Positional OSA with obvious symptoms - buying a PAP without official diagnosis

[Ralph_SC]

Hello everyone,
Sorry for the long post, and thanks in advance for some advice and help (questions are in blue below the looooong story

In 2021 I started to have issuses with sinuses and blocked nose which was accompanied by fatigue and day sleepiness. At first I blamed my nose and in 2024 went for septoplasty (deviated septum straightening) and sinus surgery. Yes, there was an improvement but only in the nasal resistance. Fatigue still persisted. I was aware of OSA and UARS phenomenon so I started to notice some correlated symptoms - I am barely unable to sleep on my back - in half a minute my tongue chokes me, I wake up and turn to my side. I am also having a TMJ (temporomandibular joint syndrome) and bruxism (teeth grinding). My pallate is also very narrow.

So, in 2024 I took an in home sleep test. Machine was send to my house, and I got a report by an email: only 2% sleep time spent on back with AHI 43 (!), 35% left side with AHI 8, 61% right side with AHI 4.8, (missing 2% time from 100% was standing)
The algorithm somehow calculated overall AHI of 4.9 and the doctor made a report that it is below 5.0 AHI norm of the Polish Pulmonological Comitee and American Academy of Sleep Medicine.

In Poland there are very few specialists and the waiting times are very long. But I found an ENT running a clinic which specialises in OSA treatment. Showed him my report- he told me that I don't have OSA (average AHI matters), he can't offer me any surgery and even I am not a candidate for CPAP. Only I have to sleep on my side Ah, yes, and told me to check thyroid levels, consider depression, not an OSA

One week later I had my apointment with a dentist who treats jaw disorders (TMJ). He is perfect doctor - "up to date" - goes to seminars, has a PhD in jaw disorders, he makes science collaborations with hospitals etc. I mentioned the suspection of OSA and showed him the report - his eyes went big and in 5 minutes I was given an adress of a newly opened facility which does full polisomnography in lab study. He said that I am having an OSA, and it is far from mild - all my symptoms are correlated and even by teeth grinding is 90% sure from apnea.

So, summing up: I was untraeted for long time, and the lab sleep study is booked for an end of the year. Quality od life has decreased, I am now nearly "retreated" from normal social life. I cannot wait another months for seeing next specialist (and my symptoms are so obvious). One day a thought appeared in my head - to buy a CPAP/BIPAP in the mean time to get some of my lost life back (and save my heart as well).

I am thinking of buying an Resmed 10 Aircurve Vauto and learn how to set and master the machine using many internet tutorials.
But some questions still bother me:

1. Can I do any harm to myself? From many googled opinions (reddit) I can only do some good, but I am still a bit afraid
2. Will BiPAP be better? I can afford Bilevel, maybe it is an "overkill" but I really want to buy even a better machine in advance (This Resmed machine can also be set in continous mode if needed)
3. I have also a mild controlled asthma - there is mild obstruction lung defect (even called "borderline"), it shouldnt be a factor (people with much worse lung function sleep much better than me). But maybe it puts BiPAP a little bit higher than a CPAP?
4. Is this a completely stupid idea or has someone followed that route and felt the improvement?
5. I know that the route should be diagnosis+machine+sleep tech, but believe me, for many doctors in my country OSA, titration, UARS are some magic words.

Thaks in advance for any advices,
Best Regards

[mlmollenkamp]

Based just on my own experience only! (I'm not a doctor and can't offer real medical advice). I've used PAP treatment (mostly APAP) for about 25 years. I use a ResMed S10 with good success. The vast majority of people do well with a pretty ordinary auto CPAP. What ever you get, especially if you do it on your own, get a machine that you can use with OSCAR so you can track what's actually happening. I wish I'd had it for the first decade I used a machine.

To your questions.
While an AHI of just below 5 doesn't qualify, from personal experience that even an AHI of 2 to 4 can be a problem, daytime sleepiness etc. My son in law just barely qualified with an AHI of 6 and CPAP made a huge improvement in his ability to function. A single sleep test isn't as magically indicative as doctors would like it to be. My AHI varies over a wide range from night to night. So your next test will be different, for better or worse. If I sleep on my right side my blood oxygen regularly drops to the low 80%. I try not to... Just because you only slept on your back 2% of the time doesn't mean you don't sometimes sleep in that position longer some nights or that its not harmful. I suggest you sleep on your back during your next test if your goal is to get a machine paid for by insurance .

As to harming yourself, I don't think there is any way a machine is going to harm most people. There are some very specific cardiac conditions that rule out PAP treatment, but if you are generally healthy otherwise you are not going to do any harm to your self (I'm not a doctor though!). I suggest you talk to your Pulmonologist and ask if you have any medical conditions that would contradict CPAP treatment.

Most of the time BIPAP is prescribed for comfort (compliance: meaning being comfortable enough to use the machine regularly), but there are specific BIPAP machines that treat more complex issues, ASV for example. They are much more expensive, so much so its probably not worth spending what they cost just because there is a remote possibility you need one. The majority people do fine with an Auto CPAP. In my experience most doctors prescribe an auto CPAP with the default settings. They then deal with any issues if it doesn't work. Unless you find a bargain on a more sophisticated machine an auto CPAP is going to be much less expensive than a BIPAP and is about 90% likely to be what you need. The most likely need for an ordinary BIPAP isn't medical its comfort. But most people are totally OK with an ordinary auto CPAP.

I don't know what's involved in purchasing a machine in Poland. In the US I see used ones regularly on Craigslist or Facebook, most are machines being sold by people who could never get comfortable with them. About 10 years ago I was between doctors and my machine failed. I purchased a used travel machine that served me well until I could get a sleep test and new machine, it took 6 months or so. I currently have 3 machines, 2 ResMed S10's, an old one for travel and a fairly new one that never leaves my beside. I still have the very small (Z1) machine I purchased for travel. Its not a great machine but is nice when I'm away for one or two nights. If you were to purchase a used machine it would probably serve nicely as a backup once you have a doctor and a prescribed machine. In general I think that finding the right mask is more difficult than finding the right machine. I pretty regularly pay for masks out of pocket to try them out, I've switched masks this way several times. The cost of a mask isn't as important as living a life with my eyes open.

Good luck, let us know how things turn out.

[Senortocino]

Thank you both so much for your posts.

First to ralph_sc for bringing up a problem similar to mine.

And second to Mimollenkamp for the detailed response. I now have the confidence to try and deal with my own problem while I wait for an official diagnosis. I imagine that I won’t need a prescription to buy a CPAP machine on Facebook, right?

Thanks again.

[Julie]

I don't know what Facebook does, but unless you know for sure, don't just count on 'probably'. Check things out!

[GrandmaA]

While an AHI of just below 5 doesn't qualify, from personal experience that even an AHI of 2 to 4 can be a problem, daytime sleepiness etc. My son in law just barely qualified with an AHI of 6 and CPAP made a huge improvement in his ability to function. A single sleep test isn't as magically indicative as doctors would like it to be.

Me too. My AHI was officially 5.9 (I call it 6, six times in an hour I stopped breathing, for up to 37 seconds a time), and CPAP has made a huge improvement in my quality of life.

But I always sleep on my side and I'm wondering if like the OP if I do ever sleep on my back it is much higher. I didn't happen to when I did the study, but maybe sometimes I do without remembering and that might also explain why I've seen so much improvement.

I can't believe serious medical people would dismiss the OP's study result the way they did. That's terrible.