Hypopnea questions

[roster]

........ I also had zero hypopneas while sleeping on my side, which I usually do but was unable to 3/4th of the sleep study night due to all the stuff hooked up to me. ........

What were the blood-ox levels while side sleeping?

[roster]

....... On the initial sleep study (last September) my results showed that I not only had problems when I was asleep, but also when I was awake (though less so). ........

What problems did you have while awake?

BTW, love SW VA.

Regards,

[Catnap]

I had mostly hypopneas during my sleep study, also. I also have high blood pressure which was very refractive to treatment (i.e., no matter what combination of meds, it wouldn't stay in the normal range). After I started CPAP, my blood pressure stabilized and remains under good control with one medication, for the first time in many years. Also, I lost weight once I started CPAP with no deliberate effort; I attribute it to the increase in energy, but there is some research that indicates that sleep problems may contribute to obesity fairly directly. My own thinking would be, if you don't trust your sleep doc enough to try CPAP on her/his recommendation, take your study results to another one for a second opinion. Maybe the second opinion will agree with your thinking, maybe not. At least you will feel more confident that you are/are not taking a serious health risk.

I have thought about a second opinion. At first it seems like it would be a betrayal, but I suppose most docs are used to it, and I, the customer, always comes first I suppose. I've been with my doc for almost 20 years now. Makes it harder to do that.

I've worked in healthcare for a l-o-n-g time (sheesh, it's kind of sobering to think how long), and really, requests for second opinion are so routine that most doctors don't even think about it one way or the other. Those that do tend to fall in two categories: Those who are so arrogant that they assume any other physician in her/his right mind will agree with the original recommendation, and those who take it as a sign of a cooperative, well-informed patient. Either way, they don't object to the idea.

[PST]

This is in reply to IACEYOU's question, rather than the original post.

If I lacked most clinical symptoms of OSA, and then I underwent a sleep study during which I had no apneas at all and no hypopneas except when sleeping on my back, I would resist the idea of undertaking CPAP therapy. It's a huge commitment.

I say that as someone who considers himself a CPAP success story, at least to the extent that eight weeks is long enough to judge. By the first day I started getting relief from symptoms that had been making life difficult. That gives me genuine motivation, so I want to stick with it and I predict that I will. But compliance is a big problem with CPAP therapy. How can anyone expect to do this every day if he isn't getting positive feedback? Lot's of CPAP machines gather dust or end up on eBay.

The one symptom IACEYOU (may I just call you The Dude?) has is high blood pressure. While there is excellent evidence that OSA can cause hypertension, and many people experience lower blood pressure if their OSA is treated, there are many other people with hypertension and no OSA. The Dude says that he has been under treatment for hypertension since age 17. We know that OSA is correlated with age and weight, even though it's true you can have it while young and skinny. If he now has a case of sleep disordered breathing (I guess we can't call is OSA because he didn't have any A's) after 35 years and 50 lbs, then the hypertension probably came first and has a different cause.

One thing that struck me is that "don't sleep on your back" is part of the treatment plan for some people. It is for me. My doctor prescribed a pressure of 17 cm, which he said was not enough to prevent all apneas when I was on my back during titration, but he'd rather not go higher. There are devices to help those who find it difficult to do it on their own. I cycle, so the first thing that came to mind was to sleep in a cycling jersey, which has pockets in the back for water bottles. I hasn't been necessary. The point is, if side sleep + CPAP is a legitimate prescription, why not side sleep alone if that suffices? Or maybe side sleep + a dental device. They may have a poor record for hard core cases, but this might be the right fit.

I would certainly consider the second opinion. I was interested that The Dude said it was his primary care physician pushing him to go with CPAP. Did the sleep specialist agree, or did he just make the diagnosis?

One question to think about. Are you getting up often in the middle of the night to go to the bathroom? Many people around here have gone from four or five times a night to zero, instantly. Of course, a 52-year-old man can have nocturia for other reasons, like benign prostate hyperplasia. But if you are up frequently without another explanation, that would be a argument in favor of giving CPAP a try.

[Greybeard]

This thread has been hijacked. The OP is concerned about Hypopnias, which is understandable given her diagnosis. Kaylis did not say who gave her the diagnosis, but I would encourage her to consult with her sleep specialist and do further research on this forum.

As for IACEYOU, you hijacked this thread you are ignoring a potentially serious condition that could result in injury or death. Do so at your own risk.

[Muse-Inc]

...If I lacked most clinical symptoms of OSA, and then I underwent a sleep study during which I had no apneas at all and no hypopneas except when sleeping on my back, I would resist the idea of undertaking CPAP therapy. It's a huge commitment...

