[Diagnosis] Had at home sleep study done not sure about results

[Bobbyjones]

I don't understand your doctor's conclusion.  Home studies are good screening devices, and this one says mild sleep apnea.  My wife had a full sleep study with a result of 9.4 AHI, mostly hypopnea, and was subsequently given a titration study and auto CPAP.  This was insured.  I would expect if you took a full polysomnograhy study, your results would likely increase, not decrease.  So under insurance and medicare guidelines I'm familiar with, you qualify at 6.9 AHI overall with higher events supine.  This link is the current Medicare Decision Memo for coverage. https://www.cms.gov/medicare-coverage-da...romdb=true  You qualify for coverage under 2.d. and 3.b.  Based on the results of your 3-channel home study and the symptoms you summarized in your first post, your PCP can prescribe based on your results if you wish.  Online suppliers like Supplier #30 would look at this and issue a prescription ($99 prescription service).  So it's your choice if you want a valid prescription and insurance coverage.

With a prescription, you could work with your insurance and an in-network provider to get suitable equipment.  If your deductible and copay are relatively high, then getting equipment from an Amazon vendor is an obvious winner.  If you go that route, take the time to inquire with the seller if they are an authorized seller of the equipment and can provide warranty support.  Also look carefully that the package is complete with the humidifier, heated hose and carry case, and the seller is based in the United States.   For a mask, I like the Resmed Airfit P10.  It sells on Amazon for $65 and includes all 3 sizes of nasal cushion (pillows).

The nurse said the doctor believed the equipment over estimated my results so he pretty much ignored them. So my PCP should be able to prescribe anyway since the data shows I do qualify? I can just purchase from amazon the machine/mask and let it figure out how much pressure I need i.e. no titration study needed. I appreciate the information and advise.

[Sleeprider]

Back when I started this in 2008, I was diagnosed in a clinical sleep study with very severe OSA, but I was intolerant of the clinic...didn't sleep.  So I was prescribed auto CPAP and self-titration.  Equipment was not as easy to obtain data from back then, but I was able to use the smartcard and Encore software to get optimized.  Today, machines and software are so easy to use.  And yes, you could get the Dreamstation Auto, set it to 6-20 and experiment with A-Flex and probably be very comfortable.  

The general consensus for home testing is it under-estimates OSA (see link and quote below).  Where borderline results or uncertainty exist, the appropriate response is to schedule a multi-path PSG test in a sleep clinic, especially if there is insurance.   To dismiss a patient with complaints of fatigue, headache and other symptoms who actually scores above significance thresholds is unprofessional.  You should complain.

Should, Would, Or Could Providers Do Home Sleep Testing? http://www.sleepreviewmag.com/2014/12/sh...p-testing/

The apnea-hypopnea index for HST (“AHI”) is calculated using total recording time (TRT) or some indirect estimate of TST, so “AHI” derived from HST = apneas + hypopneas/TRT (or an estimate of TRT). If “AHI” determined by HST is ≥ 5, the true AHI is often underestimated, and the lower the sleep efficiency (TST/TRT x 100) the greater the underestimate. False negatives (ie, AHI < 5) could also occur. As with any single-night study, including PSG, the severity of OSA may also be underestimated due to lack of or limited supine and/or REM sleep and/or night-to-night variability of sleep habits, medication effects, alcohol, caffeine, smoking, and environmental factors.

In other words, home sleep tests (HST) dilute your AHI by counting all time of the test, including prior to sleep onset, arousals and awake periods. The sensitivity of the sensors is clearly less defined than PSG, so the results don't overestimate, they underestimate severity. If a doctor doesn't believe the tests he administers, why does he waste his and your time and money?

[trish6hundred]

Hi Bobbyjones,
WELCOME! to the forum.!
Good luck to you as you start your CPAP journey, hang in there for more responses to your post.

[car54]

I had a home study also. I had  under 5.0 apneas and about a 15 hypopneas. The doctor prescribed cpap for me just because of the high hypopneas. My wife said the night I took it I had less apneas then normal. I never had a full study at a clinic. My GP prescribed an auto machine and I was pretty much on my own. Your GP can write the prescription, it does not have to come from a sleep doctor. For now try sleeping on  your side like BEEJ suggested.

