Pre Apnea diagnosis

Good for you Bob! Come back and tell us how it went and what you learned. Be sure to get a copy of the study results.

Just to followup on my earlier posts...


Due largely to the helpful reponses to my posts, I got a referral to the local pulmonologist/sleep apnea doctor. I was a little skeptical because the sleep lab and this doctor's are joined at the hip, it the same building (and no other offices in the building). I found the specialist to be arrogrant, but he did order a sleep lab overnight test immediately which I took, and he concluded I had 90 of the "stop breathng" episodes per hour (I still don't know the terminology), which I found hard to believe because that mean I stopped breathing more than once a minute, which makes me think that that what counts as "stopped breathing" must be a rather low threshold. In any event, he diagnosed me with severe sleep apnia,immeidately schedule me for another overnight sleep lab test to get the parameters for a CPAP machine. I was discourage to find out I have to sleep with this thing for the rest of my life and was concerned about the apparent difficulty getting used to it.

To my surprise, it didn't bother me nearly as much as I expected and I did sleep pretty good the first night with it and it actually felt pretty good. I tested my self with my own oximeter (which the specialist dismissed as a pointless exercise), and noted my SPO02 levels went from bouncing all over the 80's and 90's pre CPAP to solidity staying 94% or above the entire night post CPAP which provided me with some empirical independent evidence that something beneficial is happening.

I actually got my more interesting feedback from the sleep technician who monitored me for the CPAP machine. She told me "I had it pretty bad", and so I quizzed her on remark. She said, among other things, that the fact that they had to set the CPAP setting to 18 (out of an apparent max of 20) was significant and she observed my sleep movements changing significantly as the CPAP machine went online.

Bottom line. So far so good... but still am somewhat skeptiical about the whole thing.... Thanks again for the feedback, kind of a lonely experience, really appreciate the support from total strangers...

Bob6466 wrote:... To my surprise, it didn't bother me nearly as much as I expected and I did sleep pretty good the first night with it and it actually felt pretty good. I tested my self with my own oximeter (which the specialist dismissed as a pointless exercise), and noted my SPO02 levels went from bouncing all over the 80's and 90's pre CPAP to solidity staying 94% or above the entire night post CPAP which provided me with some empirical independent evidence that something beneficial is happening. ...

Bottom line. So far so good... but still am somewhat skeptiical about the whole thing ...

Why be skeptical? You have two ways to measure how xPAP therapy impacts you. Those are not owned by the sleep lab. They can not "fake" these two things.

FIrst we have your own pulse oximeter. It shows through the numbers that your sleep improved. Why do you think the numbers were dropping? Below 88% is considered the point where you need oxygen! Clearly your body was not getting enough oxygen! So, with CPAP it is. That seems to indicate it is in fact doing its job.

Second we have how you feel. Again, no lab in the world can fake that. You feel somewhat better. That will improve as you continue to sleep soundly.

Read some more, you will find that while an AHI of 90 is very high, it's not unusual. AHI stands for your apnea and hypopnea index. This is both the number of times you stopped breathing (apnea) and the number of times you had an airflow restriction (hypopnea). So, it's not just the number of times you stop breathing. But I suspect your apnea index (apneas alone) is pretty high even then.

>Why be skeptical?

I'm skeptical, but not stupid. I am giving my sleep doctor the benefit of the doubt and am carefully following his instruction to learn and use the CPAP stuff properly.

Your points are all well reasoned and probably right. I am skeptical because it is big leap from "Gee doc, I sure urinate frequently in the night" to "you have a life threatening, incurable condition that is going to require you to use CPAP therapy every time you sleep for the rest of your life."

My remaining skepticism has to do mostly which the shock of learning how widespread this supposedly is and/or the cost of treatment. I would like to know, for example, if you randomly did sleep lab tests like the ones I have had to a sample of the general population, how many would be diagnosed with serous sleep apnea? From my reading it sounds like 25% of the population would. When a physical condition affects 25% of the population it sounds more like the human condition to me than an deadly condition, so I am wondering if it isn't being hyped a little.

My sleep doc said he could pick me out at a mall as a likely candidate. This comment raised my eyebrows. Given this is a throat condition and no one looked at my throat until very late in the process, this surprised me. I surmised it was because I am overweight and quizzed the doctor on it, but he said, no it was primarily because of my facial structure. He may have just been being polite, probably was my weight (male, 250), but if facial structure is a big marker for this widespread, potential fatal condition, then why aren't people pulled out of the crowds at malls and tested? Furthermore, if this because of face structure, wouldn't it be likely that my siblings and all my kids would share the condition? How come none of my three doctors have raised that possibility? Who can afford the $5000 in tests per person to to figure this out on a maybe? I'll probably be doing a poor mans sleep test on my family members with my $120 recordng oximeter, seems a little improper.

One factor that contradicts my skeptism is that the insurance company is willing to pay for this without balking (at least with my test results). In my experience, insurance companies balk on suspicious diagnoses, so it does indeed appear to me that they would rather bear the expense of sleep labs and CPAP machines that treat the result of the untreated condition...

