How do we know that a OSA Dx isn't a scam?

[larry63]

My test..if you don't think its working, go without it for a couple days and see how you feel! alot of people don't realize how much better they are doing until they go with out it and realize they are much worse the next day.

Actually I was thinking of doing that (and my body is screaming at me to do that anyway!!).

Of course, it's hard for me to imagine things being much worse then they are now. At least before therapy I was able to get _some_ work done, and be only an hour late for work. Now it's two hours late and I might as well not even show up.

But I'll give it a try for two nights. Good idea! Thanks. My theory is that I'm waking up often during the night to adjust my mask because the hiss wakes me up.
It seem that I wake up no when I shift from back to side for example, because the nasal pillows shift position and I need to re-seal them.

Before I used CPAP, I only remembered waking up when I needed to pee or drink water, or from some other outside disturbance. Now, I wake up more often then that to adjust the mask, then it takes a few minutes to get back to sleep?

I guess that means to try another mask...?

Or it could be the opposite, like I said in another msg, that I actually more often sleep half the night without therapy because I just involuntarily fall asleep on the couch or in a chair.

[larry63]

Well, larry, I am likely a few miles off base, but one thing caught my eye. You say you snore loudly and continually, but your mask is a nasal pillow. But isn't the whole point of CPAP to get the pressure in there to stay? Is a nasal pillow going to do that if your mouth is constantly open with snoring?

Ok, well first of all I did snore loudly and continually before CPAP. But honestly I didn't know snoring didn't require the mouth to be open. I've certainly caught my self mildly snoring as I was falling asleep, and I assure you that my mouth was closed. But maybe that's different then full blown snoring.

I have to admit (and I'm not being argumentative here), that I really don't understand the premise. Isn't CPAP to eliminate snoring, hence, your mouth would not need to be open?

I did notice once that even though I was wearing the nasal pillows I did hear a sound in my throat once while I was trying to sleep. But again, my mouth was closed. Really! i assure you!

And another thing - my sleep study indicated heavy snoring, yet they did not suggest a full face mask. So, I don't mean any offense, but either they f'd up, or your premise must be wrong.

I have constricted nasal passages, I've been a mouth breather all my life, and my respirologist, sleep study tech, and DME tech unanimously prescribed a full-face mask for me, a recommendation which to me made eminently good sense and still does. Of course I am also a little sceptical as to how nasal masks or nasal pillows alone can work for vigorous snorers.

Not nasally congested on this end, except sometimes just somewhat, but am still able to breath through both nostrils.

But I'm thinking on this issue - the DME recommended a chin strap or a full face mask, to see if it made a difference, Initially I was think of them faxing an rx for a chin strap. But if my insurance pays for it, I'm thinking, why not get a full face mask instead? It would come in handy when I have a cold, right?

[larry63]

I should re-mention one thing in my case,

that the AHI in the report I obtained pretty much matches what is displayed on the LCD, namely between 0 and 2 AHI.

This is with the caveat that if the flow is over the limit (17% percent of the time, the detection is unreliable).

Well, I don't want to analyze it anymore. Unfortunately, no doctor actually analyzed the report - it's only but in an SQL DB that my ENT doc can DL.

So really I don't know what it implies.

[DoriC]

I have to admit (and I'm not being argumentative here), that I really don't understand the premise. Isn't CPAP to eliminate snoring, hence, your mouth would not need to be open?

Larry, you don't have to snore to be breathing through your mouth. I watch my husband sleep sometimes and can see through his FF mask that his mouth is open but he's not snoring and his mask isn't leaking, he's just in deep restful sleep. The correct pressure finally did eliminate his snores. It sounds like you're having pretty large leaks so any of your data would be unreliable. You may be a candidate for a FF mask, try the Quattro or the Ultra Mirage but make sure it's the right size and adjusted properly. Most people avoid sleeping or napping without their cpap.

[larry63]

Larry,

The concept of "sleep debt" or any reliable predictability of repayment has been "discussed" on here before, and is not universally accepted. To me it contains too many variables to expect a one-size-fits-all. Since we are not speaking of regaining hour for hour the sleep lost, I prefer to think of it as recovery time, or, however long it takes to achieve one's personal optimal recovery. But whatever it is called, if one accepts that sleep deprivation affects body systems such as hormonal balance, insulin sensitivity, muscle repair, etc., and if one accepts that low oxygen can damage organs and the brain, and if one accepts that stress hormones that accompany apnea can adversely affect health, it just makes sense to me that efficient recovery would require extra rest and sleep through the recovery period (whatever time that may be). Sleep apnea adds another layer to general sleep deprivation. In any other assault on one's health it is generally accepted that recovery takes time and rest is advised. I don't see this being an exception.

