When can one discontinue CPAP useage

Bama Rambler wrote:If you took anxiety meds, sleeping pill & 4 beers, you really should have an in center sleep study done.

Day_Dreamer wrote:Test results outlined:

Thanks everyone for the input

Please remember

Test is a home sleep study ARES sleep report
Anxiety meds were taken also a sleeping pill as well as 3-4 beers right before sleep ( I actually was unable to sleep for one home test thus the Beer)
Never able to complete tilaration test
Machine Purchase out of pocket via a CPAP vendor who was able to generate a prescription via an on site Dr. after reviewing my home sleep test
My GP literally got the fax when I was in his office and looked at it for 30 seconds claiming Mild to Moderate OSD


Date 2/7/14
Time slept 5.5
latency 12minutes
sleep efficiency 79%

Overall respiratory disturbance
RDI =16 based on a 1% hypopnea desaturation critera with confirmation from surrogate arousal indicators
percentage of time below 90% spo2 = 0%
Mean SP02 96%
average desatursation across all events 2%
Mean pulse rates of 79BPM with very frequent pulse rate variability 61 events with 6BPM inc/decre
slept supine 29% of the time
snored 35% ( My wife claims I only snore when I've had some beers)

I will meet with a NEW DR. next week he is in the weil cornell sleep center in NYC as recommended by a fellow member.

Any other info needed please let me know

Thanks in advance for everyone taking the time to try and help

Day_Dreamer wrote:
Overall respiratory disturbance
RDI =16 based on a 1% hypopnea desaturation critera with confirmation from surrogate arousal indicators
percentage of time below 90% spo2 = 0%
Mean SP02 96%

Day_Dreamer wrote:The problem is, I was unable to complete an in office sleep test. I tried a few times. Since working in lower manhattan during the attack, I have been treated for severe anxiety. I cannot stand being wrapped up.

robysue wrote:Day_Dreamer (and others)

I am NOT trying to start any arguments. For all it's worth, I think you are right to get a second opinion. The circumstances of your sleep test do make a case for further investigation by someone new.

But I do want to point out that the CPAP prescription was NOT necessarily out of line and a case can be made for diagnosing you with mild-to-moderate OSA.

You wrote the test results included:

Day_Dreamer wrote:

Overall respiratory disturbance
RDI =16 based on a 1% hypopnea desaturation critera with confirmation from surrogate arousal indicators
percentage of time below 90% spo2 = 0%
Mean SP02 96%

Sounds like the RDI was based on estimating hypopneas that would have been scored as hypopneas under the alternative standard in an in-lab sleep test: For a hypopnea to be scored under the alternative standard, all you have to have is a 50% reduction in airflow along with an associated EEG arousal---NO O2 desat is required to score a hypopnea under the alternative standard in an in-lab sleep test if there is an EEG arousal.

Seems like the hypopneas on your in-home sleep test were scored by looking for a combination of flow reduction together with a minor O2 desat and surrogate arousal indicators---i.e. data that strongly implies an EEG arousal did take place even though there was no EEG data recorded during the test.

So it is reasonable to think that if you had been in the lab that night, most or all of the hypopneas that the RDI = 16 is based on would indeed have been scored based on the combination of the respiratory data and the EEG data. In other words, your AHI/RDI using the alternative standard for scoring hypopneas might very well have been 16 on this night, And an AHI or RDI that uses hypopneas with arousal (i.e. hypopneas scored under the alternative standard) is considered a legitimate way to diagnose OSA and an RDI = 16 based on including hypopneas with arousal does indeed meet the standard for moderate sleep apnea since the cutoff between mild and moderate sleep apnea is an AHI or RDI = 15. Most doctors will prescribe a CPAP for an RDI > 15 even if the hypopneas are all scored under the "alternative" standard rather than the "recommended" standard and most private insurers are willing to pay for a CPAP in this case. So if your doctor and insurance company accept the "alternative" standard for scoring hypopneas, then based on this sleep test, a diagnosis of moderate OSA is reasonable and you would qualify for a CPAP

Please note that Medicare, however, insists that the hypopneas be scored under the "recommended" standard, which requires a 4% drop in O2 for a hypopnea to be scored. The discrepancy between the definitions of hypopnea in the "alternative" standard and the "recommended" standard do mean that some people (like myself) will get a diagnosis of OSA only under one of the two scoring standards. In your case, it looks like you would NOT qualify for a CPAP under the standard that Medicare accepts.

