another sleep study

[jasonuk75]

Hi all

been on fixed pressure cpap 2 weeks now, still quite tired not feeling great, have kept onto hospital as auto cpap i had for a week worked great, so yesterday sleep tech at hospital give me a appointment to go in, av not had auto machene, but came home with oximeter, that clip on finger, so done a home sleep study last night, took it back 11am today, should get phone call today to see if pressure needs changing on cpap,
sooo i;m being patient, at least i;m coping with cpap keeping mask on during night ect, sleep tech assures me this will get sorted and i will feel better

Jason

[James @ Intus]

Good they take action Jason, not all people can expect that service. Try and get a read-out of the traces if you can. It's nice to study those a bit yourself, or even share in the forums if you feel like it.

[jasonuk75]

hi James everyone

sleep tech phoned me back 6pm. good news and bad news, good news pressure on cpap is ok, last night oximeter recored 2 ahi a hour
but
oximeter also recorded low oyxgen sats, sleep tech is going to speak to a resp
dr and see wot he says, he said i may need a special cpap machene called a VPAP, wot is that, and can it bring my sats up, with 2ahi a hour am i right in saying OSA aint causing low sats,, on oximeter me sat were between 80 and 86, how bad is that?? can certan cpap bring up oxygen sats, without need for oxygen? kinda of nervious bout going to sleep tonight !!
Jason

[Alleycat]

Hi Jason
VPAP is actually NIV - non-invasive ventilation. Looks a lot like CPAP in some models but is actually a lot more complex. As well as setting the inspiratory pressure, the expiratory pressure is also set (as well as lots of other settings) and NIV helps with the work of breathing as opposed to just supporting the airways as in CPAP. Without knowing a bit more about your history it is hard to say why your oxygen levels are so low (they should ideally be above 95%). If you are very overweight you may have something called obesity hypoventilation syndrome, whereby the weight of the chest causes you to underbreathe (hypoventilate) and thus your oxygen levels reduce. Other things that can cause low oxygen levels are lung conditions such as COPD or neurological conditions to as MND. CPAP and NIV can bring up your sats without additional oxygen by helping you to breathe more effectively.
There is a middle ground between CPAP and NIV called Bi-level CPAP. I know Respironics do one, not sure about the other companies.

The other issue if you are more tired on the fixed pressure than you were on the auto is, is the fixed pressure causing you to wake more in the night and thus disturbing your sleep. The sleep study on fixed pressure showed that it is effectively controlling your AHI but it doesn't tell you if it is actually over-treating you some of the time and thus disturbing your sleep. You didn't say what your fixed pressure was.

Try not to worry too much. People with severe OSA can regularly have oxygen levels well below 80% and go years before they even seek treatment.

Keep us posted on how you get on.
AC
xx

[Alleycat]

Hi Jason
Just read your other post and so got abit more of an idea of what's been happening with you. 14.5 is quite a high pressure, although the machine you have can go as high as 20. However, given that you said you are struggling to sleep at night, I suspect that you are just struggling with the fixed pressure. I would never advise you just lowering the pressure if you were to find out how, as your machine has been set at this pressure for a reason. However, a good test would be if you can convince them to let you have another go with the auto-if you miracurously feel better again then you have your answer and you just need to convince them to let you keep an auto.
Which hospital are you at?

As for the low oxygen you should also ask what your baseline oxygen levels (ie between apnoea events) were like on your original sleep study. If they were normal then it is also possible that there was an error from the oximeter, which can happen through wrong positioning, dirty or discoloured finger nails, or in people with dark skin.

AC
xxx

[jasonuk75]

Dear AC
ty for replying to post, ty for all the info u provieded was very helpfiull,
yes i am overweight at 15 stone i;m 5 foot 7", cpap i have is remstar pro, m series set at 4 then ramping to 14.5 after 20 mins, i was getting 130ahi a hour, now down to 2ahi a hour, yep i;m waking up through night at least once sleep tech going to speak to respertary breathing dr, and will get back to me

Jason

[jasonuk75]

sleep deprieved

Hi
ty AC for ur post again, today me not amused!! getting more sleep deprieved as days go on and feeling a lot worst, on wed went to hospital with plan of borrowing a auto machiene but nope was giving oxi meter to do sleep study at home ok can understand that AHI was being recorded instead of switching machenes, but oxi showed low oxygen sats, original oxi mertry sleep test also show low oxygen sats cos was having 130 ahi a hour, but on this one this week ahi was 2 ahi a hour so cpap is controlling apenea at least
sleep tech said he needs to speak to respetary dr, i may need a vpap, so waiting on hospital getting back to me, not sure if 14,5 is waking me up i fall of to sleep ok, but only sleep say 3 hours then wake up, pressure aint uncomftable or anything on waking so dont know
was just thinknig in light of being sleep deprieved if i even get a hint from hospital well auto machenes r to expensive we dont give then out, steam is likley to come from every part of me !!! red tape and politics i dont care for when feeling so ill lol lol

Jason

[Alleycat]

Jason
Depending on the deal your hospital is getting autos aren't that much more expensive than fixed pressure (they used to be but not any more) An outpatient appointment costs on average £100 so the more of these you are having messing around will far out way the cost difference between the machines. Usually in these situations who shouts the loudest wins.
Good luck
x

[Tigers Fan]

Don't get excited, newbies!

