Is cpap worth it for mild apena?

[ThisGuy]

I haven't seen my doctor since taking the home sleep test, but have the results. Some interpretation would appreciated. My limited knowledge doesn't really see the need for cpap. AHI of 5.5-9.7 seems to be just above normal. Why go through the expense and hassle of cpap at this level? Maybe there is something I'm not seeing. O2 saturation could be better, but again, it's just under acceptable. Anyone else been in this position and find cpap to be a great improvement or a waste of time? I frequently wake 3-5 time a night and typically never feel rested. I became a heavy snorer about 3 yrs ago. I'm in my mid 40s and average size. I also only have 18% kidney function, so being exhausted isn't unusual. I was sort of expecting to see a high AHI number and looking for cpap to help, but with this result I feel like it may not be as much a benefit as a hassle.

Impressions

1. This Type 3 Portable Sleep Test demonstrates mild apnea with
AHI of 7.9 for total sleep time (9.5 when supine) with O2 nadir
of 86%.

Recommendations:

1. Nasal CPAP is indicated.
2. Avoidance of alcohol and sedatives is recommended.
3. Persons with excessive daytime sleepiness may be at an
increased risk for motor vehicle and occupation-related
accidents. This should be explained to the patient and treatment
of underlying sleep disorder should be addressed.


Sleep Data
The study began at 9:14:55 PM and ended at 6:07:43 AM for a total
recording time (TRT) of 532.8 minutes. The patient's time in bed
(TIB) was 532.8 minutes with a monitoring time (MT) of 526.8
minutes.

Respiratory Data
A total of 69 events were observed during the analysis period as
follows, 18 obstructive apneas (2.1/hr), 24 central apneas
(2.7/hr), 0 mixed apneas (0.0/hr) and 27 hypopneas (3.1/hr) for a
total apnea-hypopnea index/respiratory event index (AHI/REI) of
7.9 /hour of sleep. The supine AHI/REI was 9.5/hr. AHI/REI in
non-supine positions were as follows: Prone /hr, Left 5.5/hr,
Right 9.7/hr and up 0.0/hr.

97 desaturations occurred during the study. Desaturations were
based on 4% or greater drop from baseline. The lowest SaO2 was
86% with an average of 91%. 185.4 minutes were spent below 90%
saturation. The total time spent <89 was 72.4 min.

Cardiac Data
The average heart rate during sleep was 81.6 bpm. The highest
heart rate during sleep was 118 bpm. The highest heart rate
during recording was 118 bpm. The lowest heart rate during sleep
was 63 bpm.

[robysue]

Short answer:

Many people with mild apnea who are symptomatic find significant relief from the OSA symptoms when they use CPAP.

In particular: CPAP will usually help with the daytime fatigue that is associated with the untreated OSA. It will usually allow the user to wake up feeling more rested when they sleep with CPAP---once they're through the initial transistion period. It will help with any O2 desats. It will prevent the snoring arousals (which can be as disturbing as the OSA arousals in some people.) And most of all, it will prevent the symptoms from worsening as the untreated OSA worsens with age.

As for individual stories of success: Hubby's sleep test showed an overall AHI of not quite 10, but it was just over 10 when he was on his back. He could have opted to try positional therapy. But he was very symptomatic: Falling asleep every night in front of TV shows he wanted to watch. Going to bed by 9:00 and waking up multiple times during the night to go pee. Waking up around 7:30 for the day not feeling rested. And he spent a good 9 months hemming and hawing over whether CPAP would be worth it. (He was on the front lines of dealing with my absolutely awful CPAP adjustment period.) When he finally started CPAP, he was amazed: Within one week he was no longer falling asleep so early. And he was not waking up nearly as often to go to the bathroom. His sleep pattern has become a strong morning lark (i.e. he's now usually up by 5:30), so he still goes to be relatively early. And he now can enjoy sleeping on his back, which is his prefered sleep position.

[Drowsyhead]

I am no doctor but it looks like you do. That's a personal decision you would need to come to terms with. I hate it as much as the next guy and gal but it's your health we are talking about. Some docs might be a little quick to prescribed because of financial reasons such as getting kickbacks from the DME companies and charging outrageous prices for unnecessary sleep studies who knows. I would say at least try it out and see how you feel.If you feel better then you need it simple as that. You had 24 central meaning your brain didn't tell your body to breathe 24 times during the study and another 18 was blocked so you couldn't breathe. Those are all scary especially the central ones. You had more central then obstructive. I also have mixed like you.Anything greater than 5 is consider having sleep apnea. You said you never feel rested that is a big red flag. If you weren't tired that is one thing but you are and that is not normal to be tired but as you said you had only so much Kidney function so you will have to decide when you began to become tired.If it was after the kidney issue or the snoring three years ago or they both started the same time. You would need to talk to your doctors. I would say it can't hurt to try. Have a video camera and record yourself sleeping at night and also try to use a oximeter to record your reading if you can get a hold of such a device to see how your oxygen levels are or do a second test if you can to see if the first one was not accurate and to confirm. If you don't need an afternoon nap or don't doze off during the day then maybe wait 6 months and then do another study. Just a suggestions. Hope others respond and give you their opinions.

