Not Trying to Stir Up Trouble...But...

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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corvallisgrace75
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Not Trying to Stir Up Trouble...But...

Post by corvallisgrace75 » Sat Jun 27, 2015 10:42 am

Hi Everyone,

Thanks to all of you who have contributed to the various threads I have started. Slolwy but surely, I am learning the lingo. Doing more reading with each passing day. After 4 nights of using my CPAP device, I feel positive about how I've adapted to it thus far.

As I mentioned, I was found to have 10 awakenings/hour. My sleep doctor told me that this was considered to be "moderate". However, upon doing further research, I learned that my sleep apnea is mild. I thought, "Okay, mild or not, I'm sure there are still benefits for me."

As we know, curiosity killed the cat. I did some Googling and found the following article from the Journal of Clinical Sleep Medicine. The title of the article is "Mild Obstructive Sleep Apnea Should Not Be Treated". Here's the link: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/ Then, I found this article from the same journal. "Mild Obstructive Sleep Apnea Syndrome Should Be Treated" Here's the link: http://www.aasmnet.org/jcsm/articles/030302.pdf This article mentions that the author received research support from ResMed corporation.

Again, for those of you seasoned veterans, I'm curious to know what your thoughts are on this (if you care to read either of the articles). I'm disappointed. I guess because I imagined that CPAP therapy would provide noticeable benefits that would ease what has felt like a life time of sleepiness. But things do not seem to be clear cut. In reality, I think some of my sleepiness could probably be attributed to poor sleep habits, my weight, medications, anxiety, etc. In a few of my threads, I've asked about people's sleeping habits (such as falling asleep in front of the TV and having it on all night long like I do) as well as their experience using the CPAP. Thus far, nobody has commented about their sleep habits and the role that these habits may play in contributing to sleep quality and feelings of restfulness.

I'm just a newbie. I may just be blowing smoke out of my ass at this point. So for those of you who have already been doing this type of research for years, I welcome your thoughts/opinions. Thanks!
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Re: Not Trying to Stir Up Trouble...But...

Post by Julie » Sat Jun 27, 2015 10:53 am

Hi... first thing to note is that the links above are both from 2007 (and research biblio. therefore even earlier), and a lot's happened since then. The second is that while many of the factors you mention about weight, meds, anxiety etc. certainly contribute to OSA, but until they're resolved, Cpap needs to be used - that or something else as effective, which so far no other entity has been found to be.

My question is why not use Cpap, even in relatively mild cases - what have you got to lose? Besides potentially killing someone on the road, having a stroke at some point, etc. etc. The second article does say that using Cpap is a good idea even in mild cases... so I don't quite see the point here. So ResMed funded that one, but does that make it invalid?
Last edited by Julie on Sat Jun 27, 2015 11:22 am, edited 4 times in total.

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Re: Not Trying to Stir Up Trouble...But...

Post by postitnote » Sat Jun 27, 2015 10:59 am

Julie wrote:Hi... first thing to note is that the links above are both from 2007, and a lot's happened since then. The second is that while many of the factors you mention about weight, meds, anxiety etc. certainly contribute to OSA, but until they're resolved, Cpap needs to be used - that or something else as effective, which so far no one entity has been found.

My question is why not use Cpap, even in relatively mild cases - what have you got to lose? Besides potentially killing someone on the road, having a stroke at some point, etc. etc.
Julie is correct! I've said before if there was a cure I'd still keep my cpap on the lowest setting. Once the mask is on my body goes nighty night. It's like white noise in a way. Very soothing.
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Re: Not Trying to Stir Up Trouble...But...

Post by BlackSpinner » Sat Jun 27, 2015 11:02 am

While mild OSA "MAY " not need cpap therapy, when all the other issues are added in the untreated mild OSA may be the straw that breaks the camels back.

Personally I have found that even minor medical issues don't just add up, they multiply exponentially together, popping out little health issues left and right. Treat the OSA and you get a bit of relief to address the other issues. Sometimes it feels like one is playing a games of pick up sticks; remove a stick and you don't have it in your way, cluttering up the situation.

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Re: Not Trying to Stir Up Trouble...But...

Post by corvallisgrace75 » Sat Jun 27, 2015 11:10 am

Julie wrote:Hi... first thing to note is that the links above are both from 2007 (and research biblio. therefore even earlier), and a lot's happened since then. The second is that while many of the factors you mention about weight, meds, anxiety etc. certainly contribute to OSA, but until they're resolved, Cpap needs to be used - that or something else as effective, which so far no one entity has been found.

