Sleep Apnea, to treat or not to treat!!!

I did some digging for some more definitive empirical comments regarding untreated OSA.
Take some time and google "untreated OSA" and there are lots of journal articles to read. I just found these 4 right off the top



http://eurheartj.oxfordjournals.org/con ... 9/709.full
In part from above
A growing body of evidence supports an association between obstructive sleep apnoea (OSA) and cardiovascular disease. Pathophysiologic mechanisms that are present in patients with OSA – including sympathetic activation, endothelial dysfunction, oxidative stress, systemic inflammation, hypercoagulability, hyperleptinemia, and insulin resistance – may influence the development and progression of cardiac and vascular pathology.1 OSA is widely prevalent in patients with obesity, diabetes, and hypertension.1 Our understanding of the relative importance and interactions of these cardiovascular disease mechanisms and risk factors in patients with OSA may have direct implications for the development of targeted preventive and therapeutic strategies.

http://www.ncbi.nlm.nih.gov/pubmed/21150380

http://www.ncbi.nlm.nih.gov/pubmed/20842596

http://www.ncbi.nlm.nih.gov/pubmed/20662752
In part from above
Obstructive sleep apnea (OSA) is a common sleep disorder, and research on the effects of sleep apnea is important to gain insight into how sleep affects health. Untreated OSA has been associated with important health consequences, such as an increased risk for hypertension, cardiovascular disease and diabetes. Previous studies have shown that OSA also represents a risk factor for stroke. The relationship between OSA and stroke is particularly relevant, as stroke is the second leading cause of death globally. The reviewed article presents new data from the Sleep Heart Health Study, a longitudinal cohort study, which shows an association between incident stroke and untreated OSA of varying severity for men and possibly more severe OSA for women. The study is discussed in the context of the current state of knowledge about OSA, in particular its health consequences, and the general limitations in conducting research with OSA patients.

carbonman wrote:

cyklopps wrote:Finally, I would enjoy hearing from others who like me have ponderd this issue how you arrived at an answer. Phil

sung to Sympathy for the Devil
Rolling Stones

Please allow me to introduce myself
I'm something you can not see or taste
I've been around for a long, long time
Stole many a man's breathe and faith

Pleased to meet you
Hope you guess my name
But what's puzzling you
Is the nature of my game

I'm still around although you may feel fine.
I'll make damn sure you despise me,
w/claustorphobia, rhinorrhea and aerophagia,
as you fight me w/machines and masks,
oral and mandibular device.

I'll take you to the bathroom until
the day you won't ever come back.
I"ll stick around until I see it's time
for a stroke or heart attack.

Pleased to meet you
Hope you guess my name
But what's puzzling you
Is the nature of my game

I revel in your skepticism.
I laugh w/glee that you should think
I'm just a fad.
Cardiologist laugh up their sleeve,
that no one is ever returned, negatively.

Just as every patient is a casuality
you can not determine your longevity
by the data of all history, you doubt....
that I degrade the quality of your life.

Tell me baby, what's my name
Tell me honey, can ya guess my name
Tell me baby, what's my name
I tell you one time, you're to blame

So, if we should meet, alone in the night
don't be concerned, don't fear my sight,
disregard the purpose of my plight......
I'm only here to steal your life.

Pleased to meet you
Hope you guess my name
But what's puzzling you
Is the nature of my game

Excellent burst of creativity!

That needs to go into the CPAP Wiki under "Surprise Me".

cyklopps wrote: So how strong is the data on heart attacks or strokes for an otherwise healthy 64 year old with untreated sleep apnea?

I don't know "how strong" the data is about the cardiovascular risks with OSA. Do you desaturate at all? If your oxygen saturations are a complete non-issue, and all your respiratory events were scored as such due to associated arousals and no desaturations, then what I was told is that (1) we don't know what it does to the brain, (2) we know that the cardiovascular risks are associated with desaturating, therefore, based on what we know, respiratory events associated with arousals only are a quality of life issue.

