2 labs, 2 stories

One sleep lab had me up to 11 pressure, and added oxygen, level 2.
Second sleep lab has me at 7 pressure, NO oxygen.
Shall I go for a third?
At least the existence of "too many" PLMDs during REM were documented by 2nd lab.

Just where does this all lead, and to whom does one listen? At least I'm pretty well settled on a comfortable mask, CL-2 Simple Cushion Small, waiting on Petite.
Before you ask, the reason for 2nd lab was due to family Dr. wanting me to be seem by Pulmonary Dr. who is associated with 2nd lab, thus the test.

It seems I'll have to 'follow latest directive' from lab2 until I can prove to them that I need oxygen - OR NOT.

I am very disturbed at such discrepancies in sleep lab results and treatment. I get as much help from my DME!

The reality is, BOTH labs could be absolutely correct in their assessment of your physiological state, including your pressure requirements, your oxygen saturation, and your need for supplemental oxygen ON THE NIGHTS THAT YOU WERE OBSERVED.

There is a tremendous variability in most parameters of interest, depending on a host of factors which contribute to the measured values. These include (but not limited to) what you ate for supper, what was your choice of beverage? how much did you drink? did you drink too much? too little? how much sodium did you get on that particular day? what are you allergic to? what allergens were you exposed to? how much sleep did you get the night before? what were you thinking about? were you worried about something? were you happy? dopey? grumpy? smiley? Sneezy? did you take your meds, did you take all of them? what was the timing? what was the weather? was it cold? hot? humid? windy? smoggy? was there smoke in the air? pollens? Was the wind blowing North? East? South? West? Other? Was your sleep tech cheerful? polite? impolite? overworked? careful? male? female? did you relate well? were you less anxious the second time? more? was it a Monday? a Friday? full moon? ........ and on and on and on and on.... (I'm only getting started).

Given the discrepancies in your sleep studies, you might be a good candidate for an APAP; it would record the differences in pressure requirements from night to night, in fact minute-to-minute, and RESPOND to those differences. It's like getting a sleep study EACH AND EVERY NIGHT. If your pressure requirements are indeed as variable as your two sleep studies suggest, you may actually NEED an APAP or BiPAP that is able to detect and respond to your widely variable pressure needs. I actually think most people who use CPAP would benefit from an APAP for that very reason. Some machines will also interface with an oximeter, which in your case seems like that might also be of interest.

Individual variability is under-rated and under-appreciated, and difficult to measure. Traditional sleep studies are not capable of measuring that. Certainly not on a sampling interval of ONE NIGHT A YEAR, or longer. In your case, a THIRD study, as you suggest, will just be one more data point, and the question will remain open. It's not like two-out-of-three wins the prize.

My interpretation of your two sleep studies thus far:
Sometimes you're a 7, sometimes you're an 11, sometimes you need oxygen, and sometimes you don't. Also maybe sometimes you're something else. In fact probably. (It's hard to jump straight from 7 to 11). Also don't assume those are necessarily the minimum and maximum values. I see no reason to doubt the findings, just because they're different.

Thank you for your information - ALL of it!!
I do understand that there are many factors to a good night's sleep, even without apnea/sleep apnea/low oxygen level/etc.
What bothers me is the 2nd lab insisting thus far that NO oxy is indicated, even though they are aware of low pulse ox levels. I'm going along with their dictum for next 4 weeks, and the low oxy will show, according to my DME, who has been as much help as anyone else! So, I if I feel like a nap, I'll take out the card and hook up the oxygen, since I know in my heart/body that I need it.
Thank you for your recommendation of having an APAP; I'm going to look into that. I'm also requesting that my DME find out which humidifiers have ambient tracking. Until recently, hardly any water was 'used' from my integrated heated humidifier. (I made fleece covers for my hose). Now, for the last week, there's only been a few tablespoons of water LEFT! I did turn down the humidity level, but received same results. I cannot find (inquired from CPAP.COM) a humidifier that holds more than 400 ml. I'm wondering why that is!? I do not get rainout, so I know I am using the humidity; don't wake up, and am comfortable.
Q: cannot we, as a consumer, get any xpap machine which we feel helps us most? Certainly someone else cannot know that. No, I don't NEED the 'best' of everything, but I have intentions of self-monitoring, once I can afford the hardware and software. I'm not finding anyone else too reliable, or maybe I am impatient? At least I've found the correct mask for me - I think!!! It's the same one they (lab2) came in and tore off me in middle of night and put a different one on me! They said it leaked - well, if it leaks, tweat it first!! Guess I'll get out the camcorder, tripod, and hope for the best. The mask was Comfort Lite; I've since purchased the CL2 with simple cushion; terrific for side sleeper I am.

