Sleep apnea - am I missing something

Parent Cafe
1

H gets a message last night informing him that his sleep apnea testing showed “mild” with “5 stoppages per hour” AND he should consider whether he wants a CPAP or go to a dentist for a mouth apparatus. Due to his getting back late at night and other things going on in our lives, we decide we’ll figure it out later.

Today I have to cover a Spanish class at school (no sub for the teacher - I’m free that period, etc). I don’t speak Spanish. The kids have an assignment to work on, so I told them, “Normally this is where I’d tell you if you have questions, feel free to ask. It’s makes me feel useful and keeps my brain young. But, since I don’t speak Spanish, this time I’m telling you, ‘Google is your friend’ or… who’s the best student in this class? Louis? Ask either of them for a more trustworthy answer. Meanwhile I’m going to go sit at the desk on my cell phone playing ‘Substitute Teacher.’” They chuckle - class goes well (regardless of what you think of my decision on how to run class).

I look up sleep apnea and get sites ranging from NIH to Mayo all of which say “mild” and “5 per hour” is essentially meaningless. Lose weight. Perhaps change sleeping position. Both CPAP and apparatus do nothing even if used.

Being a science/math person I’m extremely inclined to trust NIH and Mayo barring something else brought to my attention - so why the “frightening” directions left on the phone? Am I missing something? Seems odd to have such conflicting info.

If my conclusion is correct, at least that’s one thing easily cleared up from the overload of issues on our plate last night!

(H is currently still out working in the field trying to get projects done - he approves of both my research and this message asking WTH after what I found earlier. He’s supposed to know his own thoughts by Tuesday.)

2

Those directions don’t sound too frightening to me. Maybe both the msg and your research are correct. They’re saying that his apnea is mild so he can do these things. Or not?

3

Sounds like a CYA by the messenger (MD?Sleep center?). Any result other than Negative gets a message with suggested interventions. Then it’s up to the patient to follow through.

4

To be more clear… the message says “do something - here are the choices.” The research says don’t bother with those choices. They don’t work even if you do them for his level of apnea.

It was a sleep center that left the message so could be CYA.

5

I didn’t see anything on the Mayo site about how many stoppages warrants a CPAP machine. I can tell you it’s completely cured DH’s snoring so I am sleeping much better! DH also says he’s feeling more rested. That’s the bottom line for us.

6

From the little I know (dh and our kids all have sleep apnea), it sounds as if your husband’s case is indeed mild. We saw apnea events ranging from 40 - 60+/hr. in their tests. All of them use self-titrating (auto-adjusting) CPAP machines. Dh looked into the dental device but it was not recommended given the severity of his problem. They now have nasal pillow “masks” that permit side sleeping and are comfortable, at least they became so once everyone adjusted to wearing anything at all.

It’s good that your dh was tested, but unless his doctor sees other causes for concern such as very low blood oxygen levels then it doesn’t seem to be anything to worry about. (I am not a doctor, but I am a professional level worrier and borrower of trouble, and this would not upset me.)

7

Everyone I know who’s done a CPAP swears by them.

8

I believe 5 is mild, 10 is moderate, and 15 is severe. Did he try the CPAP? I did once, and I admit I felt so much better the next day. Given that apnea correlates to both cardiac problems and dementia, I personally feel like it is important to treat. The mouth guards are relatively easy to use and inexpensive-might be worth trying.

9

I’d see if I could get a second real-life opinion.

10

It is commonly thought in the medical community that mild sleep apnea only needs to be treated if there are symptoms or co-morbidities. What was the reason your husband was tested in the first place? Is he overly tired, loud snorer, or does he suffer from a-fib, hypertension, etc.? Also, if it was a home sleep apnea test, it may have underestimated the breathing “stoppages” per hour.

Still, he should have the chance to review the study with his MD and not just rely on a message.

