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Looking for Info before meeting with Doc. Have gathered some data already.
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Sleeprider Online
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Post: #11
RE: Looking for Info before meeting with Doc. Have gathered some data already.
(07-17-2015 04:28 PM)lowT Wrote:  Sleeprider: I am about 250-300 ng/dL. That is sort of an average of about 10 tests. I have done EVERYTHING else besides a sleep study. It is probably a lost cause to restore it naturally, but I want to be sure. I also want to see if I am one of the lucky ones with both low T and sleep problems, haha. The way I see it, even if I fix my T, I still want to be sure my sleep is good. That said, I don't have any obvious signs of sleep problems (no snoring, don't move around at night, have dreams, SpO2 doesn't go below 95% during sleep). So it certainly doesn't seem like a sleep problem, but I just can't say for certain.

Hormone replacement therapy has several potential side-effect, one of them being that it can make sleep apnea worse. Men that are already treated aren't affected by this, but if you have borderline apnea now, it might not be after starting therapy. So should you be tested before or after starting HRT?

Well, maybe neither. You could just work with your primary physician to discuss your symptoms and see if he would support getting an auto-titrating CPAP based on that. Any modern Resmed or Philips auto machine will produce data that will let you see respiratory events and self-titrate. Buy a used machine off Craigslist and your cost could be less than $500 for machine, new mask and supplies to start. You're paying out of pocket, so a data capable machine will tell you and your doctor is this is the path forward, and you can skip the expensive study and get effective care by working with the available software, your doctor and this forum. If CPAP is NOT for you, resell it.

Your making yourself miserable for nothing with those low T levels. Bring them up with a prescription for transdermal or injectable (cheaper) T based on the recommendation of your urologist or endocrinologist. If your insurance is not excellent, be warned the popular transdermal therapy can cost $400/month, compared to about $140 for 6-months of T-cypionate and 1-cc 25 ga 5/8" syringes.

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07-17-2015 05:51 PM
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lowT Offline

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Post: #12
RE: Looking for Info before meeting with Doc. Have gathered some data already.
Great info everyone Smile I really appreciate it. I do think I need to continue to follow up on the sleep question and it seems I don't have enough info to rule it out yet.

(07-17-2015 05:51 PM)Sleeprider Wrote:  Well, maybe neither. You could just work with your primary physician to discuss your symptoms and see if he would support getting an auto-titrating CPAP based on that. Any modern Resmed or Philips auto machine will produce data that will let you see respiratory events and self-titrate. Buy a used machine off Craigslist and your cost could be less than $500 for machine, new mask and supplies to start. You're paying out of pocket, so a data capable machine will tell you and your doctor is this is the path forward, and you can skip the expensive study and get effective care by working with the available software, your doctor and this forum. If CPAP is NOT for you, resell it.

Your making yourself miserable for nothing with those low T levels.

Well that is interesting. My PCP has been great. He has actually suggested to go on testosterone and I have been the one wanting to wait until I exhausted everything. The reason is that I consider low T a "marker" of health and the theory is that if I can get my T back naturally then I will have resolved the root cause problems (instead of masking them).

That said, yeah, the sleep study is out of pocket. So one lab night plus a consultation is going to be $1,000! Of course, then I would need to buy equipment if there was a problem...but at that point I would be so relieved that the cost wouldn't be a big deal.

I am interested in this option, but my main fear has been that there are so many different types of machines (CPAP, APAP, bi-level, etc.) that I did not know where to start. Then I was concerned about giving up prematurely because I felt uncomfortable. But then again, I have a DIY spirit and it might come in handy if I wanted to help someone else out too.

