Sleep Study Declined. Just buy machine?

[SemiZombie]

Hi Apnea Board,

Had a sleep study done in May 2018. No sleep disorder diagnosis. So nothing came of it and things just fell to the wayside.
Multi sleep latency test and polysomnography report attached.

Went to the doctor about three months ago, chief complaint being excessive fatigue.
Did a whole battery of tests. Thyroid normal. Blood normal. No diabetes. Testosterone low, but not enough for therapy.
Picked up elevated liver enzymes, went back and did a ultrasound. Diagnosed with NAFLD (non-alchoholic fatty liver disease).
One of the symptoms of NAFLD is fatigue.

Current weight is 183cm / 109kg (6ft / 240lbs). Nearly all the weight is in abdominal region. Skinny fat.
Currently on antidepressant to help with irritability and mood as well as hypertension medication.

Went to a pulmonologist and suggested a sleep study. Sleep study was declined by the medical insurance as it not on the benefits schedule.
It will be pointless to object. They will pay a substantial amount for medical devices, but you need to buy it and then provide the script and a medical report for reimbursement.
Since I am not covered for the sleep study, I cannot get the medical report. So will need to pay cash without reimbursement.

So the sleep disorder is kinda self-diagnosed based on symptoms.

I tick alot of symptom boxes with both OSA and UARS. Since they are treated with CPAP and BiPAP respectively and they BiPAP is more expensive.


Symptoms being:

• Unrefreshing sleep (wake up tired)
  
• Cognitive impairment (brain fog)
  
• Frequent wakings with urge to urinate (2 - 5 times per/night)
  
• Headaches (comes and goes throughout the day)
  
• Raspy/sore throat when waking
  
• Hypertension
  
• Obese
  
• Irritability
  
• Reduced libido (might also be reduced by body fat, as it apparently also affects testosterone)
  
• Require at least one nap a day (usually midday)
  

Things that do not help my sleep/weight:

• Sugar dependent (for energy)
  
• Age: 34m
  
• High calorie junk food every two days or so for dinner
  
• No exercise (little energy for that)
  
• Stationary
  

Things in my favor:

• Awesome and supporting wife!
  
• Taking medicine religiously
  
• Melatonin 5mg 1hr before bed
  
• Strong will to improve and get better
  
• SleepApneaBoard :-)
  

Question:
Should I just close my eyes and buy the BiPAP ( cry @ $$$ ), since it will also apparently help with OSA if I do have it, as CPAP will not help with UARS, if I do have that?
It might also be a complete waste, since I might not even have a sleep disorder.

Thanks a lot,
SemiZombie

[Sleeprider]

From a medical point of view the conclusions and recommendations in your sleep study are irrefutable. You simply don't have sleep disordered breathing or oxygen desaturation of concern, and therefore will not qualify for insurance coverage for the use of CPAP. There are breathing disorders such as flow limitation and even upper airway resistance syndrome (UARS) that will not show up on these results and require interpretation of the respiratory flow wave and statistics such as tidal volume, and minute vent. We can actually see those metrics using CPAP software like Oscar. You can ask your regular physician for a prescription based on your symptoms, with the awareness it may or may not work. It won't hurt you, you just won't qualify for insurance coverage. Skip the sleep specialists, the insurance companies own them. You can source equipment without a prescription, but it's easier if you have one.

If you were to self-treat, you need something that provides some pressure difference between inhale and exhale (IPAP/EPAP) to actively treat potential flow limitation and to normalize breathing volumes. I think a Resmed Airsense 10 Autoset makes the most sense, and just set it to a minimum pressure of 7.0 and maximum of 12.0 with EPR on full time at 3, using a nasal interface like the Resmed Airfit P10 nasal pillows. There is nothing in your testing that suggests any of this is needed, and CPAP can bring its own suite of sleep disruption. That said, it can improve ventilation, reduce respiratory effort and may make a difference in your case. If you decide to to that, take a look on places like Facebook Marketplace, Craigslist, Offerup and others for a well-priced machine, or use one of the online suppliers for new equipment. Use the equipment and observe results using OSCAR and forum support, and hope for an improvement. I hope you find relief from your fatigue whatever you decide.

[Gideon]

What Sleepriders said.

Do you have a friend that has a ResMed elite or AutoSet. If you can get one for one night we can tell a lot from the detailed charts produced

[Hydrangea]

It looks like you have Narcolepsy. And they recommended a Narcolepsy med for you.

If Narcolepsy is your problem, then a CPAP is going to be an utter waste of money for you.

(This isn't medical advice. I'm just saying what I'm seeing on your attachments.)

[Geer1]

Any symptoms of digestive or allergy issues like nasal congestion, heartburn, ibs (diarrhea, constipation, bloating) etc?

[SemiZombie]

It looks like you have Narcolepsy. And they recommended a Narcolepsy med for you.  

If Narcolepsy is your problem, then a CPAP is going to be an utter waste of money for you.

(This isn't medical advice.  I'm just saying what I'm seeing on your attachments.)

The Dr suggested Modifinal for the EDS (Excessive Daytime Sleepiness), however we discontinued the use as it is very potent.

---

What Sleepriders said.

Do you have a friend that has a ResMed elite or AutoSet.  If you can get one for one night we can tell a lot from the detailed charts produced

No family or friends with CPAP machine. Called around and none of the suppliers want to rent out machines due to COVID.

[slowriter]

The RDI reported by your sleep study (0.7) suggests you do not have UARS.

Just for comparison, my RDI was 24, and my sleep staging during the study highly-fragmented by RERAs, with hardly any REM.

In your study, by contrast, REM was in the good range, and deep sleep if anything was rather high (not sure if that's a problem or not).

So while it's true trying a PAP machine can't hurt, I'm skeptical it will help.

[Cpapian]

If you buy a machine second hand and it doesn't work out for you,  you could just resell it afterwards.  Something to think about.

[Geer1]

Still curious, other signs of allergy (nasal congestion, itchy, sneezing etc) or digestive problems?

Your sleep study data indicates sleep disordered breathing is not the problem.

[Hydrangea]

I'm still voting for Narcolepsy, even if the med wasn't the right fit for you.