[Diagnosis] Negative for Sleep Apnea?

[jakthebomb]

I received my results and I was told that I was Negative for Sleep Apnea. However, I feel that the test was invalid as it took me forever to sleep. I did have 15 Hypopneas recorded. I am currently trying to get my doctor to prescribe me a CPAP.

My roommate is not convinced of the results. She has witnessed for over a year, me struggling to breath within a half hour of going to sleep. I showed her a YouTube Video (Search "My Best Friend's Sleep Apnea" in YouTube by "Brandon Lee") She said "That is exactly what you do every night when you sleep".

I don't exactly have the funds to just buy a CPAP outright. I was looking at the Philips DreamStation Auto CPAP - DSX500T11

Has anyone heard of Sleep Apnea going undiagnosed even after having a Sleep Study? I have all of the symptoms that are common for those with Sleep Apnea,

- Excessive daytime sleepiness, insomnia, nightmares, sleep deprivation, snoring
- Episodes of no breathing, breathing through the mouth, loud breathing
- Depression, dry mouth, dry throat, fatigue, headache, irritability, mood swings

I wore my Apple Watch with Sleep++ for the past two nights and it said over 25% restlessness, my roommate wore it last night and it said 4% restlessness. I am really desperate for relief.

-Results-
POLYSOMNOGRAM IMPRESSIONS: Raw data reviewed, indicated the following:
1. Negative for Sleep Apnea. Apnea/Hypopnea Index was only 3.5 events per hour of sleep. Oxygen saturation was essentially maintained above 88.0% throughout study.
2. Supine AHI was 7.0. Non-Supine AHI was 1.7. REM AHI was 0.0,
3. Mild to Moderate Intermittent snoring.
4. Periodic limb movements were noted with a PLM Index of 16.8, not associated with significant arousals.
5. Sleep efficiency was decreased at 66.7%. REM sleep was decreased although obtained in supine position.
6. Cardiac rhythm was sinus with intermittent PVCs,

RECOMMENDATIONS:
1. Clinical correlation is advised regarding Periodic Limb Movements.
2. Follow up with the referring physician, Dr. Girish Daulat for further management.
3. If clinical suspicion for sleep apnea is high, a repeat polysomnography may be considered.
4. Should you have any questions pertaining to this study, please feel free to contact us,

Sleep Architecture:
Lights Out: 10:42:00 PM Lights On: 5:12:44 AM
Total Recording Time: 390.7 Total Sleep Period. 341.7 Total Sleep Time: 260.5
Sleep Latency: 49.0 REM Latency. 226.0 Sleep Efficiency: 65.7%
# REM Periods: 2 # Stage Shifts 143 Awakenings: 32

Sleep Stage as % TST:
Stage N1: 3.3% Stage N3: 38.0%
Stage N2: 49.3% REM: 9.4%


Respiratory Analysis: Non-REM REM TOTAL INDEX
Central Apneas 0 0 0 0.0
Obstructive Apneas 0 0 0 0.0
Mixed Apneas 0 0 0 0.0
Hypopneas 15 0 15 3.5
Apneas + Hypopneas 15 0 15 3.5


Supine Events No. of Events 10 Index 7.0

Non-Supine Events No. of Events 5 Index 1.7

REM Events No. of Events 0 Index 0.0

Non-REM Events No. of Events 15 Index 3.3


Oxygen Analysis: Awake Non-REM REM TRT
Mean SaG2 (%) 96.1 95.3 95.1 95.5
Min. Sa02 (%) 56.0 36.0 93.0 36.0
Max. Sa02 (%) 100.0 100.0 97.0 100.0

PLM's: Arousal Index PLM Index PLM Arousal PLM Total
| Total Sleep 3.5 16.8 15 73 |

Arousal Analysis: Non-REM Index REM Index TOTAL Index
Total Arousals 131 33.3 8 19.6 139 32.0
PLM Arousals 10 2.5 2 4.9 15 3.5
Respiratory Arousals 10 2.5 0 0.0 10 2.3
Spontaneous Arousals 108 27.5 6 14.7 114 26.3

[Sleeprider]

The results are below mild apnea thresholds, and perhaps they are not representative due to the clinical environment. I would guess you can obtain a prescription from the doctor, by explaining all of your symptoms and resulting disability, but it will not translate into insurance coverage. Does that make sense? A prescription would at least let you obtain the auto cpap you mentioned, with mask, etc for an outlay of about $500-$520. It might be worth it.

