Sleep Test Results. Need adivce.

[wbwlsaf]

Hi everyone,

I recently took a home sleep test from Lofta and I'm looking for some advice. I'm a 20 year old male, normal weight, don't drink or smoke, and have hypothyroidism that I'm treating. My symptoms are brain fog, fatigue, difficulty sleeping, anxiety, OCD, derealization, panic attacks and unexplained high blood pressure and heart rate that I've seen multiple cardiologists for.

My non-REM sleep numbers aren't terrible, but my REM sleep seems to be much worse.

From my research, it seems like doctors primarily focus on the AHI instead of RDI, but my RDI is much higher than my AHI, what are the chances insurance will cover treatment based on my numbers? If they don't, would it be worth investing in a $1000 CPAP machine? Has anyone with similar numbers and symptoms started treatment, and did it improve your quality of life?

I really need guidance, so any advice would be greatly appreciated!

   
   
   

[DaveSkvn]

Hi Wbwlsaf,

Based on the result of your test, I doubt many would say you have OSA. You are in the clear on that one. 

The RDI is the AHI + no of RERAs (respiratory effort related arousals). If you look at this video (about 5:30) it seems a number of studies have shown RERAs don't affect daytime alertness

https://www.youtube.com/watch?v=HCiPtQhN9uk

Whilst some "process-based" (cookie cutter) clinics may offer CPAP based on an RDI, others may be more sceptical.

You might want to have a look into UARS (that's what the video is about). As the video says there is no simple effective test for this available yet and an oximetry based test like Lofta is not of much use.

CPAP machines are very much designed to detect and react to OSA. They, and the clinics monitoring them, are all about the AHI. I've been on a CPAP machine for years with a low, treated AHI and still have daytime sleepiness. This does not cause any interest in a sleep clinic - they have done their job dispensing the CPAP and getting the AHI down. Once you have bought the CPAP machine and using it you may be deemed to be 'diagnosed OSA' (with all that in entails about fitness to drive etc) and have difficulty stopping it.

Whilst I understand they are useful for UARS, CPAP machines have not been designed specifically to treat it. Don't buy a CPAP machine in the hope it will magically deal with undiagnosed UARS.

Your list of conditions sounds dreadful to live with. My heart goes out to you and I fully understand your desire to find some way to deal with the crushing fatigue but, personally, I don't think, based on the study results, that CPAP is your path forward.

You mention a number of conditions which may be treated by fairly heavy medication. Have you considered drug interactions?

Best of luck finding some kind of relief.

[G. Szabo]

I do not think that insurance will cover your CPAP machine with this low AHI number. Your oxygen saturation is excellent, too. The only thing that stands out is the HR, which has some high-rate periods but is not overly high. 

You probably could get away with strictly sleeping on your side and using a soft cervical collar without a CPAP device. Nevertheless, if you have daytime sleepiness or morning headaches, you might want to dig a bit deeper.

If you try a machine, you can buy it significantly cheaper than $1,000. Mainly because you have mild to nonexistent apnea, you  want to try a simple CPAP to start with.

[THEVGE]

My feeling to your results is anxiety/stress and/or UARS. I am in the same boat. My AHI is low and only hypopneas, but I have high RDI. The question I currently have: is my body stressed so I wake up all the time or do I have UARS? If you have UARS, bi-level is the way to go typically and CPAP will not help you. But I would without a doubt reflect on the possibility of anxiety/stress in parallel. I waited very long accepting this, and now that I have, my heart rate went down significantly! Your heart rate looks almost like you may have atrial fibrillation (I also suffer from this) which can also be caused by stress.

[PeaceLoveAndPizza]

Your numbers look similar to mine with low AHI but higher RDI. I did have quite a bit of snoring as well and decided to purchase my own used CPAP machine as insurance was not worth fighting. In my case the CPAP took care of the snoring and helped with deeper sleep stages, which seems to have reduced RDI per my smartwatch.

Note that you may find some used CPAP machines with low hours for around $200 USD. Facebook Marketplace, Craigslist, etc, are worth keeping an eye on. Just be sure you see the machine in-person if possible or buy from a trusted source, plus use PayPal to pay for the protection in case of rip-off.

Read the following and see if anything resonates. 

https://www.sleepfoundation.org/sleep-apnea

https://www.sleepfoundation.org/sleep-hygiene