Relationship between consumption of alcohol and sleep apnea

[zonker]

Interesting topic . . .
(((What am I doing with this corkscrew?)))

hopefully, not plunging it into the bullfrog!

Perhaps she's still in the training not to flinch stage.

[dbebz]

Okay everyone, I need some serious advice on how to take this new information. This is an update from the original thread so read that one if you need more information:

My original doctor told me to have some alcoholic beverages and sleep on my back because that will cause my sleep apnea to manifest itself for the at home sleep study. So i did just that. I went from a 7 or 8 out of 10 quality of sleep to having a 1 or 2 quality of sleep that night. It was completely out of the normal for me. My AHI according to the original sleep study scored by the sleep physician was 52 events per hour.

After consulting with multiple doctors, I was told "that is not fair, alcohol makes sleep apnea worse and if you don't usually drink then that is not an accurate test." The sleep apnea clinic appeared extremely dismissive about any of these concerns but I became forceful with them and asked for another sleep study, which I did. They were under the impression I was "under denial" despite me explaining I received what I would say is not the best medical advice. I explained to them that if I need to use CPAP I will, but I want to make sure I need it.

So I did the NEW sleep study for 2 nights. First night, I used it the entire night, had an AHI of 11. Second night, the battery died after only 3 hours and I had an AHI of 17. Due to the device, I was uncomfortable on my side with the plastic sticking out so I kept rolling on my back. I also have chronic ENT issues (doctors think I have something irritating my throat and vocal chords, as well as possible asthma/cough and my nasal passages get plugged especially at night.) I couldn't get a close look at the stats, but it looks like near the beginning my oxygen saturation went down to 88% once and then didn't drop below 90% any other times. I wish I could take a closer look but couldn't get a copy.

The sleep clinic basically told me "You're still pretty much moderate, you need to get CPAP." When I asked them to send the results to the sleep physician to be scored, they at first said it wouldn't make a difference and it costs them money. I also asked for copies of the reports and they declined, stating they are "unofficial" and they don't want them "floating around." I explained how my other doctor told me that this is a lifelong diagnosis, and I want to be diagnosed properly if that is the case. I work in law enforcement as well as in the aviation industry and I don't want medical examiners for the rest of my life thinking my baseline is 52 events per hour if that is not the case. The sleep clinic then relented and said they will send in the results to the sleep physician. They claimed that the at home study usually under reports apnea, so it will probably be higher, but I remember my 'severe' study and they said "oh once it's scored it usually goes down." So which one is it?

I am not convinced that this place is only caring about money as it took a month of pestering them about my health and they kept saying they need to bill me for the machine. The sleep clinic also mentioned I should keep using it in the meantime while I await my results and that they need to bill me this week. I almost signed the paperwork last week before I decided to finally speak up and say something.

My questions are:

-When is CPAP indicated in terms of severity?
-What do you all think about this situation? Am I in denial as they say or was I legitimate in getting this looked at? I take my health seriously so if this indeed is just about money that really concerns me.

[Miss Emerita]

Not sure you saw my earlier post in your second thread.

Here are the levels of apnea:

None/Minimal: AHI < 5 per hour
Mild: AHI ≥ 5, but < 15 per hour
Moderate: AHI ≥ 15, but < 30 per hour
Severe: AHI ≥ 30 per hour

In the U.S., most physicians will recommend PAP treatment for an AHI of 5 or above.

Also in the U.S., you have a legal right to see your sleep study. If the clinic won't give it to you, get it from the sleep doctor. And of course you should hear from your sleep doctor about how he or she interprets the study and its results. Do you have an appointment to talk and go over things?

[chunkyfrog]

The fact that you have apnea has been put on your permanent record.
The number is meaningless unless you refuse treatment.
Even the results of the second study will not change that.
You still need cpap.
Yes, it will mean that you will always have Big Brother peering over your shoulder.
It is part of the price of doing whatever it is you do--because--safety.
Thank you for your service.

[dbebz]

I understand that, but the fact is that multiple doctors have stated that doing a test under those parameters is not an accurate assessment and should not result in having a diagnosis that doesn’t fit what a typical day is. Obviously I have sleep apnea, but they can’t base my daily normal on a test that was inaccurate. I have consulted today with doctors who have said that advice was very strange and not representative of how it’s done.

