Newbie - Questions about Diagnosis and Snoring Relief

jeffro2 · Post by **jeffro2** » Mon Sep 10, 2012 12:21 am

Hi. I'm new here and have a few questions. My wife has complained quite a bit about my snoring over the past couple of years. I did a sleep study several months ago and my doctor never showed me my results from the sleep study, but he said that I didn't meet criteria for a diagnosis in the majority of my sleep for the night; however, he did say that during the deepest phases of sleep that I was well above the number of events for a disgnosis (I stopped breathing for some amount of time on several occassions). The sleep tech said that I slept quietly until around 4 am when I started snoring loudly.

I have several questions..... Even though I don't meet the official guidelines for a diagnosis, should I consider pursuing getting a prescription for a cpap machine if I can talk my doctor into it? If I get an "automatic" machine, can I skip the sleep study that I was told is required in order to monitor my sleep with a cpap machine (I assume to determine the right pressure levels for me)? If so many machines are automatic, why are these follow-up sleep studies really necessary?

Finally, the most important question on my mind (and my wife's, I'm sure), how effective will a cpap machine be in providing some relief from snoring? Will it eliminate my snoring all together? If the answer is no, what, if anything, have you all found to help with snoring?

zoocrewphoto · Post by **zoocrewphoto** » Mon Sep 10, 2012 1:16 am

You need to get a copy of your sleep study. You have a legal right to it, so you need to ask for it, and put it writing if need be. Once you have it, you can post your results here and get some better advice. Depending on what it says, you may need to look for a different doctor. The good news is that any doctor, even a dentist, can write a prescription for a cpap machine. So, if you really should be getting one, then they can write the prescription for you. Ideally, you should still get the titration sleep study as that is designed to determine the levels of pressure needed throughout the night. And they can also check to make sure that the pressure isn't causing problems as some people have central apneas when the pressure gets too high for them.

I am curious how the overall apneas aren't enough to qualify, yet you were well above during the deeper sleep. Normally, the criteria is an ahi of 5 or higher, which is the average of breathing problems per hour. If you were severe during part of your sleep, that should have averaged with the mild part and still had more than 5.

You really need that sleep summary report.

And cpap will most likely eliminate your snoring. I snore very badly without my machine. With it, I am very quiet. I travel and share a hotel room, usually with my sister, mom, or friends. Nobody has heard me snore with the machine. They are all thrilled with the results. And I feel much better too

Julie · Post by **Julie** » Mon Sep 10, 2012 4:31 am

You might be one of the 'lucky' people in whom sleeping position (e.g. side vs back) is 99% of the answer. In other words getting used to not sleeping on your back pretty well eliminates most of your 'events'. As far as snoring goes, you might want to see an ENT specialist to be sure that you don't have a problem like large turbinates that can be dealt with - but whatever you do don't let them talk you into getting your tonsils removed (rarely works and occasionally makes things worse), or having surgery called a UPPP which seems to revert within a year to the need for cpap all over again most of the time.

jeffro2 · Post by **jeffro2** » Mon Sep 10, 2012 6:18 am

Thanks for the quick replies! Knowing now that too much pressure could cause an apnea as well makes sense to me now, and I can see the importance of needing the sleep study with a machine and why a prescription is needed. I'm going to follow up and try to get a copy of my sleep study.

As for surgery, my ENT told me that he could remove my tonsils and do some other procedure, but he said it may not do any good.... Maybe 50% chance of it helping. So, I've opted not to do it.

How much does insurance tend to pay on these machines?

Pugsy · Post by **Pugsy** » Mon Sep 10, 2012 7:02 am

jeffro2 wrote: How much does insurance tend to pay on these machines?

Totally depends on your insurance plan and your deductible and do they buy outright or rent to own for a few months and if so...does the rent to own go into this coming January where deductible typically start all over.....so you need to check with your insurance company yourself to know for sure.

