Compliance report lack of details

[rbeville13]

I had my first at home sleep study done last November. I had an AHI of 39 or so and O2 dropped to about 78%. The doctor set me up for a CPAP.

When I had my 30 day follow up, I got a copy of the report. It only shows the AHI versus the daily reading I get in DreamMapper showing the three types of apneas. 

Should the doctor be seeing the types of apneas and not just all clustered in a single number?

I was reading this forum and saw stories about chin tucking and since I do that I got a soft cervical collar. My AHI numbers dropped from around 4.0 to numbers like 1.4 and even got a couple zero nights.

I asked for a second at home sleep study a couple months ago. The first study had a lot of obstructive apneas and the second test had a lot of hypo-apneas. The second study had an AHI of about 42 and O2 dropped to about 84%. I was tired from doing a lot of traveling and physical work the days before this second test.

I feel the doctor is not concerned about the type of apneas I have, but rather just controlling the AHI.

I appreciate any feedback or experience of others.

[Sleeprider]

I think most sleep doctors will screen for efficacy based on the simple AHI that insurance also uses to measure whether treatment is effective. I hope he also discussed your therapy and you had an opportunity to raise issues of comfort and any concerns you might have with the therapy. Even with higher detail of our sleep from OSCAR charts, we usually take the time to ask "how do you feel". If problems are present, then a closer look at event types and even finer details of respiration like flow limitation and arousals may be needed; however it would not be common to look for problems beyond the obvious without a complaint.

It would be great if doctors could have the time and interest to do a deep-dig on our health and CPAP results, but it is probably impractical to expect that. If you have specific concerns for future encounters, you should be prepared to provide descriptions, images and statistics of anything you want to discuss, particularly if they affect your well-being, cognition or other aspects of your life. Your identification of positional obstruction (chin-tucking) and taking measures to treat that are really commendable. You researched the problem, found an effective solution, and have taken charge of your therapy, and that is the best way to get the best results possible.

[SarcasticDave94]

I'd agree with Sleeprider. My take is that unless you voice symptoms or complaints, the doc is just going to gloss over the little info he's interested in so as to appease the insurance bean counters. Issues you present should prompt Dr. Dolittle to look deeper. I did say should but not that he would. Push him to look into it on a deeper level. Or shop for a more interested and knowledgeable doc.

[rbeville13]

Thank you both for your replies.

I felt he was questioning why I would be interested in the specific numbers instead of just being happy my AHI is lower.

He was not that interested in the fact I was trying the collar as a way to improve the numbers.
Also, he did not really seem to want to discuss the fact that the second test had a major shift in the type of apnea that was the greatest number.

Sounds like I need to look for a different doctor.

Most see to be ENT specialists, but I had heard some are Cardio-Pulmonary specialists. Any ideas there?

It seems to me that hypo-apneas would be more concerning since the descriptions I see are that they are shallow or slow breathing. Since they are the higher number when I am on the CPAP doesn't that mean it cannot correct those instances as well as obstructive or clear airway apneas. Also, I think I would be wise to get an oximeter to track my O2 levels while I sleep.

[SarcasticDave94]

It depends on what kind of primary care physician (PCP) you have now. He or she could discuss the needs and record medical necessity without a specialist, including potentially a script for treatment devices like xPAP. The catch is if the PCP is willing. I myself use a pulmonary specialist, as my PCP doesn't want to stray from general medical practice. My circumstance was somewhat put on me by insurance requirements as I was on Medicaid until 2-3 months ago with zero income at the time. My pulmonary doc treats both my apnea and COPD, so he's not focused on sleep issues exclusively. He does his part and I add my symptom/complaint list, wants, requirements, self advocacy bits and we meet at a mostly happy medium.

FWIW I've been seen by an ENT for ear and breathing issues. His assistant took images via the nice little camera scope stuck through my nose to see if there were obstructions to address in the throat. This was about the same time I was trying other things medically to avoid PAP therapy in 2016. The ENT I saw didn't have any suggestions from his specialty, and I wasn't super thrilled with cutting bits off in the nose, mouth, and throat areas.

[rbeville13]

My ENT says mine is obstructive, but did not think surgery would help. Actually, he said he could not guaranty it would help. It was like if I wanted him to we could try surgery.

[SarcasticDave94]

I think that sounds similar. I will say this, quite a few have commented on AB that they tried some sort of surgery, and while somewhat successful, the PAP machine was still needed. Me, I'd skip the surgery if only to avoid the extra pain of the surgery itself.