Confused-- TWO ENTs told me I don't need CPAP

[UphillRun]

Hi everyone,

I had an in lab sleep study, which resulted in the following numbers:

Overall RDI: 11.0
Overall AHI: 1.9 (9 apneas, 1 hypopnea)
RDI during REM: 28.3
AHI during REM: 7.8

Based on the sleep study, the doctor recommended CPAP so been giving that a shot a little. However, I met with two different ENTs (from different practices), who did an exam of my throat and examined my CT scan. One of them recommended surgery for a deviated septum and enlarged turbinates, and said that would likely fix my sleep issues. The other one said surgery alone likely won't fix the sleep issue, and it's not worth risks at this stage. This second one even said she wouldn't even classify me as mild sleep apnea. However, both ENTs said that they're not seeing significant airway obstruction and that I shouldn't even need CPAP. Has anyone been in a similar boat?? I'm so confused on what to do at this point. Seems like the majority of my issue might be related to the high RDI during REM.... is that possibly caused by something other than obstruction, ie stress causing arousals?

Also for context...In general, majority of the night I have no snoring or mild snoring, but I do have maybe 3-10 minutes per night of loud-ish snoring. Not overweight, low blood pressure, etc.

[Julie]

Pay attention to the second ENT - the one who has your interests first, not the other who's looking to finance his second Porsche.

The second doctor said all the things I would after seeing your study, so unless you still feel bad all day and unless a whole bunch of labs, etc. have shown no other reason for symptoms, I'd stick with No. 2.

You don't need to snore to have apnea, and you don't need to be big/fat either, just as long as you have the 'right' anatomy of a narrow jaw, possibly large tongue and either of those blocking your airway to some extent.

But then it doesn't sound like you're the poster child for apnea, and I'd look elsewhere for answers.

[jnk...]

A lot of ENTs aren't informed on the subtleties of sleep-disordered breathing. Give PAP therapy the full shot for improving your health. A stable airway during REM is a worthy goal.

[palerider]

If all that it took to effectively diagnose sleep apnea was to look up someone's nose and down their throat, then the whole science of polysomnography wouldn't have been invented.

Your RDI means, that on *average* your sleep is being disturbed by some kind of respiratory related issue every six minutes or so.

You may not "need" a CPAP, but you'll sleep better, and be more rested when you get it working well.

[jnk...]

And as for two ENTs with differing opinions: I am reminded of the old adage that a guy with one watch always knows what time it is but a man with two watches is never sure.

[kteague]

Since it appears from the results you quoted you have a copy of your sleep study report, you might want to check a few things. A study is only as good as what they were able to capture in that night, and sleeping in a sleep lab may not be representative of how you usually sleep.

We know you got some REM sleep, but was it sufficient to be representative of usual REM sleep? If not, your events during REM on another
night could be a higher count.

Were you supine during all the REM sleep recorded? If so, that's great. If not, it's always possible REM while supine could have resulted in
more events.

Was time spent in sleep during your study a substantial amount? Too little sleep may not give a full picture. While a short amount of
sleep may be enough to make a positive diagnosis if events manifest soon after falling asleep, short sleep may not be enough to be sure
what would have happened in a longer sleep session.

I only mention these things because sometimes study results, when not not taken in context, can give a false sense of security. Best wishes figuring things out.

[zonker]

And as for two ENTs with differing opinions: I am reminded of the old adage that a guy with one watch always knows what time it is but a man with two watches is never sure.

very good, sir, very good.

am stealing that and removing your name.

[jnk...]

You'll have to take it up with Segal(l) and Bloch and the fact-checkers as to whose name gets attached: https://en.wikipedia.org/wiki/Segal%27s_law