Few Questions

[APAPNewbie]

I was diagnosed with mild sleep apnea, AHI 5.5, last month via a home study after my PCP recommended it based on excessive fatigue during the day. snoring, interrupted sleep, and my wife hearing gasping and other abnormal sounds from me while sleeping.  My sleep doc then tried for in lab titration which was also denied by insurance who them approved me for the auto cpap resmed airsense 11 which i have been using for just over 2 weeks.  So far the worst nights have had 6-8 events per hour which is higher than my 5.2 AHI from the home study, while other nights have been below 1 per hour according to the software.  My doctor tried 2 times for an in lab study before sending me with the home machine due to my insurance, united, declining these.  I initially was going to use my neurologist's sleep lab but they had scheduled me for an appointment over 6 months out and that was too long to wait, so I sought another source which got me in the study under 2 weeks.  

I called my neurologist to cancel my appointment and the scheduler was kind of an a**h*le about cancelling the appointment, and refused to do it stating the home study is garbage, and more data can be discovered through an in lab study, etc, etc.  Anyway, Ive been using OSCAR and have been impressed with the data captured each night on my SD card as its been isolating events to a certain period which is usually high numbers of events early on and towards the end of the night.  So I Was wondering, with this much data being captured by the machine, what will the in lab study even capture that is necessary at this point for further evaluation, especially since I have a machine?  I am questioning the utility of this especially since I have a machine and a diagnosis, so is there any real value or is this just a "nice to have" study at this point?

Secondly, my event numbers are inconsistent across each day, so is this just my body being getting used to the machine or is something else going on?  I am trying to correlate the different graphs at the same time as the events but keep going back and forth to the oscar wiki and leaving a litttle confused.  I have a follow up appointment with my sleep doctor in a few weeks, and was wondering what I should be asking or expecting from that, and also how often, if at all, i should be meeting with him?

[Phaleronic]

Well, we'd really like to see some of your charts

Personally I had a home sleep study done with 02 monitoring and the ekg box-it showed severe OSA and heavy desaturation (8 years ago)-I thought it was a decent study, my mother recently did a lab study and was diagnosed @ 4.9ahi/rdi but they wouldn't get her a machine because she was just under 5...I've since set her up on a remediated machine of mine and she's doing well, but she really did not like the in lab study nor the sleep doctor.

[APAPNewbie]

When I get home from work, I will post a bunch

[BoxcarPete]

In lab studies are much more accurate for mild cases. If you have, say, 30+ events/hr on a home test then you for sure have a problem and need CPAP. In my case, I had around 5.3 AHI to start, but 25 in REM sleep vs 0 in nREM sleep. I'm glad I had the PSG rather than home test, since it's entirely possible the home test would have clocked me at 4.9 for no diagnosis, and no REM attribution. I'd be lucky if the sleep doc would have even noted the clustering at all.

AHI by itself doesn't nearly tell the whole story. In my case, the REM clustering was having a different impact on my quality of life than a simple 5.3 would suggest. After my nasal surgery, I had a follow up home study that simply came back 2.8 without much more context. I pushed for another PSG and it actually came back squeaky clean, AHI 0.0 for the night (though bruxism was still noted). If you want to do the CPAP thing long-term and it works for you, that's great. If you want to pursue alternatives, I think it's very valuable to have the most detailed baseline possible for future comparison.

$.02

[APAPNewbie]

In lab studies are much more accurate for mild cases. If you have, say, 30+ events/hr on a home test then you for sure have a problem and need CPAP. In my case, I had around 5.3 AHI to start, but 25 in REM sleep vs 0 in nREM sleep. I'm glad I had the PSG rather than home test, since it's entirely possible the home test would have clocked me at 4.9 for no diagnosis, and no REM attribution. I'd be lucky if the sleep doc would have even noted the clustering at all.

AHI by itself doesn't nearly tell the whole story. In my case, the REM clustering was having a different impact on my quality of life than a simple 5.3 would suggest. After my nasal surgery, I had a follow up home study that simply came back 2.8 without much more context. I pushed for another PSG and it actually came back squeaky clean, AHI 0.0 for the night (though bruxism was still noted). If you want to do the CPAP thing long-term and it works for you, that's great. If you want to pursue alternatives, I think it's very valuable to have the most detailed baseline possible for future comparison.