Thank you for the opportunity to give me a forum to discuss my concerns.

Bob6466 wrote:... I'm skeptical, but not stupid. ...

I did not say you were. In fact, I consider health skepticism a GREAT trait. Instead, I wondered why you were, because we might be able to help explain what we've learned from both experience and research.

Bob6466 wrote:... Your points are all well reasoned and probably right. I am skeptical because it is big leap from "Gee doc, I sure urinate frequently in the night" to "you have a life threatening, incurable condition that is going to require you to use CPAP therapy every time you sleep for the rest of your life." ...

Ah, two issues are in play.

First, you (correctly) wonder why it went from the need to take a leak every couple hours to obstructive sleep apnea. Unfortunately, a lot of doctors do not provide the education they should. In a nutshell, the apnea event causes higher blood pressure in the pulmonary (lungs) side of the cardiovascular system. To try to combat this higher pressure, you heart triggers your kidneys to decrease the fluid content in your body. So, during the obstructions, your heart causes your kidneys to go into overdrive. Your heart does not know about the obstruction. It just knows it needs to drop that pressure. Your kidneys do their job. And of course your bladder gets you up to handle the need to urinate.

In fact, that is why high blood pressure can lead to kidney problems. Eventually the increased demand to urinate due to high blood pressure damages the kidneys.

The other issue is the absolute shock of dealing with a life threatening condition. How can lack of sleep be life threatening? Well, sleep deprivation is in fact a torture. Unfortunately for you (and us) our bodies foist it on us. But it's not really any different than having a diagnosis of diabetes or the like. But it does take a while to come to terms with it.

And PLEASE feel free to talk out your skepticism here. It's healthy. It's important for you to come to grips with it.

Bob6466 wrote:... My remaining skepticism has to do mostly which the shock of learning how widespread this supposedly is and/or the cost of treatment. When a physical condition affects 25% of the population it sounds more like the human condition to me than an deadly condition, so I am wondering if it isn't being hyped a little. ...

Diabetes is probably in the same category. It is and can be just as deadly. It might be a "human condition", but untreated it maims and kills far too many people each year.

The underlying problem is not that it is common. Rather the real problem is that so few doctors REALLY understand it. They get more training in diabetes than they do in sleep apnea. They should in fact get equal time. ...[/quote]

Bob6466 wrote:... My sleep doc said he could pick me out at a mall as a likely candidate. This comment raised my eyebrows. Given this is a throat condition and no one looked at my throat until very late in the process, this surprised me. I surmised it was because I am overweight and quizzed the doctor on it, but he said, no it was primarily because of my facial structure. He may have just been being polite, probably was my weight (male, 250), but if facial structure is a big marker for this widespread, potential fatal condition, then why aren't people pulled out of the crowds at malls and tested? ...

Actually, he sounds more like a doctor who knows his stuff. Yes, weight contributes to the sleep apnea. But there is a HIGH correlation between family history and obstructive sleep apnea. Just like there is a high correlation between family history and diabetes. If you grandparents had it, there is a high chance you will have it. And weight is not always a factor. In fact, as your doctor noted, the facial structure is a better predictor than weight.

Let me provide a personal example. In my teens I started to snore. My sister complained that I snored horribly. She complained that I would stop snoring and snore/snort very loudly when I started back up. Sound familiar? My weight at the time? About 20 pounds BELOW my ideal weight!! So, why did I develop obstructive sleep apnea? Well the other complaint she made was that I snored "just like Granddad". And that's the issue. My grandfather died fairly young (mid 60s) due to heart problems. He had uncontrolled high blood pressure and angina and ... (remember the comment about the hypertension due to the obstruction?)

So, the issue is more that people tend to be prone to this and doctors are not taught to look for it as an issue.

Bob6466 wrote:... Furthermore, if this because of face structure, wouldn't it be likely that my siblings and all my kids would share the condition? How come none of my three doctors have raised that possibility? ...

They may not know to look. How did you make the leap form urination problem to sleep problems? Probably an educated doctor along the way recognized the symptoms as a possible issue.

Bob6466 wrote:... Who can afford the $5000 in tests per person to to figure this out on a maybe? I'll probably be doing a poor mans sleep test on my family members with my $120 recordng oximeter, seems a little improper. ...

No. It's very important to do that. If they have severe drops then it is reasonable to go to the doctor and say "Is it possible?". They will order the test and you can know for certain.

But the CPAP manufacturers are in fact trying to drive down the cost of the diagnostic screening. They are working toward a hoem screening unit that will allow you to test at home and drop the cost of the screening. It may help drop some of the initial costs.

And yes, if you have it, there is a high likelyhood that your children will have it. Just as it is likely your siblings will have obstructive sleep apnea. I caution my children about this. I don't know if they believe it. But my wife and I watch for signs of it when we listen to them sleep.

