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How serious are these numbers?
#1
How serious are these numbers?
Never had any serious sleep problems until a few months ago (I'm in my early sixties). Snore, sure -- but my wife retrained me early on and it's minimal. Anyhow, something went wrong in late March and I was actually admitted to ICU for a pulmonary edema (again, never before) accompanied with 200+ BP one frightful night.

Long story short -- they're still scratching their heads over why all this happened but in the meantime, my brother suggested asking for a sleep study and after getting the nod from my doctor, in I went. Here's the results that were sent to my doctor:
  • Apnea Hypopnea Index (AHI) 36.1 events per hour
  • During supine sleep the AHI was 48.3 events hour
  • During REM sleep the AHI was 22 events per hour
  • The lowest 02 saturation was 89%
  • The patient spent O.1 minutes of total sleep time with 02 sat less than 90%.
  • EKG showed: A-Fib & sinus bradycardia
  • Sleep Efficiency: normal
  • PLMs: none
So I don't expect sleep doctor expertise here (I guess), but in general, is this as serious as they told me it is? And given that it was all sort of post-trauma, how often should I be retested? Has anyone ever gotten into CPAP stuff and then improved to the point where they don't need it again? Or is there a tendency for it to make you more dependent on it?

Clarification: afib has been there for a least 30 years. They can't seem to clear this up despite several attempts. I actually had a cardio conversion 4 days before the edema episode (they say that there is no connection). And, I'm scheduled for cardio-ablation procedure (my 4th) probably in the late fall. Right now I'm on beta-blockers, and BP meds. My pulse and bp numbers are rock solidly normal now.

The biggest problem I have (besides the usual discomfort of trying to sleep with a face-hugger on me) is that I hate the idea of adding more permanent tech to clutter up my health regime and... well, life. I mean, both of us just retired, we were hoping to travel a lot more.

FTR, I'm very fit, and thin. No alcohol, rec drugs, caffeine and a well-balanced healthy diet. And actively retired. Or rather, was active -- I have never taken so long to recover from anything in terms of fatigue, than I have with that edema episode. Now I sleep a lot more in the day, get tired so easily, and dizzy if I'm in the heat for just a short time.

My wife is all for going ahead with CPAP, and most people that I know who have gone to CPAP say it's great. I tell you, the best sleeps I've had in years were the 3 nights in the ICU. Then an orderly told me that's because they 'spike' the air there with O2! (hah)

I have booked an appointment with a vendor this Tuesday, but I am having lots of doubts about the ride I'm hopping on. I hope that it's a ride that I can someday get off -- without being put in a box first, that is.

Or are these numbers not to be ignored at all and just a strong indication that I have really no other choices?

I'd appreciate some considerate lay opinions and experiences to share. As they say, even though theory and practice are the same thing, in practice (including sometimes, medical)... they're not.

Thanks very much.
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#2
RE: How serious are these numbers?
Maybe more important: what are you doing about your afib? (Oh wait sorry I see that you've had it for a while).

Often apnia and afib are related. You need to address both. Adding tech equipment is the least of your worries now. It's all worth it to start addressing your afib and apnea. Get thee to a cardiologist and then to an Ep (electrophysiologist) if you haven't already. Have you had an ablation? Did you try anti-arrhythmia drugs like flecainide? I speak from experience about afib. A GP will want to manage it; don't let him or her. You need a specialist. Sorry if you know all this and have already done these things.
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#3
RE: How serious are these numbers?
Thanks for your concerns, but yes, I've already done all that. Plus, my brother is a cardiac research scientist (30 years in the field) so he's pretty good at helping me understand where I am with that stuff. But he's also the one who suggested the sleep study.

If anything, I'm hoping that getting into CPAP will help narrow down some of the guesswork with my cardiac health that's now going on as it should eliminate another possibly-related factor.

Thanks again for your prompt response!

Cheers.
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#4
RE: How serious are these numbers?
Yes, these numbers are serious. An AHI of 36.1 means that your breathing is stopping or pausing an average of 36.1 times per hour. That means every two minutes! This is very hard on both the brain and the body.

