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how to increase AHI during sleep study
#1
how to increase AHI during sleep study
I am fighting with insurance, trying to get surgical treatment covered. I'm getting ready for another sleep study and I want to make sure that my AHI during the study is high enough that insurance will cover the surgery. Any tips?

I've had two sleep studies: the first one at-home with AHI 27 / lowest oxygen desaturation in mid-80s, second one at a sleep center with AHI 11.9 / lowest oxygen desaturation 86%. I need an AHI of 15 at a sleep center in order to get insurance to cover the surgery.

I have a theory that my second study's AHI was lower because I went for a long run the day before the study (I was concerned about being able to sleep during the study and hoped this would tire me out). My theory is that the physical exertion caused me to spend more time in deep sleep / less time in REM sleep which would then lower my AHI. I also think that my low oxygen levels indicate that I don't arouse as easily as others when apnea occurs, which means that I have fewer apnea events each of which last longer, which means that my relatively low AHI is not a good indication of the severity of my sleep apnea. Insurance is looking only at the 11.9 AHI and saying that my sleep apnea is mild and therefore I don't qualify for surgery, but it would be more accurate to look at a combination of AHI and oxygen.

I use CPAP and hate it for a variety of reasons. I'm pretty committed to MMA surgery, having already spent the last year in braces and getting a couple of teeth extracted in preparation.

Other than NOT going for a long run the day before the study, can you think of how else I could bump my AHI up a few notches? Should I avoid using my CPAP for a few days before the study in order to increase the REM backlog? If I had a drink would that help? 

Thanks for any suggestions.



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#2
RE: how to increase AHI during sleep study
What is your AHI on CPAP? Just curious, as I'd do anything to avoid any kind of surgery, pills, PT, CPAP, exercise, etc.
#3
RE: how to increase AHI during sleep study
Hi MeTheInvincible - Welcome

I hope you are aware that the MMA surgery only delays CPAP use, at best.  It will not prevent it.   As far as your request for steps to fail a sleep study, I am reluctant to provide aid and/or advice to something I regard as providing fraudulent results.   Maybe another member won't possess my reservations on this matter.

Either way,
Good Luck!
#4
RE: how to increase AHI during sleep study
o.O ... I would always advise against surgery ... but what the heck - looks like you did your homework and you know what you are doing.

generally they advice to stay away from alcohol as it increases snoring and obstructive events during the night. (Maybe you want to read up on what to avoid with sleepapnea ... a while ago I saw curves from someone showing a pattern that looked like beginning periodic breahting ... turned out to be over the counter sedatives / mild "drug abuse"^^)



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#5
RE: how to increase AHI during sleep study
AHI on CPAP is usually around 2. I have a really hard time with aerophagia. When I use CPAP, I wake up every morning with a stomach ache and gas. I've tried turning the pressure down but there doesn't seem to be any sweet spot where pressure is high enough to stop apneas but low enough to not shoot air into my stomach. I also travel a lot to places where it's not reasonable to tote a CPAP and battery (no I'm not going to pack a CPAP and battery into a dry bag for an extended kayak camping trip or explain to my Nicaraguan hosts why I can't sleep in a hammock like everyone else). I'm young and the prospect of a surgery plus a few months recovery sounds much better than 60 years of CPAP. I'm fit with a clearly small jaw so extra weight isn't the problem. I understand that for other people, surgery seems like something you'd do anything to avoid but for me it seems like the best option.
#6
RE: how to increase AHI during sleep study
(06-09-2017, 11:02 AM)MeTheInvincible Wrote: AHI on CPAP is usually around 2. I have a really hard time with aerophagia. When I use CPAP, I wake up every morning with a stomach ache and gas. I've tried turning the pressure down but there doesn't seem to be any sweet spot where pressure is high enough to stop apneas but low enough to not shoot air into my stomach.

There's more to it than that. What you need is bi-level therapy (commonly called BiPAP or VPAP), and I highly recommend one that auto adjusts the pressure, like the one I have. The bi-level therapy lowers the pressure on exhale, and the auto-adjustment of the pressure means you can spend more time at lower pressures.

For example, I was titrated at a pressure of 13 cm, but that causes painful aerophagia. To reduce it to a tolerable level I need to lower the pressure to 10 cm, but the I get a lot of hypopneas. Right now I start at a pressure of 10 cm and my machine raises it only when needed. My exhalation pressure is always 4.4 cm lower that those numbers. This keeps my AHI low and I have no pain from aerophagia.

Quote:I'm young and the prospect of a surgery plus a few months recovery sounds much better than 60 years of CPAP.

If a surgeon promised you that, get a second opinion. There's a good chance the surgery won't help you at all. There's a chance it will, but you'll still need CPAP therapy set to a lower pressure. And as the years go by and you lose muscle tone your apnea will get worse. Plus, there are permanent side effects from the surgery such as difficulty swallowing.

In my opinion, the surgery is a mistake. Take your CPAP with you when you sleep on the hammock!
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
#7
RE: how to increase AHI during sleep study
The thing you have to keep in mind is that the surgery is supposed to be very painful and as already mentioned, it only delays the onset of Apnea. It doesn't prevent it for the long term. The vast majority of people (really everyone that I have read about) that have had this surgery reverted back to where they were in a few years if the surgery even succeeded to begin with. Personally, I would not get this surgery.



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#8
RE: how to increase AHI during sleep study
I forgot to mention that the surgery could actually make your problem worse. I found an old thread that discusses the pitfalls of the surgery:
http://www.apneaboard.com/forums/Thread-...17#pid1117

Here is another thread:
http://www.apneaboard.com/forums/Thread-...surgery%22

Please look at this post:
http://www.apneaboard.com/forums/Thread-...2#pid46382

Be careful of what you wish for!
#9
RE: how to increase AHI during sleep study
(06-09-2017, 10:07 AM)MeTheInvincible Wrote: I am fighting with insurance, trying to get surgical treatment covered. I'm getting ready for another sleep study and I want to make sure that my AHI during the study is high enough that insurance will cover the surgery. Any tips?

Other than NOT going for a long run the day before the study, can you think of how else I could bump my AHI up a few notches? Should I avoid using my CPAP for a few days before the study in order to increase the REM backlog? If I had a drink would that help? 

Thanks for any suggestions.


You are pretty much asking us to help you commit insurance fraud.  That is not what we do here.

With that said, you are already using a bipap according to your profile.  Aerophagia can miserable, but there are many folk here that can help with that issue.  

As others have said, that surgery isn't a guarantee that it will not cure your apnea.  
I understand your concerns with being young and using cpap, but alot of folk young and old adjust their lifestyles and most seem to have no problem traveling with their cpap.  

I believe we can help you adjust and overcome aerophagia and get the proper adjustments to your bipap, but I get the feeling that's not what you want.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com
Dreaming



https://www.sleepfiles.com/OSCAR
OSCAR Chart Organization
Using Attachments to Post ScreenShots.



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.
#10
RE: how to increase AHI during sleep study
Also, be careful talking about this in a public forum as what you are asking information for is close to insurance fraud. Purposely doing something to raise your AHI higher than it would be otherwise for the purpose of getting insurance to pay for something? Yeah, not a good idea.

You've gotten good advice on what to do as well as how to cope with your CPAP.

As your body slowly dies from various sleep apnea related illnesses and conditions because the surgery didn't work (or didn't work for long), come back and we'll help you figure out how to make CPAP work for you.
PaulaO2


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.







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