New member, wired for sleep

[chunkyfrog]

I was feeling so terrible; I was bouncing off walls, dozing off at my desk, at the movies, and driving.
--I was that sleep deprived; I might have even killed someone.
My AHI was only 13, but thank goodness for comorbidities:
High blood pressure and diabetes may have saved my life, as my insurance had to cover my apnea.
Sometimes bad things can be good.
Other health problems may actually help.

[pootsie]

Well, if there is some other effective approach, I am happy to try it. I was kinda looking forward to trying CPAP, though. Pity I'm not sicker, eh, Froggy?

[grapeshly]

Pootsie, we all think an AHI above 5 (and yours is 10) indicates sleep apnea. That above 15 thing is out of step with current medical opinion. If I were you I'd take the test results to get a second opinion. If someone has observed that your breathing has stopped, in my book, that's a sure sign of a problem. And you have been drowsy during the daytime? (And not just after a big lunch, either, but at all or at random times?) Another indicator. I don't even know if there is some other "treatment" and I worry that if you don't get this looked at, not only will it get worse, but your body will start taking a beating. Trust us older folks, who have been undiagnosed for years and years on this, sleep apnea is a slow and silent killer.

[jdm2857]

Here's the Medicare required sleep test results for the coverage of CPAP:

B. The patient has a Medicare-covered sleep test that meets either of the following criteria (1 or 2):

The apnea-hypopnea index (AHI) or Respiratory Disturbance Index (RDI) is greater than or equal to 15 events per hour with a minimum of 30 events; or,
The AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour with a minimum of 10 events and documentation of:

a. Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia; or,

b. Hypertension, ischemic heart disease, or history of stroke.

Many private insurance companies follow the Medicare rules.

So finding a doctor to write a script for you should not be a problem. Your primary care physician can do it.

[grapeshly]

Also, I would add that my doc said that a large neck diameter and/or unusually small passage of your throat (some of which they can see just by looking at the physiology of the back of your mouth opening) are also factors that together with the observed stopped breathing and the drowsiness and the numbers from the study, indicate a high probability of OSA. He said this to me because I had only a home study, and without a study done at a sleep lab he wasn't sure my insurance company would accept the diagnosis, so he added that for supporting evidence.

[Kenwood]

So here is my update:

My second study is cancelled. My AHI is only 10.6. The doctor does not prescribe CPAP for less than 15.

I am instead scheduled for a follow-up consultation for more conservative therapy.

I have to say, if 10.6 is this sleepy and groggy, 15+ must really, really suck. I feel for you!

RUN from that doctor!!!

AHI < 5 NORMAL
5 = < AHI < 15 MILD
15 = < AHI < 30 MODERATE
30 = < AHI SEVERE

[pootsie]

Wow, some strong reactions here!

I will certainly consider the second-opinion route. I have my next appt. with the Dr. on 5/15, so I will see what happens then.

Thank you all for your input. If anyone else has something to say, please chime in!

[chunkyfrog]

Tell the doc you are considering driving a big rig, and you plan to put his name down as your physician on your CDL application.
If he is OK with you not being treated, then whatever happens, happens--the lawyers will know who to come after!

[pootsie]

Too late--they already know I'm a lawyer.

The world is safer if I pass out

[Pugsy]

Too late--they already know I'm a lawyer.

The world is safer if I pass out

Sometimes it's more than just an AHI number unfortunately but the medical community leaves and breathes numbers.
My AHI in non REM sleep was only 12...not all that scarey but I had some massive long events in that 12 per hours causing desats to 73% and that was before I got to REM sleep where my AHI was over 50.
So a single AHI number doesn't always tell the whole story.

After I started cpap therapy my AHI dropped down to around 8 or 9 per hour but they were all clustered in little groups with a lot of bland time in between. I still felt horrible..still had the morning headaches...still had to get up and pee 3 to 5 times a night. Once my AHI got down to around 3 (and the clusters no longer existed) that was when I started feeling better.
So once again..the AHI didn't tell the whole story.

