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Finished HST, possibly negative?
#31
RE: Finished HST, possibly negative?
Impressive work. I could not find a program to open the .OSA file. The others links worked fine. Do you realize how much flow limitation is shown in this graphic? That's drastic. Also the number of hypopnea events along with desats in your test result document is compelling. You need to be on CPAP. What is your next step with regard to getting a doctor to look at this.

[Image: JFDZ5lB.png]
Sleeprider
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#32
RE: Finished HST, possibly negative?
How do you think I feel when I saw it? Lmao, I seriously thought green was supposed to be the background color for that bar.

In any case, My primary is going to be discussing the details with me sometime next week. In almost all cases with seeing him, I feel it's going to end in a referral to a specialist, then that to a PSG. While I'm at my primary, I'll either asks for tests and a few more specialists. Mainly a pulmonologist and anything else he suggest.
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#33
RE: Finished HST, possibly negative?
I think your test adequately demonstrates obstructive sleep apnea that further testing is not needed, or if you have a PSG test, it should be a two-part test. The first part of the test should document the FL, OA, H and O2 issues, and the second half should be a titration to determine you effective pressure range to alleviate the obstruction and promote normal breathing. I personally think you would actually benefit from bilevel.

I'm sure you understand this, but nearly every breath you take at night is decapitated. You could simulate this by slowly squeezing your nose closed on each inhale while your awake. You couldn't tolerate it for long. Since you never establish a normal tidal volume, the hypopneas are under-recorded. You almost never achieve the 97% acceptable/normal saturation rate at night. I think the flow limitation alone is determination...you can't sleep and rest like that. It must be exhausting! The effort is there, the flow is not. Fortunately, this is a very easy problem to solve.

I think you need to see your primary doctor with the objective of walking out with a prescription for auto CPAP and self-titration. Your work here demonstrates you can do that and understand the results. Your test demonstrates a strong need for this therapy. You are starving for air and experiencing all the side-effects of that. I see no reason whatsoever to delay therapy. Go for the additional two part testing if you can't get the script, but make the case that you can use an Auto CPAP machine for 30 days and prove the benefits with data.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#34
RE: Finished HST, possibly negative?
(09-16-2017, 04:42 PM)Sleeprider Wrote: I think your test adequately demonstrates obstructive sleep apnea that further testing is not needed, or if you have a PSG test, it should be a two-part test.  The first part of the test should document the FL, OA, H and O2 issues, and the second half should be a titration to determine you effective pressure range to alleviate the obstruction and promote normal breathing.  I personally think you would actually benefit from bilevel.  

I'm sure you understand this, but nearly every breath you take at night is decapitated.  You could simulate this by slowly squeezing your nose closed on each inhale while your awake.  You couldn't tolerate it for long.  Since you never establish a normal tidal volume, the hypopneas are under-recorded. You almost never achieve the 97% acceptable/normal saturation rate at night.  I think the flow limitation alone is determination...you can't sleep and rest like that. It must be exhausting!  The effort is there, the flow is not. Fortunately, this is a very easy problem to solve.

I think you need to see your primary doctor with the objective of walking out with a prescription for auto CPAP and self-titration.  Your work here demonstrates you can do that and understand the results.  Your test demonstrates a strong need for this therapy. You are starving for air and experiencing all the side-effects of that.  I see no reason whatsoever to delay therapy.  Go for the additional two part testing if you can't get the script, but make the case that you can use an Auto CPAP machine for 30 days and prove the benefits with data.

So the final result is a in-lab PSG. I was not, and could not if my life depended on it(lol), convince my PCP to sign for a CPAP and self-titration due to the report stating "A CPAP machine is not indicated". Go figure.  All of the labs around here use EEGs, but none of them specifically seem to look for UARS, or seemed concerned with it as much as they should. 


My PCP's office called and informed me that they had received the results of my sleep test. Low and behold, the results was just the same report I had, but signed by the specialist. At this point, I'm fairly upset because not only does this mean that the sleep services I went through NOT properly score my exam(and instead went with what a machine automatically analysed), the specialist they went through probably didn't bother to even consider anything past what was printed on the first page. As I'm speaking with the front desk person over the phone (apparently PCPs don't directly call you, I always thought that was the case though), she informs me that my PCP wants me to visit an ENT specialist for "snoring treatment". I immediately ask if the doctor paid any attention to the amount of desat, flow limitations and heart spikes on the report, because snoring in itself does not cause this. She says she'll step away and ask the doctor to review and see what he says.

It should be noted that my PCP is NOT a board certified sleep specialist, so I'm attempting to cut him a little slack. But even the report said that a PSG was recommended due to the sensitivity of the home study test. So I'm a little of kilter at this point.

The receptionist returns and states that the doctor feels that I should have a at home sleep study (god dammit). The receptionist doesn't seem to understand the difference between a sleep study and a in lab PSG (she states she doesn't fully understand, that's not me being an ass, lol). So I tell her that i'm going to find my own center and have contact my PCP when I do so we can go from there. 

I seriously hope this is as ridiculous as it gets.
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#35
RE: Finished HST, possibly negative?
You can only hope. Keep at it. You have plenty to go on.

