat would disappear without affecting your brain or heart?