My question is why not use Cpap, even in relatively mild cases - what have you got to lose? Besides potentially killing someone on the road, having a stroke at some point, etc. etc. The second article does say that using Cpap is a good idea even in mild cases... so I don't quite see the point here. So ResMed funded that one, but does that make it invalid?
Thanks, Julie! I tried to find articles that were more recent than 2007 in addressing the efficacy of using the CPAP for mild cases of apnea. As I mentioned before, I was told by my sleep doctor that if I had my very large tonsils removed, it would cut my awakenings in half, thus putting me in a normal range and removing the need for a CPAP device. I'm not sure how many others on here have had abnormally large tonsils as part of their potential issue. I know of one anecdotal instance where the person was told to have their tonsils removed after the sleep study. It was never suggested to this person that she use a CPAP. I'd like to do some research that applies more specifically to my situation, as I think everybody's situation is unique.

The reality is, I have no qualms about continuing to use the CPAP. What is disappointing to me is the fact that it may not be as helpful as I'm hoping it will be. I'm not the type who gets tired on the road or at work. I'm the type who falls asleep in front of the TV, or while reading. I still find it interesting that in the article that mentioned not treating mild sleep apnea, it was mentioned that "This is not an industry supported study. Dr. Littner has indicated no financial conflicts of interest" In the article that says mild sleep apnea should be treated, it was mentioned that, "This is not an industry supported study. Dr. Brown has received research support from ResMed Corporation."

Who knows? Maybe Dr. Littner is still out there. He's from UCLA and I live about 20 minutes away from UCLA. Maybe I should go knock on his door and ask for his opinion-- if it's changed and what he thinks. I'm kidding, obviously. But it's all very interesting to me. I believe, for myself, that changing my sleep habits will be as important here as my continued use of the CPAP.
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Re: Not Trying to Stir Up Trouble...But...

Post by Goofproof » Sat Jun 27, 2015 11:15 am

On severity of sleep apnea: You say your rate is 10 per hour, and are told it's mild. The number isn't all to be considered, it's a game of Russian Roulette, what if one of those 10 events triggered a heart attact or stroke, a possibility What would you call your Sleep Apnea then, still mild?

Labels are deceptive, and often incorrectly applied, or totally wrong. As for as written articles, often they are written and passed off as fact, by people with learning that can't produce anything useful, but words,the fact they do doesn't make it accurate or true. It's best to learn how things work, then make your own determination on what's correct or worthwhile. Read all you like, but be careful what you read into things. Jim

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Last edited by Goofproof on Sat Jun 27, 2015 11:20 am, edited 1 time in total.
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Re: Not Trying to Stir Up Trouble...But...

Post by corvallisgrace75 » Sat Jun 27, 2015 11:17 am

BlackSpinner wrote:While mild OSA "MAY " not need cpap therapy, when all the other issues are added in the untreated mild OSA may be the straw that breaks the camels back.

Personally I have found that even minor medical issues don't just add up, they multiply exponentially together, popping out little health issues left and right. Treat the OSA and you get a bit of relief to address the other issues. Sometimes it feels like one is playing a games of pick up sticks; remove a stick and you don't have it in your way, cluttering up the situation.
I definitely agree, BlackSpinner. I do hope to get a bit of relief to address the other issues. As I've mentioned, I don't have issues continuing to use the CPAP. It's the benefits and relief that I am more curious about. I suppose that even if CPAP therapy is nothing more than placebo for me, it's still doing more than not using it.
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Re: Not Trying to Stir Up Trouble...But...

Post by bwexler » Sat Jun 27, 2015 11:25 am

Obviously improving your sleep hygiene will make a difference. Everything you can do to get restful sleep will improve your overall results, including CPAP.
You did not mention who funded the study/article that suggested not to treat mild sleep apnea.
You are still learning the language of sleep apnea. Your sleep study probably did not say you had 10 awakenings per hour. It more likely said your AHI was 10. AHI is apnea hypopnea index, which means you either stopped breathing or had shallow breathing 10 times per hour for at least 10 seconds each. 100 seconds per hour is not that bad. What if each indecent lasted a minute or more? AHI does not tell you that but the graphs from your sleep study will, and so will the graphs from Sleepyhead software.
Get all the information you can absorb, but you have to put it into action before it can make a difference in your outcome.
So turn off your TV. Get to bed at an appropriate time. remove any disturbances from your bedroom. maintain a comfortable sleeping temperature, and use your CPAP. Then if you are lucky you will begin to see results in a few days, or maybe a month or two. We are all different.

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Re: Not Trying to Stir Up Trouble...But...