11

He does have HBP. Otherwise snoring and general cardiac family history so is trying to be proactive rather than reactive for that. It’s his cardiologist who recommended the sleep study and who he’ll be seeing on Tuesday. It’s entirely possible the cardiologist will agree with not treating it, but like me, H prefers to be informed about medical “stuff” prior to discussing things with a doctor in order to have more intelligent discussion in the office - and if we have questions, etc.

The message definitely implied (stated) A or B as options - nothing else. My research seems to show Option C is the best choice. Now I’m just looking for reasons C might not be the best choice so he can be informed about those if suggested.

Unfortunately the sleep center has only sent his results to his PCP - not the cardiologist who referred him. We’re both scratching our heads about that one. He tried calling today, but only got a robot. He told me he didn’t have time to deal with that, so figured he’d just let the cardiologist listen to the message (on his phone). I suspect seeing the actual results would be better, but maybe not. His/our PCP has retired so who knows where those will end up - or when. They should get to the office and his file - eventually. Totally different systems, so not likely interchangeable for viewing. The sleep center is in the same system as the cardiologist - maybe that will help?

12

Full study is important. His index may be 5 (which is the AVERAGE per hour), but perhaps it is much greater during REM sleep…or he never went into deep sleep (just like you can have a B average with both A’s and C’s). They also look at how low his blood oxygen saturation dropped during the study.

I am kind of surprised they left something like that on a phone message, though, and don’t blame you for being skeptical.

13

@roycroftmom nope, 0-5 events/hr is considered to not have sleep apnea, 5-15 events is mild, 15-30 is moderate, and greater then 30 is severe. One of the dangers of coming to CC for med advice is everyone seems to have slept in a Holiday Inn Express last night.

14

Blood oxygen dropped to 89%, but they said that wasn’t bad on the message. I haven’t looked up that part at all. I’ll admit I was paying attention to what was going on in the Spanish class a wee bit. Don’t need to make the news about X going on in a classroom while the teacher is totally oblivious.

This is pure fact finding - google first - then filling in gaps knowing there are folks on here who know far more from either being involved in medicine or personal BTDT. I’ll share with H. He’ll discuss with the cardiologist - then make a plan they decide on. Neither of us like not having foundational knowledge. His expertise is engineering. Mine is math/science, but only goes to high school Bio level for that part of science. Anatomy is the one science class at our school I couldn’t teach even if I had to. We learn medical things as needed as we go through life. This is one of those times.

He’s busy catching up on work due to other parts of our life that have pulled us away a bit. I have free time. He’s happy I can research this for him and give him the quick run down (already forwarded him the links I saw at school).

15

Physician here (retired anesthesiologist), on CPAP. I’m surprised your H isn’t meeting with a sleep specialist, ie a pulmonologist who also has training and certification in sleep medicine. Agree with the REM comment of post # 11. Even with CPAP many (most?) will still have hypopnea/apnea episodes but far less frequent than without.

Operative word from the sleep center, a cya one- “consider” a machine et al. He needs to discuss results with someone who is a subspecialist in this field. My retired cardiologist H knows how sleep apnea affects the heart but he, like others in his specialty, is not an expert on interpreting a sleep study. There was a good reason your H was sent for the hopefully complete study but what to do with it belongs in the hands of the expert. The complete study would include using CPAP and seeing the difference it made. Too much to go into here.

Perhaps the next step is an appointment with the sleep expert now that sleep study results are known.

Aside- and that expert may grouse about what was ordered just as H used to about tests ordered by some who did not know exactly which test was the way to go. Originally, many years ago, I had two studies because my bedtimes were such that I never got the REM sleep part that showed my need. I jumped through hoops again to get Medicare coverage- I knew it helped.

16

DH uses a CPAP. His numbers were horrendous – 71.8% oxygen sats, Apnea+Hypopnea Index (AHI) was 50/hr, Respiratory Disturbances (RDI) 64/hr, and on his back, it was 90/hr. He’d stop breathing for 15-20 seconds, give a huge croak and then start breathing again. It woke me up constantly, and then I’d lie in bed waiting for him to breathe again. Neither of us got any rest. He’s also overweight, has HBP and has diabetes.

