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[Diagnosis] Mild sleep disordered breathing
#1
Mild sleep disordered breathing
Hi all - new to the forum. Thank you to all for the info here as its been very very helpful in understanding SA for me. Dare I say more helpful than my doctors..

I'd love to pick your brain on some of my diagnose numbers if I may..apologies ahead of time if I'm posting this in the wrong place as I learn my way around the board.
Let me start by saying that my father has sleep apnea and has been using a CPAP machine for over 6-7 years now. He now also has Afib (not sure if its as a result of years of undiagnosed SA or unrelated). My younger brother and I also sleep like my father in that we have a "crazy loud can't breathe snore", which in consideration to my wife I've masked or fully done away with by converting to a side sleeper. However now whenever I do find myself sleeping on my back I have breathing issues before I even have a chance to fall asleep deep enough where I can get to snore.


The last 2-3 months Ive started to get symptoms such as day time fatigue, needing daily afternoon naps, no energy for any sort of exercise, morning and sometimes all day headaches and being angry or just less patient, low (no) libido. Also at night I get a Jolt feeling to the chest while sleeping (typically later in the night..4-5 am or so) and also occasional heart rate spikes to the 100s or 110s. Also muscle twitches or tingling at times.
So I told my doctor about it and also mentioned my family history....and they asked to do an overnight oximetry about 6-7 weeks ago the results of which came back as "mild sleep disordered breathing". Upon symptom getting worse I pushed my doc for an actual sleep study and due to the Covid 19 situation they set me up with a at home sleep study (Watch PAT). The clinical note from the sleep doc on the study says "Clinical Impression: This home sleep apnea test  shows mild sleep disordered breathing with RDI 12.4."
Its very unfortunate that the night that I did the Watch Pat test I had the best sleep I had had in weeks..so likely it didn't capture much useful data in doing a good diagnoses. 
I have a call with the sleep doctor tomorrow and I'm afraid that she'll say just that to me and brush this off, while my symptoms persist or get worse.

What do you all think about these numbers and/or what if anything else I should push for?

Thanks in advance and I hope to one day help others in this forum!

Gary


Attached Files
.pdf   Oximetry .pdf (Size: 214.99 KB / Downloads: 23)
.pdf   sleep study.pdf (Size: 473.93 KB / Downloads: 28)
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#2
RE: Mild sleep disordered breathing
Gary, at-home sleep studies offer a snapshot of what your sleep apnea may be. They have some difficulty accurately detecting sleep, and that can dilute the findings with wake-time. Your sleep study bases AHI on the presence of an oxygen desaturation equal or greater than 4%. That is fairly standard, but also misses many events that are disruptive to sleep from respiratory effort related arousal (RERA) that are from less severe airway obstruction. Almost no diagnostic test is sensitive to flow limitation which is the root of snoring, hypopnea and obstructive apnea. So a mild sleep disordered breathing diagnosis must be considered together with your other symptoms of sleep disorder, such as complaints of snoring, fatigue, general tiredness and of course any high blood pressure, weight issues and family history. This is where the case is made for you to get treatment.

Obstructive sleep disordered breathing doesn't tend to get a lot better as you age. You're still young and relatively healthy, and a good way to keep that, is to take advantage of treatment that eliminates even brief oxygen desaturation and mostly all the sleep disruption. I think the best course is not to passively look at these results and assume they are mile, but rather that sleep disruptions every 4-5 minutes through the night are not the something to be tolerated or ignored. You can feel better and avoid future problems by treating it early. You may have to be your own advocate for this treatment, but you will avoid banishment to the couch and the possible onset of more severe fatigue that wll occur as this progresses.

As far as what equipment best addresses this, auto CPAP and self-titration is pretty obvious. You can use a fully data capable machine, along with free software like OSCAR to fine-tune therapy and achieve your goals for better, more healthy, quiet sleep. I'll specifically recommend you try the Resmed Airfit P10 nasal pillows mask with a Resmed Airsense 10 Autoset CPAP machine. The mask is the lightest and easiest nasal pillow to tolerate, and personally having done this quite a few years, I have not found anything better. The Resmed Autoset is a very responsive auto CPAP that has bilevel pressure capability to provide lower exhale pressure (EPAP) and higher inhale pressure (IPAP). This makes it capable of resolving the kinds of flow limitation that cause your RERA and hypopnea better than any alternative on the market. It's just better. Try to get the script, and if your insurance is good get the right equipment from a local supplier. If insurance is not going to cover, consider online purchase options for much less.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: Mild sleep disordered breathing
I want to caution you to not allow the word "mild" to distract you nor your doctor.

If something was bothering you in a "mild" way, you would not have seen a doctor for it and pursued help.

So sure, *compared to others* who may have it *more severely*, yours may not be *as severe*. But that doesn't mean it's not hindering your life and your health.

My doctor said I had very mild obstructive sleep apnea, and it wasn't even worth bothering to treat. I told him I don't know what else to do (to feel more awake, etc.), so please could we pursue it. Sure enough, the CPAP is a *life-changer* for me, and I wish I had it 20 years ago!
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#4
RE: Mild sleep disordered breathing
An RDI of 12 means something is disturbing your sleep, on average, once every 5 minutes all night long. Do you sleep well with someone giving you an elbow jab that is severe enough to disturb your sleep every 5 minutes? I didn't think so.

