Diagnosed with OSA but sleep clinic is closed.

[Reno]

Howdy all!

I suspected OSA but GP wouldn’t refer me to a sleep clinic, so I got a sleep apnea test done by Philips Diagnostic Service.

Results are in!
AHI 109.6 OAI 86.2 CAI 2.8 MAI 8.0 ODI 106.4 CSR % of TIB 0.00%.

I was planning to buy my own CPAP machine as my local NHS haven’t been the most helpful and I wasn’t relishing the idea of a second-hand machine. So I was thinking of getting a Dreamstation APAP and monitoring the OSA myself.

Unfortunately, I think the clinician’s comments may have put a spanner in the works.

This is an extremely severe degree of sleep apnoea which should ideally be treated with CPAP (Continuous Positive Airways Pressure) as a matter of some urgency. The average oxygen saturation is significantly reduced at 86%. The nadir of 55% is of concern. With a reported BMI of 68.8kg/m2 it may be that normal CPAP is not the answer here. I would strongly advise an urgent referral to a local sleep centre where they can investigate whether there is an element of obesity hyperventilation which could require bi-level ventilation.

So CPAP may or may not be the answer. I guess I’ll have to try to and use the sleep report to get my GP to refer me to the sleep clinic, but the sleep clinic is closed because of COVID-19.

Do I have any options or am I forced to wait until NHS is back up and running?

- James

[Giny @ Intus]

Hello James,

We can understand your frustration but I would advise to discuss the results with your GP for further advise. You might want to buy a CPAP for now but that might not be sufficient. The cost of the DreamStation Auto CPAP Machine is £549 so if you were to have a BIPAP in the end, the DreamStation would then not be sufficient enough and you would have wasted some money. As you said, being medical equipment, for obvious hygiene reasons, it is not ideal to re use it by somebody else.
An automatic CPAP machine adjusts the pressure throughout the night. The machine has numerous sensors built-in to assess what pressure level you require at any given time. Whereas the BiLevel – indicates a flow generator that delivers 2 distinct pressures, one for inhalation and the second for exhalation.

I would suggest to share your results with your GP for further advise.

Giny

[Reno]

Hi Giny, thanks for your reply.

I do intend to speak to my GP, initially to avoid contraindications, but I guess now to check out this hypoventilation risk. My GP isn’t seeing people in-clinic so I’ve e-mailed ahead my report and will try and get a telephone appointment to discuss it.

To be honest, I can barely function. My concentration in particular has been brutally effected. So I kind of want to get started ASAP on something to try and improve quality of life. I know the real solution here is weight loss. I am taking it very seriously. My BMI on the night of my sleep study was 68.8 and that’s now down 64.6 today. So progressing, but still a long way to go.

There is little public info OHS and with my concentration, reading articles targeting professionals has been rough, but I saw this BMJ article say:

...observational and a few randomised controlled trials with short-term follow-up have shown that both CPAP and NIV are equally effective in improving daytime and nighttime hypercapnia as well as symptoms in patients with OHS.

So CPAP doesn’t seem to be a bad option if I even have OHS.

The clinician does say I “should ideally be treated with CPAP as a matter of some urgency” but then contradicts later saying “it may be that normal CPAP is not the answer here.” Would this be sufficient evidence to buy a CPAP machine?

[Giny @ Intus]

Hi Reno,

One of the main symptoms of Obstructive Sleep Apnoea is excessive tiredness during the day. Loosing weight is also a very good start as it could be beneficial not only for our OSA but also for your health.
You are correct there seems to be a contradiction in the recommendation of the equipment to use. If you were to buy a CPAP for now, as long as you certify that you will also seek medical, then you can buy one from us. You will also need to consider a mask as none of the machines come with a mask.

Please give me your email address and I can send you further details.

Giny

[Reno]

Hi Giny,

Just want to say thank you so much for your help. Put an order through cpap.co.uk and sent the necessary documents and self-certified I will seek further medical support. Order approved! Got the Philips Auto Dreamstation with a nasal pillow mask. (because beard )

Weirdly enough, I’m over-the-moon and kind of excited. Odd, I know, but joy is joy so I may as well enjoy it.

So thank you again! I really appreciated your help.

- James / Reno

[Giny @ Intus]

Hi James / Reno,

Thank you for your order and I am glad to hear that you are excited. The hardest part of the therapy is to get on with the mask and to adjust to it.
It can take 2-3 weeks to get used to a mask. Please watch fitting video and do not hesitate to contact us if we can be of any further assistance.
Nasal masks are normally recommended for people who breathe through their nose only at night.

I suppose you are looking for a good night sleep but please bear in mind that CPAP might not be sufficient for you.

Giny

[Reno]

I am aware it can be hard to adjust to, but from what I’ve heard, it mostly requires persistence. If they’re are any problems I can’t figure out, I can always pop back on here and ask.

Nasal masks are normally recommended for people who breathe through their nose only at night.

Yea, I know. From what I’ve been told, nasal pillows seem to be best for getting a good seal and full face masks are more likely to leak. I imagine the beard would only exacerbate seal problems. Before I consider shaving, I want to try the pillow first. If I have problems or the pressure needs to go up to high, I may have to consider removing the face fuzz and moving to a nasal or a full-face.

I suppose you are looking for a good night sleep but please bear in mind that CPAP might not be sufficient for you.

You’re probably right, and don’t worry. I am aware of that possibility that cpap may not work. But all things considered and based on my personal research of OSA and OSH, I feel pretty comfortable taking on the risk.

- James

[Giny @ Intus]

Hi James,

It seems that you are very well documented. With such a positive attitude and research done, you are already a step ahead. And yes we are here to help and assist you with your therapy.

So please do not hesitate to contact us either by phine, 0800 024 8050 or email: [email protected]

Giny