mild apnea: is the treatment worse than the disorder?

Hello All-

I was diagnosed with very mild apnea three weeks ago. My oxygen level did not go below 93% and my AHI was 8. The doctor recommended CPAP, so I wanted to try his recommendations. His rationale is that apnea tends to get worse, which could lead to increased risk of heart disease/stroke down the road (I am 28 years old). I'm currently in the process of losing 100 lbs. (have lost 50 already). Other than that, I do not have any other risk factors for heart disease/stroke.

Plus, he said it was disrupting my stage 3 and 4 sleep, which I did not get any of the first night of the study. With the mask, I did have some stage 3 sleep, but no stage 4 still. To make things a little more complex, I have spontaneous arousals, PLMD, and RLS. I also have fibromyalgia and a seizure disorder, which is under control with medications. The second night of the study, my spontaneous arousals and PLM increased signifcantly.

My former sleep doctor, who disagreed and said it was UARS, not apnea, said lose weight and it would resolve itself. However, 50 lbs. later, I have seen no improvement, so I went to get a second opinion.

I have tried to sleep with the mask every night for the past week and a half. I have been able to sleep with it on for six hours total in the week and a half. I have already switched out masks once, with only slight improvement. I have broken out from the mask material, so now I have sores on my face where the mask hits. Also, I don't know if others have this problem, but it feels like the air is hitting my chin under the mask instead of going into my airway. The bridge of my nose hurts, and the leaks are bad-although not as bad as the Comfort Gel was. I am will to try pad-a-cheeks and stuff like that, if I decide I can handle this mask. I have sensory issues from the fibromyalgia and the seizure disorder, which is compounding matters.

So, any advice would be appreciated. But, my main question is: With apnea this mild, is it worth it to treat with CPAP?

I'd say treat. You don't know whether its your weight or other issues, i.e. poor innervation of muscles etc. that could be causing the sleep apnea. It takes time to feel better.

Hea83ther wrote:Hello All-

I was diagnosed with very mild apnea three weeks ago. My oxygen level did not go below 93% and my AHI was 8. The doctor recommended CPAP, so I wanted to try his recommendations. His rationale is that apnea tends to get worse, which could lead to increased risk of heart disease/stroke down the road (I am 28 years old). I'm currently in the process of losing 100 lbs. (have lost 50 already). Other than that, I do not have any other risk factors for heart disease/stroke.

Plus, he said it was disrupting my stage 3 and 4 sleep, which I did not get any of the first night of the study. With the mask, I did have some stage 3 sleep, but no stage 4 still. To make things a little more complex, I have spontaneous arousals, PLMD, and RLS. I also have fibromyalgia and a seizure disorder, which is under control with medications. The second night of the study, my spontaneous arousals and PLM increased signifcantly.

My former sleep doctor, who disagreed and said it was UARS, not apnea, said lose weight and it would resolve itself. However, 50 lbs. later, I have seen no improvement, so I went to get a second opinion.

I have tried to sleep with the mask every night for the past week and a half. I have been able to sleep with it on for six hours total in the week and a half. I have already switched out masks once, with only slight improvement. I have broken out from the mask material, so now I have sores on my face where the mask hits. Also, I don't know if others have this problem, but it feels like the air is hitting my chin under the mask instead of going into my airway. The bridge of my nose hurts, and the leaks are bad-although not as bad as the Comfort Gel was. I am will to try pad-a-cheeks and stuff like that, if I decide I can handle this mask. I have sensory issues from the fibromyalgia and the seizure disorder, which is compounding matters.

So, any advice would be appreciated. But, my main question is: With apnea this mild, is it worth it to treat with CPAP?

Hea83ther wrote:Hello All-

I was diagnosed with very mild apnea three weeks ago. My oxygen level did not go below 93% and my AHI was 8. The doctor recommended CPAP, so I wanted to try his recommendations. His rationale is that apnea tends to get worse, which could lead to increased risk of heart disease/stroke down the road (I am 28 years old). I'm currently in the process of losing 100 lbs. (have lost 50 already). Other than that, I do not have any other risk factors for heart disease/stroke.Plus, he said it was disrupting my stage 3 and 4 sleep, which I did not get any of the first night of the study. With the mask, I did have some stage 3 sleep, but no stage 4 still. To make things a little more complex, I have spontaneous arousals, PLMD, and RLS. I also have fibromyalgia and a seizure disorder, which is under control with medications. The second night of the study, my spontaneous arousals and PLM increased signifcantly.

