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Lessons Learned - 6 Months on CPAP
05-21-2012, 11:27 AM
Great post b36! Should make a sticky out of it for new folks to read and re-read and then maybe read again. I'm still looking for informational posts I saw a couple of months ago and didn't have the foresight to write down their location. Live and learn!
Your post was excellent, but I am fairly certain most sleep physicians would argue against taking sleep meds before a sleep study.
Although I do understand how difficult it is to sleep with all those wires hooked up, I would bet, depending on the medication, that the medication could alter the results of the sleep study. It could cause sleep that is deeper than normal and result in overdiagnosing sleep apnea If not, it might at the very least cause error in the titration results. In other words, if you are in a very deep sleep because of the sleep medication, you could have more frequent events which could be more difficult to overcome with any given pressure. Based on that single sleep study alone, if could be prescribed a CPAP pressure that is too high for you, assuming you don't regularly take sleep medications. This higher than needed pressure could be unnecessarily uncomfortable and lead to poor compliance. Even worse, could be an increase in central apneas which can happen when CPAP pressures are set too high. In your case, however, because you are using an Autoset machine, that isn't likely to be an issue, but for those who are restricted to using CPAP, that could be a problem
So, instead of taking sleep meds, what can you do if you imagine not sleeping during a sleep study? Other than sleeping little before the sleep study (go to bed late the night before the study and avoid naps and caffeine), you can't do much. I didn't think I could sleep,either and I wasn't totally wrong, even though I did all that. I slept for only the last 2 hours of my sleep study. That was only long enough to diagnose my OSA, but not long enough to get the titration study done.
My provider prescribed a CPAP machine anyway with a pressure set at 7.0 (just a guess on her part), which was comfortable enough to use, but proved ineffective for me. I was instructed to return to the sleep lab in a month for titration, once I got used to the machine. The thought of going back to the lab was scarry but I agreed I would.
However, after seeing no benefit from the CPAP set at 7.0, I requested after 2 weeks that my provider approve an S9 Autoset. I could see no point to returning to the sleep lab to be titrated in an artificial environment, where I wasn't likely to sleep like I do at home.
I was suprised but my argument won favor with my sleep physician. I got my Autoset S9 and saw a difference the first night. The Rescan and SleepHead software showed that I needed a the mean pressure close to 8.0, but at times needed a pressure as high as 12.0. Even a sleep study might not have showed the variability of my needs or would have suggested I needed a higher pressure for the occasional more severe obstructive event.
LESSON LEARNED: if your CPAP isn't working at all for you, instead of going back to a sleep lab to get titrated, or re-titrated, insist on an autoPAP machine. Don't take sleep meds before going to a sleep lab. These can lead to altering your sleep study results or leadi to higher. possibly deleterious pressure settings being prescribed than what you need
05-21-2012, 03:01 PM
You bring up some valid points but let me explain my comments a little further.
I knew very little going into my sleep study about what to expect. I asked the technician on the phone what the evening would be like and after it was described to me in detail, I asked if there was any problem if I brought along some mild sleeping pills just in case I couldn’t fall asleep. They did say that it was preferred that I not use sleep medications if possible, but if I couldn’t fall asleep, then by all means, take a pill so they could gather sleep data rather than waste an evening tossing and turning and not being able to sleep at all.
During both my initial sleep study and my second titration study, I did attempt to fall asleep naturally and laid there wide awake for about an hour each time. Both times I called in the sleep technician and asked if it was alright if I took a pill and they said that was fine, so that’s what I did. Seeing that they billed me $3,500 and $4,000 for the two studies, I thought it would be better to gather all of the sleep data they could get, even it was somewhat artificially induced. (Thanks to insurance, I only paid about $750 in total for the two studies out of pocket.)
I was prescribed a straight 10.0 CPAP setting. As mentioned in my initial post, I was able to obtain an S9 Autoset machine and I’ve reviewed the effectiveness of my therapy using both ResScan and Sleepyhead software daily, plus 3 and 6 month follow-ups with my physician. I have tried minor variations in pressure settings using both straight CPAP settings from 10.0 to 11.0 and APAP range of 9.0 to 12.0. One nice feature with Sleepyhead is that it calculates averages each time you change your machine settings and regardless of the settings I’ve used if measured over a month’s period at a time, my average AHI has been between 0.45 and 0.58, so not a significant difference.
By all means, if you can fall asleep on your own without any medication, that would be preferred. But if you attempt to fall asleep and can’t, based on my experiences, I don’t think taking a sleeping pill is going to produce radically different results. Also, we’re only talking about a one night sleep study and who’s to say that one evening’s test result will produce a perfect setting? Now that I’ve been under CPAP therapy for almost 8 months, I think experience over time is the best determinant for finding the ideal machine pressure settings for each individual.