The Apnea–Hypopnea Index or Apnoea–Hypopnoea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep. The apneas (pauses in breathing) must last for at least 10 seconds and be associated with a decrease in blood oxygenation. Combining AHI and oxygen desaturation gives an overall sleep apnea severity score that evaluates both the number of sleep disruptions and the degree of oxygen desaturation (low oxygen level in the blood).

The AHI is calculated by dividing the number of apnea events by the number of hours of sleep. The AHI values are categorized as:

Normal: 0-4
Mild sleep apnea: 5-14
Moderate sleep apnea: 15-29
Severe sleep apnea: 30 or more

[Cardsfan]

Yes, you have sleep apnea. You need treatment. The best treatment is CPAP. DO IT.

[Julie]

But that being said, if you could train yourself to not sleep on your back all night, you might have a case... which would need rechecking with a new test after establishing the routine.

[bwexler]

You spent over an hour below 89% O2 saturation. That is not good. You also had more central events than obstructive, also not good.
Do you know the cause of your kidney problems? Could apnea and desaturation have been a contributing factor?
I suspect you need an in lab titration study to determine if you will need an ASV CPAP machine to treat the central events.
You should consider the total time in apnea events which may be much more relevant than the AHI. An event must last at least 10 seconds to be counted, but can last a minute or two. Five events per hour lasting 2 minutes each would be more significant than 20 events per hour lasting 10 or 15 seconds each.
You definitely need to gather more information and I think you will benefit from PAP therapy.

[ChicagoGranny]

But that being said, if you could train yourself to not sleep on your back all night, you might have a case... which would need rechecking with a new test after establishing the routine.

Not!

AHI/REI in
non-supine positions were as follows: Prone /hr, Left 5.5/hr,
Right 9.7/hr and up 0.0/hr.

[ThisGuy]

Thanks for all the feedback. I'm not anit cpap and will be following up with my doctor. My intention for now would be to go forward with treatment and see how it works for me. The way I feel, I was expecting to see a moderate level AHI and kind of surprised at my results. I've read that most insurance companies require you to rent to own the equipment and send compliance reports. If that is true, I assume I would not be out the full cost of the equipment if I determine it is not beneficial after a few weeks\months. As far as my kidney condition, it's been a progressive problem my entire life. In the past 2 years it has progress to the point of being placed on the transplant list. So, my general tiredness has just slowly progressed, so I've considered it normal. But the last couple years it is more evident. I feel that contributes to my desire to go to bed at 8:30. But I think when I wake up and don't feel much relief from sleeping is caused by my poor sleep. The snoring is bad enough my wife has a separate room. I do get up 1-2 time a night to use the restroom besides the 2-3 other times I wake up. Another thing I consider is that the test was a home study. I flipped and flopped and laid awake for a little more than 2 hrs at the start of the sleep. I would assume the test doesn't account for this and as such would not have an accurate AHI if my actual sleep time was more like 6 hrs, not 9 hrs. So half the time I was asleep, my O2 was under 90%.

[chunkyfrog]

Ah, denial is strong in this one.
It yearns to go toward the light, insisting it is not an illusion,
Just beyond the pit.

[LSAT]

Even at the low levels you reported, you would still stop breathing 40-50 time s a night.

[Cardsfan]

Get the cpap. You will be amazed at what a real night of sleep can do for your mental well being. Without treatment, you suffocate over and over all night. I bet not one person on here would give up their treatment. We would not steer you wrong.

[Morchella]

If you're still on the fence, you might want to discuss it with your kidney specialist. Although brief administration of CPAP increases renal resistance in people who don't have apnea (http://ccforum.biomedcentral.com/articles/10.1186/cc304), people who *do* have apnea often have higher renal resistance to start with, and successful apnea treatment normalizes their resistance (https://ndt.oxfordjournals.org/content/ ... fq472.full). It sounds like those same researchers have done a whole series of papers about kidney problems in apnea sufferers that you might want to explore.

Also, just a personal data point: my AHI jumped from around 5 to 21.5 over the course of five years in my mid-40's, so even if you don't think it's worth treating now, it probably will be in a couple years, so why suffer needlessly before taking the plunge?

[chunkyfrog]

Seriously, if you feel "fine", that is the "fine" you are accustomed to.
After a period of cpap use, you will be amazed how much better you can feel.

[ChicagoGranny]

Even at the low levels you reported, you would still stop breathing 40-50 time s a night.

And that is 40-50 awakenings. No one can ever be healthy with that going on.

My intention for now would be to go forward with treatment and see how it works for me.

A better approach would be a determination to make CPAP work for you.

[ThisGuy]

My renal doctor suggested that I get the sleep study. I was at my ENT for sinus congested and mentioned it to him. Turns out he is a sleep specialist and order the sleep study for me. The home sleep study was done by a sleep lab outside the ENT office. So, I got the results as posted above, but don't go back to see my ENT for 2 weeks to discuss.

So what now? I'm under the impression that I am done with the sleep lab. The sleep lab will forward the results to my ENT. From here, what happens? How is my pressure determined? Is a second test done with a CPAP to confirm that it corrects the issues? How do I get equipment? Am I able to have a voice in which equipment I get? I have high deductible ($3500) Anthem BCBS insurance, so I suppose I'll end up paying for the equipment and put it against my deductible? If so, am I better off buying online and submitting my receipt towards my deductible?

The sleep lab I went to spend about 10 minutes showing me how to put on the equipment and didn't explain anything further, so I'm just curious how this goes.