My friend snores and stops breathing. Your comments ?

[Physician]

A 60 year old White male friend and a super-nice guy is a heavy smoker. His wife nagged him because of his heavy snoring and she witnessed him having minutes of apnea during the night. He finally went for a sleep study last December, and had a repeat one yesterday (results pending). So far he has received no treatment. He has no daytime sleepiness and claims excellent energy. His doctors have given him confusing messages... okay to not treat, must be treated, mild, serious, etc.

Please comment on his test results below, what treatment you would recommend, and risks if untreated. When I mentioned a BiPAP/PAP machine he was vehemently opposed to a machine, mask, pillows, etc. He thinks a mouth appliance alone will help. He jokingly offered divorce as another option, since he views his wife complaining is the only problem.

He will be reading the comments here in this thread and that will be more beneficial to him than the answers I gave him over the phone.

RESULTS FROM DECEMBER 2010 (rounded off)

BMI = 30
AI = 29
OI = 9
CI = 20
MI (mixed) = 0
HI = 19

AHI = 47
Av 02 sat = 94%
Lowest sat = 82%
% sleep time 02 < 90% = 0.1%
Snore - 0%

[LinkC]

At AHI=47, your friend has severe OSA. Unless he is tired of living and wants out, he needs to treat it.

If he isn't already, he needs to be made aware of the dangers of untreated OSA--especially at his level of severity.

If he still refuses to treat it, ask him if I can take out a life insurance policy on him... Seriously, there ARE consequences. None of them good.

[redjoe]

If it looks like a duck, walks like a duck, and quacks like a duck...

As Link said, your friend needs help, and SOON!

[Physician]

At AHI=47, your friend has severe OSA. Unless he is tired of living and wants out, he needs to treat it..

OSA ? Don't think you meant OSA, since the study is consistent with predominantly CENTRAL SA. Right ?

Where is the best article/web page for a listing of all the risks of his degree of untreated sleep apnea ? He would benefit from reading such an authorative dissertation.

[redjoe]

At AHI=47, your friend has severe OSA. Unless he is tired of living and wants out, he needs to treat it..

OSA ? Don't think you meant OSA, since the study is consistent with predominantly CENTRAL SA. Right ?

Where is the best article/web page for a listing of all the risks of his degree of untreated sleep apnea ? He would benefit from reading such an authorative dissertation.

Yes, given the data you've posted, he has more centrals than obstructives but, in any case he needs help. The AHI of 47 means he has a significant breathing problem, on average, 47 times per hour. That's serious business!

If you are, as your screen name indicates, a physician, won't he listen to you about the dangers?

I can't point you to an article right now, but how's this for starters:

Stroke, heart attack, heart arrythmia and other abnormalities, hypertension, type 2 diabetes, sexual dysfunction, clinical depression, nocturia, increased risk of automobile and other accidents, night sweats, morning headaches

Those are just off the top of my head. Enough for now?

[rested gal]

With a high Central Index in the sleep study, I'd be getting the heart checked out....thoroughly. I'd want to be sure I wasn't on the Congestive Heart Failure road.

He definitely needs to be on some kind of xPAP therapy, imho. With all those centrals...it might be that an ASV machine would suit him better. He might need to get treatment for both...obstructives and centrals. An ASV machine could do that -- treat both.

On the other hand, if those were post arousal centrals (following recovery breaths after obstructive apneas) the centrals might disappear when CPAP prevents the obstructive apneas. However, I'd think a good scorer would be able to tell the difference between "normal" (normal for what was going on at the time) centrals, and "real" centrals, where the brain had not sent a timely signal to "breathe now."

he was vehemently opposed to a machine, mask, pillows, etc.

You can lead a horse to water....

He thinks a mouth appliance alone will help.

An oral device would do nothing, zilch, nada for centrals, because the airway is already open during a central apnea.

[JointPain]

I am not a medical practitioner, and this is not medical advice, but there is ample reason to believe he has a serious condition. The benefits of treating this likely and potentially very serious condition far outweigh the inconveniences and risks of using XPAP in the very unlikely case that there's nothing wrong with him.

The only way I can think of for the true skeptic to be convinced one way or the other is for him to commit 100% to a "short trial" and evaluate how his statistics and how he feels after the trial compare to those before. Given the data from his sleep study, not doing so would be like an ostrich sticking its head in the sand.

Unfortunately, a short trial for CPAP is probably at least six months to a year long and may involve a bit of difficulty getting adjusted initially. I took to it like a fish to water, but lots of others, especially here, run into problems of one kind or another that need to get resolved before they get effective therapy, and that might take a little time. So, this would be a major commitment, but surely one worth making for his life (or perhaps his quality of life if would have had and survived a stroke or heart attack).

I would strongly encourage him to get a fully data capable machine and to get detailed feedback on his breathing while asleep, especially until he is known to be getting effective therapy.

He should go back to the doctor that recommends he be treated immediately and follow his recommendations for specific treatment.

[Mr Bill]

I am not a doctor. That said, it looks to me like he needs a sleep study titration with an ASV capable machine, to see if those centrals persist with CPAP BIPAP therapy and whether they go away with ASV therapy. To me, it looks like he needs treatment.

[BusyLyn]

He has no daytime sleepiness and claims excellent energy.