Also; I would like to speak to the sleep doctor but it just gets sent to a sleep physician at a hospital who interprets it and send it back to them. Not sure how to actually look into it:

I was told if your typical AHI is less than 15 then they don’t recommend CPAP where I am from. I have medical issues that I am dealing with as well that I would hope to rectify as a doctor advised me that increases severity of sleep apnea.

I am not against using CPAP by any means. I just want an accurate diagnosis via a proper testing method and have all treatment options on the table. Like a physician advised me, it’s not fair that I’d forever be assumed that I have 50+ events per hour every night if it really is in the low 10’s. I don’t ever drink so I am open to whatever treatment is necessary. The CPAP place is pressuring me to purchase the machine well before the trial ended, was reluctant to send the new results to the sleep physician and I feel like they aren’t interested in hearing anything.

For example, I was told by them that my AHI would not go below 40 and alcohol doesn’t make a difference. That has proven to be not true. So yes, I want a proper relationship of trust and open communication when it is in regards to my health.

[dbebz]

Not sure you saw my earlier post in your second thread.

Here are the levels of apnea:

None/Minimal: AHI < 5 per hour
Mild: AHI ≥ 5, but < 15 per hour
Moderate: AHI ≥ 15, but < 30 per hour
Severe: AHI ≥ 30 per hour

In the U.S., most physicians will recommend PAP treatment for an AHI of 5 or above.

Also in the U.S., you have a legal right to see your sleep study. If the clinic won't give it to you, get it from the sleep doctor. And of course you should hear from your sleep doctor about how he or she interprets the study and its results. Do you have an appointment to talk and go over things?

And thanks for the information. Where I am from I believe they try to do lifestyle changes for mild apnea, and recommend CPAP when you hit the moderate mark. But I open open to whatever treatment is needed.

[Pugsy]

Are you somewhere in Europe or the UK area?

I have heard from some people in France that 15 AHI is their cut off line in the sand. 5 AHI is the line in the sand here in the US when other co morbidity factors are present...and snoring or excessive sleepiness qualifies along with other more obvious usual health issues.
UK NHS uses the 15 AHI line in the sand unless significant other factors are also going on.

I do understand that there are large parts of the world that don't adopt the same criteria as the US does though.

As for the original diagnosis of 50 AHI being on your records....records can be changed or corrected.

It does sound like the sleep clinic you are using is more interested in selling stuff though.....to be honest at this point with what all they have done and told you...I am not so sure I would believe them if they told me the sun rose in the East and set in the West.

So.....why did you end up getting a sleep study done in the first place? What was going on that you didn't like seeing that prompted you to look down the OSA road?

[dbebz]

The reason I did the sleep study was I noticed when ‘crashing’ at friend’s places, my friends say I make choking sounds in my sleep. After the fact, I realized the major times this happens is when I drink and sleep on my back. I’ve been told by my friends that adjusting my position greatly improves these sounds.

I honestly don’t feel too tired on a day to day basis. Maybe 3/10. I don’t ever fall asleep at the job, never doze off etc. I decided to get checked out just to make sure I’m good. But then my doctor told me to drink and sleep on my back for my at home sleep study I never felt more terrible in my life. I rarely drink so usually I wake up fairly well rested. I have a crappy sleep schedule which probably makes me more tired, but for years I slept on 8 hours and managed to function every day. I’ve completed a university degree, worked multiple jobs with shift work and functioned well. The night of my test was a marked departure from how my body feels. I know what feels right and doesn’t. I obviously have some extend of apnea but to suddenly go “welp, here’s my 52 per hour sleep apnea study that is not realistic. I’ll just pretend that I didn’t cheat myself.” Not gonna happen. I’m a really nice guy and don’t like conflict, so I wasn’t as pushy with the clinic and original doctor who sent me for testing. The fact they said “52 won’t go down to any lower than 40, trust me” shows the dishonesty or lack of care to look into the issues. Then when they see the AHI of 11, “welI don’t need to send this to the specialist” yeah you do.

