Newly Diagnosed 21 Y/O Seeking Advice

[KarD786]

Hello cpap community. I have been lurking around these forums since first going for my sleep study about two weeks ago. The reason I went for a sleep study is because I would wake up in a wide awake state at between 6:00AM-7:30AM every morning. This was happening no matter what time I slept, whether it was 11PM or 3AM. Being a 21 year old I find myself out at 3AM a couple of times a month. I was also getting my thyroid medication adjusted at the time (Hashimoto's), so I thought that could be the cause. Once my thyroid was regulated, I had no relief. Infact, it had gotten worse as I was now starting to feel awakened by shortness of breath right as I was falling asleep, up to ten times before I finally fell asleep. Prior to all of this occuring, I was an extremely deep back sleeper, one of the deepest sleepers I've come accross. I once failed to wake up after a car hit my house when I was 12 years old, and up until about a year and a half ago I would need to hit the snooze button about five times in order to wake up. The results from my sleep study are as follows:

Sleep Architecture:
Stage 1 6.5%
Stage 2 80.6%
Slow Wave (3/4): 4.9%
REM: 8.0%

Positional Data: 48% of the time supine, 2% left lateral, and 50% in right lateral position

Oxygen: Room Air/Awake: 95%
Lowest: 92%

3.0 Apneas and 53 Hypopneas with the longest being 41.5 seconds in duration. 2 of the apneas were central.

AHI: 14.5
In REM: 3.2

The doctor gave me three options. Surgery which he said he only recommended if the snoring was a nuisance (I am surprisingly not a loud snorer at all. The second option was the mouth guard from a certified dental physician. This is what my preferred option was, but I was a little worried when he had mentioned that the mouthguard will only reduce the apneas by about 2/3, putting me at a fine line. The out of pocket expense will be about $1000 for a mouthguard, but I consider that fairly reasonable being the fact that it has a 5 year lifespan. The third option was the fully effective CPAP which my insurance would most likely cover 100%. I am stuck on whether to opt for a mouthguard and take the risk, or go for a CPAP, suffer the nuisance, but be 100% sure I'll be receiving effective therapy. I am only 21, so the CPAP would really put a damper on the way I spend the next ten years of my prime years. However I understand that my health is priority, and will allow that to take a backseat if it ensures optimal health. Looking for any advice/suggestions/comments from experienced users. Thank you

[KarD786]

Just to add a little bit more information that may be helpful. Total sleep time of the study was 436.5 minutes while total sleep time was 232 minutes. This was not a normal night for me as I usually sleep through the night till it becomes light, which is where my awakenings start. Sleep Efficiency was 53%, Sleep Latency was 32 Minutes, and REM Latency was 253 Minutes. I was a bit confused about this number. It is well over the range of 60-120Min, and my REM sleep in the architecture was clearly shortened. However, how can REM Latency be 253 minutes if I only slept 232 minutes? Or is this referring to 252 minutes into the total time of the sleep study?

[SleepyToo2]

Would getting both mouth guard and CPAP be an option? If you grind your teeth you could claim the mouth guard was to stop that, which becomes a legitimate claim on insurance. I don't know how the dental device would work for your particular sleep diagnosis, but at least theoretically you could use the CPAP most nights, but those when you don't make it home you would have a good alternative in your pocket. You are lucky to be diagnosed so young, and you will find lots of posts about others in similar single situations as yourself. Generally, the opinion is that the CPAP can improve relationships - you are less grumpy, your partner gets more sleep, etc., etc. I will leave the etc. to your imagination. Also, remember that you only wear a CPAP mask when you are sleeping, if you get my drift. Good luck, and post back with questions.

[Nick Danger]

Good luck! I know I was really bummed out when I was told (at the age of 45) that I would have to use the machine every night for the rest of my life. None of us like to hear that and many (maybe all) worry about the effect that will have on our sexual experiences. In my case, it hasn't been a big deal (especially after I got used to the machine).

If you try XPAP, make sure that you get a fully data capable machine (though, if you've been reading this forum for the last couple of weeks, you have likely already come to that conclusion!).

I underwent 3 surgeries - septoplasty (this helped daytime breathing and decreased the required CPAP pressure, but didn't improve AHI); UPPP (the roto-rooter job, didn't improve AHI); and genioglossal/hyoid advancements (this eliminated AHI for a couple of years, but the symptoms returned). None of these surgeries have a high success rate in eliminating obstructive sleep apnea. I did not opt to try the lower jaw advancement - this surgery reportedly has a much higher chance of success than the other surgeries, but has a relatively high rate of complications and a very difficult recovery period. Knowing what I know now, I would have proceeded with the septoplasty, but not the other surgeries.