Just a little light reading...
http://www.ncbi.nlm.nih.gov/pubmed/18533327
http://www.ncbi.nlm.nih.gov/pubmed/17548824

Tks, I'm beat so my apologies in advance, but thanks for the cites. But from a very quick glance of the abstracts, the first one deals only with acute spleep deprivation, so it's not really relavent.

And the second one may be relevant but the study was done only with rats.

I certainly don't mean to disparage but sorry I have to limit my time on these forums and if you have a more informed opinion of on or two of these studies it would be great to here.

[larry63]

I have to admit (and I'm not being argumentative here), that I really don't understand the premise. Isn't CPAP to eliminate snoring, hence, your mouth would not need to be open?

Larry, you don't have to snore to be breathing through your mouth. I watch my husband sleep sometimes and can see through his FF mask that his mouth is open but he's not snoring and his mask isn't leaking, he's just in deep restful sleep. The correct pressure finally did eliminate his snores. It sounds like you're having pretty large leaks so any of your data would be unreliable. You may be a candidate for a FF mask, try the Quattro or the Ultra Mirage but make sure it's the right size and adjusted properly. Most people avoid sleeping or napping without their cpap.

Umm, I think there is some mis-communication here. It is my understanding that snoring does not imply that one is breathing through the mouth.
But conversely, breathing through the mouth does not imply snoring, hence all four possibilties are possible:

SNORING / BREATHING_THROUGH_MOUTH
F/ F
F/ T
T/ T
T /F

Or am I completely misunderstanding you? Sorry if this doesn't make sense.

And FWIW, even though I am skeptical that I can be mouth breathing without the massive rush of air waking me up (even a minor nose leak or a rush of a breeze through a window wakes me up) I am going to either get a chin guard or a FF mask. I'm actually leaning toward the full face mask (if the insurance will pay for it) because that would come in handy if I get a URI where I can't breath through my nose.

[NotMuffy]

It is my understanding that snoring does not imply that one is breathing through the mouth.

With apologies to Bill Clinton, it depends upon what your definition of "snoring" is.

If it refers to the racket generated by soft palate and uvula, and since those structures move forward during nasal breathing, then that's exactly what it implies (AKA, the infamous "Definite Maybe").

That narrowing of definition allows the "Wear A $70.00 Chin Strap and Your SDB Will Be Cured" people the tiniest sliver of truth that protects them summary execution (however, it would only have a shot if the diagnosis were "Primary Snoring", and not OSA, UARS, etc.).

Ahhh, WTH, let's get the Dillon anyway.

[larry63]

It is my understanding that snoring does not imply that one is breathing through the mouth.

With apologies to Bill Clinton, it depends upon what your definition of "snoring" is.

If it refers to the racket generated by soft palate and uvula, and since those structures move forward during nasal breathing, then that's exactly what it implies (AKA, the infamous "Definite Maybe").

That narrowing of definition allows the "Wear A $70.00 Chin Strap and Your SDB Will Be Cured" people the tiniest sliver of truth that protects them summary execution (however, it would only have a shot if the diagnosis were "Primary Snoring", and not OSA, UARS, etc.).

Ahhh, WTH, let's get the Dillon anyway.

Ok, I guess it wasn't 100db snoring I was feeling as I was falling asleep with my mouth shut. More of a feeling that things were closing up, and _some_ sound was being made, although it wasn't loud.

[larry63]

Larry: "So why did my sleep study show an AHI of 65? Doesn't that mean that on the average, I have trouble breathing for more than 10 seconds every frigging minute?!?"

Did you ask your doctor how many of the apneas are OSA and how many are centrals? Is it possible that you'd be better off on a bipap or ASV? More expensive machines again, to make you worry about being scammed, but perhaps necessary in your case. That's where I'm headed. My titration study showed that my obstructives were eliminated but my centrals went up a bit. My AHI is still high, so the doctor is guessing that the centrals have increased since I went on the CPAP (I don't have access to data, but since this machine is going bye bye I'm glad I didn't purchase the software). I trust my doctor because he's a part-time prof at Penn State teaching sleep disturbances and pulmonary neurology. Does your clinic website provide bios of the doctors so that you can see what education, fellowships or positions they've had?