$.02

Thank you.  That makes sense.  What alternatives are you referring to?  Im workng on weight loss as I put on 40# over the past 3 years, but I think a lot of this is related to respitory problems I developed after serving in Iraq and afghanistan as these symptoms went back to when I was pretty slim.

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Well, we'd really like to see some of your charts

Personally I had a home sleep study done with 02 monitoring and the ekg box-it showed severe OSA and heavy desaturation (8 years ago)-I thought it was a decent study, my mother recently did a lab study and was diagnosed @ 4.9ahi/rdi but they wouldn't get her a machine because she was just under 5...I've since set her up on a remediated machine of mine and she's doing well, but she really did not like the in lab study nor the sleep doctor.

 what categories of data are the most important since I can only fit a handful in the screenshot from oscar.

[Phaleronic]

Thank you.  That makes sense.  What alternatives are you referring to?  Im workng on weight loss as I put on 40# over the past 3 years, but I think a lot of this is related to respitory problems I developed after serving in Iraq and afghanistan as these symptoms went back to when I was pretty slim.

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 what categories of data are the most important since I can only fit a handful in the screenshot from oscar.

There is a link in the sidebar regarding how to show us the data we need,  but the default F12 hotkey gives us mostly what we need :

[OpalRose]

what categories of data are the most important since I can only fit a handful in the screenshot from oscar.

We only see to see two or three graphs, something more recent.

See the links below in my signature line for guidance on Organizing and layout of a chart and by using the Attachment Feature to upload it here.  

Use the F12 key to take a Screenshot of the daily page.  For starters, include the following graphs:  Events, Flow Rate, Pressure, Leak Rate and Flow Limitation.  Always include the entire left sidebar minus the calendar and pie chart.

Set your display to the Standard view.  
(View > Reset Graphs > Standard)
Take a screenshot of your Daily screen.
   * For Windows or Linux: Use the F12 key
   * For a Mac: Use Fn+F12

[BoxcarPete]

For CPAP alternatives, there are many. Unfortunately, few work as well as CPAP, and even those few will definitely depend on the person. Mandibular Advancement Devices are in my opinion not worth it. Sleep position (side sleeping, wedge pillows, and the soft cervical collar; an apnea board special) can all help but usually not eliminate on their own. Then there are a variety of surgeries, which will require clinical indication and have an equally varied risk/reward profile. Avoid UPPP unless absolutely necessary; septoplasty and turbinate resection are bread and butter for a good ENT. Adenoid tissue is rare to be present in adults, but if it's there it's worth removing. According to your OP, you're not a candidate for inspire, though it still boggles my mind as to why someone would want that anyway.

In my case, my mother recalls snoring going back all the way to my childhood, when she would listen to the monitor and the loud snoring would sporadically pause. Took me into an ENT to get my tonsils and adenoids out right around my eighth birthday. Gained weight quickly (this was a good thing) and basically changed my life. Fast forward 22 years when I complain to my doctor that I feel like I'm 29 going on 60. Based on my family history he told me to go get a sleep study and I got my diagnosis. Very little help came from them on getting CPAP to work, especially because this was in 2020. I looked into some few other things like side sleeping and MAD, which I wore for a year and messed up my jaw (got better), but finally found my way here and back into CPAP again. Didn't have excellent results, and after thinking some more on the issue, went to find an ENT who specializes in sleep medicine. He scoped me and informed me that I could benefit from an extensive nose rebuild and it would be worth going to surgery and re-evaluating afterwards. I know, surgeon recommending surgery, but recall that I had a life-changing procedure in my childhood and the adenoids were back to occupying 50-70% of my nasopharynx again so I went for the three-in-one (septum, turbinates, adenoids). That was 8 months ago and now I'm off PAP and rock solid with blood pressure firmly back to 120/80, a squeaky clean PSG, and only feeling sleep deprived when I do all the things that would negatively affect anyone's sleep.

So, long story short, alternatives are very person-dependent because OSA is a syndrome and not a disease. Many things can contribute to it, so there are just as many or more potential ways to eliminate those contributions.

CPAP treats the symptoms pretty directly and is very effective in that way, but for those who wish to dig a little deeper for the root cause there are docs out there who will help you do just that. Some folk will tell you none of the alternatives are worth it because you might still need CPAP anyway, but you're coming from a place of mild OSA, so if you're still young enough, you might buy yourself a decade or two PAP-free before age encourages you to seek more direct mechanical assistance.