Bob6466 wrote:... One factor that contradicts my skeptism is that the insurance company is willing to pay for this without balking (at least with my test results). In my experience, insurance companies balk on suspicious diagnoses, so it does indeed appear to me that they would rather bear the expense of sleep labs and CPAP machines that treat the result of the untreated condition ...

Exactly. They know that without it you will end up in intensive care due to either a heart attack or a stroke. The costs of the testing and CPAP therapy are miniscule compared to either of those scenarios.

Bob6466 wrote:... Thank you for the opportunity to give me a forum to discuss my concerns. ...

That's why we are here. As I noted, your skepticism is a GREAT thing to have. And it does take time to come to grips with this condition. It is a chronic condition that can be well managed, but will impact you one way or another. Like living with diabetes, you will have to adjust your lifestyle. But unlike diabetes, the lifestyle changes are not as pervasive. You just need the machine to help you sleep better. You don't need to adjust what you eat, when you eat, how often you eat ... You just adjust what you do when you sleep and that's about it. Not bad as chronic conditions go.

Anyway, again welcome. thanks for taking the time to explain your skepticism. We sure do understand how you feel.

When a physical condition affects 25% of the population it sounds more like the human condition to me than an deadly condition, so I am wondering if it isn't being hyped a little.

Let's see:


Heart conditions - the most prevalent reason for death - once you get to a certain age?

The various kinds of dementia? (1 out of 3 people above the age of 80)

White hair?

Overweight?

Short sightedness (that's about 25% of the population, starting at a young age).

Back aches - a direct result of walking on 2?

Why not sleep apnea, a direct result of being a talking creature?

The definition of a breath stoppage -- apnea -- is anything 10 seconds and longer -- so your calculations were right. And - depending on the type of machine and software you use, you may see the correlation between apneas and hypoxia.

http://www.aasmnet.org/Resources/Practi ... graphy.pdf

My sleep doc said he could pick me out at a mall as a likely candidate. This comment raised my eyebrows. Given this is a throat condition and no one looked at my throat until very late in the process, this surprised me. I surmised it was because I am overweight and quizzed the doctor on it, but he said, no it was primarily because of my facial structure. He may have just been being polite, probably was my weight (male, 250), but if facial structure is a big marker for this widespread, potential fatal condition, then why aren't people pulled out of the crowds at malls and tested?

It was only in the 80's that some doctors watched their patients sleep and realized they were choking/waking/choking at an alarming rate. Medicine identified healthy blood oxygenation before it identified sleep apnea -- and those patients were hypoxic -- like you.
Oh, by the way, the doctor may have been quite honest about your facial structure: small narrow jaw, receding chin (did you have teeth extracted for orthodontic reasons?) for instance?

Furthermore, if this because of face structure, wouldn't it be likely that my siblings and all my kids would share the condition?

Very possible. And it runs in families.

How come none of my three doctors have raised that possibility?

Ignorance.

I'll probably be doing a poor mans sleep test on my family members with my $120 recording oximeter, seems a little improper.

You'd be doing some of them a big favor.


I'm glad you posted, had the test and now have a machine.
Welcome to the forum.

Bob6466 wrote: I would like to know, for example, if you randomly did sleep lab tests like the ones I have had to a sample of the general population, how many would be diagnosed with serous sleep apnea? From my reading it sounds like 25% of the population would. When a physical condition affects 25% of the population it sounds more like the human condition to me than an deadly condition, so I am wondering if it isn't being hyped a little.

.........but if facial structure is a big marker for this widespread, potential fatal condition, then why aren't people pulled out of the crowds at malls and tested?

I believe that at least 50% of the population either has, or will develop, SDB at a level that treatment would be highly beneficial to their physical and mental health. Yes, it is the human condition and the human condition is 100% deadly.

I do "pull them out at the mall", but that story will have to wait for another day.

You are asking good questions. I think you would thoroughly enjoy reading all of Dr. Steven Parks blogs and his book, Sleep, Interrupted. Start with this article http://doctorstevenpark.com/sleep-apnea ... l-wrinkles and be sure to click on the link, Nutrition and Physical Degeneration, in the article.

As far as I am concerned, Dr. Parks is the cat's meow of sleep apnea.

"It is not the size of the neck on the outside, it is the size of the airway in the neck.

rooster wrote:... You are asking good questions. I think you would thoroughly enjoy reading all of Dr. Steven Parks blogs and his book, Sleep, Interrupted. Start with this article http://doctorstevenpark.com/sleep-apnea ... l-wrinkles and be sure to click on the link, Nutrition and Physical Degeneration, in the article.

As far as I am concerned, Dr. Parks is the cat's meow of sleep apnea.

"It is not the size of the neck on the outside, it is the size of the airway in the neck.

Rooster, you date yourself, sir! Unfortunately, I understand all too well!!

Though the inside of the neck matters for most people, when OSA runs in a family, it might not be the issue. My doctors keep noting that I have a nice clear airway and should not have problems. So, sometimes even with a clear airway it's a tendency of the throat to close at night (soft palette closing on the airway as well as tongue).

But I definitely agree a good doctor who clearly communicates to patients and doctors alike makes a big difference.