Is there any way this person doesn't have OSA?

[Shin Ryoku]

I know that OSA isn't supposed to be diagnosed with a PAP machine.  

But suppose for example that I suspect a family member has OSA and have them wear my PAP machine on CPAP 4 overnight with a full face mask and get this:



Selected "highlights":






My question is, is there any way that person doesn't have OSA?  I know that CPAP 4 could theoretically treat OSA and cause a person with OSA to not show events, but could wearing a mask with CPAP 4 cause a person without OSA to show events?

The only confounder I can think of would be the mask pushing the jaw backwards a bit, but my guess is that this result would almost certainly mean that they have the diagnosis.  What do you think?

[kiwii]

For clarification:

Did this person sleep during the night? I think it would be hard to breath on a straight setting of 4, and would expect frequent awakenings. However that *is* a lot going on there. But is it possible that at least some of it is awake junk?

[Shin Ryoku]

They felt like they slept soundly through the night and had no difficulty at all breathing at that setting while wearing a Simplus full face mask.

[DeepBreathing]

I'm no doctor but I would take that result as pretty conclusive evidence that something is badly wrong and a proper sleep study is in order. Alternatively, try a higher pressure and see if the AHI improves, which would be evidence they respond the the treatment this experiment indicates they need.

[OpalRose]

Agree, a lot going on there. I can't imagine sleeping all night with a pressure of 4 either, and I would have to guess that if this person didn't have OSA, that graph would have looked way less busy.

If this person is agreeable, repeat the experiment and raise the pressure to 6 and see what shows.

[Sleeprider]

Flow limitation and snores seem to confirm obstruction. The apneas all end in a very strong recovery breath/gasp approaching 130 mL. The detailed flow rate graphs show ragged peaks that may be obstructive flow limitation. These are long apnea events, and this person needs help sooner than later.

Since the device you're using is an Autoset, I think I'd open it up and see if it resolves a significant proportion of events. Clearly this is someone with sleep disordered breathing, and it is most likely obstructive. If APAP pressure in the 6-18 range resolves the events to less than 5 AHI, he might have enough evidence to request a doctor to prescribe a CPAP device. If results are significantly higher than that, then there is plenty of evidence to refer for sleep study. Either way, this experiment should expedite getting appropriate therapy at a low risk.

[Shin Ryoku]

Thanks, everyone.

[Sleep2Snore]

They need to get a proper sleet study done.

[Sleeprider]

They need to get a proper sleet study done.

It's far too cold for sleet here!  I actually think a sleep study could be unnecessary if this relative were able to demonstrate efficacy with CPAP pressure.  In fact if he had a relative who was, say a dentist or other medical professional, he could probably even get a prescription that was legitimate.  Not much doubt in my mind what we're looking at is plain old OSA, and CPAP is the answer.  Even with a sleep study this individual would get a CPAP to start with regardless of how many sensors he is hooked up to or even if he showed some central apnea.  Call me a cynic, but blowing $3000 on a sleep study is rarely worthwhile. This "screening" test has all the merit of a home sleep study.

[Shin Ryoku]

Let me come clean here. This person in the first post isn't really a family member; it is me. I self-diagnosed from symptoms (waking up gasping, loud snoring, sleepiness, large neck size, high BP, high BMI, etc) and then just bought an APAP (then another APAP, and then a BPAP) after that and started using it without ever doing a proper sleep study due to a combination of high insurance deductible and the fact that I resemble the old adage that "doctors make the worst patients".

What I found over time was that I needed to bring my EPAP all the way up to a min of 17 in order to have an AHI consistently under 5. With the first post in this thread, I just wanted to get some input as to whether I could be wrong all this time about my diagnosis, so I dropped my pressure all the way down and did this test shown above. The night prior to that, I used CPAP 7 EPR3 and got an intermediate result (fwiw had some nasal congestion from a resolving cold):



Some "highlights":








All of it points to OSA, but I still have a sliver of doubt since I didn't do it the right way.

I did recently do a type 2 home sleep study from this online service: http://axgsleepdiagnostics.com/product/c...nattended/

Unfortunately I spent little of the study night sleeping - had a lot of anxiety about whether the leads might fall off or the battery die on the test unit. Hopefully I slept enough to get a diagnosis!

Anyway, thanks again, everyone. I will wait for my study results and share them when they arrive!