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Need Help Choosing a CPAP Machine
#31
RE: Need Help Choosing a CPAP Machine
(06-14-2018, 04:11 PM)jmjm28 Wrote:
(06-14-2018, 01:07 PM)Mosquitobait Wrote:
(06-13-2018, 12:59 PM)jmjm28 Wrote: Thanks Shaun, makes sense, just trying to get up to speed. Somewhat related -- I recently purchased a CMS 50F Pulse Oximeter, used it several nights, and found that I'm averaging around 10 desaturation events per hour using the SP02 Assistant software which defines an event as a drop of 4% for at least 10 minutes. Are these the same type of events (>5 hour with symptons) that Medicare uses to qualify you for a CPAP machine. In other words, assuming the CMS 50F is accurate, should I reasonably assume that my professional home sleep study will show a CPAP qualifying diagnosis or are we talking apples and oranges?

Jim

Apples and oranges.  Medicare's primary requirement is an AHI of 5 or over.

So you're saying that "desaturation events" and "AHI events" are different animals. Could you please explain the difference. I've tried to research it
online but couldn't get a clear answer. Thanks.

Jim

Although a desaturation event will follow an AHI event in most cases, and they are related by one will follow the other, they specifically are 2 measurements. A desaturation event is is defined as a blood oxygen level drop by 3% from baseline. If you run 98% O2 sat and have an obstructive apnea, your blood oxygen level drops to 95%, you've experienced an apnea event (ahi event) and a desaturation event. If you do not experience a desaturation during the apnea, you've only had an ahi event. On the other hand, you can experience diminished pulmonary function with desaturation events while not experiencing an apnea event. 

AHI events are defined as an apnea of any type or hypopnea lasting 10 or more seconds.

Although related, still completely different.

Edit: related may not be the best terminology, desaturation can correspond with apnea.
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#32
RE: Need Help Choosing a CPAP Machine
There is an oxygen desaturation index as well. I've included this in the Sleep Indeces article in the wiki.
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#33
RE: Need Help Choosing a CPAP Machine
(06-14-2018, 01:07 PM)Mosquitobait Wrote:
(06-13-2018, 12:59 PM)jmjm28 Wrote: Thanks Shaun, makes sense, just trying to get up to speed. Somewhat related -- I recently purchased a CMS 50F Pulse Oximeter, used it several nights, and found that I'm averaging around 10 desaturation events per hour using the SP02 Assistant software which defines an event as a drop of 4% for at least 10 minutes. Are these the same type of events (>5 hour with symptons) that Medicare uses to qualify you for a CPAP machine. In other words, assuming the CMS 50F is accurate, should I reasonably assume that my professional home sleep study will show a CPAP qualifying diagnosis or are we talking apples and oranges?

Jim

Apples and oranges.  Medicare's primary requirement is an AHI of 5 or over.  If you don't meet that, the doc has to file a bunch of other paperwork to qualify.  This is especially true when your problem is diminished lung capacity or a heart problem vs. apnea.   They fudged my numbers just a bit - I would have qualified for the low oxygen level, but there would have been a lot more paperwork.

However, the primary focus of the sleep study generally is to either rule out or to identify OSA.  Failing the test, so to speak, usually results in a diagnosis of sleep apnea.  You can't assume that the test will result in that diagnosis.  You clearly can (and maybe should, but there are other issues that cloud the water for me) hope that the diagnosis will agree with your expectations, given your experiences.

The first of my recent sleep studies included a heart-beat monitor and an oximeter with an APAP machine; my second included only an oximeter with a Bi-level PAP machine.  I'm hoping you'll get heartrate and O₂ included in the titration.  Be sure to discuss this with the doctor; the RT prolly won't have the authority to include it if it isn't scripted.
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#34
RE: Need Help Choosing a CPAP Machine
Thanks Shaun. A lot to digest. I will ask if both heart rate and 02 will be included in the titration, assuming there is a titration which will only happen if I fail the home sleep study, if I have that correct. To clarify, the reason I hope I fail the sleep study is not because I'm a masochist, but because a diagnosis of sleep apnea gives an additional an somewhat non-invasive potential option (CPAP machine) to deal with some current health issues. If I pass the test, I will have to move on and look for other solutions to my SVTs, high morning bp and fatigue issues. Anyway, the results will be what they will be regardless of my preference. Hopefully they will be clear one way or another but I realize it's not always that way.