Before my sleep studies, I felt fine. I slept for 7+ hours a night, didn't wake up for potty breaks, had no nasty nightmares (indeed I couldn't remember dreaming at all), I didn't feel sleepy during the day, I didn't fall asleep at the drop of a hat, etc, etc, etc. But one of my doctors was quietly insistent that he wanted me to have a sleep study done just to rule out sleep apnea, so I did.

I had a lot of difficulty getting to sleep the night of my titration study, so I only slept a few hours. Even so, I was AMAZED at how wide awake I was and how energetic I felt after those few hours of restful, restorative sleep. At that moment I knew that I truly needed treatment. When you've been very sick, you usually don't know how sick you've been until you begin to recuperate and feel better. Many times you won't even admit that you're sick at all when you're at your sickest.

Your friend is in denial because he's so sick, but he can't merely wait for his body to heal itself. He won't get better without treatment. Others here have listed possible consequences due to untreated sleep apnea. Your friend has joked about divorcing his wife as the treatment for his sleep apnea, but he won't find it funny if his wife starts divorce proceedings because she cannot sit by and watch as he commits suicide by not getting treatment for his illness.

I hope that your friend admits that he has a problem and gets the help he needs - if not for his own benefit, then because he loves his wife and she wants him to live a long, healthy life.

Lyn

[BleepingBeauty]

I suggest that his wife videotape him when he's experiencing apnea. I'd think that would be enough to jolt anyone into reality, especially if it's severe. I've watched YouTube videos of people in the midst of an apnea, and it makes me unconsciously hold my breath right along with them. Eye-opening and scary when you realize just how much oxygen you're NOT getting at night.

And FWIW, oral appliances are not the recommended treatment for people with severe OSA. This therapy is.

I hope he's reading.

[Physician]

I suggest that his wife videotape him when he's experiencing apnea. I'd think that would be enough to jolt anyone into reality, especially if it's severe. I've watched YouTube videos of people in the midst of an apnea, and it makes me unconsciously hold my breath right along with them. Eye-opening and scary when you realize just how much oxygen you're NOT getting at night.

And FWIW, oral appliances are not the recommended treatment for people with severe OSA. This therapy is.

I hope he's reading.

Yes, has and will be reading all of these posts. I have a spare Respironics REMstar unit. Do you think I should loan it to him until he sees his physician next month ?

Will he need bi-PAP, or will that only be determined by the Sleep Study results ?

So I'll bet most of you would recommend this ResMed unit for him: http://www.resmed.com/us/products/vpap_ ... clinicians

[BleepingBeauty]

I have a spare Respironics REMstar unit. Do you think I should loan it to him until he sees his physician next month ?

Well, since you wrote above that, "he was vehemently opposed to a machine, mask, pillows, etc. He thinks a mouth appliance alone will help," it doesn't sound like loaning him a machine is even an option.

If he was my friend, I'd help him fit a mask (and troubleshoot any problems he had with it), loan him a data-capable machine with a pressure set in the low-middle range (8, 9, or 10 if he could handle it), and see how things went for a few days. Then read the data and make a small adjustment if need be, wait a few more days to see how things go, read the data, make a change, etc. (But I'm just another xPAP user with no medical training, so take that for what it's worth. )

Will he need bi-PAP, or will that only be determined by the Sleep Study results ?

Can't tell from what you know now. As someone upthread said, the Centrals might or might not need an ASV machine. In the meantime, until he can get the sleep study results, I don't think a reasonable straight CPAP pressure would hurt.

So I'll bet most of you would recommend this ResMed unit for him: http://www.resmed.com/us/products/vpap_ ... clinicians

If his centrals need to be treated with an ASV machine, that's the Resmed model. The Respironics model is called the BiPAP Auto SV.

[Physician]

My friend finally obtained a copy of his new sleep study. 15 pages ! My study was only two pages. After some of you give your educated opinions & recommendations, I'll post the doctor's recommendations.

Remember, he feels very energetic, has no daytime sleepiness, and his only complaint is that his wife complains of his snoring.





BMI 29
Age 64
Weight 170
Recording Time 7.5 hours
Sleep 7 hrs
SL 0.33
Awakenings 19
REM Periods 3
Apnea Count, Central 8, Obst 1
Index, Central 1.4, Obst 0.2
mean Duration, Central 10.3, Obst 27 (secs)
Hyponeas 6 with mean duration 26 secs
RERAs 24, mean duration 17 secs
AHI 15 with index 3.4 for NREM, and TST index 2.6
Apnea + Hypo + RERAs, REM index 2.2, NREM 8.1. TST index = 6.7
Mean Sp02% Wake 97.4, Non-REM 96, REM 90, TST 94

Arousals: Spont: 3 in REM, 23 in NREM, 26 in TST
Respiratory: 3 in REM, 30 in NREM, 33 in TST

Cardiac: normal

Poor sleep efficiency noted with fragmentation and WASO.

RERA's, Obst Hyponea, and Central apneas observed, and Sp02 desats seen with respiratory events.

Snoring reduced on higher therapeutic settings. PLMS were observed.

[cflame1]

He'll need to get both the apnea and the PLMS treated. One could be hiding more of the other.

[Physician]

He'll need to get both the apnea and the PLMS treated. One could be hiding more of the other.

He will be resistant to using a machine. Does this data show that treatment of his apnea is mandatory ? His wife is not bothered by any PLMS.