Is severe really severe?

Is the severity of sleep apnea related to the efficacy of the treatment?

I have been diagnosed with severe sleep apnea (RDI of 47). I have lost a lot of weight before my sleep study to get myself in the ideal range. The doctor has said that losing any more weight would not help me that much because I have severe apnea.

However, my prescribed CPAP pressure is 6 cm. At 6 cm, my RDI drops to 0. Also, sleeping on my side reduces my RDI 22. I get the feeling that these little things make huge improvements for me, despite having severe sleep apnea.

Some people have said that after losing weight, their pressure gets reduced. I'm thinking that the doctor might be wrong and that losing weight might make a drastic change. If my pressure was reduced any lower, it could end up at 0.

What are people's thoughts on this?

Prevail

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I deduce from your response that you think higher severity needs more potent treatments. Is that correct?

Prevail

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Prevail, is the information you are giving based solely on your lab time? I didn't see any equipment listed in your profile yet. I do hope you have (or will have) access to machine data so that you can feel assured that your severe sleep apnea is being effectively treated even at a low pressure. Severity of sleep apnea and pressure needed for treatment don't run a parallel track. Keep in mind the variablilty of sleep apnea mechanics, such as where the obstruction occurs, etc. Since count is the major part of the mild, moderate, or severe determination, a person with many 10 second restrictions can be termed the same as one with fewer yet a significant number of longer apneas with worse desats. The tissues of some may flutter and lightly close, and another's may collapse and lock down solidly. What's key is each person KNOWING that their prescribed pressure is woorking night to night, and that requires a data capable machine.

The pressure rate does not correlate to the severity of the apnea. Severe apnea can be treated with a low pressure such as six if that is all that is needed to keep YOUR airway open. Moderate or even mild apnea can require a much higher pressure if that is what is needed to keep that individual's airway open.

Prevail wrote:Is the severity of sleep apnea related to the efficacy of the treatment?

I have been diagnosed with severe sleep apnea (RDI of 47). I have lost a lot of weight before my sleep study to get myself in the ideal range. The doctor has said that losing any more weight would not help me that much because I have severe apnea.

However, my prescribed CPAP pressure is 6 cm. At 6 cm, my RDI drops to 0. Also, sleeping on my side reduces my RDI 22. I get the feeling that these little things make huge improvements for me, despite having severe sleep apnea.

Some people have said that after losing weight, their pressure gets reduced. I'm thinking that the doctor might be wrong and that losing weight might make a drastic change. If my pressure was reduced any lower, it could end up at 0.

What are people's thoughts on this?

Prevail

Prevail,
I'm a Sleep Technologist. The lowest setting on xPAP machines is 4 (cm/H2O). I've done multiple studies on the same person from diagnosis to the first titration to another titration years later when they have either gained or lost weight. In general, when somebody gains weight, they need more pressure to keep their airway clear. When somebody loses weight, sometimes they need less pressure.
Check out my blog listed below, you may find some answers you are looking for.

Thanks for the response sleepmba and bailachel. I checked out the blog and read the whole thing. Good stuff.

kteague wrote:Prevail, is the information you are giving based solely on your lab time? I didn't see any equipment listed in your profile yet. I do hope you have (or will have) access to machine data so that you can feel assured that your severe sleep apnea is being effectively treated even at a low pressure. Severity of sleep apnea and pressure needed for treatment don't run a parallel track. Keep in mind the variablilty of sleep apnea mechanics, such as where the obstruction occurs, etc. Since count is the major part of the mild, moderate, or severe determination, a person with many 10 second restrictions can be termed the same as one with fewer yet a significant number of longer apneas with worse desats. The tissues of some may flutter and lightly close, and another's may collapse and lock down solidly. What's key is each person KNOWING that their prescribed pressure is woorking night to night, and that requires a data capable machine.

Yes, the information comes from my somography. Maybe this will shed some more light on the topic. I haven't gotten a machine yet for a number of reasons, the first of which is that my doctor has suggested that I not rule out other treatments. He said that this was because I am young and young people tend to not like wearing the machine as much. Right now, I am being fitted with a dental appliance and if that doesn't work to my satisfaction, I'll be prepared to order a machine. If I don't have the machine, hopefully I can find something else that will measure my sleep quality.

But in the meantime, I will still continue to try other things such as losing weight and doing vocal exercises. I don't think its unreasonable to want to be able to sleep normally without the machine so that is what I am working towards. The doctor kept referring to my RDI number when I asked if other things can fix me.

Prevail

I guess its a glass half full / glass half empty situation.

Your apnea may be severe but you take a very light pressure to resolve it with CPAP. Less pressure means less tendency to leak which means more mask options. Probably less noise. Less effort learning to breath against pressure.