As suggested above, ask your doctor to please subscribe a ResMed AirSense 10 AutoSet in lieu of a formal sleep study because of the coronavirus and on the basis of Watch-Pat study and then go from there. Suggested settings 6-20 with an EPR=2 full time.

Our intention would be to review the OSCAR charts after 1 or 2 nights and suggest changes to optimize the settings.
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#5
RE: Mild sleep disordered breathing
Thanks for your replies and feedback - I will certainly push for it because I realize all too well the value of sleep and the cascading effects it has on health.

Thanks again!
Gary
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#6
RE: Mild sleep disordered breathing
(04-27-2020, 01:25 PM)Sleeprider Wrote: Gary, at-home sleep studies offer a snapshot of what your sleep apnea may be.  They have some difficulty accurately detecting sleep, and that can dilute the findings with wake-time.  Your sleep study bases AHI on the presence of an oxygen desaturation equal or greater than 4%. That is fairly standard, but also misses many events that are disruptive to sleep from respiratory effort related arousal (RERA) that are from less severe airway obstruction.  Almost no diagnostic test is sensitive to flow limitation which is the root of snoring, hypopnea and obstructive apnea.  So a mild sleep disordered breathing diagnosis must be considered together with your other symptoms of sleep disorder, such as complaints of snoring, fatigue, general tiredness and of course any high blood pressure, weight issues and family history.  This is where the case is made for you to get treatment.

Obstructive sleep disordered breathing doesn't tend to get a lot better as you age.  You're still young and relatively healthy, and a good way to keep that, is to take advantage of treatment that eliminates even brief oxygen desaturation and mostly all the sleep disruption.  I think the best course is not to passively look at these results and assume they are mile, but rather that sleep disruptions every 4-5 minutes through the night are not the something to be tolerated or ignored.  You can feel better and avoid future problems by treating it early.  You may have to be your own advocate for this treatment, but you will avoid banishment to the couch and the possible onset of more severe fatigue that wll occur as this progresses.

As far as what equipment best addresses this, auto CPAP and self-titration is pretty obvious.  You can use a fully data capable machine, along with free software like Oscar to fine-tune therapy and achieve your goals for better, more healthy, quiet sleep.  I'll specifically recommend you try the Resmed Airfit P10 nasal pillows mask with a Resmed Airsense 10 Autoset CPAP machine.  The mask is the lightest and easiest nasal pillow to tolerate, and personally having done this quite a few years, I have not found anything better.  The Resmed Autoset is a very responsive auto CPAP that has bilevel pressure capability to provide lower exhale pressure (EPAP) and higher inhale pressure (IPAP).  This makes it capable of resolving the kinds of flow limitation that cause your RERA and hypopnea better than any alternative on the market. It's just better. Try to get the script, and if your insurance is good get the right equipment from a local supplier. If insurance is not going to cover, consider online purchase options for much less.

Thank you Sleeprider!! I intend to get the Oscar software when I get set up with the machine. Would you recommend the Resmed 10 Autoset machine over either the Dreamstation BiPAP Pro (DSx600) or the Dreamstation BiPAP Auto (DSx700)? 
Also, I tried to find the answer to this question in the Masks primer but I didn't see it..can you use a Resmed machine with a Phillips dreamwear mask? Or do the masks only work with the machine that each company makes? F rom looking online it would seem the Dreamwear might be a good option just because the tube is on the top of the head so out of the way which might make things a bit easier. And seems light or minimalist, but I may be jumping the gun on that.

Thanks again for the help!
Gary
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#7
RE: Mild sleep disordered breathing
Masks and non-heated hoses are universal fit except for some mini/travel machines.

ResMed AutoSet hands down.
Why ResMed?

1. Faster algorithmic response to events than PR.

2. Lower average pressure

3. Better to avoid Aerophagia.

4. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores

5. EPR acts like a BiLevel up to a limit of 3cmw and a max pressure of 20 cmw

6. EPR follows your breathing where as Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly

7. More flexibility in treating a greater variety of Apneas and respiratory events.

8. In general provides better therapy.

I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or. BiLevel to get better therapy.

Respironics costs less
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#8
RE: Mild sleep disordered breathing
(04-27-2020, 04:56 PM)bonjour Wrote: Masks and non-heated hoses are universal fit except for some mini/travel machines.

ResMed AutoSet hands down.
Why ResMed?

1. Faster algorithmic response to events than PR.

2. Lower average pressure

3. Better to avoid Aerophagia.

4. EPR provides for better treatment of hypopneas, RERAs, Flow Limits, UARS, and snores

5. EPR acts like a BiLevel up to a limit of 3cmw and a max pressure of 20 cmw

6. EPR follows your breathing where as Flex predicts it with a feeling of fighting to get a breath when it predicts incorrectly

7. More flexibility in treating a greater variety of Apneas and respiratory events.

8. In general provides better therapy.

I have frequently told many DreamStation users that they need to get either the ReaMed AutoSet or. BiLevel to get better therapy.

Respironics costs less

Thanks so much!! Appreciate all of this!
Gary
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#9
RE: Mild sleep disordered breathing
(04-27-2020, 04:56 PM)bonjour Wrote: Why ResMed?

1. Faster algorithmic response to events than PR.

2. Lower average pressure

3. Better to avoid Aerophagia.

How is the ResMed #3 (better at avoiding aerophagia)?  Is it because of #2?  

I haven't compared my pressures on the 2 devices.  But now I'm curious!
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#10
RE: Mild sleep disordered breathing
Yes, the ability to use lower pressures helps to mitigate aerophagia.
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