I'm wondering who actually writes out your prescription.....?
Someone....."sleep doctor" has to write out a prescription for you to get your machine. Once you get that piece of paper, you can get (almost) any machine you want.

Best wishes,

Den

Wulfman wrote: Once you get that piece of paper, you can get (almost) any machine you want.

Good point, Den !

Also, no matter WHO writes it, you are entitled to a copy of it. IT'S THE LAW!

Question then becomes, who pays? Not all insurance providers will get exactly what you think you need/want. But most will cover what they consider the minimum for which they are otherwise obligated. Then you the patient will make up the difference. Some DMEs have been known to restate the above truth, as, "Insurance won't cover an (APAP/BiPAP/xPAP)", which some reasonable folk might construe as "deceptive". Some insurance providers will spring for the whole package, And many DMEs are absolutely forthright and honest. Mine at least showed me their reimbursement schedule and explained why they didn't want to sell me an APAP even though my doc specifically ordered an APAP. Simply put, they get paid the same no matter what I get. We ended up splitting the difference (wasn't much), even though I don't think I should have had to. They understood that I was happy to shop elsewhere, and they still made a good profit. I'm glad for the APAP.

Offerocker-really, if you sign in as a member instead of a guest, we can send you a private message. I might have some info regarding the software and reader for you - depending on what machine you are using.

Also, by setting up a member login, you can put what equipment you are using and also add what pressure you are set at. That info would be a big help to us when trying to address your questions.

You can PM me once you've set up a member login, so I can respond. Look at the bottom of my post where it says PM Me.

Linda,

I think she is already a member but has been having trouble logging in.

Den


Kathleen,

If you're having trouble using your login name, contact the forum administrators and see if they can get you straightened out.

Den

Ric wrote: And many DMEs are absolutely forthright and honest. Mine at least showed me their reimbursement schedule and explained why they didn't want to sell me an APAP even though my doc specifically ordered an APAP. Simply put, they get paid the same no matter what I get. We ended up splitting the difference (wasn't much), even though I don't think I should have had to.

I, and you, should be able to say - " 'Want to isn't the issue' That's your problem, not mine, the script says APAP and I should get an APAP!"

I know, unfortunately the world doesn't work that way but it should.

SB

Wulfman - I HAVE notified the administrator twice...to no avail! I've been sent new passwords, but they don't work. I've had to make up new email addresses so that I can change the userid, but never get to the profile page. I yam at a losssss! I'm glad you recognized me.

Will post question re machine soon, at this thread. I sure hope I can PM you-all. btw, you both can reach me at: kmkush@msn.com THANK YOU !

Kathleen,

I have sent you an e-mail.

Den

Thanks, Den - I'm waiting for it! I cannot PM, IM, ANYONE. So many questions to ask re Rx and xPAP. I'm at least upgraded to CPAP PRO with smart card. I want an APAP. I want an ambient tracking HH. I want.....(it all!) Thanks for both your interest Linda, I hope to hear from you.

Kathleen,

Make sure that AT LEAST you get the REMstar Pro 2 (the plain Pro model didn't have data capture)

Den