In other words, the whole business of scoring hypopneas is a mess. And under one accepted way to score hypopneas, you DO meet the criteria for a moderate sleep apnea diagnosis and you do qualify for CPAP. But under the other accepted way to score hypopneas, you do NOT meet the criteria for an OSA diagnosis and you don't qualify for CPAP.

Day_Dreamer wrote:I am having some weird closings of my throat while awake and sitting upright. as I exhale right before I inhale the area inside my throat just above my adam's apple closes and I can here a suction type sound being broken. Upon inhalation the throat opens. There also seems to be an unusual amount of thick flem building in that area.

I have been extremely stressed

Slept only about 6 hours in the last 2 days

BP is 138/88

jnk wrote:The way you confirm the need for CPAP with mild OSA is that you use it and see if you feel better.

OSA below the moderate-to-severe level is not like strep, in which a test confirms that you either have it or do not. The only reason the word "diagnosis" is even used for those patients is for the benefit of the insurance company, not to be of any benefit to the patient. For milder forms of OSA, you could round up a thousand sleep docs and still not have any way to know if a particular patient will benefit from CPAP use without having the patient trial CPAP. It is response to therapy that becomes the yardstick for mild OSA, not sleep testing.

It's like saying, "you need to get a second opinion to find out whether aspirin will help your headache." Take an aspirin. See if it helps. Then you'll know.

We need to remember that many people "without OSA," from the point of view of the criteria payers have dictated, still benefit from PAP therapy. It is important to understand that in the case of sleep-breathing, the diagnostic criteria have been hijacked by the payers and turned into a way to deny patients CPAP unless they fall into insurers' little boxed-in definition. Response to therapy is considered by the best clinicians as the more important measure of whether a mild-OSA patient needs PAP to improve symptoms of bad sleep. A good doc knows how to fudge the numbers in a way to allow a borderline patient to try PAP to see if it helps. Why sabotage that process by demanding a second opinion for the privilege of trying a therapy that may prove to be very beneficial?

Let's not buy into the insurance companies' games. If a borderline patient gets to try CPAP, support it. Let response to therapy dictate whether PAP continues. Those who have been here a while should know by now that with OSA it is not as always as simple as "you either have it or you don't."

Guest wrote:

jnk wrote:The way you confirm the need for CPAP with mild OSA is that you use it and see if you feel better.

OSA below the moderate-to-severe level is not like strep, in which a test confirms that you either have it or do not. The only reason the word "diagnosis" is even used for those patients is for the benefit of the insurance company, not to be of any benefit to the patient. For milder forms of OSA, you could round up a thousand sleep docs and still not have any way to know if a particular patient will benefit from CPAP use without having the patient trial CPAP. It is response to therapy that becomes the yardstick for mild OSA, not sleep testing.

It's like saying, "you need to get a second opinion to find out whether aspirin will help your headache." Take an aspirin. See if it helps. Then you'll know.

We need to remember that many people "without OSA," from the point of view of the criteria payers have dictated, still benefit from PAP therapy. It is important to understand that in the case of sleep-breathing, the diagnostic criteria have been hijacked by the payers and turned into a way to deny patients CPAP unless they fall into insurers' little boxed-in definition. Response to therapy is considered by the best clinicians as the more important measure of whether a mild-OSA patient needs PAP to improve symptoms of bad sleep. A good doc knows how to fudge the numbers in a way to allow a borderline patient to try PAP to see if it helps. Why sabotage that process by demanding a second opinion for the privilege of trying a therapy that may prove to be very beneficial?

Let's not buy into the insurance companies' games. If a borderline patient gets to try CPAP, support it. Let response to therapy dictate whether PAP continues. Those who have been here a while should know by now that with OSA it is not as always as simple as "you either have it or you don't."

Can the use of CPAP actually cause reliance. The old eye glass analogy is stuck in my head
Excuse my ignorance
Thanks
Go Brooklyn !
I am on Ocean Pkwy