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I had sleep apnea (now I don't) and confused
#1
First I've had major medical issues but the last 6 months have been mostly stable. A few years ago I was Dx with OSA with AHI at 5.5ish. This is fairly mild but of more concern was the desats of low 80s and high 70s. I've been using CPAP since until things started getting worse.

About six months ago I was sent for another sleep study. This sleep study showed my AHI being only 2.4 and thus my insurance took my CPAP away. This sleep study did show I had a severe case of PLMD and I started meds for this.

Within the last six months (gets worse over time) my blood pressure has jumped to 140s/90s (1+ year before was 120s/70-85ish) with no BP meds.

When I do any exercise for an extended amount of time I start getting very short of breath and I get some chest pain and I tend to sweat badly (soaking socks etc). I'm sleeping for large periods of time (12-14 hours) and waking up feeling more tired than when I went to bed. I wake up almost every morning with nausea as well.

Some nights I just can't fall asleep without 3 pillows raising my head up as it just feels harder (more force needed) to breath.

I've also had tingling in my hands and feet and the worst is extreme itching on my feet a couple of times each month. I scratch them until raw with blood.

My doc has done an EKG that was normal. My bloodwork was normal but my B12 was low 300s (normal I guess was above 200 but I should be higher for my age).

I was sent to a neuro who didn't seem concerned and just gave me an Rx for an itching cream and said if this doesn't help that I needed to see a derm doc.

I'm just feeling so bad right now and have no clue what to do next and just hoping for some advice.
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#2
I know this answer may not be very helpful -- and for that I apologize:
This sounds more like a general medical problem that needs to be investigated by qualified physicians.

"I've had major medical issues but the last 6 months have been mostly stable."
What does that mean?

An EKG is a short look into cardiac activity. You should seek the full M.O.T. on cardiac status.
Like a stress test, 24 hour Holter monitor, and echocardiogram.

A friend of mine was unable to sleep lying down; turned out he was in fibrillation and congestive heart failure.
And, his GP missed it. Not until he checked into an ER was his problem discovered.


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#3
I have to agree with Mongo. My first reaction was 'heart problems'. Your at-rest EKG can easily miss things. My own irregularities only show up during a stress test. Chest pains, shortness of breath, and sweating are not normal. I think you need a referral to a cardiologist as soon as possible.
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#4
multime,
Nice to see your back, and sorry to hear you are still having so many problems.

I was just reading through some of your posts from last year, and did notice that you suffer from heart problems.

I hope you are following up with your cardiologist.

Wishing you well,
OpalRose
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#5
Multime, did you obtain a complete copy of your last negative sleep study? Were the desaturations still present?

Your insurance seriously took away a CPAP that was several years old? What in the world did that accomplish?
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#6
(01-05-2016, 10:15 AM)Sleeprider Wrote: Your insurance seriously took away a CPAP that was several years old? What in the world did that accomplish?

Not meaning to sound flippant, hopefully that got his attention directed at the real issue, which I think is a heart problem.

An echocardiogram with doppler and color flow plus a followup stress test seems to be in order.

Dude

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#7
It's good dude. I am sometimes perplexed at the behavior of insurance, but if he didn't need CPAP, I though it would be like any other prescription. You're free to toss it. I just looked at it as a machine that has been in use several years has no real value. I could only wish that DMEs would take back the walkers and crutches I was issued, once I recovered.
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#8
I never considered this could be heart issues. My past major medical issues included a pulmonary embolism which caused a mild heart attack and a mild stroke. I currently have no lasting impact from the stroke and my CKMB etc labs look fine with regards to the heart. My heart (besides the EKG) hasn't been looked at since that hospital stay.

I do have asthma but this is well controlled with prevention meds (Flovent). My last echo done in 2013 was normal but it did mention that I had redundant mitral valve with mild MR and also mild TR with normal PA pressure.

MR and TR stand for Mitral Valve Regurgitation and Tricuspid Regurgitation.

So I guess I'm wondering if in just under three years if my heart could change this much. I just don't really have a clue. Could this MR and/or TR go from mild to far worse that quickly.

I guess the next step is seeing my PCP again and stressing these concerns and go from there.

Oh and I had 3 total apneas (all central) and 8 hypopneas for an AHI of 2.1. I had 4 total desats greater than 4% change with my lowest at 92%.

My PLM index was 72.3 and PLM arousal index was 4.1.

My insurance said that my AHI had to be greater than 5 to keep getting treatment. My appeal was also denied.
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#9
(01-06-2016, 05:13 AM)multime Wrote: I never considered this could be heart issues. My past major medical issues included a pulmonary embolism which caused a mild heart attack and a mild stroke. I currently have no lasting impact from the stroke and my CKMB etc labs look fine with regards to the heart. My heart (besides the EKG) hasn't been looked at since that hospital stay.

I do have asthma but this is well controlled with prevention meds (Flovent). My last echo done in 2013 was normal but it did mention that I had redundant mitral valve with mild MR and also mild TR with normal PA pressure.

MR and TR stand for Mitral Valve Regurgitation and Tricuspid Regurgitation.

So I guess I'm wondering if in just under three years if my heart could change this much. I just don't really have a clue. Could this MR and/or TR go from mild to far worse that quickly.

I guess the next step is seeing my PCP again and stressing these concerns and go from there.

Oh and I had 3 total apneas (all central) and 8 hypopneas for an AHI of 2.1. I had 4 total desats greater than 4% change with my lowest at 92%.

My PLM index was 72.3 and PLM arousal index was 4.1.

My insurance said that my AHI had to be greater than 5 to keep getting treatment. My appeal was also denied.

Multime,

This may or may not be relevant to your situation but when I had a full scale sleep study in 2014, my AHI was 5.9 but RDI was 23 due to RERAs being counted that didn't qualify as apneas/hypopneas.

Do you know if your sleep study measured them? Since many insurance companies still just go by AHI, it might not have made a difference in your case but this might still be worth looking into.

Also, when I had another study in 2015, sleep doc told me to stay off of the machine for two days prior to the study as he felt if I didn't, it might make the results look less serious than they truly were. For what it is worth, my AHI this time was 25 with no RERAS although to be honest, I found it hard to believe that that number was zero since I had 60 unexplained arousals.

I just find it hard to believe that you could end up not having any sleep breathing disorder after being diagnosed with apnea previously although I guess anything is possible.

49er

PS - Forgot to mention that the lowest O2 level was 90% and at each low point, it was only for a few seconds.

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#10
This is what I have.

First in home study (no EEG) in June 2013.

35 CAs
8 OAs
67 obstructed hypopneas

AHI = 10.5/hour
RERAS = 0
Lowest SAT was 82%.

Titration Lab study in July 2013...

AHI = 6.64
Lowest O2 SAT = 83%
No mention of RERAS on this lab study nor the newest lab study done in June 2015.

Both of my tests in 2013 showed both bradycardias and tachycardias.

My study in 2015 showed normal cardiac rhythm.
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