Good point! I have the report somewhere but I remember most my events being hyno and actual apneas, and only 2 or 3 centrals.
Unfoturnately I don't know if I even _have_ a clinic. What happened is Is referred to my PCP (In the US, this is sort of the primary doctor that you usually see), to and ear-nose-and-throat doctor (ENT), who then referred me to a sleep center who did the sleep study. I assume that some sort of sleep doctor looked
at the raw data and formulated a summary report which then went back to the ENT, who then wrote a prescription that when to a Durable Medical Equipment provider (DME), which came by and dropped the CPAP pump and a mask off. So it is really difficult for me, when I have a question, to determine whom to call.
I think it's the DME, but they admit that they're a bit overwhelmed by the amount of OSA cases that they are given, and don't really know all of the equipment yet.

[larry63]

My sleep study showed no REM cycles without CPAP. In the last 4 months I have started dreaming again. As well as my depression has improved, no need to take sleeping pills anymore. Overall just feel better. Used to be a really restless sleeper. Waking up frequesntly. Now barely move when I sleep. Diagnosed 4 month ago and haven't missed a night since.

You are so lucky! I miss my dreams. I don't recall any since I started CPAP. Last night I took the advice of someone to experiment and go a couple days with out,
and guess what? Awesome dreams!! I really am hoping that eventually I'll start remembering dreams again, because to me they're an essential part of my psyche.
I can't imagine life without dreams...

[Tired Linda]

I can't imagine life without dreams...

I can't imagine my life without CPAP.

[larry63]

It's not like Lyme's where it is diagnosis by elimination. There is an active, concrete collection of positive data. Not just a bunch of negative test results.

Very true and thanks for pointing that out. (However, it's actually "Lyme" disease, not "Lyme's". Lyme is actually a town in Connecticut US, where an unusually high percentage or arthritis was found buy a Dr. Steer (don't remember his first name or his last name spelling). But the takeaway is if you ever venture into the northeast US, remember to say "Lyme" and not "Lyme's" lol).

Anyhow you are correct, the Lyme disease controversy and the OSA controversy are really coming from opposite directions. The first is a grass roots movement who demand long-term antibiotics even though the university researchers denied the likelyhood of a chronic disease that caused fatigue, depression, neurological impairments, and the like.

OSA however, seems to be the opposite in the sense that there are definite objective tests that presumably are reliable. However there is still the problem that, like chronic Lyme treatment, people often feel worse with treatment then without.

I am not saying that either chronic Lyme or chronic OSA is a bogus diagnosis. I am only saying that when people feel worse when they are treated for a condition, it naturally could create a doubt in their mind. And I would not have even brought up Lyme except that a similar thing happened to me with the tx for Lyme. And now this is the second chronic condition in my life that has symptoms that have got worse with treatment, instead of better.

[larry63]

Larry,

http://www.ncbi.nlm.nih.gov/pubmed/17548824

I read that abstract again. Even though done with rats, it is an interesting result. What it means, who knows? I'm not a medical researcher.
But perhaps it's a start. Unfortunately I'm not really hooked up into to the medical research databases. I'm not really sure how a few days with
rats compares to a few years with humans.

Perhaps there have been some studies done with, for example, war veterans? I'm just thinking of some situation where people have been
chronically sleep-deprived for years. What about studies on shift-work people for example?

I know that this whole sleep-dept question is really a difficult one to answer, because obviously it would be unethical to do a controlled
study on humans.

Very interesting question though. I bet that the medical field is only just begining to learn what goes on.

I mean, after all, the last I heard, we are not even sure what the purpose of sleep is in the first place, or why we even need it! (Is this still true?)

[mgrunk]

FWIW, in regards to dreams, I have had nightmares my entire life. Since I started CPAP and am able to record the data, I found that when I was waking up from the nightmares, I had just had an apnea. So, I wonder how much of our remembering dreams is apnea related, and that we remember them because we've waken ourselves up to breathe.

[BlackSpinner]

You are so lucky! I miss my dreams. I don't recall any since I started CPAP. Last night I took the advice of someone to experiment and go a couple days with out,
and guess what? Awesome dreams!! I really am hoping that eventually I'll start remembering dreams again, because to me they're an essential part of my psyche.
I can't imagine life without dreams...

Well the reason you remember your dreams is because you woke up due to an event where you stopped breathing. So you can have a short life with vivid dreams or you can have a long one and learn meditation and lucid dreaming.