BTW it is common for some people to have OSA be worse in REM stage sleep or sleeping on their back or both.
I am documented much worse in REM stage sleep at AHI of 53 ...average per hour.
But in non REM sleep I barely make the diagnosis of OSA with 12 events per hour BUT those 12 average events were around 45 seconds long and my oxygen levels dropped to 73%. So overall number averages don't always tell the whole story. So there is so much more to this than just the annoyance of snoring.

JohnO · Post by **JohnO** » Mon Sep 10, 2012 7:26 am

Welcome!

As others have said, the answers lie in your sleep study report. Try to make sure you get a complete copy, and not just a summary. The data should be there regarding your sleeping positions (left side, back, stomach, etc.) as well as your phase of sleep (light, deep, REM, etc.). It would also show how low your blood oxygen got during your events.

Is it possible that with all the probes and wires that you didn't sleep as much as you normally do? Did you take any type of sleeping pill before the study? If you didn't sleep as much, your test data may not show the impacts you would have had in a typical night.

I started on the machine 37 days ago. My wife, who had often slept in another room due to my snoring, now says she can't hear a thing from me!

John

jeffro2 · Post by **jeffro2** » Mon Sep 10, 2012 8:03 am

Thx. I will ask for a full report. I know what you mean by the snoring being the least problematic issue to be concerned with, but of course since I don't know what's going on when I sleep, the only thing I hear from my wife is the complaints from snoring! Lol. A friend of mine told me that the cpap saved his marriage. He was half joking, I'm sure, but only half! Lol

BlackSpinner · Post by **BlackSpinner** » Mon Sep 10, 2012 8:19 am

jeffro2 wrote: I have several questions..... Even though I don't meet the official guidelines for a diagnosis, should I consider pursuing getting a prescription for a cpap machine if I can talk my doctor into it? If I get an "automatic" machine, can I skip the sleep study that I was told is required in order to monitor my sleep with a cpap machine (I assume to determine the right pressure levels for me)? If so many machines are automatic, why are these follow-up sleep studies really necessary?

Finally, the most important question on my mind (and my wife's, I'm sure), how effective will a cpap machine be in providing some relief from snoring? Will it eliminate my snoring all together? If the answer is no, what, if anything, have you all found to help with snoring?

I have a friend who was prescribed a cpap machine for just this issue. It worked fine for him and his wife, when he wore it.

xenablue · Post by **xenablue** » Mon Sep 10, 2012 8:22 am

jeffro2 wrote:Thanks for the quick replies! Knowing now that too much pressure could cause an apnea as well makes sense to me now, and I can see the importance of needing the sleep study with a machine and why a prescription is needed. I'm going to follow up and try to get a copy of my sleep study.

As for surgery, my ENT told me that he could remove my tonsils and do some other procedure, but he said it may not do any good.... Maybe 50% chance of it helping. So, I've opted not to do it.

How much does insurance tend to pay on these machines?

You should succeed 100% with getting a copy of your full sleep study - not just the results. You are entitled to this, it belongs to you, so don't take "NO" for an answer. It will help you understand what went on during your study, and also help the wonderful, experienced XPAPpers here to help you!

I agree with what others have said about surgery - my neurologist mentioned it to me, and said she did that because she's obliged to give me all options, but couldn't recommend any surgeries, certainly in my case, as they are rarely successful.

Cheers,
xena

themonk · Post by **themonk** » Mon Sep 10, 2012 8:46 am

I'll piggyback on the posts about obtaining a full copy of your sleep study. One thing to pay special attention to is the scoring criteria your lab used for hypopneas. Which of the two criteria your lab uses could have a big impact on whether you are positive or negative for apnea. It is very possibly you could be negative with this lab and positive at another, or vice versa.

I would make my lab defend whatever their diagnosis is. A sleep study is not a perfect measure with variance even using the same scoring criteria due to human judgment/error/greed. Add in different scoring criteria and any diagnosis should be met with suspicion and should be questioned heavily before accepting it. If you are looking for a positive diagnosis and your lab used the recommended scoring criteria, you could ask them to re-score using the alternative. It is more liberal and 'ensnares' more people.

