Asking for a friend
Discovered today that a friend of mine who I haven't been in touch with for a while had a failed home study, (something didn't work and needs redone) so was talking to him about sleep apnea.
He describes fuzzy head, constantly exhausted, sore head in the morning and bad snoring where his wife says he stops breathing - I was telling him to get a sleep study done, however..............
Is there anything stopping me loaning him a rig and setting it wide open and allowing it to auto titrate - would there be any downside of starting treatment ahead of a diagnosis ?
If not then what would you suggest setting it to / advice ?
Rob
RE: Asking for a friend
If it is going to be some time before the re-test, or if he is faced with a big out of pocket cost, then I don't see why you can't do the trial you're suggesting. Set the machine to Auto, min pressure 6, max 20 and EPR 2. I'd put a new card in it so that his results aren't contaminated by existing data, then see what #SleepyHead shows up. It's a fairly simplistic approach but should give you (and him) sufficient data to get going.
I assume that Canada requires a prescription for the machine etc, so he'll need a "proper" sleep test at some stage to keep things legal.
RE: Asking for a friend
So my buddy is one month into treatment and has taken to it like a star.
Feels like a million bucks, cloudiness gone, snoring gone, tiredness gone and last night we downloaded sleepyhead onto his laptop and had a look at results.
Machine each night is ranging between 8-12 and his AHI is averaging about 1, mostly hypos so he's happy where he is. He's just had a bunch of medical checks done and heart function etc all good so anything preventing him from just carrying on with whats working other than needing a prescription at some stage ? (Funnily enough I've got machines aplenty to give him)........
The other thought I had was could he set the Resmed Airsense to CPAP at say 5cm to get an idea what his AHI would be for a night or two - see what shows up when the pressure doesn't rise to prevent ?
Is this a crazy idea / in this instance is there really any need for a sleep study if it can be rigged in this way ?
Rob
RE: Asking for a friend
I understand your question, and it does seem prima fascie reasonable. However, the fact is that the machine, even off, imparts a confound into the process of determining how he'd react to the nose cover and its vent. He could still breath okay, probably, but we all know that it wouldn't be natural due to the restriction imposed by that array of tiny holes in the vent. Similarly, the 5 cm you suggest would impart their own confound to the validity of any conclusions you could draw from whatever the results are.
It would be best if he were evaluated with the least number of intrusive measures and devices. Something covering his face with the aim of determining what his apnea would be will only reveal what his apnea will be with the cover. Add 5 cm, and ditto...you'll only learn how he fares with 5 cm. It won't be a true reading of his real impediment.
RE: Asking for a friend
The trouble is if no events show up all you can conclude is that he is well treated at the pressure you test with. There is no way to rig the machine to provide no pressure.
If reducing pressure causes an increase in events you can conclude that he does have sleep apnea. An AHI of 5 is required for a diagnosis of OSA.
A doctor may make a diagnosis if you can show him a consistent AHI of greater than 5 at suboptimal pressures. Ask your doctor, you may be lucky.
RE: Asking for a friend
not sure what purpose would be served since you already know from how he feels that it's working. whether his untreated ahi is 9 or 90, it shouldn't make any difference with respect to titration. indicators as to whether a different modality is needed should show up in the machine data and your friend's symptoms.
still, I understand the curiosity. it's my understanding one can have an at-home test for a couple hundred dollars through online cpap concerns. I'm not completely sure but I believe some even offer a prescription for a machine, maybe for an additional charge.
running the machine is a no cost alternative that won't be accurate but could confirm the existence and type of apnea (although you probably know these things from using the machine at 8-12 cmw) and give you a general idea with respect to severity. one assumes ahi will be lower than without the machine, given the modicum of treatment received at even the lowest pressure of 4cmw. it's probably reasonable to assume your friend's untreated ahi would be at least as high and probably higher than the ahi returned from the machine set low. obviously the higher pressure needed to avoid air starvation, the greater the difference may be between actual untreated ahi and that returned by the machine.
it doesn't seem likely but I suppose the possibility that using a cpap machine at lowest pressure might aggravate or worsen apnea should be considered. for that reason it might be useful for your friend to note he feels the day after, compared to not using the machine and compared to using the machine at 8-12 cmw.
RE: Asking for a friend
Can he simply take another home study but opt to pay for it out of pocket? I believe the results aren't always accurate depending on how it is setup. Based off the follow up comments, it seems like he is benefiting from the machine.
RE: Asking for a friend
running the machine will be inaccurate with respect to untreated ahi to the extent that it is providing therapy even at the lowest setting. otoh, it's my understanding that the at-home tests are pretty accurate but not as accurate and informative as in-lab polysomnography.
RE: Asking for a friend
thanks for all the responses, he's feeling fantastic, full of energy and the snoring has stopped so he's happy just to assume its working and leave well alone.
Rob
