What are the differences between mild, moderate, severe OSA?

LOL ractar28...PRICELESS description.
Simple...and so true!

lol ractar 28! Good way to put it.. Then I am definitely mild.. I am not ready to kill anyone... YET! *Looks over at her DME*

ractar 28 I love your explanation and I'm a combination of the moderate discription and the severe discription.

Michelle, you may want to look at how long you slept during the study and how much of that time was supine AND in REM, as this is often the worst case scenario. If you had little REM sleep, and even less while supine, your study is likely to not show the full extent of your apenas as you normally sleep. And since you can't just put on the mask for REM sleep, to be protected you will need it when not in REM also. Mild sleep apnea doesn't mean you don't need treatment - that would be a normal study. In any other realm, would you be ok with ignoring a 'mild' heart attack, or a 'mild' stroke? When we listen to our body's signs of impending danger and treat things while still mild, we may avoid a real health crisis.

For future reference, once your cpap treatment is stabilized, if you still feel your sleep is not restful, consider getting your limb movements evaluated. Some movements resolve with cpap treatment, others find they get worse. If you happen to be one of those persons like me with Periodic Limb Movement Disorder, the arousals from those movements can preclude apneas during testing and make it difficult for the test to determine the true extent of ones OSA. I know I've had OSA since at least 1995 based on symptoms, doctors' evaluations, and reports from those who observed my sleep. However, it was nearly 10 years and 4 studies later before it was captured - after my limb movements were more under control. I'm only telling you this so you can consider that with moderately severe limb movements reported during your test, there's a possibility you don't yet have a full picture of your sleep issues.

Not trying to discourage you at all, just want you to consider all angles. Personally, I think your doctor served you well to prescribe cpap treatment. But I'm a bit jaded on that since I suffered the consequences of not getting diagnosed and treated early on. Mine has in less than 3 years gone from mild to moderate to severe. I take that to mean all the untreated years that did all the damage were while my OSA was still mild. Hmmm - tell that to my brain and body.

Hang in there, Michelle. And please continue to be proactive in this aspect of your health.

Kathy

I think that the AHI values demarcating the mild, moderate, and severe categories are likely too high for many folks, and arbitrary at best.

I say this because, as one who reviews nightly data daily, I can tell the difference in alertness between a 0.5 AHI night and a (mercifully rare) 1.5 AHI night. I had undiagnosed OSA for many decades, and was a "bell ringer" on the AHI scale for the SS. So, I suspect that it's quite possible that OSA patients who've had sleep apnea for decades might be more receptive to anoxic triggers in responding to events (in epinepherine and cytokine producing ways) than those with a more recent history of the disorder.

I suspect that there are many folks who have been dismissed from sleep studies with AHIs of "only 4", but who desperately need xPAP treatment.

Regards all - -



.

MichelleFL - I have been wondering, all through both your threads about maybe not going ahead with therapy - Was that AHI 4.something, from your recent titration or your original sleep study when you were first diagnosed? You may have said which it was but I didn't see it.

If it was from your original sleep study then you are possibly borderline mild. If I was "borderline" mild, I would want treatment. Odds are, it will become moderate or severe.

If it was from your titration, then you achieved that AHI WITH the machine. This means that your sleep apnea could be moderate or severe, but WITH therapy you get an AHI of 4.something. Anything under AHI 5 is considered "treated" apnea if that is from your titration. With a machine, you get below 5 AHI which is where we want to be.

If it is from your titiration you are already moderate or severe and, therefore, need therapy.

Hawthorne wrote:Was that AHI 4.something, from your recent titration or your original sleep study when you were first diagnosed? You may have said which it was but I didn't see it.

My AHI of 4.9 is from the first sleep study and not from my titration. I ordered my titration results which should be here in the mail any day now.. You know how snail mail is..

Thanks for clarifying that for me.

It will be interesting to see what your titration AHI and other data was! That will give us more information.

A titration was suggested for a reason after your initial sleep study.

ractar28 wrote:Without a cpap, these are the determining factors:

Mild = Tired and cranky
Moderate = Ticked off and ready to kill.
Severe = Too tired to kill.

That perfectly describes my progression over the years.

Michelle, I'm glad to hear you've asked for your sleep study reports and that they are on the way to you.

A word about "mild"... in a full PSG study I finally had an opportunity to have done (two years after I'd started treating myself) my overall AHI barely got into the "mild" designation. But -- my AHI in just REM sleep was way up in the 20's.

I had already found that "cpap" treatment was doing me good. Felt like a morning person each morning, for the first time in my life. No longer got drowsy driving on long trips. No matter what the outcome of that sleep study had been, I'd have continued using "cpap" for the rest of my life. I had felt improvement.