No treatment was not an option for me - I already have various cardio risk factors without adding untreated apnea to the mix. Granted the severity of my apnea is much higher than yours (AHI = 90 before treatment). I suspect that, left untreated, yours will become more severe over time (especially when you begin that midlife weight gain - if you do).

[KarD786]

I am glad you brought that up. I actually brought the same scenario up to my sleep doctor. I asked him that if I get the CPAP now and want to give the mouthguard a try at a later time, will the insurance give me grief? He said that they most likely would give me a hard time if the CPAP is effective. And assuming my sleep returns to normal (extremely deep), I really don't see myself having a problem complying with CPAP. However I would like to have the option of having a mouthguard when I spend nights outside my home. Another option I was thinking about was going to an ENT and possibly getting surgery and the mouthguard. If that will effectively get my AHI under 5, that would be the ideal option as I can then have the peace of mind without having to adjust to a CPAP at such a young age. The way I look at it is that if I can get by without a CPAP until the age of 30 where I will be looking to settle down, that would be optimal. However I am about one year away from finishing my undergrad and planning to go to grad school to get my MBA. Therefore I don't want lack of sleep to negatively effect my school performance. Lately I have had trouble concentrating and just an overall feeling od depression.

[Julie]

Just remember that a mouthguard won't do anything to keep your airway open, which is the point of Cpap of course. And do make every effort to stay off your back - it's the worst position for provoking apneas... there is even a pop. of people with 'positional apnea' who once they began sleeping in other positions, some using a small, soft cervical collar to keep their heads up and airway more open, had follow up sleep studies and no longer needed cpap... though keep an eye out for trouble by using an oximeter on occasion.

[hyperlexis]

Not much advice to give -- the best bet is from your actual physician. Your AHI is enough you need some kind of treatment. Dental devices may work, but then again, possibly not very well. CPAP or BIPAP, etc., would likely do much better. And re the other issues yes, it totally sucks. But there are definitely ways around it. Kick her out, nicely.... Or you just go home.... Or stick with the nasal pillows, if need be. Some are super, super tiny nowadays, like the new ResMed P10, or the nasal N10. And if you like a FFM better, some are now very unobtrusive and discreet, like the new Airfit F10 or even the older Quattro FX. Or, just own it man and go with the ultimate, fighter-pilot model, the Hans Rudolph V2. -- The Harley of FFMs. Whatever you do, you should feel much better rested if you go on therapy. Good luck.

[NYCzzz]

I was in my 30s when diagnosed... thought it was the end of the world... question -- are you male or female? I ask because, as a guy, I have been pleasantly surprised at just how NOT A BIG DEAL having a CPAP has been with women, even as a single guy. I used to have a mouthguard which was effective for me but not as much effective as the CPAP. the best thing you can do is get what is going to make you FEEL the best.

[KarD786]

Thanks for all the additional device. I called up my insurance and neither the medical nor dental will cover a mouthguard. So I'm going to go with the CPAP. I honestly need a months of good sleep before I can think straight going forward. Coming out of hypothyroid and walking straight into this has made the last six months hell. Just to add, despite being hypothyroid I am not overweight and am rather lean. I am 5'10 165 pounds. I have had no motivation for life as of lately. I'm really hoping the cpap helps. And I'm really hoping that I can finally sleep like a baby as I did about two years ago

[archangle]

Do NOT!!! get the surgery unless you try really hard at CPAP and can't make it work.

Google "UPPP problems" for examples of the horrors of the after effects of apena surgery. They're working on improving their apnea surgery, but they're in the dark ages compared to CPAP. Many of the doctors/ENT's/surgeons are chop happy. They are biased by the money or their on delusions of grandeur.

The surgery side effects last for life. If you have CPAP problems, you can just stop using the machine and seek other treatment. If you do CPAP now, and they figure out how to make the surgery safe and effective in the future, you can change later. There are some newer surgical procedures. Let someone else be the guinea pigs for that for a few years.

The success rate of surgery is low, as well. Actually, the success rate for CPAP is low because many patients give up on it. Stick around here, and you can get a lot of help on making it work.

The dental devices have a really low success rate and are often incomplete cures even when they work. They do have an advantage that you can stop using them if you have problems and they don't work.

[KarD786]

Thanks for the kind words. I'm going to see an ENT doctor just to see what they have to say, but will proceed the cpap route first. As far as cpap goes, I'm not sure if I'll be able to manage the nasal mask. When I sleep on my back, I cannot sleep with my mouth closed. However since the sleep study I have tried sleeping on my side a few times and have noticed that while on my side I cannot sleep unless my mouth is closed. I'm not sure if it remains shut all night. But I want to make it work as I usually fall asleep watching tv and the nasal pillow masks are much less obtrusive. I have my titration study tomorrow since they thankfully got a cancellation. Hopefully all goes well