Yet another Newbie

Hi, just talked to my sleep dr with the results of the Monday pm sleep study. She said there were 151 'episodes,' and that there were a couple of times where my O2 dropped below 80%. She is recommending a second night with a CPAP to see how it goes and to adjust the titration. Am taking Lunesta and snoring has gotten much worse. Dentist had also talked about an appliance but MD feels the low O2 means it won't be enough.

Are 151 episodes a lot? Is the O2 drop dramatic enough for CPAP to make sense? How 'moderate' is this? Is this a result of my muscles relaxing due to sleep med and will go away once I'm off of it? Not afraid of trying CPAP but want to make sure it's neccesary given other's experience.

Any oxygen level under 94% should be improved. Mine got to 87% and needed treatment (I have mild apnea). Yours is under 80?? The number of apneas depends on the number of hours. You need the number/hours to determine how severe but if your oxygen level got that low I bet you have 'severe' sleep apnea. I'm still working on the big energy boost. But I will tell you that the absolute first thing that happened to me is that I quit sweating at night. As a matter of fact, last night I woke up freezing and I'm wearing warmer pajamas than usual.

Rusty! wrote:Dentist had also talked about an appliance but MD feels the low O2 means it won't be enough.

I'm not a doctor, but I really don't think anyone, not even a sleep doctor (or a dentist) can determine if a dental appliance for OSA "won't be enough" based on O2 drops, or even on a high number of episodes.

If pulling the jaw (and the tongue) forward during sleep happens to open the airway sufficiently, then the airway is open for breathing during sleep. There's not much way to know in advance if a dental appliance will or will not do that. But I personally wouldn't rule out trying a dental device just because of how much the O2 drops or even how severe the OSA is.

However, if I chose to go the dental device route, I'd definitely want to get a recording puse oximeter and be monitoring my own overnight O2 drops while going through the adjustment period with a dental device, like, say, the TAP (Thornton Adjustable Positioner.) As I understand those devices, you don't just pop one in and crank it forward and that's it. I think it takes a period of days, weeks, for the jaw to get used to being stretched forward a little bit more, and a little bit more, and more, until it finally is keeping the airway optimally open.

And, when the dentist had determined the device had finally been advanced as much as he thought you needed, I'd want a full diagnostic PSG sleep study again, while using the dental device, to be SURE it was effectively treating the OSA. I wouldn't go by what a bed partner said about not hearing any more snoring, etc.

That said, personally I'd go with CPAP. I'd rather have the immediate "open throat" that CPAP air can deliver, rather than go through getting the dental device working, if it took more than just a small amount of forward stretch to do the job. But for people who want to try something else or who are intolerant of CPAP, it's good that there are other options to at least try.

A lot of discussions about dental devices to advance the jaw/tongue are here:
Clickable LINKS to surgery, turbinates, Pillar, TAP experiences
viewtopic.php?t=2836

Rusty! wrote:Are 151 episodes a lot?

Yes. Depending on how many hours of actual sleep those individual events showed up in, you're in the moderate to severe category.

If the number "151" is not just a count of the separate episodes, but is actually your AHI from the study, then "AHI 151" would be extremely severe.

Rusty! wrote:Is the O2 drop dramatic enough for CPAP to make sense?

If you mean for CPAP to make sense as opposed to a dental device, I think it's all about what will keep your throat open. CPAP will for sure. Dental appliance might. Either one has its own set of problems and comfort issues. But again, I'd not judge whether a dental appliance would/would not work based on how much the O2 dropped during the study or by how many apnea/hypopnea events happened.

Rusty! wrote:How 'moderate' is this?

Again..if 151 was the AHI, that's severe. If 151 was the actual number of apneas/hypopneas recorded during x number of hours of actual sleep, then to find out what your AHI was, divide the number of hours of sleep into 151. That will give you the "AHI" (apnea/hypopnea index...the average number of episodes you had per hour.

Since you ask "how 'moderate' is this?", presumably your doctor used the word "moderate" to describe the degree of OSA you have, and probably was thinking of the AHI she saw on the study report.

These are the numbers I've read about as usually associated with degree of severity, when looking at AHI only:

AHI of:
0-4 normal, no OSA
5-14 mild OSA
15-29 moderate OSA
30 and above, severe OSA

Example: If you actually slept for a total of 6 hours at the study (even if you woke up off and on) and had 151 events recorded, divide 151 by 6. Your AHI would be 25. That would land you firmly in the "moderate" OSA category.

Rusty! wrote:Is this a result of my muscles relaxing due to sleep med and will go away once I'm off of it?

I'd say some sleep meds or even some other meds could make the muscles relax more, but I very much doubt if the sleep med is causing you to have OSA, or even having much effect on the degree of OSA you have.

Rusty! wrote: Not afraid of trying CPAP but want to make sure it's neccesary given other's experience.

From what you've written about your sleep study, I (not a doctor, mind!!) would say CPAP, or some method (like dental appliance) of keeping your airway open while you sleep, definitely is necessary.

I'd go with CPAP to start getting treatment right away.

Hey, welcome to the board!

MD said 7 hours of sleep so it was about 22 / hour.

I also had 150 episodes over a 7 hour period and O2 level that dropped below 80 once during the night.

I'm now on a cpap with a pressure of 7.

Video, how long did it tak until you felt that you were sleeping better / feeling better the next day? Right away or did it take time? Did you adjust to it well? Thanks.

In addition, I've read that MOST insurances do NOT cover the dental devices and that they can run as much as $2000, possibly more.

I was told during my sleep evaluation that if my 02 sats dropped below 88% for a specified length of time, the tech would have to call the doctor for an order to add 02 supplementation w/my CPAP to continue. I just don't remember the length of time.

88% IS THE MEDICARE REQUIRED LEVEL FOR 02 SUPPLEMENTATION, not 94% or 90%. And the amount of time during the night spent below 88% and duration of each drop below 88% are also part of the requirement.

The Dental Device (Silent Nite) was $475 (not including the impression which I had already made). You are correct - not covered under my medical. I may still have it made for the occasions that I don't want to travel with CPAP.

Rusty

Welcome to the board.

I am also new to the board and have been on a cpap for 6 nights.

I had 18 episodes per hour. Do not know about my oxygen level but I can tell you I felt better the next day after using my auto cpap with a flex.

Doctor said I needed a setting of 7 but since I have an auto machine I noticed that it has gone as high as 13.

Refer back to the board with any questions. People here really care about each other and as you can see offer their experiences to help each other.

Hunter

Thanks all for your advice / support - last night was the titration study. Sleep Tech (same as initial study) is wonderful and a bit surprised by all my questions (prompted by the board for the most part).

I settled on the Swift mask and wore a chin strap, think i ended up at a 9. Tech came in 1 x when there seemed to be a leak at 1:30 am but otherwise no problems. Minor nasal soreness, woke at 4:30 (normal) and they ended she ended the study at 6 am. Machine was a Respironics with a heated humidifier.

I feel very refreshed; Tech said I slept a lot on my back, unlike last time.

How long should it take before I get a machine?

Could be a couple weeks, but more importantly know what machine you want and what it is worth.

Get copies of both sleep studies, and your prescription in case you choose to go elsewhere later.

Know what you will pay out of pocket (your copay plus any deductable) and compare it to what you would pay online cash.

Don't take a base machine that provides no usable data as the billing code is the same for a data collecting machine and swapping out later is a pain.

Call the insurance yourself to find out what they cover don't just believe what the dme tells you.