Need suggestion for CPAP machine for someone without apnea.

Quite frankly you sound like me. I am 57 and have snored all of my life and have never been able to spend the whole night with my wife. Our marrige has survived, but it still would be nice to spend a night with her. I too have been all over with snoring my whole life and no Dr that would ever commit to a sleep apnea "official diagnosis". Now I only had a take home machine study recently, but I scored over 75% hypopneas with an AHI of about 14. The machine recorded a snore every 5 seconds over a period testing of 6 hours! I have always had difficulty breathing through my nose and have a deviated septum also. I had a PPP done 15 years ago and my current sleep Dr. said the lower airway looks good. Short of major excavation she said it was fine in the palate. CPAP helps me a lot!

Since I was scored with an AHI of about 14 it technically isn't enough to get you a machine from insurance - at least my insurance. That may be a similar situation to you - and your Dr. was possibly telling you in a way that avoided him/her hassling with an insurance company for you. Lots of Dr.'s don't want to fight for the patient - and will only deal with it if you pay out-of-pocket. That may be the real problem in a nutshell. They want you at 15.0 or greater and to be titrated in a sleep lab. I had a sleep study 15 years ago and they told me that the results were "inconclusive". I think back then it meant that I had upper airway breathing problems that were not classical obstructive apnea. My recent take-home study would support this. This time, my sleep Dr. recognized that I had a problem that wasn't "classical" and was willing to work with me about it - and I am glad we did.

I too am not really overweight - I am big from lifting and exercise, but not fat. The BMI surprises most Dr's who think I am 30lbs lighter until they weigh me. I exercise regularly still. My nose (and the rest that goes along with it) is the problem, not my weight or my palate. I just can't breathe at night and my sleep suffers from it. I tend to naturally want to breathe from my nose when I sleep, and my nose won't permit it. Even when I walk my dogs I still have to open my mouth at times to breathe because my nose won't let enough air in.

To give you an example of how tight my sinuses are, a few years ago I had a GI Dr. try to thread a catheter up my nose, down my throat, and into and down my esophagus to check my esophageal pressure. After 15 minutes he gave up - and he had been doing it for 35 years as a GI speicialist.

My point is that this is about you - not me - but the parallels are uncanny. I truly think there are lots of "upper airway" people like me that don't always have upper airway resistance syndrome. We have "upper airway restriction syndrome" - my name for seriously plugged up sinuses. I don't need a test to feel what is wrong with me - and you are likely the same. Sleep tests most likely see problems like this as hypopneas - and OA's are minimal or non-existent. We still can benefit from CPAP a great deal even when our AHI is under 15. Certainly our wives can! The surgeons are really only a last resort. Stay away from anyone who wants to cut you up anymore - even a dentist. These things are generally not reversible in most cases. I am a minimalist when it comes to surgery. I will only consider RF turbinate reduction for me - and that's it - no more. But I suspect it will not help much. I was stupid to get a PPP and suffered greatly because of it - and it changed nothing - not one snore or sleep issue. I was unlucky (and stupid) enough to believe a Dr. who could only do a PPP instead of looking in my nose. Years later, they finally looked in my nose and said "boy .... this is the problem!" And no, I do not believe you are in denial about OA - you probably are just plugged up.

It looks like you can afford a machine on your own. If you can get your Dr. to give you an Rx for one - you can order one like mine (check equipment below post) with humidifier at cpap.com for about $650. My snoring is greatly reduced with a nasal mask (for some reason FF masks gets worse results even when leaks are overcome)- my machine score an average of 5 per hour (as opposed to one every 5 seconds without). I paid out-of-pocket for my machine on line (but got an Rx from my Dr.) and CPAP really helped. My machine occasionally records and OA or two, and is more likely to show hypopneas (and does on occasions) - which is what you would expect if you had a plugged up upper airway. If you can get and Rx and can afford it - then what have you got to lose? I found myself feeling many times less tired after a few weeks - and I thought I was just getting older. Obviously not. As soon as I can kick the dogs out of our bedroom we will try a night together. All the years of "adjoining hotel rooms" when we travel, etc. we could have saved enough to pay for a new CPAP every year. Sorry for the long ramble ... but this one really struck home with me.

Good luck.

Has your wife tried EAR PLUGS at night? I use them.

If, after a sleep study, two doctors have told you that you are not a good candidate for CPAP, then you are probably not a good candidate for CPAP. What were your AI, HI, CI, and AHI during your sleep study? You need a copy of the complete sleep study report (about 8 pages) to determine those numbers. Don't go any further down the CPAP road until you have your sleep study report and know your AI, HI, CI, and AHI.

It is not a good idea to play around with CPAP unnecessarily. Excessive pressure can cause central apneas, which are a neurological problem where the brain fails to send signals to breathe even when the upper airway is open. You don't want to screw around with something that may cause you to develop a neurological problem.

Dental appliances may help with your snoring problem. Have you spoken with your dentist yet?

Breathe Jimbo wrote:If, after a sleep study, two doctors have told you that you are not a good candidate for CPAP, then you are probably not a good candidate for CPAP. What were your AI, HI, CI, and AHI during your sleep study? You need a copy of the complete sleep study report (about 8 pages) to determine those numbers. Don't go any further down the CPAP road until you have your sleep study report and know your AI, HI, CI, and AHI.