Now, somehow I doubt that you did not have desaturations. But if you did, and you feel just fine during the day, if I were you and I didn't want to give CPAP a go, I would buy a top of the line oximeter and I would regularly check to make sure that I didn't start desaturating. I would recognize that I may be doing some unknown harm to myself, but personally I would be OK with doing that for a time and maybe having another sleep study down the road. Out of kindness to my spouse who is "tolerating" my snoring, I'd move to the guest bedroom forever, as her quality of life is at stake here too.

If I did have desaturations, as I suspect you do, I would discuss this with my spouse:

I feel fine and have no symptoms other than loud snoring which my wife tolerates. I dread the thought of lying in bed nightly looking like a military fighter pilot with a machine humming by my side; never again able to enjoy the night smells or my wife's garden in the morning.

I'd have a frank discussion about how my snoring affects her vs. my appearance in bed and my ability to smell the garden during the time the mask is on. Then I'd have a discussion about the risks I'd be undertaking and what my demise or incapacitation would do to her vs. my appearance in bed and my ability to smell the garden during the time the mask is on. If after this discussion, I decided not to use CPAP anyway, I would buy long-term care insurance and I would document that I love my wife's garden so much that I'd like to be buried under it sooner than later. ( Black Spinner--I did this for you! This is a little joke referring to the fact that I'm not a fan of the 2x4 approach to getting people to comply with CPAP, but you seem very logical, with your priorities, and I think you'll be able to take my half-joke in stride).

Just for the record, here is cyklopps first post:

cyklopps wrote:I was diagnosed with Sleep Apnea in 2009 with an AHI index of 33.7. Also Oxygen desaturation was 81%. Due to my not wanting to go with CPAP, my Dr put me on Oxygen while sleeping with the Concentrator set a 2. I have used the Oxygen nightly since 2009 and twice have had overnight home Oximetry tests that both showed six desaturation events of less than 3 minutes and mean oxygen level of 97.6. The lowest oxygen level went down to 91%. My conclusion is that while not perfect, these oxygen levels were a good improvement even though I know I still had the apnea. I have never suffered adverse symptoms from my sleep apnea other than loud snoring. No tiredness, depression, etc.
Recently I was able to try using a a used Remaster Pro M Series CPAP owned by a friend who wants to sell it. It is set at 7 and I have tried it for the past week. Not quite as bad as I thought!!! My Dr knows about this and of course wants me to go back to the hospital for another sleep study to get the machine settings customized. I am not sure I need to do this based on things I read on this forum. Since I started using the machine my APN/HYP is 5.7. I know how to adjust the pressure so I may try raising or lowering it. What do some of you on this forum think of this idea? Is my spendint $1000 plus for my copay on a sleep study worth the investment? Phil

Many of us were very shocked to learn that we had an untreatable chronic medical condition when we were diagnosed with OSA. There's nothing external to see, and most of our bedtime partners are sympathetic or at least accept us for what we are or what we do. Now that's great as regards ahem, private activity between consenting adults, but not so good when we have an abnormally high risk of stroke or heart attack in our sleep because of oxygen not reaching the heart or brain.

Then we learn that this condition is more common than we thought ... and then we wonder why it still seems to be such a well -kept secret, as we don't know anybody who suffers from OSA. But wow! hope! management with xPAP therapy will bring our risk down to normal, our sleep will be of much better quality and our loved ones will have a better night because we're not snoring our heads off .................. the future looks rosy.

And then .... we get to see what this success depends on. A hose, a bedside unit and a mask. THUD.

We face a massive lifestyle change. And it doesn't look good - if you'll pardon the pun. BUT the benefits outweigh the risks, and as has been said, your partner/spouse wants you around for as long as possible.

It's your decision as to whether you accept treatment for Sleep Apnoea. But I would strongly urge you to do so. You get your life back and a better and longer one too. Please don't ignore a wake-up call for better health.