We're all family here...you can call me B36 if you'd like!
05-21-2012, 04:06 PM
(05-21-2012, 12:00 PM)BabyDoc Wrote: LESSON LEARNED: Don't take sleep meds before going to a sleep lab. These can lead to altering your sleep study results or leadi to higher. possibly deleterious pressure settings being prescribed than what you needIt remind reading abut it in this thread: Sleeping Pills and Death Risk
"Sedation worsens sleep apnea, for example, and we know sleep apnea is associated with risk of death," said Green. "We tend to think that a sleeping pill once in a while is harmless, but there's no such thing as a medication free of risk."
05-21-2012, 04:46 PM
Based on your experience, I still would not recommend people take sleep medication prior to their study, unless the sleep physician is aware of the medication and can take that medication's possible effect into consideration when reviewing the study. A sleep technician should not be your source of council when it comes to taking sleep medications prior to a sleep study. They can't prescribe, nor should they approve its use.
Iimagine somebody taking a sleep medication and then being diagnosed with mild sleep apnea with an AHI of only 7. That person, without the sleep medication, might test normal.
Again, as long as the sleep physician knows and approves of the sleep medication, it shouldn't be a major problem. However, my sleep physican, would NOT approve its use. I have mild sleep apnea, which is a certain diagnosis without sleep medication, although I barely slept. The Autoset is a cost effective substitution for a titration study that would be possibly erroneous if carried out under sedative medication.
05-21-2012, 06:06 PM
As mentioned in my original post my sleep medication was prescribed by my physician and he was aware I would use it if I couldn't sleep during my sleep study.
I don't think I mentioned it in this thread, but my physician that prescribed the medication has sleep apnea and has been on CPAP therapy for 8 years.
I've had 3 and 6 month follow up reviews with the same physician who has been pleased with my progress under therapy.
I'm quite certain I am a sleep apnea sufferer as I snored so loud my fiancee had to often sleep in another room, I would fight to stay awake during the day sitting at my desk and driving home from work prior to beginning CPAP therapy. Post therapy, I no longer snore at all and I'm not as tired during the day as I was previously.
Please do not take sleep medications if you believe you will get more accurate results by staying awake during your sleep tests.
We're all family here...you can call me B36 if you'd like!
(05-21-2012, 06:06 PM)b360155 Wrote: .....Please do not take sleep medications if you believe you will get more accurate results by staying awake during your sleep tests.
Do I sense some sarcasm in this remark? Obviously nobody will get any results from their sleep study if they are awake, but it is rare that people don't sleep at all during the 8 hour test. I slept only 2 hours but it was enough to make an accurate diagnosis, even though I couldn't get the titration done.
As Zonk pointed out, sleep medications can cause sleep apnea and worse. Yet, I am not questioning the results of your diagnosis. You obviously have sleep apnea of a greater degree than I do. There is no doubt that your sleep lab diagnosis wasn't all caused by medications. I am glad you are doing well with your therapy.
06-06-2012, 02:28 AM
I was really impressed with your detailed assessment I would have liked to have read this before i did my test.... Like you i was awake from 10.00pm till 2.30. Laying there!!! finally fell asleep only to be woken by the nurse stating i had tossed some of my wires off at 3.10 took me another hour to drop off again. only to be woken at 5.45 with a bright light... Not a pleasant start to a new day.
06-06-2012, 07:13 AM
Great info B36, and most appreciated!
(06-06-2012, 02:28 AM)Trickyman Wrote: Howdy
You're most welcome! Just curious, if I'm doing the math right, it looks like you got 40 minutes of sleep before being awakened, then another hour and 35 minutes. Did the Sleep Center feel they were able to gather sufficient data in that amount of time to make a reliable diagnosis of your condition? Also, welcome to the forum!
You're welcome too! Another option that a friend of mine used recently was an at home sleep apnea test that he ordered through a website he saw online. They send you a monitoring device, you sleep with it on, then send the device back for a Sleep Specialist to analyze. They send you the results and Rx if the test is positive for sleep apnea. Seems to be something gaining in popularity and might be something worth considering since you can do it in the comfort of your own home which would presumably make it easier to fall asleep and it's much less expensive than going to a sleep center. He was also able to purchase a S9 Autoset, humidifier, hose and mask at a substantially discounted price to what a DME charges.
I have no personal experience with this process myself so I'm not advocating it over going to an actual Sleep Center for testing, just mentioning it as an alternative that could be worth looking into for people that believe they might have sleep apnea. My friend is happy with the process and feels he is now benefitting from the treatment with his new machine and supplies.
We're all family here...you can call me B36 if you'd like!
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