Car54

[Phill]

"Notice that you do much better not sleeping on your back.
Obstructive apnea is 6.5 times higher on your back (2.6 vs 0.4 )
Hypopnea is about 3.4 times higher on your back (8.09 vs 2.6)
Central apnea is 7 times higher on your back, though there aren't many of them (1.4 vs 0.2)"

Agreed the results are better when not sleeping on your back, however during my home sleep test I had a device about the size of a cigar box attached to my chest, which obviously made sleeping on my chest next to impossible, and sleeping on my side difficult.

I pointed out to the morons that this was hardly likely to be truly representative of a normal nights sleep for me, forcing me to sleep on my back and giving me high readings.

So, my sleep apnea could well have been diagnosed when in fact the problem is down to being forced to sleep unnaturally for many on ones back.

I should add that I have never had the extreme daytime tiredness etc. that many describe on this site.

[Bobbyjones]

Thanks for all the replies, I tried sleeping on my sides last night but it was difficult, it is hard to not shift to my back. It is more comfortable to sleep on my side at first but eventually sleeping on my back becomes more comfortable. I'm not sure if I actually stayed on my sides though, I certainly don't feel any different. I will probably try contacting my PCP about a prescription or just order on amazon. I was looking at Philips Respironics DreamWear Nasal CPAP Mask [link removed], any opinions on it?

-----
Moderator Action: Link Removed

To maintain our status as an educational organization, the only commercial links allowed in this forum are to CPAP-related manufacturer websites.  This is stated in the Apnea Board Rules with details given in the Commercial Links Policy section.

-----

[Beej]

If you're not used to sleeping on your side, it will feel odd at first. Sometimes you just need to give yourself some time to adapt.
A small pillow between the knees and/or one to prop the upper arm up a bit can help keep your body aligned and more comfortable,

[Bobbyjones]

Well my PCP (nurse) said the pcp couldn't prescribe anything due to not knowing how basically and I tried the sleep clinic I had the home study with and wanted to a trial cpap for a week, which is what they do if you test positive for apnea. They basically said you don't have sleep apnea again. I'm not even sure if sleep apnea/uars is causing all these symptoms. Just recently my brain fog has gotten worse, could apnea/uars worsen over time and eventually cause insomnia? That's what happened like 5 or 6 months ago. I still want to try cpap but those guys are unhelpful.

[stanleydean]

I was a back sleeper most of my life until I guess when sleep apnea started to kick in but I was in denial. My snoring had become monumental and out of consideration for my wife and also for my right to sleep in the same room I started sleeping on my left side which actually reduced the snoring considerably, sleeping on my right side was out of the question because of a badly torn rotator cuff. After I finally talked with my PCP in 2000 and had a clinical sleep study I got a CPAP machine plus supplemental oxygen. I thought "oh boy, now I can go back to sleeping on my back". Wrong! after about two years sleeping on my left side I was no longer comfortable any other way and that is still the way it is. Occasionally I will roll over on my back for a short while but it doesn't last. As mentioned by others I also find that sleeping with a small pillow between my knees is very helpful.

Stick with it and you will make progress in this journey. Don't hesitate to try different things until you find the right mix for you.

Stan

[Sleeprider]

Well my PCP (nurse) said the pcp couldn't prescribe anything due to not knowing how basically and I tried the sleep clinic I had the home study with and wanted to a trial cpap for a week, which is what they do if you test positive for apnea. They basically said you don't have sleep apnea again. I'm not even sure if sleep apnea/uars is causing all these symptoms. Just recently my brain fog has gotten worse, could apnea/uars worsen over time and eventually cause insomnia? That's what happened like 5 or 6 months ago. I still want to try cpap but those guys are unhelpful.

So first your doctor prescribes a home sleep study and says he doesn't believe in the results, and even though you had mild apnea indicated, they said you dont have it. On top of that they don't listen to your symptoms and complaints.  This doctor is a waste of time.

You have two choices.  Find another doctor, or just take this into your own hands and get the job done.  For about $500 you can have a top of the line auto CPAP and mask. Or, you can find another doctor, make an appointment to explain your need for a sleep test, take the test, wait for the results, possibly take a second test for titration, get referred to a DME, and hopefully end up with what you want by sometime around August.

Search Dreamstation Auto CPAP DX500T11 and Resmed Airfit P10. The choice is yours.  I usually just suggest Amazon, but nothing is showing up there right now.