A REMstar CPAP - as dispensed in Southampton - costs £275 privately and a REMstar APAP - as dispensed in Leicester - costs £475 privately. The APAP is therefore all but 75% more expensive, privately. I call that a lot more expensive - still.

From those prices, we can possibly deduct an amount for bulk purchase discount but we'd have to add the costs of however many layers of management and purchasers - so let's leave them stand.

A £200 difference over how many machines are dispensed annually - not counting Leicester and its APAPs. 5000? That's a £1,000,000 difference. 10,000? that's £2,000,000.

It's not difficult to see that Jason can shout as loudly as he likes at as many clinic appointments as he can get but I suspect he's going to stay disappointed unless he has clinical evidence that he needs an upgrade - or moves to Leicester, of course.

His 'extra' appointments don't cost £100 or any other figure more than the clinic is already spending - the infrastructure and staff are there and paid for, used or not. An 'extra' appointment might possibly impact on waiting list lengths and/or the amount of time staff have available to stand at the desk discussing cases - or whatever.

'Doing a Tony' with local MP, newspapers and radio might eventually get you an APAP, Jason - and good luck to you. I was about to try in Southampton when whoever awarded them a Certificate of Clinical Excellence (the PCT CEO, I suspect!!!!)

End the Post Code lottery! If Leicester can have APAPs, why can't we all? Mind, if Ospreys can stay in the European Cup, why can't Leicester Tigers?? A bad, sad day!!

TF

[Alleycat]

TF
Think you are showing a lack of understanding of NHS funding....hospitals receive funding for each appointment depending on the agreement with the PCT, average first patient appointment £156 and £76 for follow-up...therefore averages around £100. (see Dr Foster!)

I also think you underestimate the discount that bulk buying and clever wheeler dealing can get you and the difference can be much less than £200...hospitals don't pay anything like £475 for a Remstar Auto...that as you rightly say is the private price (try halving it and you may be somewhere near).

Watch this space for new guidelines all sleep centres are going to be expected to adhere to in the not too distant future and hopefully some of the postcode discrepancies will not be so apparant.

[Tigers Fan]

Jason
Depending on the deal your hospital is getting autos aren't that much more expensive than fixed pressure (they used to be but not any more) An outpatient appointment costs on average £100 so the more of these you are having messing around will far out way the cost difference between the machines. Usually in these situations who shouts the loudest wins.
Good luck
x

Hi Alleycat

Taking your own figures, the cost of a follow-up appintment for Jason is £76 not an average £100. He can have ten follow-ups and the cost per appointment remains at £76. If, as you say, the clinic doesn't get that £76 until or unless Jason turns up or makes an appointment, why on earth would they offset it against the cost of an APAP? Rather, they would encourage him to keep cocming back! A few seconds to tell Jason he can't have an APAP and they receive another £76 - keep on coming back, we want to fund another manager!

I didn't under-estimate the power of bulk purchasing, I offset it against the cost of layer upon layer of managers and purchasers that surely would have to be added to the unit cost of Jason's APAP. Not that we'll ever find out but I wonder how accurate was my guesstimate.

I was delighted - I chose not to despair - by your phrase, " ... guidelines all sleep centres are going to be expected to adhere to ...". If we translate that into Real English it means, "Carry on doing what you like, as you always have."

TF

[Alleycat]

I think we're being pedantic on numbers here...when I said an average of £100 I meant the average outpatient appointment given the new to follow-up raio and average, works out around £100.
TF
Despite the obvious disdain you feel for the NHS and the professionals that actually care a great deal about their patients, whilst having to protect a budget so that they can provide the best service to all their patients, the cost of equipment is not the primary concern to the shop-floor nurse/physiologist. After all it doesn't come out of their pocket and it is their decision.

The cost of managers/ purchasers is the same regardless of the number of machines purchased therefore I fail to see how you can add this to the average price of a machine.

I'm sorry if your own experiences have warped your ideas of the NHS but there is a hell of a lot of work goes on that you are probably unaware of (and yes a lot of red tape and burocracy) which go into improving services, such as the 18 week wait initiative.

Jason- I hope things are improving for you and you manage to get sorted.
AC

[jasonuk75]

HI AC last week was given a cpap with humidifier, from NHS, yep things r improving, i;m still waking once or more during night, but i;m tolerating cpap, keeping mask on ect
last week i became a member of local health club, been going swimming this week, so things are improving as before cpap i considered hiring a electric scooter from local shop mobility to get out and about my body was suffering that much
still waiting to hear from respertiary dr as my oxygen sats were low on cpap, is this normal?? my AHI was under 5, from 130 wow
jason

[Tigers Fan]

Te dum.

Hi Alleycat

You call it pedantic, I call it correcting deliberately misleading mis-information.

'Professional' is a funny word and can be used to imply competence and/or only a person paid for their activity. I have absolute regard for the competent in the NHS or anywhere. I am a passionate defender of the principles behind the NHS. I reserve my dis-regard for the incompetent, un-neccessary, money wasting layers of so-called management, the bureaucrats who serve no purpose except to continue the bureaucracy and stifle the NHS in so doing.

The cost to the tax-payer of anything in the NHS includes the costs of all the layers of managers, their staff and offices. Only a bureaucrat could fail to appreciate that fact. Whichever budget it comes from, we taxpayers fund it.

TF