This is BAD advice! The above was my situation tho I had typical apnea exhaustion. I had so many hypopneas and so much desaturation in my PSG that I am in the SEVERE category!!! You don't have to have AI to qualify, hypopneas count too...that's why it's AHIs and not just AIs.

On 8/20, I'll have been on CPAP therarpy for 2 years...every single night and every single nap. While I have recovered much of my pre-apnea functionality, my short-term memory is not fully restored...I refuse to think I can't recover more with more effective therapy.

Apnea is potentially fatal. Apnea includes hypopnea events. Even hypopneas can cause destaturation that might cause fatal arhythmias. Don't be fooled into thinking hypopneas are not serious..they are, serious as death.

[PST]

...If I lacked most clinical symptoms of OSA, and then I underwent a sleep study during which I had no apneas at all and no hypopneas except when sleeping on my back, I would resist the idea of undertaking CPAP therapy. It's a huge commitment...

This is BAD advice! The above was my situation tho I had typical apnea exhaustion. I had so many hypopneas and so much desaturation in my PSG that I am in the SEVERE category!!! You don't have to have AI to qualify, hypopneas count too...that's why it's AHIs and not just AIs.

On 8/20, I'll have been on CPAP therarpy for 2 years...every single night and every single nap. While I have recovered much of my pre-apnea functionality, my short-term memory is not fully restored...I refuse to think I can't recover more with more effective therapy.

Apnea is potentially fatal. Apnea includes hypopnea events. Even hypopneas can cause destaturation that might cause fatal arhythmias. Don't be fooled into thinking hypopneas are not serious..they are, serious as death.

The oldest joke I can remember goes something like this:

PATIENT: Doctor, it hurts when I do this.

DOCTOR: Don't do that.

IACEYOU says that he doesn't sleep on his back, only on his side. But when he had a sleep study done, he spent most of the time on his back because of the way he was wired up. He further says that all of his hypopneas occurred when he was on his back. He says he had zero hypopneas when he was on his side. Zero.

I didn't say or imply that only apneas count. I agree with you that repetitive hypopneas that cause deep drops in oxygen saturation call for treatment. I just don't think it's realistic to believe that someone will submit to CPAP willingly and then stick with it the way you and I have when an equally effective alternative, for him, is rolling over.

In addition, in contrast to most of us taking part in this forum, he has no symptoms to report. He specifically denies having fatigue, and he says nothing about morning headaches, falling asleep at the wheel, or the like. So he's unlikely to feel a benefit he can offset against the inconvenience of CPAP.

When I say "resist," I mean ask probing questions. For starters, IACEYOU deserves a thoughtful answer from his doctor to the question, "Why can't I just sleep on my side?"

[Muse-Inc]

...most of the time on his back because of the way he was wired up. He further says that all of his hypopneas occurred when he was on his back. He says he had zero hypopneas when he was on his side. Zero.

I, too, only had hypopneas when sleeping on my back and zero on my side. Now, I sleep exclusively on my side and wake up in the same position I was in when I went to sleep and I now have apnea as well as hypopnea on my side as reported on my loaner APAP. The Sleep Lab and one's own bed are not identical.

...he has no symptoms to report. He specifically denies having fatigue, and he says nothing about morning headaches, falling asleep at the wheel, or the like...

Unless his Sleep Study was completely wrong and I will grant that possibility however remote, I'll repeat the words of wisdom I read in the first theads I read when I joined..."DE NIAL."

...IACEYOU deserves a thoughtful answer from his doctor to the question, "Why can't I just sleep on my side?"

Given that most people move between 40-80 times/night, it's likely he spends some time on his back; if he's absolutely sure that his sleeping in the strangeness of the lab wired like a rat is identical to how he sleeps at home AND that his desats are home never get below 92% or so, then he's risking his life...IMHO of course. And yes, he does deserve an answer from his sleep doc.

[IACEYOU]

I appreciate all the comments, even the deathly ones. (I love you too Muse )

As far as the thread hijacking, guilty as charged. Newbies don't like to start threads. And where I post on other forums, threads are made to be hijacked. As long as there is pertinent discussion I don't see the problem.

I will be having another face to face with my doc in a few weeks. The second opinion will wait until after.

The sleep doc recommended CPAP with a pressure of 7, which my doc said was low, and appeared to confuse him a little since the sleep doc diagnosed me as severe, I assume due to the # of arousals while sleeping on my back, and the one spike to 77% saturation.

