Feeling discouraged: Doctor called my APAP a failure after two nights based on a physical observation.

I'm very new to this whole sleep apnea journey and just started my APAP machine. Because I have been having some trouble, I wanted someone with a pulmonology background to look at my sleep data, I made a appointment with a pulmonologist/sleep doctor.

Unfortunately, I left feeling completely confused and demoralized. I was hoping to get some perspective from this community.

I tried to show the doctor my data SleepHQ data, which included the O2 information, but he dismissed it saying it was unscientific. That only lab data was acceptable.

Then doctor quickly looked me over and said because of my recessed chin, no pressure machine will ever work for me. The my epiglottis will collapse due to positive pressure and it will never work. Said that "these machines are made for the general public, not you". Said I should never have been given one. I will say, I have seen two other sleep doctors and an ENT and while all of them have noted the recessed chin, no one has told me pressure is the wrong approach.

I know I'm struggling, and I was hoping for guidance, not a final judgment. I've only managed to actually fall asleep with the mask on for two nights.

Night 1: Was rough. I had a lot of events and my data showed my oxygen saturation dropped into the 70s. It was a bad night, for sure.

Night 2 (last night): Was better. I only kept it on for 3 hours before taking it off, I kept waking up for some reason but the large oxygen desaturations didn't happen. In my mind, this was a small step of progress and a sign that maybe things could improve.

When I tried to bring this up, he dismissed it. Said I would have "good days and bad day". He basically called the therapy a failure and said jaw surgery is the only option.

My Questions for you:

Is this guy right?

How much can a physical abnormality determine the success of PAP therapy without even trying to adjust settings, try different masks, or just give it time?

I'm just trying to understand if his assessment has merit. Is it really correct to just call this a failure now and be done with it?

The only thing we did agree on is that I should have a drug induced sleep endoscopy done for more information.

Thanks for reading and for any insight you can share.

TL;DR: My doctor saw a physical abnormality, declared my APAP therapy a failure after only two nights of use, and didn't look at my data. I'm feeling really discouraged and wondering if this is a normal or valid assessment.

Last nights sleep data. Does seem like I can handle pressure without epiglottis collapse, as he claimed would happen.

https://sleephq.com/public/a29fee60-770 ... 38f7a3104c

Forget that moron doctor. Tell him I said to go to hell.

Your statistics are good. Especially for so soon in the "game". Your settings look good.

Some of those drops in O2 might be artifacts. And they are not very low. 92% is still considered normal.

Why only three hours usage? I would like to see a night with longer usage. You can post a link in this thread after another night. Please stick to this one thread.

BTW, a pulmonologist is not the best to see about APNEA/CPAP unless he is also board certified in and currently practices sleep medicine. And why is he commenting on your anatomy? He's not an ENT.

I hate that he discouraged you.

taxpin wrote: ↑

Thu Aug 21, 2025 3:14 pm

only lab data . . . acceptable.

Medical people often believe that they are generally expected/required to go by medical-grade data from a validated source to keep their license and to be protected legally. That principle doesn't prevent you from choosing to take on the responsibilty of using other data to maximize effectiveness of a properly used medical therapy on your own body.

taxpin wrote: ↑

Thu Aug 21, 2025 3:14 pm

because of my recessed chin, no pressure machine will ever work for me.

I am not aware of retrognathia, in itself, ever constituting a contraindication for PAP therapy. Perhaps there at times are increased challenges, but we all have various forms of those, one way or another.

With a patient as intelligent and involved as you are, not every doc may be a good match for you. That's fine. But never let any one doc's opinion rob you of your commendable motivation and concentrated effort to make the best choices in improving your sleep and overall health.

I wish you all the best with it.

ChicagoGranny wrote: ↑

Thu Aug 21, 2025 4:30 pm

Why only three hours usage? I would like to see a night with longer usage. You can post a link in this thread after another night. Please stick to this one thread.