I just managed to get ahold of the doctor’s office for the sleep medicine specialist (who also specializes in respirology). She said it is a months long wait, but after I explained the situation her jaw dropped. She told me to get an urgent referral and she will get me in ASAP. Probably in a week. She explained that with my throat issues, it is very possible that positional therapy, treating these issues and the ENT appointment could very well bring my AHI even lower. It was basically 11 per hour with all these issues and tossing and turning from my back and side. The cut off in here in Canada varies but she said usually above 15 indicates CPAP, unless the mild apnea isn’t associated with treatable conditions.

In the end, she also said it was concerning that nobody was listening to me and said my apnea index wouldn’t change, and then when it went from 52 to 11, the clinic was reluctant to send it to the specialist for scoring.

I will look into all of this and figure it out. She said the doctor is impartial, and expert and will only recommend the best treatment for each patient, including CPAP if actually needed. I may even get the sleep lab to be sure. The fact that multiple doctors have now told me that this situation’s circumstances are extremely concerning demonstrates to me that I need to look into it further. I am very pleased I was able to get ahold of this doctor’s office and will figure it out.

Sorry if I sound angry, but I have a preconceived belief of doctors not helping and making things worse and this situation kind of reaffirmed that for me.

[HDCowboy]

Hmmmmmm....you sure? After a few drinks I sleep pretty dang good! I drank a six pack of Twisted Tea last night before going to bed and I had an AHI of .1 which lower than normal!

[dbebz]

Hahahaha nice! I’ve read that most people tend to get worse, but some have the weird affect of actually improving with alcohol.

Regardless, I may still need CPAP depending on my results. I may still be bordering mild to moderate but we aren’t exactly sure yet. I’m just happy that I’m going to see some specialists first to make sure I look into everything first as my throat issues definitely are making CPAP harder to manage. And the sleep clinic has agreed to back off a bit and give me some breathing room to look into this before making me do a final payment decision.

Twisted tea eh... good choice.

[khauser]

Note that even if alcohol improves ahi, it also interferes with your sleep cycles and you get less restorative sleep. You're also more likely to wake up (and probably have to pee), and to be dehydrated in the morning.
I'm not saying don't (that would be hypocritical) ... just be aware of the effects.

[MeToo]

I drink regularly (typically 2 glasses of wine) but I've changed the way I drink. I never have nightcaps, and rarely drink much with, or after, dinner. I drink early - finish by 6:30-7:00pm and drink lots of water afterwards. I find the alcohol leaving my system makes me feel tired and helps me fall asleep, but insofar as I can tell, going to bed 3 hrs after my last drink doesn't hinder the quality of my sleep in any way. I measure it by AHI and looking at Autosleep Apple watch app.

Cheers!

[nicholasjh1]

No idea why the doc said this, though I can say that when I heavily drink my apnea goes way down. Maybe because I can sleep on my side all night? Or maybe because it disturbs REM sleep. I don't drink now though and may apnea hasn't really changed other then that odd time where I'd sleep on my side all night and have no apnea's after drinking. But perhaps knowing your history he knows you drink on the regular and wanted to make sure it was normal circumstances and that you didn't miss severe drinking apnea. either way 50 is a lot, so regardless of your non-drinking outcome I'd say you need a mask. Just think, if drinking does it, then the slightest allergen or sickness would also do it. In addition it's doubtful that you are at 0 without drinking so you likely need it anyway. apparently pugsy lives in a dream world because there are plenty of even "moderate" drinkers who wouldn't find it hard to "just quit". That's fine that pugsy can easily not drink, but that also means Pugsy has no business implying its easy to stop drinking to "help" apnea. Personally I've managed to stop drinking but I've been an average 2-3 drink a day person for 20 years. it was not an easy task by any means. If you can do it though I say go for it.

[nicholasjh1]

Now that I read your follow up post I'm guessing the original doc doesn't agree with the ridiculous number of 15 AHI and wanted to do you a solid by suggesting you drink and sleep on your back, so that you'd qualify for the machine. You should shake the man's hand, stop whinning about clearly having apnea and start recovering by using the machine. Or you can ignore it and have interrupted sleep every night and huge oxygen loss whenever you get sick, have bad allergies, or the occaisional drink. Your choice, get busy living, or get busy dieing.

[chunkyfrog]

'Glasses of wine"
The size of said glasses might be an issue.
There was a time when a wine glass was about the size of a juice glass, only nicer.
Now, 16 ounces seems to be all I can get.
I find 6 ounces to be perfect--and only one, of course.
Dang if anybody has that size.