The blood/ox levels while side sleeping are not clear to me Rooster. Some of the sleep study lingo is still not clear to me. The report states that while side sleeping I had zero arousals and a RERA index of 0.0. I had ox saturation levels above 89% for 76.5% of the entire sleep study, and in the 80's 23.2% of the study, and .3% in the 70's (the one spike to 77%). I will also add that my EEG was normal during the sleep test, and I also had a stress test and echocardiogram before the the test and my heart was pumping like way it should be, no blockage yada yada yada...

I get up to use the RR one time during the night, sometimes not until an hour before I usually get up. I sleep about 7.5 hours a night and awake with no headaches, and I've always liked to brag that I can wake up in the morning and immediately do math. That is still the case. I do not take naps nor do I fall asleep at the wheel or during any other activities. I drink no caffeinated beverages and don't drink or smoke. So what do I do? :musicalnote:

I know this is not the forum where I'll get instant validation for my reasoning behind not wanting to CPAP. It is, after all, a CPAPtalk forum. What better place to get straight talk from knowlegable people? If I wanted instant validation I'd be posting at anticpap-talk.com.

You may call me The Dude if you like.

[krousseau]

Suggest doing more reading about hypopnea and UARS. There are some excellent old threads here-look for threads & posts by SWS and Rested Gal.

XPAP is appropriate treatment for UARS and hypopnea. Although some insurance companies may not want to pay for the machine if you don't have apnea--your sleep lab/doc can appeal their decision.

[jules]

CPAP will not solve it all. An "I don't need it attitude" won't solve anything in the long run, and if you go into using CPAP, a positive attitude is one of the best things to allow CPAP treatment to succeed.

For me I was told if I lose weight I might be able to drop the HBP meds - got the same speech with CPAP. Now lots of pounds from my max (12o + ) and on CPAP now for over 3 1/2 years my BP meds haven't changed from after the first month whenthey were first Rxed back in 2000 and I get flack for my BP at the doc's office half the time still. I do monitor it at home too.

How are you going to stay on your side? You looked at the tennis ball on the PJ top solution?

How are you going to lose weight and maintain that loss? It isn't easy as you get older to even lose it. It has to be a life style change not a diet and so it has to be slow changes you can live with and maintain.

If you want CPAP get it; if you want to accept the consequences of not trying it out for a while, it's your life, just don't drive on roads I am on when you are too tired to drive.

[Muse-Inc]

...high blood pressure...fluctuating weight... With desats below 92%

IACEYOU, the first 2 are likely why your doc was razzing you to get a Sleep Study...savvy doc, I'd keep him . While your HTN and wt may very well have other causes, they are also indicative of apnea. With desats into the 70s, that's just too low and occurs for too long for your long-term health. Wt gain is often the result of apnea. If you have refractory HTN (hard to treat, mulitple drugs) it is often caused by O2 deprivation that you may have been experiencing to some degree every night since your teens; this type of hypertension is most effectively managed by an angiotension receptor blocker...here's an article worth reading: http://eon.businesswire.com/portal/site ... ewsLang=en

Just more for you to consider. Be sure to check out Doc Falcon's posts here for UARS too. As I've posted before, apnea mangles our lives, a bit differently for each of us. Latest study I read suggested that perhaps as many as 40% of Americans might have apena...scary thought that 4 of every 10 drivers around you at any time might be so sleepy they're dangerous to themselves and others.

[roster]

.........I will be having another face to face with my doc in a few weeks. .........

I assume you will be prepared with questions for the doc.

If:

• -I could absolutely avoid sleeping on my back and
  -my blood-ox levels were normal while sleeping on my side or tummy and
  -my sleep study conclusively showed no signs of sleep-disordered breathing (SDB) while sleeping on my side and
  -I was committed to lifelong observance of SDB symptoms (Because it is a progressive condition),

then I would be forego CPAP treatment in the meantime.

Those are four critical Ifs. I doubt that you slept on your side long enough and in enough of each sleep stage to rule out SDB while sidesleeping.

We can give you some advice on side and tummy sleeping if you end up taking this route.

[IACEYOU]

Yeah, there will be a lot of questions asked.

Thanks everyone.

Jules...If I knew your state I promise to avoid driving there, though, like I said, I rarely get sleepy doing anything.
Well, almost anything.

[jules]

Jules...If I knew your state I promise to avoid driving there, though, like I said, I rarely get sleepy doing anything.

state of confusion


actually I live in WA these days --- very very close to the Pacific Ocean - well as close as we could afford to buy but I do have plenty of relatives in Nebraska as my parents were both from there