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I'm soooo confused
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claysea+
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Post: #1
I'm soooo confused
My doctor said I don't qualify for the diagnosis of OSA, because they averaged the 4 times/hour I had apnea on my side with the 12 times I had apnea on my back. I am only 1 point away from qualifying (through insurance) for a CPAP. However, my O2 sats were so low that they want to prescribe me oxygen. Wouldn't it make sense to have a CPAP with the oxygen leading in? The doctor's answer is "Don't sleep on your back and you'll be fine". I told them I was willing to self-pay for the CPAP and insurance is already covering the oxygen. Am I asking for something unnecessary or is she just being stubborn.
02-27-2013 03:26 PM
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jdireton Offline

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Post: #2
RE: I'm soooo confused
Disclaimer: I'm not a doctor and I don't have all of your study information. Beware any advice!

Short answer, if you're having significant O2 desaturations with that low of a AHI (apnea hypopnea events per hour), you may have another issue. How many seconds were your apnea events and did they correspond to the O2 events exactly? What was your O2 recovery time after each desat event? Exactly how severe were the O2 events (85% or 70%)?

Sorry, there's a lot more questions to really even make a broad recommendation. If you're not happy with the doctor, seek a second opinion. I don't want to be mean to anyone on the board, but sometimes we get a comment like "CPAP not working" from someone who then explains their respiratory issues, blood pressure issues, diabetes, heart issues, etc. CPAP is not magic for everything and the last thing you'd want is to mask an underlying condition.

I understand this is confusing and encourage you to continue to ask questions on this board. I'll bet others will be giving you some good advice in the very near future and may disagree with me. We all just want to help.
02-27-2013 04:00 PM
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DocWils Offline

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Post: #3
RE: I'm soooo confused
I AM a doctor, and I concur with jdireton. This may be from other factors, and without seeing your file I cannot hazard a guess. However, if you feel you are getting the brush off from your doc, then brush him off and find one who is willing to have a closer look at you. O2 desaturation is simply not normal under any circumstance, is dangerous to your continued good health, and if it cannot be traced to apnoea, then you have to be checked for other problems.

I do not know how thorough your sleep test was, nor what criterion they used, so I cannot even comment on whether that is where the confusion lies. But I do encourage you to go more deeply into the problem. O2 desaturation is mostly caused by one or another form of apnoea, but not they are not the only causes. If a thorough sleep study has been made (and not seeing the file I cannot say) and from it they cannot deduce the cause of the lowered sO2sats, then other reasons have to be examined, including but not exclusively thyroid, other forms of breathing difficulties than SA, and a thorough lung function and heart function exam has to be carried out. First, though, be sure that your sleep study was thorough, examining your sleeping and waking cycle, your o2 intake and saturation, that you were hooked up to a heart monitor and if necessary, a sleeping eeg (which would be necessary for a diagnostic of OSA in some (but not all) cases, and at any rate would better monitor variations in your sleeping brain and pinpoint other possible causes of desaturation. A 24 hour bp monitor would also be useful. In addition, a through nasal exam would not go amiss, to determine if there is any potential blockage or narrowing there, which will not show up as apnoea in any normal sleep study.

CPAP is not a cure all - it is a method to handle sleep apnoea, but if you are suffering from another problem, it will do nothing.
02-27-2013 06:19 PM
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Sleepster Offline
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Post: #4
RE: I'm soooo confused
(02-27-2013 03:26 PM)claysea+ Wrote:  My doctor said I don't qualify for the diagnosis of OSA, because they averaged the 4 times/hour I had apnea on my side with the 12 times I had apnea on my back.

If you had 12 event lying on your back that wouldn't necessarily give you an AHI of 12. If you had 12 events per hour then you'd have an AHI of 12 and you would qualify for CPAP therapy with a diagnosis of mild sleep apnea.

But there's more to the story than just AHI. Perhaps your doctor is correct and all you need is oxygen. Do not get your mind fixated on the notion that you need CPAP therapy.

Like the others said, see another doctor and get a second opinion, but don't go in there convinced you need a CPAP machine when maybe you don't. Maybe all you need is oxygen. You can buy an oximeter and measure your oxygen level yourself while you sleep. Maybe the oxygen therapy will work and you'll feel better. Like CPAP therapy, though, you may have to wait a few weeks for your symptoms to improve.

Sleepster
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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.
02-27-2013 09:43 PM
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zonk Offline

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Post: #5
RE: I'm soooo confused
whats the doctors diagnoses for the low O2 desat

during an apnea the airways closed and the added oxygen got nowhere to go until airways opened up
look for the durations of apnea events. few longer ones can do more harm than more shorter 10 seconds ones

tennis ball sewn on back of pyjama top might help avoiding sleeping on your back
(This post was last modified: 02-28-2013 03:51 AM by zonk.)
02-28-2013 03:29 AM
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Shastzi Offline

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Post: #6
RE: I'm soooo confused
I agree with all the above.
And get a wrist worn oximeter. Start collecting a ton of logging data then you can take printouts to any Doc and say: "I think I have a problem with O2 desats at night"

Do not put off getting checked out and getting a diagnosis. O2 desaturations are a serious issue.

Best of luck and wishes on your quest. Stay in touch!

Sleep-well

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

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02-28-2013 06:47 AM
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zimlich Offline

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Post: #7
RE: I'm soooo confused
Claysea+, I won't repeat the good advice you have gotten. I would encourage you to seek a second opinion and to follow up with your family doctor or an Internal Medicine Specialist to oversee and coordinate your care. Good luck, please keep posting and let us know how you are doing.
Mary
02-28-2013 09:55 AM
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PaulaO2 Offline
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Post: #8
RE: I'm soooo confused
The CPAP won't deliver the oxygen any better, if that is what you are looking for. And with an AHI of less than 5, it won't be doing much for your apnea events, either.

Forget sleep apnea and focus on why your O2 got so low. Keep poking 'em with sticks until they find out why.

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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.
02-28-2013 06:52 PM
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zonk Offline

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Post: #9
RE: I'm soooo confused
(02-27-2013 03:26 PM)claysea+ Wrote:  My doctor said I don't qualify for the diagnosis of OSA, because they averaged the 4 times/hour I had apnea on my side with the 12 times I had apnea on my back. I am only 1 point away from qualifying (through insurance) for a CPAP. However, my O2 sats were so low that they want to prescribe me oxygen. Wouldn't it make sense to have a CPAP with the oxygen leading in? The doctor's answer is "Don't sleep on your back and you'll be fine". I told them I was willing to self-pay for the CPAP and insurance is already covering the oxygen. Am I asking for something unnecessary or is she just being stubborn.
Apnea to be scored have to last 10 seconds or longer, less than 10 seconds not scored or counted towards AHI

unlike RDI, AHI does not includes respiratory-effort related arousas (RERAs).
Respiratory disturbance index (RDI)
http://www.apneaboard.com/wiki/index.php?title=RDI

Upper Airway Resistance Syndrome
http://www.apneaboard.com/forums/Thread-...e-Syndrome
03-02-2013 07:05 PM
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