Don’t know what the doctor said to him (because DH didn’t go to a dr for 11 years from this late 30s through his 40s, so he’s not the compliant sort), but he agreed to get a CPAP and faithfully uses it every night. Gets through about six hours with it. He struggled with it for a while, but pushed through. He can tell if he doesn’t use it (i.e., if he is on an overnight trip and doesn’t take it so he doesn’t have to check his bag).

I have nothing but admiration for him – I can’t stand anything strange on my person when I sleep. No earplugs, sheet and blanket must be a certain way, no tags on clothing, and no touching. I would not be able to do a CPAP.

I’ve heard commercials for an implant that stimulates your breathing, but I don’t know anyone who has done it. I don’t think DH would do that; right now I’m trying convince him to go to the dr and get a new travel CPAP that will run on a charger. He’s had his current machine for five years, so he should be eligible for a new one by now.

One piece of advice: get a CPAP cleaning machine. It’s hard to keep the mask and tubing as pristine as it should be. DH was getting colds and snuffles constantly and sharing them with me. As soon as he got the sterilizer – we both got better.

My BIL (DH’s brother) had surgery to try to correct his sleep apnea. It worked for a while, but the results didn’t last. He also said the recovery was very painful.

I had an at-home sleep study, which we used as a diagnostic tool. I was fine, so never needed to see an expert. With abnormal results, I’d get him to a sleep specialist who can give you an IRL assessment.

17

re cleaning- nasal pillows versus mask could make a difference. Also- if using a heated humidifier be sure to use distilled water, empty in the morning to dry out. I can see where cleaning a mask would be helpful in the machine as it could be hard to thoroughly clean it. Many variables.

18

Who knows. A specialist may be what is recommended next. Time will tell. That will be up to H ultimately. It still seems better to us to be more well versed in the subject than clueless in order to thoughtfully make decisions, so I appreciate everyone’s thoughts and experiences.

19

His overall AHI might have been 5 but you need to look at the full set of data. My brother had an AHI of just over 5 but each event lasted up to a full minute so that made it dangerous. My AHI is 5 overall but much higher if I’m on my back - and I have central apnea’s so now I have an external ventilator.

Our entire family of husband and I, both daughters, son in law and BF are all on cpap, bipap or ASV. When we go tent camping without electricity you can hear us halfway across the campground!

20

I’ve been using a c-pap machine for over three years now following a diagnosis of extremely severe sleep apnea. The report said I stopped breathing an average of 120 times per hr, with each cessation lasting 19-21 seconds. But how is that even possible? If true, I shouldn’t have even been alive by the time I finally sought help. I’m one who can’t imagine spending a night trying to sleep without my c-pap. Otherwise, I’m startled awake every time I gasp from lack of oxygen in the wake of an episode (which apparently happens many times per hour).

I use a nasal pillows mask, which I find much more comfortable than the any of the full coverage ones I tried. Due to musculoskeletal issues stemming from curvature of the spine, I can now only sleep flat on my back. I wish I could go back to being able to change sleeping positions throughout the night, and thereby take advantage of the nasal pillow mask’s side sleeper friendliness. But, ?.

One thing I wish I could do is kiss the feet of the inventor of the SoClean c-pap cleaning machine. Keeping my c-pap machine (humidifier chamber included), mask, and hose sterilized is almost effortless with is device. I would highly recommend it to anyone who must use a c-pap, as manually washing the peripherals daily in hot soapy water, then thoroughly drying them by hand is a drudgery best avoided if at all possible.

OP, I hope your H soon gets all the answers he needs in order to make an informed decision. I would also highly recommend that he seek the help of a Pulmonologist/Sleep Specialist to accurately ascertain the extend of his apnea. Good luck.??