How bad does one need to be to require CPAP machine.

[daubernut]

I recently had surgery and after I awoke I was told by nursing to get myself checked out for sleep apnea. It was bad enough that they would not allow me to even have a sleeping pill when they were given out to the other patients while I was in hospital. I had an oximeter overnight home test done a couple of weeks back and the results just came back that I stop breathing twelve times an hour. I wake up almost every morning with a severe headache. Spouse sleeps in living room to get away from the din of my snoring and the thrashing I do through the night. PCP has put my name in for sleep test at local sleep center. It may be next year before I get my appointment at the sleep center. My blood pressure has been creeping up as well as the weight. I am so tired all the time. All I want to do is sleep. PCP says my readings do not warrant a CPAP at this time. How bad does it need to get? I already have a heart arrhythmia and my grandmother died suddenly in her sleep leaving two young grade school children behind. Just curious as to whether I should be more aggressive with my doctor. I have snored for decades but always attributed it to a broken nose. I take no medications whatsoever at present. Feedback would be appreciated.

[avi123]

Ask any of your docs to send you to a Sleep Doc, preferably to a Neurologist who also holds an MD in Sleep Medicine.

[zoocrewphoto]

You need to go to a sleep doctor. Many do not require a referral. There are some doctors who assume that cpap is not required if less than 15 per hour. But with the severe headaches, it sounds like your oxygen desats are bad. Sometimes, the number per hour isn't a great indicator since multiple short apneas may not be as bad as only a few, but much longer apnea events. Ask for a copy of the overnight oximetry report. That should say how low your desats went and how often. Also, with other issues such as high blood pressure and heart problems usually points to the need for cpap treatment even if the sleep apnea is considered mild.

[Pugsy]

Welcome to the forum.
The overnight pulse oximetry test that you had at home was pretty much just a test to see how many times your oxygen dropped.
Often sleep apnea events cause drops in oxygen but they don't always cause a significant drop and there are other sleep disordered breathing problems besides sleep apnea.
12 times an hour your oxygen levels dropped...doesn't sound horrible but might be more important to find out just how bad the oxygen levels dropped during those 12 times.

During my initial diagnostic sleep study in non REM sleep I stopped breathing only about 12 times per hour also. Doesn't sound all that horrible but I was having some really long events and my oxygen dropped to 73%. Because of this I was not getting much REM sleep and in REM sleep my OSA was 5 times worse in terms of numbers of events. Couldn't stay in REM very long at all. Kept waking up. All that fragmented sleep was making my sleep quality in general....horrible and I felt like crap.
I also had everyday morning headaches that were killers....BTW those pretty much totally went away once I was able to optimize my therapy.

So it's much more than a simple number of how many times we stop breathing....and 12 per hour makes the diagnosis for mild sleep apnea. With "mild" being 5 to15 per hour.
http://en.wikipedia.org/wiki/Sleep_apnea

So you meet initial diagnostic criteria for mild sleep apnea.
How come it takes so long to get an appointment at the Sleep Center where you live?

[chunkyfrog]

My AHI was only 13 diagnosed; but I was a walking zombie, with skull-splitting headaches every morning,
waking several times a night from strenuous, disturbing dreams. Couldn't be trusted to drive.
My insurance covers my cpap due to "co-morbidities", like high blood pressure. You need to get to a sleep doc.

[caffeinatedcfo]

My oxygen stats were pretty good in my Sleep study. However, my AHI (how often I stop breathing 10secs or more per hour) was 45.5! After 67 on my back!

I too woke often with morning headaches, daytime fatigue, snoring loudly , etc.

Take the above advise and see a real sleep doc and have a sleep study done in a lab.

[Dreamrobot]

Yes I vote for you to be agressive with the system and get some treatment. You only live once, and how bad does it affect your life everyday? You mentioned quite a few things that are not positive things in your everyday routine and that could affect your future life.
Good luck,
dreamrobot

[sawinglogz]

To answer your specific question, many insurers consider 15 events per hour to be the magic number at which they'll cover CPAP without much fuss.

But, as many people here have already pointed out, you might well experience debilitating symptoms well under that number.

There are a number of ways you might still convince your insurer to cover your treatment. You might be "lucky" enough to have a "co-morbid" factor (like high blood pressure) that puts you into a category that your insurance will cover. Or they might be willing to cover you if you have a high Epworth score. Different insurers have different specific requirements, so we can't answer in detail here.