You can see the study below for proof:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635578/

If it were me, I would explore oral appliances. CPAP sucks for the majority of people and I would do anything to avoid using them if I didn't have to. You could explore an oral appliance with some positional therapy and probably see relief from whatever breathing/snoring issues you have based on what you have provided.

jeffro2 · Post by **jeffro2** » Mon Sep 10, 2012 9:51 am

Thx. My doctor talked briefly about an appliance, but said he didn't recommend it because in his experience he hadn't seen them to be effective for his other patients. If such things do actually work, I wonder where I would find out more about them?

cherylgrrl · Post by **cherylgrrl** » Mon Sep 10, 2012 10:37 am

In my case, surgical/semi-surgical options gave short-term results but the sleep apnea came roaring back worse than before after a few years. My first diagnosis was about 10 years ago. My ENT talked me into a series of procedures called somnoplasty, which reduced the amount of tissue in my sinuses, upper palate, and back of tongue. It helped enough that I was able to pass a second sleep test about 6 months later, but the procedures are expensive and not covered by all insurance. About 5 years later, after getting married and informed by hubby that I snore up a storm, I went to a new ENT who discovered I had a deviated septum. (Wonder why the first ENT never picked that up -- should have thought that would be a no-brainer!)

Sinus surgery followed, with lessening of snoring. Over the next 5 years, a slow ramp-up of snoring. Finally I changed GPs and the new one thought I should have another sleep test. Bingo! Sleep apnea again! This time I just threw in the towel and decided CPAP was the way to go. It hasn't been easy, but my husband is delighted because I'm as silent as a sphinx at night and now am down to an AHI of 0.0 most nights. It is very satisfying to see this result, and good to know I'm not hurting myself anymore through sleep deficit and oxygen deprivation. I wish I had gone on CPAP 10 years ago, I'd probably be healthier today.

themonk · Post by **themonk** » Mon Sep 10, 2012 10:39 am

Your doc is likely not well informed in dentistry, and if you are one of the darker sorts like myself, has little financial interest in you treating your issues via a dentist. I have little faith in sleep docs so that colors my opinions. Consider that a caveat.

Anywho, you can read here for real life facts and not best guesses:

http://dissertations.ub.rug.nl/facultie ... a.hoekema/

Anything other than PAP usually gets pretty harsh feedback from people on message boards, but facts are facts. For some people, surgery and oral appliances work great, as in treats sleep issues fully. For some, they don't work as well, or at all. It is worth exploring because you very well might be in the camp where these things work. I am afraid you are going to have to become an expert if you want to get the type of treatment you deserve.

I'll re-state, I would do everything in my power to avoid a diagnosis and PAP if I didn't have it, but that is me. It is well worth finding a dentist who specializes in sleep medicine and at least having a chat. Also, Is your ENT someone who is trained in sleep medicine? If not, find one that is and consider seeing him/her. Take whatever info they give you and test it against any research you can find.

cherylgrrl · Post by **cherylgrrl** » Thu Sep 13, 2012 12:47 pm

Here's a forum folder with several threads on oral appliances. In addition, the forum moderator is a certified sleep technician who will generally answer questions:
http://www.freecpapadvice.com/forum/vie ... 0374f1d584

jeffro2 · Post by **jeffro2** » Thu Sep 13, 2012 1:06 pm

Thanks! That's more encouraging than I expected. I'll be talking to my dentist about this soon, and post on that forum some as well. I do have a sleep study to try cpap within the next few days as well, so, I'll find something to address my issue one way or the other eventually, I'm sure.

Newbie - Questions about Diagnosis and Snoring Relief

Newbie - Questions about Diagnosis and Snoring Relief

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Re: Newbie - Questions about Diagnosis and Snoring Relief

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Re: Newbie - Questions about Diagnosis and Snoring Relief