Is Skipping Treatment Ever Good?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Spreech01
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Is Skipping Treatment Ever Good?

Post by Spreech01 » Sun Feb 18, 2018 6:42 pm

I was diagnosed with mild OSA three years ago. I started with a CPAP (F&P ICON) and then switched to a custom-made Mandibular Advancement Device (MAD) oral appliance. Neither treatment option appears to work. Starting this past June, I decided to try an experiment and catalog my results:


*No Treatment (June - Aug.):*
Receive 6 hours of sleep per business day (5 hrs overnight + 1 hr after-work nap). Receive 11 hours of sleep on weekends (10 hrs overnight + 1 hr afternoon nap).

*CPAP (Aug. - Dec.):*
Receive 6.5 hours of sleep per business day (5 hrs overnight + 1.5 hr after-work nap [no treatment]). Receive 13 hours of sleep on weekends (12 overnight + 1 hr afternoon nap [no treatment]). Software was used to analyze CPAP data: AHI varied from 2 - 15 per night. Doctor issued a nasal mask and three "full-face" masks (each with different sizes and strap layout) during follow-up visits. Despite changes in pressure and masks, I discontinued treatment because my daytime lethargy became intolerable.

*Mandibular Advancement Device (Dec. - Current):*
Receive 6.5 hours of sleep per business day (5 hrs overnight + 1.5 hr after-work nap [no treatment]). Receive 12 hours of sleep on weekends (11 hrs overnight + 1 hr afternoon nap [no treatment]). Doctor made minor adjustments to the appliance, but each change was reverted back to the default setting, as my jaw could not handle the adjustments. Unable to tolerate daytime lethargy and getting out of bed is nearly impossible, so I'm likely to discontinue treatment


The above results seem incredibly counterintuitive, especially with all the research I have done on the efficacy of both treatment options. I have followed the advice of the doctors, allowed for adjustments in treatment, but the outcome is always the same: I am always tired, but I am much less tired when I do not treat my OSA. My psychiatrist is currently treating me for depression, and has given me a prescription for Adderall to combat daytime fatigue. My sleep doctor has mentioned possibly wanting to test me for narcolepsy.

Not sure what to do! I feel that my lethargy is costing me greatly.

TedVPAP
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Re: Is Skipping Treatment Ever Good?

Post by TedVPAP » Sun Feb 18, 2018 6:54 pm

Your OSA was diagnosed as mild so it is not surprising that you don't feel better using CPAP if your treatment has not been optimized. Your AHI with CPAP is not great.
I suggest you read the three links below so that we can see what your CPAP data looks like.

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TASmart
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Re: Is Skipping Treatment Ever Good?

Post by TASmart » Sun Feb 18, 2018 7:02 pm

GEtting only 5 hours sleep per night is most likely insufficient. No wonder you are lethargic. I think you need to improve your sleep hygiene and schedule so that you can get 7-9 hours sleep each night, then see how you feel.
All posts reflect my own opinion based on my experience and reading.
Your mileage may vary
Past performance is no guarantee of future results
Consult with your own physician as people very

TedVPAP
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Re: Is Skipping Treatment Ever Good?

Post by TedVPAP » Sun Feb 18, 2018 7:10 pm

TASmart wrote:
Sun Feb 18, 2018 7:02 pm
GEtting only 5 hours sleep per night is most likely insufficient. No wonder you are lethargic. I think you need to improve your sleep hygiene and schedule so that you can get 7-9 hours sleep each night, then see how you feel.
Excellent point.

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Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

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Goofproof
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Re: Is Skipping Treatment Ever Good?

Post by Goofproof » Sun Feb 18, 2018 7:34 pm

I never have put a revolver to my head and pulled the trigger, not even with two shells removed, I've never slept without my XPAP. Not that I'm Brave, I'm just not dumb enough to unnecessary tempt fate. Jim
Use data to optimize your xPAP treatment!

"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire

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chunkyfrog
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Re: Is Skipping Treatment Ever Good?

Post by chunkyfrog » Sun Feb 18, 2018 8:26 pm

Skipping treatment?
UNTHINKABLE!

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kteague
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Re: Is Skipping Treatment Ever Good?

Post by kteague » Sun Feb 18, 2018 8:35 pm

There's probably a few scenarios where treatment is so problematic that skipping it would be better. Those situations can be like trying to pick the lesser evil. Nothing in your post mentions anything of that magnitude. Your CPAP settings seem to have not been giving you consistent therapeutic treatment, so it's no surprise you weren't feeling so good - not to mention your short sleep time. I think you would be doing yourself a great favor if you committed to going back on CPAP and using the wealth of resources of experience here to help you achieve effective treatment, and to use it consistently for all sleep with following of data from from your machine. When one still feels bad even when treatment has been optimized, other contributors have to be considered, and it's a ruling out process. Have you had a medical workup for other things that can cause your symptoms? (diabetes, thyroid dysfunction, anemia, deficiencies -just to name a few) Have your Vitamin D and B vitamins been checked? As to narcolepsy, that may be something to look at in the future. But unless you have other frank symptoms of narcolepsy (like cataplexy) I woudn't suggest pursuing this testing yet. The symptoms of other sleep disorders can present very similar to narcolepsy. For a reliable test for narcolepsy, you would want to have resolved the sleep apnea for a while then see what symptoms remain. The ones that now make you wonder about narcolepsy may largely resolve. If not, the path forward will be clearer.

