(12-02-2015 12:48 PM)kitty Wrote: In the last few months I've had 2 'home' sleep studies done because insurance would not cover an 'in facility' one at first. Both showed very mild sleep apnea. The Sleep Specialist I'm seeing told me how unreliable the home studies are and I needed to do a 'in facility' one eventually. After those 'unreliable tests' they hooked me up with an APAP machine and I wore it for 5 weeks to see if I felt any better. She deemed the machine a 'failure' since I felt no better, still extremely exhausted. My insurance would now cover an 'in facility' sleep study & the Specialist said maybe I have underlying issues like I'm not going into Non-Rem or have restless leg syndrome, that the sleep study will show all that. It was also set up for me to WEAR my APAP during the study. I thought to myself 'why??
While home studies are definitely limited, they aren't always completely unreliable. While it is possible to produce a false positive result, it isn't highly likely and two home studies both coming up with the same diagnosis are probably correct. My impression is that home studies are known more for under-reporting apnea than for over-reporting it.
So when I read your second (bolded) sentence, I took 'failure' to mean that you were still feeling poorly, not that you don't have sleep apnea. So based on the two home studies and the 5-week APAP trial, you were scheduled for an overnight titration study at the sleep center. They had you use the APAP because they had already documented that you have sleep apnea. (You could obtain a copy of the results of the at-home APAP machine to see for yourself -- likely you'd see pressure changes. Those pressure changes mean that the machine is trying to respond to some degree of airway obstruction.)
The fact that you were actually titrated during that last test at the sleep center seems to confirm that the sleep apnea diagnosis is real. There is some reason they ended up with a pressure of 9, since the lowest pressure on the machine is 4 and if you didn't have apnea, there would be no real basis for needing a higher pressure.
Quote:Is it true what the Assistant said that it would be hard to know if I have apnea while wearing the mask during the in facility sleep study??
Technically it's true that you can't rule out apnea when you're using a machine (because you're receiving some treatment even at the lowest machine pressure)-- but my guess is that they weren't trying to see if you have apnea because they already had documentation from the earlier tests that you do. They were trying to see if there are additional underlying issues (like PLMD for example) that aren't captured in most home sleep studies but might explain the lack of improvement. And they were trying to see if they could titrate you more effectively than the at-home APAP trial did.
At this point all we can do is guess about what's been going on, but my guess is that the big issue here is really poor communication from the doctor's office to you about what was going on and why. Your story of what happened mostly hangs together in my mind, but was not well explained to you along the way.
Be sure to obtain copies of everything including your two home sleep tests, the 5-week APAP report, and the in-lab titration study. It's always good to have copies of your medical records and you are entitled to them by law. Should you decide to seek a second opinion, you'll want all that documentation.
The switch from APAP to CPAP does not seem to be a big issue for you right now, it's more the question of the validity of the diagnosis. That's what I focused on in my response. An APAP machine can be set to run in CPAP mode so there's really no need to switch out the machine other than cost management. Which brings up two questions in my mind: First, are you in Canada? Second, does your doctor's office have any kind of financial relationship with the equipment supplier?
Edit: I see that Sleeprider brought up the question of UARS -- reviewing your titration study when you have the report in hand should help you see if this could be relevant. You would see in the results information about RERAs -- Respiratory Effort Related Arousals. Some labs titrate for apneas and then stop titrating the pressure when apneas are eliminated, but for some people there is still airway compromise (aka flow limitations) that affects sleep quality and daytime symptoms. I think the titration report will help clarify if this is something you need to pursue.
And one more thing -- if you are to be using a machine long-term, an auto-adjusting (APAP) machine is ideal. Failing that, be sure your CPAP machine is fully data capable, meaning it records advanced treatment data and not just a count of total hours used. What is the make and model of your current machine? You might actually be able to get some of your questions answered right now with the available software we use to look at our sleep data. We can help get you set up with that.