SleepingUgly wrote: If after this discussion, I decided not to use CPAP anyway, I would buy long-term care insurance and I would document that I love my wife's garden so much that I'd like to be buried under it sooner than later. ( Black Spinner--I did this for you! This is a little joke referring to the fact that I'm not a fan of the 2x4 approach to getting people to comply with CPAP, but you seem very logical, with your priorities, and I think you'll be able to take my half-joke in stride).

Well according to my mama's experience during WWII, humans make fabulous fertilizers for roses, so at least she will get that benefit.

cyklopps wrote:Here are some thoughts from someone new to this forum. I have been diagnosed with moderate to severe sleep apnea. But I unlike many on this forum, I feel fine and have no symptoms other than loud snoring which my wife tolerates. I dread the thought of lying in bed nightly looking like a military fighter pilot with a machine humming by my side; never again able to enjoy the night smells or my wife's garden in the morning.
I know life is full of risks and trade offs especially in medicine. If it were not for my fear of stroke or hear attack I would not treat my problem.
I also have a degree of skepticism about such a relatively new disease that huge numbers of us now have. My cardiologist brother in law tells me with a twinkle in his eye that he has never sent a patient for a sleep study that has come back negative. Yet I know he is concerned. But medicine is full of fads that come and go over the years. Anyone here who has ever see the movie "The Road to Wellsville" with Anthony Hopkins knows what I am talking about!
So how strong is the data on heart attacks or strokes for an otherwise healthy 64 year old with untreated sleep apnea? Has there been enough study of risks for different kinds of patients that I might enable me to do a personal risk assessment and decide what CPAP might be worth to me in terms of longevity verses quality of life.
Finally, I would enjoy hearing from others who like me have ponderd this issue how you arrived at an answer. Phil

I'm not sure where to start........you seem to be in serious denial.
You also may be in the earlier stages of this "condition" taking over your body......and NOW would be a good time to get the benefit from the therapy, as opposed to later, when it's done more serious damage to your health.

Who gives a rat's patootie what you look like when you're asleep in the dark?
What makes you think that you won't be able to "smell" anymore? If your wife's garden is outside your bedroom window, you'll definitely be able to smell the fragrances because the machine pulls in (and often intensifies) the smells that are in the room. I can also assure you that if a skunk passes through the garden and decides to mark the territory.....you WILL smell it. Trust me on THIS one!

There are numerous documented situations of people having strokes and heart attacks from untreated apnea. I have personal knowledge of a situation in September of 2007 where a person died during his sleep because he didn't bother wearing his CPAP equipment that night.

This isn't a "new" disease.......it's just that the TREATMENT is relatively new.......about 30 years (if you want to call that "new"). This disease is probably as old as snoring.

I would be skeptical of a brother-in-law who takes that kind of attitude. I suspect the reason so many people who go to have sleep studies done and test positive is that they exhibited too many of the conditions that people with sleep apnea have. There ARE obvious warning signs.

For me, I was so glad to find out what was wrong with me and that the condition was so easy to treat.
If one goes into this therapy with a positive outlook, there will be a positive outcome.

The river of DeNile runs through graveyards......


Den

cyklopps wrote:I have been diagnosed with moderate to severe sleep apnea. But I unlike many on this forum, I feel fine and have no symptoms other than loud snoring which my wife tolerates.

I have mild sleep apnea. Unlike many on this forum, I always felt fine and had no symptoms (that I knew of) other than loud snoring ever since I was in my early teens.

I functioned "fine" in life. Had plenty of energy to do whatever needed doing - working with show horses and show dogs.
Normal blood pressure all my life.

After starting on CPAP in my late 50's, I realized that things I had not thought of at all as "symptoms" ... were.

I thought it was normal to get drowsy driving on long interstate trips.
That's not normal. At all. I never get drowsy driving now, no matter how long the trip.

I thought it was normal to occasionally want to take an afternoon nap.
That's not normal. At all. I almost never feel the need for naps now. And if I do feel like taking a nap, it's because I stayed up too late on a night when I was going to be getting up early in the morning. Didn't put in enough sleep hours.
Before, even if I had slept 8 or 9 hours, there were some days when I'd want to take a nap.

