My sleep study (starting out)

[sabletaurus]

Good day to all,

First post here. Bumped into this site when I was researching sleep study results. My quick back story... I had an at-home sleep study in 2017 and again recently (March, 2024). The 2017 was a low AHI number, less than 10 as I recall (but I no longer can find the report); short story, I was issued an AirSense 10 (as best I can recall, it looked like this model) used it for ~ 90 days, didn't find there was any subjective change in wakefulness or quality of life, and turned it back in.

The purpose of the study was due to excessive sleepiness in daytime, and overall lack of energy. It was not a brand new, sudden sort of symptoms, but something I have felt off and on most of my life (I am in my 40s). Of note: I also have Generalized Anxiety Disorder (GAD) and this is very draining. 

Current situation: My current primary care put in orders for a new home sleep study when I had my routine physical last year. When the sleep lab analyzed the data and issued my report, I couldn't initially get the results. Instead, my primary put in orders for overnight sleep titration with no further context. (I now realize this is for fitment of CPAP and adjusting the pressure while under observation.) I found it aggravating that I was instantly referred without saying a word to me about it, or having the chance to directly discuss my results and all options on the table (if any, but I still want to have the conversation). Now, I finally have the full results of this home sleep study from March released to me. I have tried to get an appointment with a sleep MD at a couple of different facilities, but they have me on waiting lists and appointments are 5 to 6 months away. 

That setup is to get to the following point: The impression and recommendations for my overnight home sleep study stated on the report are as follows.
- Total AHI (3%) was 18 events per hour and the CMS AHI (4%) was 17 events per hour.
- Lowest O2 saturation 86% but I was above 90% the majority of the time.
- Average heart rate 51.5
- Snoring was observed (and snoring has definitely gotten a lot worse for me in the last few years)
- Consistent with diagnosis of moderate obstructive sleep apnea
- Treatment with CPAP was recommended, it is stated I could be setup on the auto mode at 5-10 cm

Questions I am hoping to get answers to:
1. Is overnight titration really necessary? It will cost me somewhere around $2000 due to high deductible health plan. Although the sleep MD said in report I could go to CPAP with auto mode, the doc never told me this and put the orders in for titration without further discussion or context.
2. How bad is this, is it enough to be impactful on mood, energy, sleepiness, anxiety? I know, a broad question, but looking for input from others who know their numbers and have been down this road with CPAP and seen quality of life improvements. 
3. Are there any realistic treatment alternatives with this moderate apnea, such as dental device that moves the jaw? Weight loss? Or other treatments? (My BMI is overweight, technically crosses into lower-end obese)
4. In 2017 when I tried CPAP I thought it was a failure for me. BUT, this was a 3 month attempt. Is it possible I gave up too soon?

To save time, money, effort, and possibly feel better sooner, given that the sleep doc said I could get a CPAP and start with auto mode, I am thinking if I push on this I could get the prescription for CPAP, skip the titration, and use guidance from this site to dial in my settings. 

Thank you, thank you for any/all that read this and can drop some more breadcrumbs for me to follow on my journey.

Cheers!

[HalfAsleep]

Many questions!

I don't believe you gave up "too soon" on your prior CPAP, because there's nothing like NOW to begin treatment. And, in 5 years, bodies can change quite a bit, new symptoms show up, etc. So, not too soon back then: your heart wasn't in ready mode.

There aren't really consistently satisfactory alternatives to PAP, though people try them, sometimes out of fantasy, but I would look at posts here referencing the options, so you can get an idea.

Yes, your AHI number is reflective of significant impact to sleep, which is a cause for all kinds of conditions, including with messing with your heart and brain. I haven't researched it, but, heck, you might even find some posters on here who lowered their BMI because of CPAP treatment.

Is your doc willing to just write the prescription for the Resmed Airsense 10 Autoset without further study? I say go for it, and skip the study. You'd pay $500 -ish for one of those out of pocket, but you need a prescription; it might cost you more if your insurance company has to select the vendor (DME) and then bill a co-pay. Once in your hands, you can simply use the machine to titrate for you, starting with the settings the doc gave you already. Post your sleep charts here, and get guidance on adjusting the numbers to benefit you. As you can see from posts, most folks here need to do that anyway, because sleep studies are not able to finesse settings.

[Deborah K.]

I agree that you don't need a titration.  Folks here will help you set your machine up properly.  Ask your doctor to specifically prescribe the ResMed AirSense 10, and to write that no other machine is to be substituted.  Sometimes the DMEs will otherwise send you whatever machine they got most cheaply.  They get paid the same amount either way and you can be stuck with a lousy machine.

If your present doctor insists on a titration or won't give you the prescription you want, go to another doctor.  It can be any doctor or an assistant who can write prescriptions, a gynecologist, a nurse practitioner, a dentist, etc.  You can make this work.

[sabletaurus]

Thanks for your replies! The context and insight is very helpful.

[kwhenrykerr]

if a used machine is ok with you check craiglist, facebook or fleamarkets. My first CPAP was $10 and worked first night. Long before I found this great information site.

[UnicornRider]

As Deborah stated, if possible have your provider of choice write the prescription for the ResMed AirCurve 10 VAuto. 

This model of AirCurve 10 is a very versatile  capable machine with several modes and special features to allow tuning and tweaking parameters to more closely match your needs. With an expected live span in excess of 20,000 hours you are looking at 10 years of life of the machine, as you age your needs are likely to change and this machine is capable of changing modes to possibly satisfy those changing needs.

The members of the forum will be able to guide you in setting up and tuning the machine to your specific needs.

Good luck, post back.