Yes, I agree ... but make sure they aren't playing the insurance game. If you are normally healthy but have an AHI of 14.9, they have to really hammer an insurance company sometimes to "make you a candidate". My sleep Dr knew I would self-pay (because I told her that's what I would do) and she agreed CPAP was a good idea but also said that she would expect that insurance would make life impossible if I tried to make a claim.

This thing about AHI being greater than 15 is insurance generated. Lots of people would benefit with AHI's of 5-14, but I expect they can't get machines covered (that's still "mild to moderate") - especially if there were few OA's or CA's. All I can tell you is that I feel so much better from going from 14 to less than 1 - and my snoring is much much less too.

No wife yet - but the dogs will visit now that they aren't afraid of the mask anymore. I'm getting there.

NewYorkNative: My wife (and others before her) swear that I snore right through ear plugs. The dogs too.

If you had layed on your back or had a tech good enough to make you lay on your back your AHI would have been a lot higher in REM. Ask for another PSG and they'll give you a cpap device.

SleepingUgly: Thanks for the feedback. When I say "save my marriage", the marriage is fine but my wife's lack of sleep is making things really hard. She cannot sleep if I'm in the room snoring, so we end up in separate rooms. This creates a lack of intimacy and a lack of time for good pillow talk. When we are together, she doesn't sleep and is exhausted. Like most folks, we have our issues but we are not "on the rocks" or anything. I would just like to (a) give her a good night's sleep each night -- or at least not be the cause if she doesn't -- and (b) feel like a married couple again.

JonquilJo: Thanks for the great post. We do sound much alike and, you are right, the price is not the issue. I'm just trying to determine if the CPAP will help.

To Everyone: I am in the process of getting the real sleep study results and will post them when I have them.

My poor husband tried industrial ear plugs and everything else before he gave up and started sleeping on the couch every night. He tried to be cheerful about it--buying himself cute fleecy footie p.j.s so he wouldn't freeze to death and telling funny stories every morning about what machinations he had to go through to get the dog off the couch so he could sleep there. I tried waiting until he was deeply asleep before I went to sleep, but my snoring could have raised the roof. My kids could hear it their rooms through two closed doors.

It was not a good way to have a marriage.

He's been back in the bed since my second night of CPAP (I was too embarassed the first night) and doesn't hear a thing. We can even chat a bit before he falls asleep as long as I can answer "um hm" or "uh uh"

cohncons wrote: To Everyone: I am in the process of getting the real sleep study results and will post them when I have them.

That will say a lot. Please post them. I've also found that nasal steroids (Flonase, Nasonex) help - especially at night. But CPAP really helps much more - me anyway. I went to the sleep Dr. in this 15 - year quest to find someone who can help my snoring. The same reasons as you. I couldn't adapt to an older model CPAP in the '90s, but the newer ones are far superior in comfort. I really WANT to put on my mask now. The extra energy was an unexpected surprise. But .... according to the sleep apnea "rules" - I do not have obstructive apnea. And overall events were not significant enough for the Dr. to deal with an insurance co. I just had a follow up with her last week and she told me that people like me were common - and that she felt bad sending many of them home with nothing. She jumped at the chance of giving me an Rx when I told her I would self-pay.

jonquiljo wrote:But .... according to the sleep apnea "rules" - I do not have obstructive apnea.

You are in San Francisco? Then you could go to Stanford. At Stanford you no doubt WOULD meet criteria and wouldn't be self-pay.

I guess I'm 'lucky', having diabetes and HBP, too.
I was at 13 in the sleep study, but it's enough with other problems for insurance.
Even at this low level, CPAP has made a huge difference with the way I feel.

SleepingUgly wrote:

jonquiljo wrote:But .... according to the sleep apnea "rules" - I do not have obstructive apnea.

You are in San Francisco? Then you could go to Stanford. At Stanford you no doubt WOULD meet criteria and wouldn't be self-pay.

Why, does Stanford raise your numbers? It's a pretty big bay here. It takes me 1 1/2 hours in off-hours traffic to get down there.

Just as an aside - I really find the insurance company "rules" about what they consider to be apnea that they feel needs a machine - to be offensive. Who is in charge here - the Dr.'s or the insurers? Don't answer that - I already know what you will say! I read somewhere it was like >15.0 unless you had a heart condition, etc. They'll pay for a $3K sleep study - but not for a $500 machine. Maybe if they didn't pay $1500 for that $500 machine they might not be so unwilling to cover us.

jonquiljo wrote:Why, does Stanford raise your numbers?

They score hypopneas more leniently than the AASM guidelines. Course if you don't have many hypopneas, it may not impact you.

It takes me 1 1/2 hours in off-hours traffic to get down there.

People go there from all over the country, maybe the world! You are within 1 1/2 hours of the place where SLEEP was invented!

Just as an aside - I really find the insurance company "rules" about what they consider to be apnea that they feel needs a machine - to be offensive. Who is in charge here - the Dr.'s or the insurers? Don't answer that - I already know what you will say! I read somewhere it was like >15.0 unless you had a heart condition, etc. They'll pay for a $3K sleep study - but not for a $500 machine. Maybe if they didn't pay $1500 for that $500 machine they might not be so unwilling to cover us.

Actually, I thought it was >5 if there are symptoms, even EDS, no? Someone who knows speak up here...

This just in from Mr. Google:

apnea/hypopnea index (AHI) of ≥ 15, or an AHI ≥5 and ≤14 with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease or history of stroke.

http://homecaremag.com/sleep/medicare-s ... ge-200908/