My former sleep doctor, who disagreed and said it was UARS, not apnea, said lose weight and it would resolve itself. However, 50 lbs. later, I have seen no improvement, so I went to get a second opinion.

I have tried to sleep with the mask every night for the past week and a half. I have been able to sleep with it on for six hours total in the week and a half. I have already switched out masks once, with only slight improvement. I have broken out from the mask material, so now I have sores on my face where the mask hits. Also, I don't know if others have this problem, but it feels like the air is hitting my chin under the mask instead of going into my airway. The bridge of my nose hurts, and the leaks are bad-although not as bad as the Comfort Gel was. I am will to try pad-a-cheeks and stuff like that, if I decide I can handle this mask. I have sensory issues from the fibromyalgia and the seizure disorder, which is compounding matters.

So, any advice would be appreciated. But, my main question is: With apnea this mild, is it worth it to treat with CPAP?

You may not have any symptoms of heart, stroke and diabetes at the moment, but without cpap you soon would.Also, my fibro has all but disapeared since using cpap.

Nanwilson-

Did you feel like your fibromyalgia made it more difficult to tolerate the mask? How long did it take after using the mask for your symptoms to go away?

Also, I couldn't find any studies showing a connection between mild apnea and increased risk of heart attack/stroke. That doesn't mean the information doesn't exist, or what you're saying isn't true, but I just haven't seen it for anything besides moderate/severe, and mostly severe.

Kairosgrammy-

What is innervation?

Thanks-

My fibro seemed to disapear about 3 months into therapy..... the pain was getting less and less, then none. As to finding data to support sleep apnea causing heart, stroke and diabetes...........it doesn't CAUSE it, it helps it along. Lack of oxygen and poor sleep will definitely make your heart and lungs work that much harder to keep up. You will find that most of us on the forum have one or more of these problems, be it heart disease or T2. If you presently have been dx'd with "mild" apnea, do you not think without therapy it would stay "mild".

I've heard that mild apnea can get worse if untreated by word of mouth, but I haven't found any evidence that supports that. I'm not sure if my oxygen dropping to 93% is risky or not; haven't been able to find research on that either, although I'm sure it exists somewhere. I think that may be why some doctors only "treat" it using lifestyle changes. It seems that much more research needs to be done on sleep disorders and neurology. There weren't any new seizure meds. invented for 50 years, and it doesn't seem like there's been many improvements in the treatment of sleep disorders either.

Not sure if CPAP will improve my sleep or not, considering the three other sleeping issues I have. I hope it will, but I'm not assuming it will, considering I'm dealing with more than apnea. Poor sleep in general has definitely been correlated to other health problems, like you said, regardless of the cause. But, if the mask is more disruptive to my sleep than the apnea, which is worse? Is 2-3 hours of good sleep per night because I can't fall asleep with the mask better than 8-9 hours of poor sleep? I honestly don't know the answer. Hopefully, I will get more used to it with time and figure out how to stop the leaks, but I obviously can't go months and months with two hours of sleep per night, especially when I have to work full time.

Hea83ther wrote: There weren't any new seizure meds. invented for 50 years, and it doesn't seem like there's been many improvements in the treatment of sleep disorders either.

Ha! Back in the 80s and earlier they'd cut a hole in your throat to treat sleep apnea!!! I'd say the CPAP machine is one of the greatest inventions ever, and also back in the early days (late 80s I believe) of CPAP they were giant noisy compressors with no data capability at all. They have progressed quite well since then and I'm grateful to have such a great machine now. If you don't want to use it then don't, but you can't say there hasn't been improvements in treating sleep disorders in the last 50 years, the CPAP of today is a HUGE improvement over hole in the throat and even the CPAPs of 20 years ago!!

But, if the mask is more disruptive to my sleep than the apnea, which is worse?

Sleep apnea is absolutely worse. You can get used to sleeping with a mask, not so with apnea! I would suggest trying a different type of mask or different size of the one you have now.

Hi Hea83ther,

I'm another one with fibromyalgia, and mine is severe enough that the rheumatologist who diagnosed it told me flatly that I'd be wheelchair-bound within five years. (That was twenty years ago... not saying he was wrong, but I got very aggressive about managing the fibro and have kept it at bay although I certainly never got symptom-free).

