AHI of 5 -- would you CPAP?

[MoneyGal]

Not me, my mother-in-law.

She has an untreated AHI of 5.

She got a CPAP machine with a non-full-face mask (I am unclear on the terminology here! and I don't know what mask.) She says that "sometimes" her mouth must be open when she's sleeping, because she wakes up with a dry mouth. She also said she is unwilling to try a FFM.

She was visiting this week and slept in the room next to ours. Apparently she has snored for decades and the last three nights were no exception -- loud, continuous snoring throughout the night.

Here are my questions:

If you had an AHI of 5, would you treat it with CPAP?
and, based on what I've written, do you think it's possible she's getting any benefit from CPAP?

[Wulfman]

My answer would be "Yes". Because, it may only get worse from this point. You didn't mention how old she is, but if it's at the beginning stages (and I believe we ALL had a point at which we got progressively worse), it will head-off the apnea becoming worse and other medical conditions creeping in.


Den

[MoneyGal]

Good point. She's 67.

Any thoughts on my second question?

[grandmma]

MoneyGal, it sounds to me as if she is in denial about certain aspects of CPAP therapy, or the need to comply fully. Could be if it is early days, she'll come around, of course.

She's using the equipment and therapy, which is good. But it sounds like she's not willing to do everything it takes to make it work, which could be improved!

From what you've written, and the snoring you've heard, she needs to get the mouth leaks under control asap in order to maximise therapy. But I'm no expert here, I think others could give you advice on this.

[DoriC]

It's possible she may need her pressure adjusted and/or she may be mouth breathing and leaking air?

[Wulfman]

Answer to second question would be "Yes", too.......but if she's leaking her therapy air out of her mouth, you/she need to figure out how to stop that.


Den

[jnk]

. . . an untreated AHI of 5.

How long ago was that in-lab diagnostic sleep study done? Her untreated AHI could be much worse now, if that was a while back.

If you had an AHI of 5, would you treat it with CPAP?

The only way I would be able to establish my PRESENT untreated AHI would be to have another diagnostic sleep study. If (by some miracle of science, in my case) my AHI was 5 during that study, I would base my decision in the weeks that followed on how I felt not treating it versus how I felt when I did treat it.

. . .do you think it's possible she's getting any benefit from CPAP?

Hard to say. Even badly executed PAP may be better than no PAP at all, in my opinion. But if she has a dry mouth and snores, she needs to stop mouth leak and get her pressures right to get optimal therapy, no doubt about that.

[MoneyGal]

Her diagnostic sleep study is less than one year old. It follows a previous study one year ago. Neither shows AHI above 5.

Does that change any answers? Would you personally treat a current AHI of 5 or less with CPAP?

[jnk]

Her diagnostic sleep study is less than one year old. It follows a previous study one year ago. Neither shows AHI above 5.

Does that change any answers? Would you personally treat a current AHI of 5 or less with CPAP?

Was she diagnosed with OSA or with UARS or what?

I believe that you have to have an RDI over 5 to be considered OSA.

I would base my judgment on how a person felt. If there is no fatigue or daytime sleepiness, I would have to ask myself what was being treated and what was being accomplished. If I'm sleepy and tired without the machine, I would use it. If I'm not sleepy or tired without it, would I use it just for fun with my AHI that low? Maybe.

[Wulfman]

Not me, my mother-in-law.

She has an untreated AHI of 5.

She got a CPAP machine with a non-full-face mask (I am unclear on the terminology here! and I don't know what mask.) She says that "sometimes" her mouth must be open when she's sleeping, because she wakes up with a dry mouth. She also said she is unwilling to try a FFM.

She was visiting this week and slept in the room next to ours. Apparently she has snored for decades and the last three nights were no exception -- loud, continuous snoring throughout the night.

Here are my questions:

If you had an AHI of 5, would you treat it with CPAP?
and, based on what I've written, do you think it's possible she's getting any benefit from CPAP?

Let's reexamine this......

How does she "feel"?

What were the reasons she had the sleep studies to begin with?

Could it actually be a problem with nasal congestion, enlarged turbinates, deviated septum, etc.?
Snoring AND apnea are not necessarily mutually inclusive. (one may exist without the other)


Den

[tillymarigold_]

Yes, I would treat an AHI that low *if* my sleep doctor said he thought CPAP would improve my symptoms. (He did, I do, and it has.)

If she snores *continuously*, without stopping every 10 minutes or so, then that doesn't sound like apnea. (I'm basing the "10 minutes" thing on her AHI.) It could be UARS, though. Could also be something else entirely.

[MoneyGal]

Thanks for all the replies. This is really helpful.

Her son (my husband) and I urged her to get a sleep study even before a sleep study was on the horizon for me...because she was saying that she could not stay awake while driving, and was napping frequently without feeling "rested." Plus my husband says his mom has been a champion snorer for as long as he could remember. I thought those symptoms added up to sleep apnea, from what I had read and heard about SDB in the past.

I was really shocked when her AHI came back at 5. Her doctor didn't recommend anything (or so she said) coming out of that study. We pushed for another study, and she had one. Results are the same. I'm not honestly sure why she has a CPAP now. (I don't mean that she "shouldn't" have one, but that I don't know what decision-making process lead to her getting one.)

We don't have a close relationship with her, so it has been hard to get a lot of information from her (she considers these matters very private, and we aren't sufficiently close to her to be able to pursue a conversation on these topics for very long before she shuts it down). Unfortunately, she is estranged from everybody in her family except her son (she is a widow), so there isn't really anybody else we can ask to help us with this. Also, she lives a 5-hour drive away from us.

I guess when I started this thread I was really wondering whether she was, in essence, "wasting her time" by putting on a CPAP. From what I could tell (from the next room), she did not have noticeable episodes of apnea. I heard very steady snoring without breaks for long periods; several hours at a stretch (I realize this doesn't mean anything...she could have all of her episodes over one hour of the night, when I was also sleeping). I am also worried that whatever the therapeutic benefits of CPAP would be in her case, she is not getting them because her mouth is clearly open.

I'm still pondering what, if anything, to do or say to her. What would you do if you were me?

[jnk]

I have some ideas on solving the Middle East peace troubles, but when it comes to mother-in-laws, I'm tellin' ya, I got NOTHIN'!

That having been said . . .

You could always drop a note saying that although you didn't mean to hear it, you noticed she 'still snores when using the machine' and you thought that 'in the interests of being helpful,' you might 'pass along the enclosed info.' You could enclose a printout of, and link to, the following:

wiki/index.php/Mask_Leaks

[snoozeandlose]

You are in a tough situation--wanting to help someone who doesn't seem to want to discuss the problem. My thought is if the doctor didn't recommend a cpap then why and how did she get it and how did she determine what setting to use? Could it possible that her O2 sats don't drop enough to cause concern?

Another thought is that there are other sleep disorders including excessive daytime sleepiness and narcolepsy. While I have OSA I have also been diagnosed with EDS and receive separate treatment for it. Take a look at the information on talkaboutsleep.com. It's another website for all sleep disorders. She doesn't realize she is very fortunate to have family that care enough to try to help. Good luck.

[Muse-Inc]

MoneyGal, I'd check her sleep stage data in her PSG...she could have seriously fragmented sleep or deranged sleep architecture; if so, then CPAP therapy would likely be helpful. As to the mouth leaking, suggest the Hybrid mask, it's the original hybrid-style and has fewer parts than the Liberty, easier to get a good fit too. And, most importantly, it does not cover the nose or touch the forehead. I am claustrophic and this mask does not evoke that fear...so she might be accept it.