Jim
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#35
RE: Need Help Choosing a CPAP Machine
Jmjm,

I felt the same way with my wife when she had the sleep study concerning whether she passed or not. My opinion was that if she passed, great. If she failed, great. Only problem i had with her passing the test was that we wouldn't know where to go with diagnostics next. Sleep apnea is a relatively easy diagnosis and the way to get the diagnosis is proven and tried, and there is a solution.
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#36
RE: Need Help Choosing a CPAP Machine
(06-14-2018, 07:27 PM)jmjm28 Wrote: Thanks Shaun. A lot to digest. I will ask if both heart rate and 02 will be included in the titration, assuming there is a titration which will only happen if I fail the home sleep study, if I have that correct. To clarify, the reason I hope I fail the sleep study is not because I'm a masochist, but because a diagnosis of sleep apnea gives an additional an somewhat non-invasive potential option (CPAP machine)  to deal with some current health issues. If I pass the test, I will have to move on and look for other solutions to my SVTs, high morning bp and fatigue issues. Anyway, the results will be what they will be regardless of my preference. Hopefully they will be clear one way or another but I realize it's not always that way.

Jim

Titration is just a fancy (and easy, if your tongue doesn't get caught between your teeth) of referring to a "method of quantitative analysis", which is what those nerds in the white lab coats are going to be doing while you're trying to sleep (or over your data if you do one of the at-home sleep studies – which I was assuming when I made the suggestion of mentioning heart rate and oxygen monitors).

Jim, if you do have OSA, the therapy for it may not correct the SVTs, the high BP, and might even not correct the fatigue.  Don't lose sight of looking for solutions for those while pursuing a resolution to this sleep apnea issue.  Those conditions are so serious that you need to keep working on them as well. jus' sayin'
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#37
RE: Need Help Choosing a CPAP Machine
Shaun: Jim, if you do have OSA, the therapy for it may not correct the SVTs, the high BP, and might even not correct the fatigue.  Don't lose sight of looking for solutions for those while pursuing a resolution to this sleep apnea issue.  Those conditions are so serious that you need to keep working on them as well. jus' sayin
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Fully understood. I am multi-tasking solutions, believe me, and have no illusions. I understand that even with a sleep apnea diagnosis (which I do not yet have) , a CPAP may not solve any of my issues. On the other hand, not perusing sleep apnea in light of my symptons would be unreasonable.

Jim
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#38
RE: Need Help Choosing a CPAP Machine
Exactly Jessee. With a positive diagnosis, nothing to lose and everything to gain. How did it finally work out with your wife?

Jim
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#39
RE: Need Help Choosing a CPAP Machine
Shaun: Titration is just a fancy (and easy, if your tongue doesn't get caught between your teeth) of referring to a "method of quantitative analysis", which is what those nerds in the white lab coats are going to be doing while you're trying to sleep (or over your data if you do one of the at-home sleep studies – which I was assuming when I made the suggestion of mentioning heart rate and oxygen monitors).
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Gotcha. I thought you meant adjusting the machine itself while I was sleeping, which I was told would be the next step if my home sleep study results suggested I needed a cpap.
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#40
RE: Need Help Choosing a CPAP Machine
(06-14-2018, 08:38 PM)jmjm28 Wrote: Exactly Jessee. With a positive diagnosis, nothing to lose and everything to gain. How did it finally work out with your wife?

Jim

She was diagnosed with mild OSA, 8 AHI or so with mostly hypopnea. She enjoys therapy. After a few weeks she started to really notice her energy levels were higher in the evenings. Afternoon naps are gone and unnecessary. She's a prime candidate that weight loss may cure the apnea. She's currently working a comprehensive dietary plan and has seen weight loss and apparel downsizing. She's doing good. She's recently diagnosed with diabetes, it runs in the family, and she's serious about the diet. She's a trooper.
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