Worst case, if it doesn't work out, you can recover about $300-$350 for used equipment. Anyway, see what the doctor says after considering your desire to use CPAP and other symptoms. Perhaps you can get this covered. False negatives do occur in sleep studies. Do a google search on "false negative polysomnography". That might arm you to make a case to your doctor.

http://www.ncbi.nlm.nih.gov/pubmed/15341897

CONCLUSIONS: There is a clear benefit of repeat PSG, with or without PES monitoring, for patients with a prior negative PSG and continued symptoms suspected of having SAS.

[holden4th]

Your oxygen analysis also does not suggest OSA as it is very good with no real drops in level at all. It looks as if all your hypopneas were while you were supine.

Can I suggest an experiment? Buy a soft cervical collar and wear that to bed. This will prevent your chin drooping towards your chest while sleeping on your back and keep your airway open much wider. They only cost about ten bucks so nothing much to lose here. This alone might deal with your hypopneas. Let us know how it works.

[jakthebomb]

The results are below mild apnea thresholds, and perhaps they are not representative due to the clinical environment. I would guess you can obtain a prescription from the doctor, by explaining all of your symptoms and resulting disability, but it will not translate into insurance coverage. Does that make sense? A prescription would at least let you obtain the auto cpap you mentioned, with mask, etc for an outlay of about $500-$520. It might be worth it.

Worst case, if it doesn't work out, you can recover about $300-$350 for used equipment. Anyway, see what the doctor says after considering your desire to use CPAP and other symptoms. Perhaps you can get this covered. False negatives do occur in sleep studies. Do a google search on "false negative polysomnography". That might arm you to make a case to your doctor.

http://www.ncbi.nlm.nih.gov/pubmed/15341897

CONCLUSIONS: There is a clear benefit of repeat PSG, with or without PES monitoring, for patients with a prior negative PSG and continued symptoms suspected of having SAS.

I was reading a bunch of doctors who studied False Negatives. Here is a Quote from Dr. Mack Jones

".... couldn't agree more with you regarding the sad state of sleep medicine. It's a
shambles; the sleep industry is a failure. Many sleep labs are failing
to do their jobs and putting patients at risk from misdiagnosis, no
diagnosis, lack of educating their patients, no followup, and the list
goes on. Medicare and insurance companies are aiding and abetting this
boondoggle.

The false negative rate of sleep studies, even in accredited sleep labs,
borders on the criminal (these patients go home thinking they don't
have a problem to suffer the catastrophic consequences of their
misdiagnosis). Something must be done to correct false negative tests.
One way to is to reduce the number of in-lab sleep studies. Forty
percent of sleep apneics do not need a sleep study because they have
already been diagnosed by a witness. A majority of others could have a
home study or go straight to an ACPAP with a smart card (diagnosis and
treatment all in one). The complicated patient (those with CHF, COPD,
etc.) can see a sleep doc (good luck).

All physicians should be able to diagnose and treat their OSA patients.
It's not rocket science, even surgeons can learn how to do it. "

I was able to find a CPAP on Amazon for $430 and that would be the Philips Respironics Auto CPAP Dreamstation. No need for a Prescription. I have Medicaid and I am currently unemployed. I can't afford to dish out the cost of a CPAP at the moment. I am going to push my doctor as my roommate is my "Witness" and she swears up and down that I am doing exactly the same thing as that woman in the video I linked to.

[trish6hundred]

Hi jakthebomb,
I hope your doctor will listen to you. Just keep pushing' on, good luck to you.

[KSMatthew]

Your roommate is a great witness to what you are doing when you sleep. But for a diagnosis of Sleep Apnea those events have to be counted and averaged over the total sleep time. That number has to meet a certain limit. You do seem to be having some pretty severe episodes, but your sleep study shows they didn't happen enough times to reach the limit of a Sleep Apnea diagnosis. Maybe some nights they do, but not the night you did the sleep study.