Rich
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#36
RE: Finished HST, possibly negative?
Well, you can do more than hope, but it's really up to you. You feel tired and that your "edge" to compete and work effectively might be slipping. You KNOW you have the nighttime oxygen levels of a severe or very severe apnea diagnosis. The problem from what we can see is flow limitation typical of UARS.

You might be able to fast-track a legitimate diagnosis using an online supplier to analyze your existing HST or using their services. Supplier #27 offers prescription services and works with many insurance companies and might give you a second opinion, or new test. Supplier #17 will simply sell you mask parts and not require a prescription. Get the Resmed Airfit P10 nasal pillows mask.

The Resmed Airsense 10 Autoset is currently $440 on Amazon. My guess is that you can fully self-equip for under $550 and just be done with it. Less using Craigslist. The medical mafia will eventually catch up to your condition, but meanwhile, they are letting you sleep with damaging oxygen desaturation because it doesn't fit into their box. I'm not an alarmist, but your oxygen desats are nothing to make light of, and can lead to longer term problems, not to mention the debilitating fatigue you know about. Your problems are real, but the idiots looking at it seem not to comprehend it.
Sleeprider
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____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#37
RE: Finished HST, possibly negative?
(09-19-2017, 08:38 PM)Sleeprider Wrote: Well,  you can do more than hope, but it's really up to you.  You feel tired and that your "edge" to compete and work effectively might be slipping.  You KNOW you have the nighttime oxygen levels of a severe or very severe apnea diagnosis.  The problem from what we can see is flow limitation typical of UARS.  

You might be able to fast-track a legitimate diagnosis using an online supplier to analyze your existing HST or using their services.  Supplier #27 offers prescription services and works with many insurance companies and might give you a second opinion, or new test.  Supplier #17 will simply sell you mask parts and not require a prescription. Get the Resmed Airfit P10 nasal pillows mask.

The Resmed Airsense 10 Autoset is currently $440 on Amazon. My guess is that you can fully self-equip for under $550 and just be done with it. Less using Craigslist.  The medical mafia will eventually catch up to your condition, but meanwhile, they are letting you sleep with damaging oxygen desaturation because it doesn't fit into their box.  I'm not an alarmist, but your oxygen desats are nothing to make light of, and can lead to longer term problems, not to mention the debilitating fatigue you know about.  Your problems are real, but the idiots looking at it seem not to comprehend it.

My girlfriend brings up a point when I spoke to her about this. I want to walk in prepared and armed with the questions and knowledge about my possible issues, but I don't want to appear as though I know more than a doctor who will obviously have more practical (and not) experience on sleep disorders and whose been doing this much longer than I've even been aware of these issues. The problem with this is that attempting to convince my doctor, or any other sleep specialist of my issues is a fine balance that I'm not sure how to tread. It's going to take time, and the last thing I want to do is feel like I'm hopping from doctor to doctor looking for one that's going to tell me what I want to hear when the last one didn't, or because I feel like they didn't. I know I have an issue, and you know I have an issue, but how do I convince insurance and a doctor that I do, even with the data that's there without risking my own health because I'm stubborn headed? 

As for the suppliers you recommended, #27 looks to be a repair depot, offering no services to analyze results and #17 looks to be pretty dependable. I'll have to look into that one. I've also given thought to picking up a APAP, I'm just not sure if I could use it to solve my issues completely. I'd run the risk of causing CAs and EPI, further straining my problem wouldn't I? Though, I suppose the EPR would probably be enough to reduce the risk of the events.
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#38
RE: Finished HST, possibly negative?
My apologies, I meant to point to Supplier #30.

Physician and clinic reviews can be helpful in identifying doctors that believe in patient empowerment and that listen, as well as those that may not provide time and focus on their patient's needs. I would start with a list of in-network providers then start looking at reviews and making a careful selection.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#39
RE: Finished HST, possibly negative?
Just wanted to post an update. I was reached out by the sleep study group that did my HST Friday. At the time, I was looking for another group to do my study with, but the SSG stated they had a opening for that night. It was last minute, but I was greatly tempted, so I said yes.

Let me tell you, I know people say PSGs are difficult to sleep though, but holy hell. It wasn't so much the wires and things stuck to my body (though that did play a part in it), it was more the worry.

"Am I sleeping properly enough? Are they gonna see anything? It's 11PM and they're kicking me out at 5AM, is there gonna be enough data?"

That in itself made it difficult to get to bed. I maybe slept, at most, 4 hours that night and I really felt it when I woke up. So, while we wait for my data to come in this week, I'll have my fingers crossed.

PS: I got my liver ultrasound back. It was fatty liver. Explains my elevated ALT and enzymes. Doc just says I'm too fat. :lol: I think it could be both my lifestyle and the possible SA I'm experiencing. All I know is that if I solve my sleeping problem, energy will come and I'll be fine after that. Lets hope the results are good (which is totally objective cause I want to see some "yeah, your sleeping sucks balls" on that report).
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#40
RE: Finished HST, possibly negative?
As long as you slept, it's fine. I don't tolerate the clinic sleeps so the only time I ever had one was my diagnostic study. They gave me an APAP and said get lost. Smile
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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