So if I did this sort of trial, I need an APAP? Any particular models that I should look for? I suppose eBay is an option as well. Also, can you get the masks, etc. on Amazon or elsewhere? Also, this would detect "respiratory events", is this correct? But is that sufficient to determine everything I need to know? I know there are several different types of machines and how would I know if I had the best one suited for my particular situation?
(This post was last modified: 07-17-2015 06:34 PM by lowT.)
07-17-2015 06:32 PM
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SaldusMiegas Online

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Post: #13
RE: Looking for Info before meeting with Doc. Have gathered some data already.
(07-17-2015 05:51 PM)Sleeprider Wrote:  Well, maybe neither. You could just work with your primary physician to discuss your symptoms and see if he would support getting an auto-titrating CPAP based on that. Any modern Resmed or Philips auto machine will produce data that will let you see respiratory events and self-titrate. Buy a used machine off Craigslist and your cost could be less than $500 for machine, new mask and supplies to start. You're paying out of pocket, so a data capable machine will tell you and your doctor is this is the path forward, and you can skip the expensive study and get effective care by working with the available software, your doctor and this forum. If CPAP is NOT for you, resell it.

+1 What he said. Wow, brilliant idea, Sleeprider.

I would definitely consider doing this, esp if I was paying for it all out of pocket.

As it happened for me, the sleep study lab tech told me when I asked about autopap machines that they are pretty good but can't beat a lab titration study for accuracy.

My experience on therapy is the fixed prescription pressure was a useful starting point. I used it for two weeks on the fixed prescription, then switched to auto mode as an experiment just to see what it would say.

The autopap machine has continuously honed the optimum pressure, and the sleep doc went with the 60 days of data I brought him and modified the prescription to match what the machine said. You and your primary doc could do the same thing.

So I am a believer that Sleeprider's suggestion is very viable and cost effective. If your primary doc is in favor, you might save the cost of one or two nights in the lab (sleep study, titration study).

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07-17-2015 06:41 PM
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Mark Douglas Offline

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Post: #14
RE: Looking for Info before meeting with Doc. Have gathered some data already.
I purchased out of pocket an auto-bipap because not only is it an auto-bipap but can also be operated as a auto-pap or straight cpap as needed/desired via simple on screen setup menu and is Sleepyhead compatible. Sorta covers almost all the possibility. Runs directly off 12VDC on a boat or RV or backup battery if a power outage. With the help of the great people here I need no sleep doc or deal with ins/DME BS.

YMMV

I use my PAP machine nightly and I feel great!
Updated: Philips Respironics System One (60 Series)
RemStar BiPAP Auto with Bi-FlexModel 760P -
Rise Time x3 Fixed Bi-Level EPAP 9.0 IPAP 11.5 (cmH2O)
07-17-2015 06:50 PM
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trish6hundred Offline

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Post: #15
RE: Looking for Info before meeting with Doc. Have gathered some data already.
Hi lowT,
WELCOME! to the forum.!
Much success to you.

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07-17-2015 07:13 PM
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lowT Offline

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Post: #16
RE: Looking for Info before meeting with Doc. Have gathered some data already.
Well, it may make more sense to just spend the money on a really good machine instead of on a sleep study, provided the machine can do the diagnosis as well.

I see a ResMed S9 autoset with H5i humidifier near me for $300. Also, I see a Phillips Respironics REMstar 60 Series BiPap Auto with Bi-Flex and Heated Humdifier for $500. A lot cheaper than $900 for a study! But I have NO IDEA if this is what I need. Also, I don't know if it is compatible with SleepyHead?

But I really have no idea which machine might be the selection for me. I would assume they would have them on eBay as well? Can I get some suggestions for the right machine for diagnostic use?
(This post was last modified: 07-17-2015 08:02 PM by lowT.)
07-17-2015 07:57 PM
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eseedhouse Offline

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Post: #17
RE: Looking for Info before meeting with Doc. Have gathered some data already.
Only a proper sleep study can make a definite diagnosis. I am happy that I live in a land where the government pays the shot for the study, and that I also have supplemental insurance (due to a union contract I helped negotiate) that covered the cost of the machine.

Ed Seedhouse
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I am neither a Doctor, nor any other kind of medical professional.

Actually you know, it is what it isn't.
07-17-2015 08:01 PM
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Sleeprider Online
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Post: #18
RE: Looking for Info before meeting with Doc. Have gathered some data already.
(07-17-2015 07:57 PM)lowT Wrote:  Well, it may make more sense to just spend the money on a really good machine instead of on a sleep study, provided the machine can do the diagnosis as well.