Post by corvallisgrace75 » Sat Jun 27, 2015 11:39 am

bwexler wrote:Obviously improving your sleep hygiene will make a difference. Everything you can do to get restful sleep will improve your overall results, including CPAP.
You did not mention who funded the study/article that suggested not to treat mild sleep apnea.
You are still learning the language of sleep apnea. Your sleep study probably did not say you had 10 awakenings per hour. It more likely said your AHI was 10. AHI is apnea hypopnea index, which means you either stopped breathing or had shallow breathing 10 times per hour for at least 10 seconds each. 100 seconds per hour is not that bad. What if each indecent lasted a minute or more? AHI does not tell you that but the graphs from your sleep study will, and so will the graphs from Sleepyhead software.
Get all the information you can absorb, but you have to put it into action before it can make a difference in your outcome.
So turn off your TV. Get to bed at an appropriate time. remove any disturbances from your bedroom. maintain a comfortable sleeping temperature, and use your CPAP. Then if you are lucky you will begin to see results in a few days, or maybe a month or two. We are all different.
Hi bwexler. Thanks for the words of encouragement. It was my doctor who told me that I had 10 awakenings per hour, based on the study I did. He did not mention how long each one was. Again, he also mentioned that removing my tonsils would remove the need for the CPAP. He posed it as an "either/or". He left the choice up to me. I'm playing devil's advocate a bit here, because I don't believe that everything is black and white or falls into one category. Just to recap about the articles from above-- the study that said that mild sleep apnea SHOULD be treated was funded by ResMed Corporation. The one that said that mild sleep apnea should NOT be treated mentioned that the Dr. indicated no financial conflicts of interest. To me, that says something. It's like the time that I told my friend that her husband should start eating walnuts to increase his fertility. And then laughed when I found out that it was funded by the Walnut Grower's Association of California. Haha!

As much as I need to continue to research and learn the lingo, I also think that the opinion of a newbie like me holds value. I am going to use Sleephead and read the links that people have included. And like you said, I'm going to get to bed at an appropriate time, remove disturbances from my bedroom, maintain a comfortable sleeping temperature and use my CPAP. If I start to feel benefits, great. As I mentioned before, even if the CPAP effect is a placebo for me, it will be worth it if it encourages me to improve my sleep hygiene. Because that has needed to change, if nothing else.
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Re: Not Trying to Stir Up Trouble...But...

Post by kteague » Sat Jun 27, 2015 11:47 am

Your question regarding treatment of mild sleep apnea valid. If you notice on here, The goal of seasoned users is not just to get below 5, but to get treatment to our personal best. Let's say one has an AHI of 10. In an 8 hour night that would be 80 events. If only a fourth of those caused arousals, that's 20, and that's some pretty disjointed sleep. And we haven't even mentioned desats yet. One thing about mild OSA is that others modes of treatment have a better chance of getting one down into an acceptable AHI range. If my OSA was in the lower range of mild, I'd want to at least see if there was a positional component. No one wants to take on an unneeded treatment.

The one researcher you referenced was sponsored by ResMed. I would have to wonder if one who finds it unnecessary to treat mild sleep apnea was sponsored by an insurance company. At any rate, it reminds me of an old saying "The only people who have minor surgery are other people." Surgery can be considered relatively minor, but the fact that it could have been worse is little comfort to the one feeling the "minor" pain.

When I struggled with still feeling awful due to my jumpy legs, I had to "bottom line" things and separate how I felt from what I knew. It was a fact I had sleep apnea. It was a fact CPAP effectively treated my sleep apnea. If I never felt better, I still needed to treat my sleep apnea. Luckily I did begin to feel better, but I had plenty other contributing health issues to work through.

My personal opinion is a mild case merits resolution. I'm thinking it's a death of a 1000 cuts. Unless there are extenuating circumstances, it needs to be addressed.

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Re: Not Trying to Stir Up Trouble...But...

Post by corvallisgrace75 » Sat Jun 27, 2015 12:13 pm

kteague wrote:Your question regarding treatment of mild sleep apnea valid. If you notice on here, The goal of seasoned users is not just to get below 5, but to get treatment to our personal best. Let's say one has an AHI of 10. In an 8 hour night that would be 80 events. If only a fourth of those caused arousals, that's 20, and that's some pretty disjointed sleep. And we haven't even mentioned desats yet. One thing about mild OSA is that others modes of treatment have a better chance of getting one down into an acceptable AHI range. If my OSA was in the lower range of mild, I'd want to at least see if there was a positional component. No one wants to take on an unneeded treatment.

The one researcher you referenced was sponsored by ResMed. I would have to wonder if one who finds it unnecessary to treat mild sleep apnea was sponsored by an insurance company. At any rate, it reminds me of an old saying "The only people who have minor surgery are other people." Surgery can be considered relatively minor, but the fact that it could have been worse is little comfort to the one feeling the "minor" pain.

When I struggled with still feeling awful due to my jumpy legs, I had to "bottom line" things and separate how I felt from what I knew. It was a fact I had sleep apnea. It was a fact CPAP effectively treated my sleep apnea. If I never felt better, I still needed to treat my sleep apnea. Luckily I did begin to feel better, but I had plenty other contributing health issues to work through.