I thought it was normal to feel a groggy in the mornings or after a nap. I thought it was normal to want to hit the snooze button a time or two before getting up.
That's not normal. At all. After starting CPAP I found that I could simply wake up in the morning, and really feel fine. Ready to get up and get going, with no slow start. No grogginess.

I thought it was normal to occasionally drift off to sleep watching TV.
That's not normal. At all. Never happens now.

I thought it was normal for some people to snore. Annoying to others, but didn't affect me, the snorer, since I couldn't hear it while I was asleep.
My snoring was not normal. At all. It was the sound of an airway starting to collapse. It was the sound of less air being breathed than normal. It was the sound of partial suffocation all night long, every night, year after year.

Bottom line, all my life I thought getting drowsy sometimes in the daytime was normal.

It's not.

Once I read up on the dangers of sleep apnea, I, unlike you, WANTED a CPAP machine. Wanted one so much I borrowed one from a friend in town. Used it every single night until I was able to buy my own machine. Have been using CPAP every sleeping moment for the past seven years.

That's how I found out that what I thought were "no symptoms" all my life, really had been symptoms of sleep apnea. I was just so used to them, and they didn't interfere with my work or my life, so I thought they were "normal."

I want to breathe easily every night while I'm asleep.

I don't want to end up debilitated from a stroke.

That's why I use CPAP.

I will say that not treating sleep apnea is akin to receiving a cancer diagnosis. It may not get you right away, but it will surely ravage your body until you eventually succumb to it. I don't mean to sound negative, but I have a family tendency for OSA. You see, my otherwise healthy father, who worked like a dog and provided for his family, snored like a lion! My Mother used to "tolerate" it because " Dad worked hard " and he slept hard. Well, @ 39 years old, the drs found a small issue with his heart. Nothing too big, just a little Nitro tablet when he had "spells". One night, at the ripe age of 58, my Dad didn't wake up! He basically died in his sleep. I gave him CPR and the ambulance rushed him to the ER where he was put on life support for 30 days until he died. They said it was likely a sleep disturbance that stopped his heart - YES - this was back in 1983! A few years later, my otherwise healthy brother, then 39 yrs old, was told by his wife to go to the drs or start sleeping in the spare room. He too, snored like a lion! Alas, my brother has been a HOSE HEAD for over 15 years now. Myself, well, I had pulmonary embolisms that brought my sleep issues more to light. But - I too, snored like a lion. I had my 14 year old daughter tested because she snores as well. You'll be amazed to know that they found NO sleep apnea. Just a delay in her reaching her REM cycle. What we are given, along with our diagnosis, is the opportunity to prevent further decay to our bodies. It's a tool to help us maximize our time here on earth. If you chose not to use a CPAP machine, then as an adult, you will deal with the consequences of your actions. Quite simply, it's your choice. I prefer to make sure that I utilize whatever options that I have at my disposal to ensure that I can continue to raise my daughter and see her through to all of life's wonderful moments! Best of luck to you and remember to think of your family when you make your decision.

Everything RestedGal said goes for me, too. Things I took as normal turned out to be symptoms of OSA. Going to the bathroom three or four times a night, pushing that snooze button, the naps...

I grew up with a parent who had to use a cpap (hers was HUGE), and my mother was not diagnosed until her heart was so damaged that basically OSA therapy was palliative. She was on oxygen during the day, and oxygen was hooked into her hose at night. Eventually she ended up on a ventilator, and finally died in 1993 from heart failure caused by long term OSA.

So when I was diagnosed with OSA, I wasn't put off by the machine or the mask.

I think I have a hard time with people who resist cpap. I am so used to medical equipment that I have to remember most people's experience is so different from mine.

My therapist said one way to look at cpap is to consider it's just air. AIr that is being used as a stent for your throat-but it's air. Can't get any more natural than that. Someday there will be better and cooler looking (or invisible) treatments. It's helpful, and if you don't have damage from the OSA then it's even more important to use the machine to prevent damage.