Since I started CPAP three months ago, I've seen health improvements in other areas, and I think I am in fact starting to see even more improvement in the fibro symptoms. Restful, restorative sleep is really important in fibro, as I'm sure you already know. I have a bit less pain, a bit more flexibility, plus the added energy from actually getting good sleep makes it easier for me to do some exercising and limbering each day - and that really, really helps.

I'm no expert by any means (and many folks here are) but I think it's very likely that if you can get this working for you, you'll soon feel better and won't want to even consider not masking up

But it sounds as though you are really suffering with your mask, and that has to change in order for you to make a go of this cpap stuff and give it a chance to help you. Can you tell us more about your mask annd machine? I see you have them listed - can you tell us what your pressure is, and what the problems were with the other mask was that you tried? I'm hoping that some of the folks with experience of your particular mask(s) and pressure will be able to suggest other masks or things for you to do to make your existing ones less leaky and more comfortable.

Hang in there!

Another thought - if you edit the title of your thread to include "Quattro Full Face problems" or something like that, it might attract the attention of folks who use and have experience problem-solving that mask. Just a thought!

Hea83ther wrote:I've heard that mild apnea can get worse if untreated by word of mouth, but I haven't found any evidence that supports that. I'm not sure if my oxygen dropping to 93% is risky or not; haven't been able to find research on that either, although I'm sure it exists somewhere. I think that may be why some doctors only "treat" it using lifestyle changes. It seems that much more research needs to be done on sleep disorders and neurology. There weren't any new seizure meds. invented for 50 years, and it doesn't seem like there's been many improvements in the treatment of sleep disorders either. .

Yes well you don't start out severe all of a sudden so you have to start somewhere. Of course it will get more sever as you age just the same way your boobs end up closer to your waist after a few years. Life style changes don't do a damned thing for you if it is the structure of your throat, any more then they do anything for saggy boobs.

In your case I would treat every single damn minor thing that can be treated. Think of your health like a bucket full of water, one extra drop can make the whole thing overflow and be unliftable, scoop out some and suddenly it is manageable. In cases of chronic illness every little bit counts.

Hea83ther,

A diagnostic AHI - 8 is indeed very mild apnea. But since one of the docs you have consulted had mentioned UARS, it's reasonable to ask: Have you got a copy of the sleep study itself? I mean hard copies of the full summary data and graphs along with the doctor's dictated interpretation.

My understanding of current thinking is that many, but not all sleep docs regard UARS and OSA as being on the same continuum of sleep disordered breathing---in other words, that the line between UARS and OSA is fuzzy. And many sleep docs do believe that as we age, untreated OSA will get progressively worse. And certainly with women there is a decided tendency for existing UARS/OSA to worsen when we hit menopause and many women first develop OSA during or after menopause. So if you choose to not treat your sleep disordered breathing at all right now (because it is so mild and treatment seems to be worse than the disease), then you need to be prudent and open and honest in future years about the subtle worsening of UARS/OSA symptoms and not write them off as just more fibromyalgia symptoms.

My own advice, such as it is, is to give CPAP a good, long fair trial. That means trying to make CPAP work for at least three or four months before concluding that it will not work at all for you.

Since your current machine records no efficacy data, you and your doc are working somewhat blind in trying to figure out just why you're not feeling any different. Although the fact that your sleep is much more interrupted is a big issue. So we'll tackle that one first. You need to first of all acclimate yourself to the feel of the mask. It may help to wear the mask for several hours during the daytime or early evening while reading or watching TV just so that you can get used to how it feels. Second, you need to make a commitment to actually sleeping with the mask all night long. Once you can wear the mask for an hour or so during the daytime without feeling like you are fighting it, then it's time to start forcing yourself to NOT sleep without the mask. And that means two things:

1. When you first go to bed, you have to have the mask on. And if you get to the point where you're tempted to just rip the mask off so that you can "get some sleep", that means you need to get out of bed, settle yourself down in a different room, and return to bed only after you are calm enough and sleepy enough to mask up and try again.
2. When you wake up in the middle of the night desperate to rip the mask off and go back to sleep without the mask, you need to get out of bed, settle yourself down in a different room, and return to bed only after you are calm enough and sleepy enough to mask up again.

If after a month or two of consistently using the machine every night, all night long you are still finding that you have to get up out of bed multiple times because you wake and want to rip the mask off, then it's time to contact the doc and ask where to go from here.