My personal opinion is a mild case merits resolution. I'm thinking it's a death of a 1000 cuts. Unless there are extenuating circumstances, it needs to be addressed.
Thank you, kteague for such a thoughtful response! I appreciate it!

It is interesting to wonder if the doctor who said that mild sleep apnea did not need treatment was funded by an insurance company. I would imagine that in an article from a reputable journal, posted on the site of the National Institute of Medicine, there would need to be disclosure of funding-- even if it was from an insurance company. But who really knows? I found it interesting that ResMed-funded study came a few months after the study proclaiming that mild apnea need not be treated. Makes me wonder about the motives there.

I definitely think it will be easier to separate how I feel from what I know in time. I do not intend to stop using the CPAP. I intend to continue using it, by all means. I'm wondering how effective it will truly be. And what I know is, there's still a lot more to know out there. And I'd be willing to bet that there's probably evidence pointing to both sides of things-- just as these articles have. I also believe in questioning things-- even if I don't have all of the evidence. Because one will never have all of the evidence, and I'd rather keep an open mind. Again, this does not mean abandoning CPAP therapy for me. Rather, I like to see things from all sides. It's a colorful, diverse world out there. You never know what you're going to find!
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Re: Not Trying to Stir Up Trouble...But...

Post by palerider » Sat Jun 27, 2015 12:43 pm

one of the things I'd point out, is that given that the information you found was so old, it doesn't address the modern cpap machines, and the state of the art has improved quite a bit since 2007.

whether that modifies or invalidates the points that were determined back then is something to consider.

the newer as10 for her machine with it's more intelligent pressure management, or even the s9 machines, more effective than the best available in 2007.

it may be like reading an article about computers and their limitations and comparing them to what's common today....

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Re: Not Trying to Stir Up Trouble...But...

Post by corvallisgrace75 » Sat Jun 27, 2015 12:44 pm

Goofproof wrote:On severity of sleep apnea: You say your rate is 10 per hour, and are told it's mild. The number isn't all to be considered, it's a game of Russian Roulette, what if one of those 10 events triggered a heart attact or stroke, a possibility What would you call your Sleep Apnea then, still mild?

Labels are deceptive, and often incorrectly applied, or totally wrong. As for as written articles, often they are written and passed off as fact, by people with learning that can't produce anything useful, but words,the fact they do doesn't make it accurate or true. It's best to learn how things work, then make your own determination on what's correct or worthwhile. Read all you like, but be careful what you read into things. Jim

Those who can do, the others publish.....
I'm basing most of what I know about my situation on what the doctor told me. He gave me a choice about using the CPAP based on the results of my study. Of course, it's always a choice. But he believes that my very LARGE tonsils are part of what's obstructing my breathing. I was told to get them out 11 years ago and that they probably were contributing to sleep issues. But I was too scared to get surgery. Now they have a laser procedure that is much simpler. I'm still afraid of getting that procedure at this point. I would hope that if there was something else in the study that I needed to know or be aware of, he would have told me.

Please understand that what we're told by our respective doctors and their interpretations of our individual results varies highly. That doesn't mean that there shouldn't be a label placed on it. In my doctor's case, I think he used a label to help me understand my situation. He took many of my personal factors into account-- things that I have not necessarily shared here-- in advising me. Labels may be deceptive, but they also help give us perspective. Imagine if we were all lumped into the same category and there were no distinctions made. I think that is far more dangerous.

I think saying, "be careful what you read into things" is like saying the sky is blue. It goes without saying. That's why I presented articles from a reputable journal that was posted on the National Library of Medicine's website.To imply that someone is only publishing because they can't "do" is a silly belief. But to each their own. I do agree that we need to see what is right for ourselves and make that determination.
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Re: Not Trying to Stir Up Trouble...But...

Post by bwexler » Sat Jun 27, 2015 12:54 pm

It's a colorful, diverse world out there. You never know what you're going to find! Especially in a box of chocolates.

Did either study indicate that the author conducted the actual study? So many of these articles simply compile meta data from several studies conducted by others. That leaves them free to discard any study that does not conform to their objective going in.

There have been numerous posts here by folks who had the surgery, got the bill, got the pain, but little or no results. Most of them recommend against surgery for OSA (obstructive sleep apnea).
I have a severe allergy to scalpels.

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Re: Not Trying to Stir Up Trouble...But...

Post by Goofproof » Sat Jun 27, 2015 1:34 pm

You are worried about Resmed funding that study, I wonder about your doctor being a surgeon, it's his job to see answers that he can provide, as better solutions.

In the wild, Elephant hunters, do tend to see elephants, it's the nature of things. I had me tonsils out as a young child, th a t is much easier, but even then they can grow back. As long as a little blown clean air slaves my sleep apnea, it will be the answer for me. We all must find our own answers, and live with them. Jim
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