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[Diagnosis] Recent Diagnosis; Should I Pursue Treatment?
#1
Question 
Greetings all. I'd like to get your advice on whether to start CPAP therapy in earnest, or any therapy, for that matter.  I had a sleep study, and the short version is that I was diagnosed with mild OSA. I'm questioning whether it's worth the expense, time, and hassle to fully proceed with CPAP therapy to address what are generally mild symptoms.

Here's my background:
54 yo male
5' 10"; 175 lbs
active cyclist, in pretty good shape

Sleep Study Results
(Let me know if there are any other numbers I should provide)
AHI: 5.0
RDI: 8.0
Oxygen: 99.4% spent at or above 90% saturation

More info for anyone patient enough to read it...

Sleeping: Every night I wake up 2 - 3 times to use the bathroom. I can usually fall asleep pretty quickly after these awakenings (for lack of a better term).  I do snore, and in some instances, will awaken with a honking sound. I assume these are caused by apneas. On most mornings, I feel fairly well rested.

Daytime sleepiness: I have a desk job. In most situations, I don't have any problems staying awake during the day. However, any time spent when I'm not fully engaged such as some meetings, or having to read boring content, I definitely struggle with staying awake. (Fortunately, I spend most of day doing engaging work.) I've also had a few occasions while driving, typically on highways, where I start getting sleepy, but I've never fallen asleep or had any close calls.

I do have attention issues, which I've chalked up to ADD, although I've never been formally diagnosed. I've heard the ADD symptoms can be caused by sleep apnea.

CPAP: I did titration study and the conclusion was a CPAP with a setting of 14cm and a FFM mask. I've tried this on and off for a couple of weeks, and sleep worse with the CPAP than without, primarily due to mask leaks, and presumably due to the fact that I'm getting use to the whole thing.

So I'm questioning whether it's worth the expense, time, and hassle to continue with the CPAP therapy to address what are generally mild symptoms.
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#2
Once you get use to it you can look forward to only having to get up maybe once during the night. Feeling you have more energy than before. Knowing your getting a head start on a problem that doesn't go away but gets worse over time. Yeah I'd say it's worth the cost and hassle. Just like working out. It's hard at first but after a while you don't feel right without it.
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#3
You sound like me 10 years ago.  It gets worse.  Start treatment now, I wish that I had not waited.
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#4
(10-05-2017, 04:05 PM)bbooker703 Wrote: Greetings all. I'd like to get your advice on whether to start CPAP therapy in earnest, or any therapy, for that matter.  I had a sleep study, and the short version is that I was diagnosed with mild OSA. I'm questioning whether it's worth the expense, time, and hassle to fully proceed with CPAP therapy to address what are generally mild symptoms.

Here's my background:
54 yo male
5' 10"; 175 lbs
active cyclist, in pretty good shape

Sleep Study Results
(Let me know if there are any other numbers I should provide)
AHI: 5.0
RDI: 8.0
Oxygen: 99.4% spent at or above 90% saturation

More info for anyone patient enough to read it...

Sleeping: Every night I wake up 2 - 3 times to use the bathroom. I can usually fall asleep pretty quickly after these awakenings (for lack of a better term).  I do snore, and in some instances, will awaken with a honking sound. I assume these are caused by apneas. On most mornings, I feel fairly well rested.

Daytime sleepiness: I have a desk job. In most situations, I don't have any problems staying awake during the day. However, any time spent when I'm not fully engaged such as some meetings, or having to read boring content, I definitely struggle with staying awake. (Fortunately, I spend most of day doing engaging work.) I've also had a few occasions while driving, typically on highways, where I start getting sleepy, but I've never fallen asleep or had any close calls.

I do have attention issues, which I've chalked up to ADD, although I've never been formally diagnosed. I've heard the ADD symptoms can be caused by sleep apnea.

CPAP: I did titration study and the conclusion was a CPAP with a setting of 14cm and a FFM mask. I've tried this on and off for a couple of weeks, and sleep worse with the CPAP than without, primarily due to mask leaks, and presumably due to the fact that I'm getting use to the whole thing.

So I'm questioning whether it's worth the expense, time, and hassle to continue with the CPAP therapy to address what are generally mild symptoms.

A few questions to flesh out the info, since otherwise the answer in your case might be a vague "it depends."