Bear in mind that if UARS (Upper Airway Resistance Syndrome) is playing a part in your sleep disordered breathing, you might score a very low "AHI" simply because with UARS the brain can be arousing the person to breathe better, BEFORE a full apnea can happen, and BEFORE there is enough O2 drop to qualify as an hypopnea. But UARS arousals can wreck sleep architecture by bouncing you up out of whatever stage of sleep you were in, into a lighter stage. Arousals are kind'a like having micro-wakeups...not really waking you up...just causing you to get pushed up to a lighter stage of sleep.

A big catch-22 about cpap treatment, however, is that the sleep disruptions and discomforts that the equipment can cause (the mask, in particular) can leave a person just as tired and sleepy as before "cpap"...or even more so. That can make a person think that cpap isn't helping at all. If they were "mild OSA" in the first place, of course they're going to reach the conclusion, "WHY do this? WHY put myself through such an uncomfortable way to try to sleep, if I'm THAT mild anyway, and ESPECIALLY if I'm not seeing any improvement?"

That's where a really good sleep doctor willing to sit down with you and go through some of your sleep study to explain what was happening and why, would be wonderful. IF such a doctor had the time and inclination to do that. Big "IF!"

Lacking that, the next best thing to do is keep digging into this message board as if you were a med student studying for the exam of your life. Keep asking questions, keep looking at ways to make everything about the setup more comfortable. And keep reading as many posts as you can find about UARS.

Here's a link to two differing opinions about the importance (or lack thereof -- I agree with Dr. Sullivan's opinion) of relying mainly on "AHI" to determine whether or not a person might benefit from CPAP:
http://www.pulmonaryreviews.com/sep02/p ... Index.html

Kathy's advice (kteague) was right on target. That would be another thing (and a very important thing) to ask that mythical good sleep doctor with a lot of time to spend going over things with you.

Were the limb movements in your study simply "limb movements" (LM)...twitches because of sleep disordered breathing arousals? Those kinds of limb movements will subside when the thing (OSA) causing the arousals is taken care of with cpap. Or are they actually PLMs (Periodic Limb Movements) which is a separate sleep disorder that has nothing to do with OSA, yet can wreck sleep architecture too if they cause many arousals -- leaving you unrested, unrefreshed, and sleepy.

A lot to think about.
Good luck, Michelle!

Thank you rested gal as always you provide so much valuable information and I appreciate the time you took out to type it all out. I guess that is why I am trying so hard to find out as much information that I can about this is because I did feel much better the night of my titration. I had energy like never before in the morning and it lasted way into the afternoon. Then took a severe drop back to my old normal self.. Image what everynight would be like with CPAP and that is why I am so excited, if not anxious to start this whole thing.. But then I start with the nagging in the back of my head.. Just like you said, if my levels are low why would I need this treatment? So thus this question and the wonderful responses I get from everyone. I am very excited to be seeing my doctor next week and pray that he will agree to an auto machine at least to try it out.. What harm is there in that? I did quite well at my titration of 4 even though mostly everyone here says that it is hard to breathe at that level. I would even consider now getting a different auto machine as long as it's an auto. I feel it will help me more with my treatment even if I am not in the serious category...

ractar28 wrote:Without a cpap, these are the determining factors:

Mild = Tired and cranky
Moderate = Ticked off and ready to kill.
Severe = Too tired to kill.

I'm going to bed with a laugh on my face.
Thanks ractar28!

Sorry Ractor - with your description, I went straight from mild to severe. Then again, It seemed like I did that even with the standard diagnosis. I suppose my hubby and son are lucky I skipped the second stage!

Hello People

I wonder if severe apeona tell tale signs could be rated as severe, A incident falling asleep crossing a street and nearly getting yourself killed or flattened is to me known as life threatening cirrcumstances which I do not to ever experince ever again as long I live!!!!
[As it resulted me to be hosited and literaly dragged off and across the street by my friend!]

But My cpap is set 12 cms ho at the moment!

Blue Snuffle nose wrote:Hello People

I wonder if severe apeona tell tale signs could be rated as severe, A incident falling asleep crossing a street and nearly getting yourself killed or flattened is to me known as life threatening cirrcumstances which I do not to ever experince ever again as long I live!!!!
[As it resulted me to be hosited and literaly dragged off and across the street by my friend!]

But My cpap is set 12 cms ho at the moment!

Blue - it's good to have friends to hoist and drag your sleeping body out of harm's way when you need that. If you're falling asleep crossing the street, you may have narcolepsy. If you're getting narcolepsy while under treatment for sleep apnea, it may mean your sleep therapy is not working correctly. You should probably get tested at the sleep lab again for proper titration (PSG) and for the multiple sleep latency test (MSLT). If you have narcolepsy, there are options.

Read Rested Gal's Links in this thread.
viewtopic.php?p=300742#p300742

Good luck on getting better therapy.