If you feel no better after a month or two of sleeping rather soundly with the mask on your nose all night long, then it's time to contact the sleep doc and ask where to go from here.

And it could be that after you make a real, honest effort at adjusting to CPAP that your insurance company just might pay for an oral appliance for treating the OSA/UARS. The OA's are not generally as effective at treating OSA as CPAP, but for folks with mild apnea like yours, they can be very effective. But many insurance companies will not pay for them unless it's been documented that you've tried and failed to adapt to using a CPAP machine. And while many people find sleeping with an OA easier than sleeping with a CPAP, there are also people who have real problems with OAs. The most common problems with OAs are jaw pain in the morning, excessive drooling at night, and discomfort at night with the OA in your mouth. And, for folks with mild-to-moderate and moderate OSA, a major problem with the OAs is that they may simply not reduce the apnea enough to be therapuetic. Typcially a second titration study with the OA in place is done several months after you start working with the OA to determine whether the OA is sufficiently effective.

My AHI was five so I was given the option of trying CPAP. I've had some trouble and have to take Provigil, but I'm glad I'm getting treatment.

Hea83ther wrote: I have tried to sleep with the mask every night for the past week and a half. I have been able to sleep with it on for six hours total in the week and a half. I have already switched out masks once, with only slight improvement. I have broken out from the mask material, so now I have sores on my face where the mask hits. Also, I don't know if others have this problem, but it feels like the air is hitting my chin under the mask instead of going into my airway. The bridge of my nose hurts, and the leaks are bad-although not as bad as the Comfort Gel was. I am will to try pad-a-cheeks and stuff like that, if I decide I can handle this mask. I have sensory issues from the fibromyalgia and the seizure disorder, which is compounding matters.

What should Hea83ther try first to fix these issues? It has got to be awfully hard to find the will to go forward with a mask that genuinely hurts and causes sores.

(I have no experience with the full face masks so anything I might suggest would be totally uninformed.)

My pressure is only set at seven, and I don't use the ramp, because I want it to seal based on the highest pressure it will be at. Plus, I wouldn't be asleep after twenty minutes anyway, so it doesn't matter I started another thread about the Quattro and got lots of suggestions, which I tried.

I've had leaking with the comfort gel, and it felt like it was too big-it really hurt my nose. Went back to the DME, and they replaced it with the Quattro. I'm still questioning if it's the right fit, it leaks, and I have to have it really tight to reduce the leaks at all, which I know messes with the air cushion. It certainly doesn't "float" on my face, like I've been told it should. My face has also broken out where the mask hits around my mouth. I'm going to try to rig up my own liner, but if that doesn't work, I guess I'm going to have to go back again and try something different.

I am not bashing CPAP, and it has helped many people; it has improved over the years, from what I have read. However, besides surgery, which is only marginally successful, there are no new treatments. 30 years is a long time for new treatments to not be invented, and many people do not tolerate CPAP well. It just seems that more money and research needs to be put into sleeping disorders (and all areas of neurology, for that matter), so that people who are not having successful treatment have other options.

I appreciate everyone's opinion and am glad that many of you have had improvements in your health; I hope I do too, and I am certainly taking your opinions into consideration-that's why I began this post. But, I still not have found any research that supports mild apnea increasing one's risk for a heart attack, stroke, or diabetes, and I would be interested in reading such research, as I have two doctors (both certified in sleep medicine) giving me very different opinions.

RocketGirl wrote:

Hea83ther wrote: I have tried to sleep with the mask every night for the past week and a half. I have been able to sleep with it on for six hours total in the week and a half. I have already switched out masks once, with only slight improvement. I have broken out from the mask material, so now I have sores on my face where the mask hits. Also, I don't know if others have this problem, but it feels like the air is hitting my chin under the mask instead of going into my airway. The bridge of my nose hurts, and the leaks are bad-although not as bad as the Comfort Gel was. I am will to try pad-a-cheeks and stuff like that, if I decide I can handle this mask. I have sensory issues from the fibromyalgia and the seizure disorder, which is compounding matters.

What should Hea83ther try first to fix these issues? It has got to be awfully hard to find the will to go forward with a mask that genuinely hurts and causes sores.

(I have no experience with the full face masks so anything I might suggest would be totally uninformed.)

Liners - my skin reacted the same way so I found this site the very next day, did a search - there is a search box after all - and created my own the same day. Problem solved.

It doesn't matter where it feels like it is hitting you in the mask, the pressure in the mask is the same.