[OpalRose]

jakthebomb,
If you are able to get your doctor to write a script for an apap, that would be the easiest route. I guess that would depend on your relationship with your doctor.

Or you can ask him/her about an overnight home sleep test. Usually the cost is a lot less and would give your doctor results to compare with your first study.

[Ockrocket]

The results are below mild apnea thresholds, and perhaps they are not representative due to the clinical environment. I would guess you can obtain a prescription from the doctor, by explaining all of your symptoms and resulting disability, but it will not translate into insurance coverage. Does that make sense? A prescription would at least let you obtain the auto cpap you mentioned, with mask, etc for an outlay of about $500-$520. It might be worth it.

Worst case, if it doesn't work out, you can recover about $300-$350 for used equipment. Anyway, see what the doctor says after considering your desire to use CPAP and other symptoms. Perhaps you can get this covered. False negatives do occur in sleep studies. Do a google search on "false negative polysomnography". That might arm you to make a case to your doctor.

http://www.ncbi.nlm.nih.gov/pubmed/15341897

CONCLUSIONS: There is a clear benefit of repeat PSG, with or without PES monitoring, for patients with a prior negative PSG and continued symptoms suspected of having SAS.

I would be interested to know if there are false positives in tests for sleep apnoea..

My home test showed 'mild sleep apnoea'.. but I'm a side sleeper and don't snore [even the wife says I don't], but if I sleep on my back I occasionally snore.
During my home sleep study I had no choice but to try to sleep on my back, it was a very restless night as I can't sleep on my back due to back pain and a compressed and bulging disc at the base of my spine.

My blood oxygen saturation never tests below 98% and is often 100% saturation when tested.

If I sleep 8 hours with no CPAP I wake up more rested than I do from using the machine for 8 hours.

My problem now is that I'm forced to use CPAP to keep my driver's licence.

Unfortunately the cost of re-doing all the tests is prohibitive for me, I've just lost my driving job even though my employers said I would go back to my substantive role in the Organisation if I got my full endorsements back to drive heavy vehicles.

I spent $6,000 on specialists/medical tests/CPAP equipment to get full licence reinstatement, the bank account and credit cards are empty, social security won't pay me anything until we sell the house [which we are still paying a mortgage on] and run out of the funds made from the sale... at 62 years of age and no formal qualifications, other than decades of driving heavy vehicles, I'm not very likely to get a job easily.
But with only my wife's income we are struggling to pay all the bills, so it is more likely the bank will sell the house out from under us.

I tried to explain to my respiratory specialist why I felt the home tests were wrong, but he wouldn't listen to my reasoning behind being forced to sleep on my back for the test when it is not the way I normally sleep.

So are 'false positives' also something that could occur in a sleep study?

If so, how can you possibly be correctly diagnosed if you can't sleep in your normal sleeping position?

[chill]

I can't imagine getting a false positive from a PSG (i.e. full monty test in a sleep lab). A false positive might be more likely in a home study, depending on what instruments were used. Drops in blood oxygen saturation more reflect the length of events than that the number of events is affecting sleep quality.

[Sleeprider]

Octrocket, if you have a link to sleep study results you posted, I'll take a look. False positives are possible because the home studies merely measure breathing flow, effort and sometime SpO2. There is no EEG or other traces to even determine if you are asleep or not. Just as machines can measure apneas during periods of disturbed sleep or changing positions, a home study can find breathing cessations. The skill of the technologies or doctor interpreting the results is very important because an obstructive apnea must show no flow, with breathing effort. Of course that could happen if you hold your breath while shifting position in bed.

Still, it would seem that with all you have sacrificed, finding a way to make CPAP work should not have been so difficult. You are 62 and home ownership has no bearing on early retirement benefits with social security. If you have equity in your home, do not wait for a bank or sheriff's sale; talk to a realtor and sell on your own terms. Tough decisions for sure, but you need to stop being a victim.