1. What persuaded you/doc to have a sleep study?
2. What persuaded your doc to proceed with a titration study?
3. What was the sleep study's definition of an AHI event? 4%+ O2 desat? 3-4% O2 desat? It should say on your sleep study.
4. Have you explored other potential health issues to explain your symptoms, so even if you did CPAP it might not address them?
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#5
You have a borderline case where CPAP will even be considered. Your AHI/RDI suggest 5-8 arousals per hour. That is disruptive, but almost within "normal' range. Many of those events will be prevented with CPAP, but then you have the disruptions inherent in the therapy itself. IMO it is nearly a draw, and this is your decision. If you think you might sleep more restfully and avoid a bathroom break at night do CPAP. Your event rate and SpO2 is such that this is not an important health matter. I think in your position I'd defer and remain aware of the possible need to re-evaluate.
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#6
(10-05-2017, 04:21 PM)Walla Walla Wrote: Once you get use to it you can look forward to only having to get up maybe once during the night. Feeling you have more energy than before. Knowing your getting a head start on a problem that doesn't go away but gets worse over time. Yeah I'd say it's worth the cost and hassle. Just like working out. It's hard at first but after a while you don't feel right without it.

(10-05-2017, 04:30 PM)chill Wrote: You sound like me 10 years ago.  It gets worse.  Start treatment now, I wish that I had not waited.

(10-05-2017, 07:33 PM)Sleeprider Wrote: You have a borderline case where CPAP will even be considered.  Your AHI/RDI suggest 5-8 arousals per hour.  That is disruptive, but almost within "normal' range.  Many of those events will be prevented with CPAP, but then you have the disruptions inherent in the therapy itself.  IMO it is nearly a draw, and this is your decision.  If you think you might sleep more restfully and avoid a bathroom break at night do CPAP.  Your event rate and SpO2 is such that this is not an important health matter.  I think in your position I'd defer and remain aware of the possible need to re-evaluate.

Thanks for the insightful replies. More food for thought.
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#7
Hi bbooker703,
WELCOME! to the forum.!
I wish you good luck on your decision to continue CPAP therapy.
Hang in there for more responses to your post.
trish6hundred
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#8
(10-05-2017, 04:31 PM)HalfAsleep Wrote: A few questions to flesh out the info, since otherwise the answer in your case might be a vague "it depends."

1. What persuaded you/doc to have a sleep study?
2. What persuaded your doc to proceed with a titration study?
3. What was the sleep study's definition of an AHI event? 4%+ O2 desat? 3-4% O2 desat? It should say on your sleep study.
4. Have you explored other potential health issues to explain your symptoms, so even if you did CPAP it might not address them?

Answers:

1. The sleep study was my idea, primarily based on the "honking" episodes that I have, assuming they were caused by sleep apnea, and worrying about the long-term health impacts. Less-so the occasional tiredness. (Also, my girl friend, who admittedly is a bit of a hypochondriac, helped convince me to get it checked out.)

2) After the sleep study, my sleep doctor suggested we try it. He did make it clear though that my symptoms were mild enough that the treatment was questionable.

3) Does this answer your question: Hypopneas: 4% or >; RERAs 2% or less desaturation; AHI with 4% oxygen desaturation or greater.

4) I've investigated other causes to some degree, but not thoroughly.
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#9
I had a college professor tell me that "no one is responsible for your health and safety but yourself." Getting advice and weighing risk is a wise move. Calculating the benefits is tough when you put dollar figures on how you feel. If your concerned about it now, wait till later when you may have regret. There are a whole lot of success stories in this forum. You could be lucky to get this under control before you waste time feeling bad. I wouldn't put off for later. I could be wrong though sir.
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#10
(10-05-2017, 08:06 PM)bbooker703 Wrote:
(10-05-2017, 04:31 PM)HalfAsleep Wrote: A few questions to flesh out the info, since otherwise the answer in your case might be a vague "it depends."

1. What persuaded you/doc to have a sleep study?
2. What persuaded your doc to proceed with a titration study?
3. What was the sleep study's definition of an AHI event? 4%+ O2 desat? 3-4% O2 desat? It should say on your sleep study.
4. Have you explored other potential health issues to explain your symptoms, so even if you did CPAP it might not address them?
 
Answers:

1. The sleep study was my idea, primarily based on the "honking" episodes that I have, assuming they were caused by sleep apnea, and worrying about the long-term health impacts. Less-so the occasional tiredness. (Also, my girl friend, who admittedly is a bit of a hypochondriac, helped convince me to get it checked out.)

2) After the sleep study, my sleep doctor suggested we try it. He did make it clear though that my symptoms were mild enough that the treatment was questionable.

3) Does this answer your question: Hypopneas: 4% or >; RERAs 2% or less desaturation; AHI with 4% oxygen desaturation or greater.

4) I've investigated other causes to some degree, but not thoroughly.

Your AHI number (5?) of 4%+ desat might well qualify you for treatment, That's what my Medicare AHI is. My sleep standard-defined is 18. I have moderate OSA. 
I qualify for Medicare coverage for treatment because I have symptoms and corollary conditions. Most insurance companies follow Medicare specs.
.
So, it depends how the apnea is calculated.
Your symptoms sound like mine, but mine are more exaggerated. I was choking,snorting, throat-flapping every time I slept. My PCP sent me for testing without hesitation.

You could look at your test and see whether most incidents were supine. If so, you could try sleeping on your side.
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