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Pugsy
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Re: Is Skipping Treatment Ever Good?

Post by Pugsy » Sun Feb 18, 2018 8:49 pm

What medications are you taking besides the Adderall?

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greatunclebill
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Re: Is Skipping Treatment Ever Good?

Post by greatunclebill » Sun Feb 18, 2018 9:19 pm

You need to stop all the silliness with your testing and find a good board certified pulmonologist sleep doctor. tell him what about your cpap treatment isn't working. perhaps you have the wrong machine. perhaps you have incorrect settings. dental devices don't work for most people. surgeries don't work for most people. correctly applied apap/bpap/cpap/vpap therapy will work for every one, even you.

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palerider
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Re: Is Skipping Treatment Ever Good?

Post by palerider » Sun Feb 18, 2018 9:51 pm

"Is Skipping Treatment Ever Good?"
No.

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D.H.
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Re: Is Skipping Treatment Ever Good?

Post by D.H. » Sun Feb 18, 2018 10:09 pm

If you go back on treatment, stop with the untreated naps!

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nicholasjh1
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Re: Is Skipping Treatment Ever Good?

Post by nicholasjh1 » Thu Feb 22, 2018 12:52 pm

15 AHI is not great at all, that's still "mild to MEdium" apnea... so it's no wonder it feels like crap. CPAP treatment is automatically going to disturb your sleep in some ways. A large part of it is avoiding the hypoxia... not necessarily the sleep disturbances, though sleep does improve over time. I would look into getting the pressure adjusted personally, but it'd be way easier to help you if you posted some sleepy head data.
Instead of Sleep apnea it should be called "Sleep deprivation, starving of oxygen, being poisoned by high CO2 levels, damaging the body and brain while it's supposed to be healing so that you constantly get worse and can never get healthy Apnea"

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Perrybucsdad
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Re: Is Skipping Treatment Ever Good?

Post by Perrybucsdad » Fri Feb 23, 2018 7:28 am

Spreech01 wrote:
Sun Feb 18, 2018 6:42 pm
Receive 6 hours of sleep per business day
I can't say that I have ever called a nights sleep a business day.

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ChicagoGranny
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Re: Is Skipping Treatment Ever Good?

Post by ChicagoGranny » Fri Feb 23, 2018 8:06 am

greatunclebill wrote:
Sun Feb 18, 2018 9:19 pm
You need to stop all the silliness with your testing and find a good board certified pulmonologist sleep doctor.
Where do people get the idea that pulmonoligists make the best sleep doctors? 99.5% of a pulmonogist's training has nothing to do with sleep apnea. A board-certified sleep medicine physician is your best bet. The exception would be if you have lung dysfunction. Even then, I would prefer having both a sleep doctor and separately a pulmonologist who does not have much of his time tied up with sleep medicine.

http://www.absm.org/default.aspx
Last edited by ChicagoGranny on Fri Feb 23, 2018 9:33 am, edited 1 time in total.

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45011ohio
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Re: Is Skipping Treatment Ever Good?

Post by 45011ohio » Fri Feb 23, 2018 8:53 am

My 2 cents.

I am a 55yo male who has always been a 5-6 hours sleeper, even when I was 10 yo. And even when I was a drinker and got drunk I would rarely sleep more than 7 hours. Some people just do not need that much sleep to be well rested for the next day.
That being said, I have other conditions that cause me to wake multiple times per night. With my new BPAP, it is showing 7.5 hours of use average per night so far, but I will lay in bed reading for 1-2 hours before actually going to sleep. YES! I know that skews my event numbers averages but if I do not wear it while reading, I will not don it when I am ready to sleep. That just how I am.

I do not use my machine every night. Sometimes I just do not feel like using it.
I was 1st dianosed over 10 years ago, and my original CPAP machine was (to me) a nightmare to use. After several months of constant struggles with it, I quit using it entirely. Last June I got a new sleep study and new CPAP. January 2018 my doctor had me do a 2nd titration sleep test because he did not like the numbers he saw after almost 6 months of almost nightly use.
(I probably use the machine 26 out of 30 nights and have really not noticed any improvement in my condition). Now I have been re-diagnosed as having complex sleep apnea.
Another possible contributing factor is that I suffer from widespread chronic pain and am on medication for it. I currently take 8 different medications including Metformin for Diabetes.