I see a ResMed S9 autoset with H5i humidifier near me for $300. Also, I see a Phillips Respironics REMstar 60 Series BiPap Auto with Bi-Flex and Heated Humdifier for $500. A lot cheaper than $900 for a study! But I have NO IDEA if this is what I need. Also, I don't know if it is compatible with SleepyHead?

But I really have no idea which machine might be the selection for me. I would assume they would have them on eBay as well? Can I get some suggestions for the right machine for diagnostic use?

Either of those machines would offer very good therapy, assuming you have sleep apnea, and both offer full therapy data. Be sure the machine you choose has not been exposed to a smoking environment. That is hard, to hide. Also, negotiate the price. Ask for $100 off. Either one would be a decent deal at $50 off. Compare prices on Supplier #2 on the supplier list link at the top of the forum for used equipment reference. Ebay does not allow sale of medical devices.

The PRS1 760 BiPAP is the machine I use. Therapeutically it is not much different from an Auto CPAP (which I also have). It can run in CPAP, Bilevel and auto bilevel modes, and it can even be setup to run like auto CPAP. In addition to obstructive and clear apneas, and hypopneas it flags flow limitations and RERA "respiratory effort related arousals". This can be important information for someone unsure what is causing fatigue, headaches and especially arousals.

If you have "events" at low pressure with a machine, it's a pretty good indication that you have more events without it. Some home studies use CPAP machines to monitor events. It's not the greatest way to Dx but it's done. As said earlier. If it turns out you don't have a problem, you saved at least $1000 on a study and can still sell the machine. I'd still have that talk with your doctor and get his opinion and support. Here are some reputable articles on DIY diagnosis and titration using auto CPAP. You decide.
http://www.ncbi.nlm.nih.gov/pubmed/12646837
http://thorax.bmj.com/content/52/1/72
http://www.aasmnet.org/jcsm/Articles/020206.pdf
http://www.atsjournals.org/doi/full/10.1...amtZvlvB2A

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07-17-2015 08:36 PM
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lowT Offline

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Post: #19
RE: Looking for Info before meeting with Doc. Have gathered some data already.
OK, so to be clear, one would need an Auto CPAP (also known as APAP, auto-titration CPAP, autoPAP, other). Basically the one that automatically adjusts the pressure as opposed to a standard CPAP (which has constant pressure). A basic bi-level would not be a candidate, but an auto bi-level should work as well? Anything that automatically adjusts the pressure and that allows recording since I guess the pressure would have to increase during an "event".

Once a device is identified, one would record and review what happens. BIG QUESTION: If there are no events (specifically respiratory events), would it be safe to assume that there is no need for a study? However, if there are events, then I would fall into a grey area where a study may help better identify the best treatment. In my case, I suspect there is a high percentage that I will not see any events.

The last question is doesn't a home sleep test provide respiratory event information as well? Those are only about $300-$350. The in lab cost is much more but tracks things like brainwaves, etc. Perhaps that is only recommended IF I fail the at home doctor study or fail the Auto CPAP self test though?
(This post was last modified: 07-17-2015 10:42 PM by lowT.)
07-17-2015 10:41 PM
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quiescence at last Offline

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Post: #20
RE: Looking for Info before meeting with Doc. Have gathered some data already.
So, here is an example of what kind of oximeter results would point to apnea:

[Image: 1KReSEU.png]

AND the correlation with apneas shown here, where the apnea causes a gradual drop, and the exaggerated breathing quickly brings it back up.

[Image: ZrWDOd6.png]

The oximeter reading below is interspersed with CPAP use and a period while not on the machine. you can see the difference the CPAP makes.

[Image: cMzh8jx.png]

[updated: Since you indicate you have no such desaturations of oxygen, you will not receive a benefit (wrt oxygen) that CPAP give us that have apnea.]

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
(This post was last modified: 07-18-2015 11:19 AM by quiescence at last.)
07-17-2015 10:50 PM
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