BTW, a pulmonologist is not the best to see about APNEA/CPAP unless he is also board certified in and currently practices sleep medicine. And why is he commenting on your anatomy? He's not an ENT.

I kept waking up for some reason. Was worried I was having o2 drops in the 70s like I had the first night. Clearly I wasn't. Still getting use to it and trying to get over the anxiousness.

Yes, he is board certified in and currently practices sleep medicine. Won't be seeing him again, but will be seeing a couple Sleep ENTs to see what they have to say.

So did this expert doctor offer any alternative treatment? Let me guess - surgery that will cost thousands?

Your SleepHQ chart looks pretty normal, especially for only your second night. I notice that each of the O2 drops corresponds with a movement, suggesting that the ring momentarily lost contact with your finger and gave a negative spike.

Don't be misled by the glossy brochures - CPAP is not an instant fix. For most of us it's a journey, and with any journey there will be occasional setbacks. This is normal, and we've all experienced it. Don't worry too much - if it doesn't work for you tonight, there's always tomorrow. Apnea is a chronic disease - it's with you for the long term, but that means there's plenty of time to get accustomed and get the therapy dialed in. But based on the three hours you've showed us, you seem to be on the right track.

Do you have copies of your sleep studies?

Respirator99 wrote: ↑

Thu Aug 21, 2025 7:54 pm

So did this expert doctor offer any alternative treatment? Let me guess - surgery that will cost thousands?

Just said I need surgery; not that he would do it. Sent me to an ENT practice with a surgeon to do a sleep endoscopy.

So last night I again had issues.

Had the mask on for over three hours. I was doing OK while awake, but fell asleep and then woke up in a panic for some reason. It didn’t look like my O2 dropped. Not sure why I woke up in a panic. Then started feeling like I was suffocating even though again my O2 was saying I was not suffocating. Then went back-and-forth with that for a while until I basically had to give up or just lay there in panic and anxiety. So then had rough sleep with nightmares and me waking up panicking trying to rip off a mask that wasn’t even there. UGH!!

Last night's data. Did my best to line up the O2 and the APAP. Times aren't in sync, unfortunately. I see there was a flow limit thing that happened there and then a leak later (this might have cued the wake up). Odd because I has my mouth taped.

https://sleephq.com/public/0aee194a-788 ... 4572468811

What an arrogant @$$hole of a doctor you ended up with! There's no reason to feel discouraged because he was a JERK and his advice was terrible. It does NOT mean you or your APAP treatment is a failure. He is a failure. And the only thing discouraging about that visit is that he gets paid to be a jerk.

Because of a genetic disorder I have a severely recessed chin. My APAP treats my severe OSA very effectively. It can work well for receded chins, and you can even do a titration study with CPAP to verify its efficacy if the machine data is supposed not reliable. I do have "good and bad" nights on CPAP. Good Nights my AHI might be 0 to 0.2. Bad nights it gets all the way up to 0.8. Which is still a very good night in reality.

Some people really do benefit more from surgical mandibular advancement, but at least a decent trial on CPAP should be done first--it's non-invasive, low risk, pain free, and relatively inexpensive and surgery remains an option if CPAP isn't enough. If you opt for surgery and have poor success, you may end up with lifelong side-effects and need CPAP anyway. So make sure you get a decent trial of CPAP before making any decisions about surgery.

taxpin wrote: ↑

Fri Aug 22, 2025 6:47 am

Had the mask on for over three hours. I was doing OK while awake, but fell asleep and then woke up in a panic for some reason.

you may have panicked because you subconscious mind was yelling at you, saying "my god, there's an alien on my face! wake up!! get it off!!". or at least that happened to me. you may want to wear your mask in the evening hours, while doing other things. this will help your "monkey brain" to get used to it.

good luck!

Nocibur wrote: ↑

Fri Aug 22, 2025 3:46 am

Do you have copies of your sleep studies?

@taxpin: Not a question I would ignore. Not from Nocibur, anyway.