High Epworth and loud complaints about your symptoms are usually enough to get a sleep study approved, although sometimes they'll only approve a home test. Insurers vary on how they handle the next step: some will approve in-lab studies, others will only approve at-home treatment. Some scenarios to give you an idea of the range of possibilities: if the home test is inconclusive, they'll generally approve an in-lab study. Then if the in-lab study shows apnea, they might approve an in-lab "titration" (figuring out appropriate CPAP settings and seeing if it has any effect) on the basis that the at-home test didn't succeed, so at-home titration isn't likely to work. Alternatively, if the home test shows apnea, they might simply approve an "auto-titrating" machine and look at your results after 30 days. Anything at-home is much cheaper than in-lab.

Now the good news is that the machines themselves are relatively inexpensive (hundreds of dollars vs. the thousands for an in-lab sleep study). So even if your insurer refuses to cover CPAP because you're just under the criteria, you might be able to get a prescription from your doctor for an APAP machine and buy one out of pocket. Then you and your doctor can look at the results and see whether it's helping you.

But remember that CPAP isn't always an immediate silver bullet for everyone, and many people struggle to acclimate to the mask (or find one that works for them).

As always, talk with your primary doctor.

What part of the world are you in that has a 1-year wait for a sleep lab?

[purple]

While a lot of folks talk about the problems which accompany untreated sleep apnea, like heart problems, headaches. and so on.

The big thing is to realize that with effective sleep apnea treatment, life gets to be a lot more fun. It is fun to have energy all through the day. To wake up feeling like I used to feel after three cups of coffee, and I still have to start the coffee to brewing.

[Thewino]

I second what purple is adding to the conversation. When i considered the downside of untreated sleep apnea, including strokes, high blood pressure, congestive heart failure, etc..., it really hit home for me.

I have three children in their 20's and I enjoy watching them grow up. If it takes wearing this contraption to be able to see my kids and my very first grandchild (six months old), I'm choosing the contraption every single time.

Since you asked for advice, if it was me, with the seriousness of untreated apnea, I would push real hard to get a sleep study done.

Then, add this site to your favorites. I've only been on CPAP one month and will admit that there is someone here to answer any question you can think of regarding CPAP. They sure helped me out and made the whole experience easier from the start.

I wish you well,

TheWino

[Sheriff Buford]

I agree with The wino (boy, doesn't that sound strange!) and purple. Years ago, my primary doctor commented on "my quality of life". I have pondered that phrase ever since. When I have a health issue, I ask myself how's my "quality of life?" To me, most of your issues may be aggravated by sleep apnea. The only way you will know is to have a sleep study done. Go ahead and have the study and see what your condition is. You won't regret it.

Sheriff

[RestedRebel]

I recently had surgery and after I awoke I was told by nursing to get myself checked out for sleep apnea. It was bad enough that they would not allow me to even have a sleeping pill when they were given out to the other patients while I was in hospital. I had an oximeter overnight home test done a couple of weeks back and the results just came back that I stop breathing twelve times an hour. I wake up almost every morning with a severe headache. Spouse sleeps in living room to get away from the din of my snoring and the thrashing I do through the night. PCP has put my name in for sleep test at local sleep center. It may be next year before I get my appointment at the sleep center. My blood pressure has been creeping up as well as the weight. I am so tired all the time. All I want to do is sleep. PCP says my readings do not warrant a CPAP at this time. How bad does it need to get? I already have a heart arrhythmia and my grandmother died suddenly in her sleep leaving two young grade school children behind. Just curious as to whether I should be more aggressive with my doctor. I have snored for decades but always attributed it to a broken nose. I take no medications whatsoever at present. Feedback would be appreciated.

I was told by the nurse anesthetist after I had had a colonoscopy, so I got a referral from my GP to a sleep study. I was diagnosed with moderate sleep apnea, received a cpap machine, and have found it to be a blessing in my life. I stopped getting the foggy feeling in my brain, feel so alert, so energetic, and my mood has improved. I have had enough energy to exercise now and lose weight and have lost 54.1 pounds since being diagnosed. If your quality of life improves, it is well worth it to breathe in humidified filtered air every night. I am one of the lucky ones who has seen a marked improvement and had success with my machine from day 1. Also, I no longer have a stuffy nose or nasal congestion because of the cpap machine. My AHI average hovers around 1.

[daubernut]

Thanks for all your responses. We only have one sleep clinic here and thousands are referred to it annually- hence the wait. I shall journal daily symptoms to bring to my appointment when it finally happens. In meantime I have bookmarked site so I can return and report my progress and learn more. Again, your responses are most appreciated and I thank you.

[daubernut]

Got my appointment with the respiratory specialist set for July 3rd so the ball is now rolling.