As for how silly the mask is, I think I'm going to put googly eyes on mine. Maybe some mask designers will think about how to make the mask less ugly and unobtrusive when they see some of these posts.

Cyclopps:
I hope you are reading all the responses to your post.
These people here have EXPERIENCE--they know what they are saying.
I can only add one little thing: Your apnea does not have to be severe to have a significant effect on your health.
Mine was only 13 events an hour--not enough for insurance coverage, had I not been lucky (!) enough to also have high blood pressure and diabetes, which may have been caused by the apnea. My father died of a heart attack at 50.
I could hear his snoring and gasping through doors and walls. Your untimely death will affect all those you love.

My husband's symptoms began just as loud snoring with other mild symptoms that seemed "normal" for him at the time. My husband ignored recommendations for a sleep study. Fast forward to 10 years later, 2 Triple Bypasses 7 years apart, high blood pressure treated with meds not always successfully, substantial memory loss and other medical issues that may be related to years of oxygen deprivation. One thing is certain, with his 100% record, your BIL sure sounds like he knows how to diagnose sleep apnea. I hope you're reading all these responses with an open mind.

To purely answer the question. 100% treat and then decide if it's worth it.

For me it came down to this. My wife kicked me out of the bedroom as I think all spouses should if the offender is unwilling to get checked out. BUT that does not work when you're on vacation. I spent 4k on the nicest vacation of my life and found myself sleeping on the cushion to the chase lounge on a tile floor while she was enjoying the comfort of the king sized bed in the other room. The next morning I got "you're an idiot and when we get home you're going straight to the sleep clinic". I guess they call that rock bottom. Enough said and it was the best move I've ever made. I too thought I was just fine other than the horrific snoring but I wasn't fine at all. I saw noticeable results, however sadly I must say my treatment was sloppy at best for 10+ years and only recently have I started using a data capable machine and really dialed in my therapy. I'm trying not to focus on the additional damage I have done and praying that my body will heal some of that damage with the awesome sleep I now get.

Excellent posts by everyone and a great title...this will end up being a must read for those considering treatment.

If you believe that breathing is important, you already see the importance of treating moderate-to-severe obstructive sleep apnea.

If you believe that sleep is important, you already see the importance of treating moderate-to-severe obstructive sleep apnea.

When the body is asleep and tries to breathe but can't, the results are violent and pervasively damaging, especially cumulatively. The insidious thing is that you are asleep, so you don't consciously remember the panicky sensation of suffocating. And if you don't have the O2-desat numbers in front of you, you don't realize how you are slowly killing every organ in your body.

When the body is trying to sleep well but keeps getting pulled out of deep sleep and REM sleep, all night long, for years and years, all the things that are supposed to happen during sleep can't happen. That shows up as physical deterioration and confusion and depression and lack of problem-solving skills. What makes that so insidious is that solving the problem of moderate-to-severe obstructive sleep apnea often requires the very clarity of thought and gumption and decisiveness that OSA robs one of.

Breathing is important. Sleep is important. If you believe those two statements of obvious truth, it is self-destructive to ignore them.

I have severe obstructive sleep apnea. I use PAP therapy because I believe that suicide is wrong, regardless of the speed at which one might attempt it.

I have severe obstructive sleep apnea. I use PAP therapy because I believe that enjoying life is a good thing. And compared to how I felt before PAP, these last few years I am alive for the first time. Before I experienced several months of successful PAP, though, I had no idea how dead I was.

I've been on CPAP for less than a month now.

When I found out that I stopped breathing, on average, 108 times every hour - that was enough for me. To think that Oxygen wasn't getting in as soon as it should and Carbon Dioxide wasn't leaving as quickly as it should - it was enough to scare me. Plus I was tired ALL OF THE TIME.

I must admit it bothers me how your cardiologist made light of it. Shame on him.

I hope your decision is based on how many people love you and want you around for a long long time - and not on how "inconvenient" CPAP is.