I wish the AHI was a clear cut indicator but sometimes it isn't.

Get a copy of your sleep study for sure...there may be something in there that points to cpap as being a viable option.
Like maybe oxygen levels...or amount of REM sleep..or whatever.

Finally...there's the UARS thing. Upper Airway Resistance Syndrome. With it the AHI is often not remarkable but people still feel like crap. Cpap is still the optimal treatment for UARS.

If your symptoms are significant..maybe there's more to it than just AHI and maybe cpap is still something worth trying.
Get that second opinion if you can.

[zoocrewphoto]

I'm going to agree that ahi is not the only factor. My mom also has sleep apnea too. Last summer, I let my mom use my machine for two partial nights since her older machine didn't have any data. The first night, I set the machine for straight 10, her prescription. AFter 4 hours, I took my machine back and uploaded the data so I could print a report before adding my own data to it. Her treated ahi was 3.4, not bad at all. Then I looked at the data. Holy crap. She had a cluster of events, 8 in 10 minutes, and one of them was over a minute long. Clear problem.

So, you may have an ahi of 10 which is classified as mild sleep apnea. But if those events are in clusters and/or long, they could actually be quite serious. Also, without seeing the sleep study results, you probably don't know yet if you sleep much on your back or got much REM. Both of those tend to be worse for events, but if you didn't have them, then your ahi isn't going to be very accurate. I did a split study, so they woke me up after 2 1/2 hours of sleep as I produced enough data to proceed with the titration. My ahi was 79 which included supine (99) and side sleeping (74). I did not reach REM sleep during the diagnosis, so my real ahi could be worse. Most of my events are shorter, so my oxygen desats are not as bad as many people here. But obviously, the number of events really messes with my sleep, and I had a lot of symptoms that I didn't know were related. I thought the gasping and choking fits were caused by acid reflux. In reality, my gasping was due to not breathing, and my gasping was bringing up the acid. My cause and effect were reversed. My bathroom trips were due to stress hormones caused by the apneas. My morning headaches were caused by the apneas (lack of oxygen). The longer I sleep, the worse my headache. I was always tired. Not as cheerful as I used to be. My blood pressure was very bad and getting worse, even with medication.

[pootsie]

The longer I sleep, the worse my headache. I was always tired.

That is so me right now.

I appreciate everyone's input here. I very well may ask to pack up my data and head somewhere else. I have my next consultation on 5/15 so I have to wait, I suppose.

Thanks, all!

[pootsie]

Situation update:

Current coverage = 100% until July 1. Then my OOP skyrockets.

If I am going to get a machine, I really want to do it now.

So I called the Dr.'s office to let them know I want to do my study with the machine, and that I "really don't" want to have to go somewhere else.

Stay tuned .... (unless you have better stuff to do, lol)

[pootsie]

I managed to get the Dr. on the phone, and we had a great talk.

Basically, his opinion (and I find it a sound one) was that we should start conservative and work up to greater intervention. He is not saying I am not a candidate for CPAP, just that he wanted to explore more conservative intervention first.

One thing that came out was my existing TMJ problem that my dentist has already prescribed a night appliance for. We had not discussed that before. Given that the apnea appliance pulls the jaw in the wrong direction for TMJ and my mouth is already full, the more conservative option of a night appliance is now ruled out (at least for now). I am not a surgery candidate in his opinion, either.

He completely understood my insurance issue, and said that since the TMJ may interfere with the night appliance option and there is a time issue with coverage, we can go ahead and give CPAP a try before any pills.

As I was halfway through writing this post, his office called back and my Monday appt. is back on!

I will be posting from the study bed again. I know y'all are aching to see my bald head with a mask on

[jdm2857]

CPAP is conservative treatment.

It has very little potential for harm, is non-invasive, and is completely reversible.

It's also pretty inexpensive as least among medical procedures.