You stated that the doctors have never been able to clear up your afib. I can't help wondering if undiagnosed sleep apnea isn't a factor in that. Here is a description from the Mayo Clinic website of the effects of sleep apnea on the heart:

  • High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).
    Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.
Yes, using a CPAP requires effort and time to get used to, but I can tell you it is absolutely worth the time and effort in the improvement in your health and energy.. You can travel with a CPAP. Depending on what type of machine you need, you can either take your usual machine or get a small CPAP designed especially for travel. 

There are many knowledgable people on this website who can help you with any issues you may have as you start your CPAP journey. No, it is not a journey you expected or asked for, but if you embrace it you will feel better and the quality of your life will improve!

Best,
Robin
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#5
RE: How serious are these numbers?
My guess is you have had untreated apnea for quite a while and the long term ramifications on your health have been compiling.

Your A-fib is probably due to untreated sleep apnea. I imagine your brother has explained this to you already as there is a well known strong correlation between A-fib and apnea. I am actually blown away that no one has recommended sleep apnea test prior to this if you have had A-fib for such a long time.

Both my grandfathers (nearing 90) have apnea, heart issues (A-fib and decongestive heart failure) because of it. CPAP treatment for the past 1-2 decades is probably the reason both are still alive. Sleep apnea puts HUGE stress on your heart because your heart has to try and make up for your bodies inability to breath effectively.

Your numbers are high, you have severe apnea and should start CPAP immediately. You will likely have to stay on it for the rest of your life, this may seem frustrating right now but after you start treatment you will probably notice a big improvement in quality of sleep/life. Figuring out how to deal with your CPAP machine will become a breeze rather than the headache you foresee, it is just one extra bag to carry around with you. I am 33 and have to travel for work, it is just like taking a second computer bag with me wherever I go.
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#6
RE: How serious are these numbers?
You have nothing to lose by trying CPAP.  Keep in mind that it's your choice.  If you hate it and can't stand life wearing a mask strapped to your face every night, you can make the decision to stop.  No one will force you to continue. You are free to put your equipment away at any time and go back to "normal" life.

I totally understand your reluctance to get started on the CPAP "ride" and your hope that it isn't a lifetime thing; that's exactly why I put off my sleep test for months last year after an episode of afib and a referral by my cardiologist for a sleep study.

There's still a part of me that whispers "what if I don't really need this?"  "Maybe the (home) sleep study wasn't accurate."  "Maybe it doesn't make any difference if I wear the mask or not..."

But surprisingly, after half a year it's just not that big of a deal.  I finally found a mask that's minimal and comfortable, I sleep pretty darned well, I feel like I'm doing my body a favor, which is a good feeling, and what the heck, I might as well keep my cardiogist and pulmonologist happy.

I can always quit using it if I want... so can you.
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#7
RE: How serious are these numbers?
Thanks for your insights plakky and Geer1. I appreciate your comments and stories. It makes me feel less apprehensive about anything when I can get it 'straight from the horse's mouth'. 

Or pharyngeal tract too, I suppose!

Cheers.
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#8
RE: How serious are these numbers?
There are always choices. BUT xPAP therapy is the gold standard.
Read this http://www.apneaboard.com/wiki/index.php..._for_Apnea
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#9
RE: How serious are these numbers?
Broacher,
Untreated sleep apnea has been tagged as the probable cause of my right ventricular enlargement.  Once I got started on APAP and beat insomnia my energy and initiative returned.  Now I’m averaging 7-8 hours of good sleep and the APAP machine is like a pacifier.  I’m asleep within five minutes of starting the machine.  But now I live with an enlarged heart.

Recommend you consider titration for a machine and starting therapy soonest.  Best wishes.
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#10
RE: How serious are these numbers?
36.1 AHI is severe so I'd go get the PAP and begin getting better. If at all possible request ResMed AirSense 10 AutoSet. Unfortunate, but unless one were diagnosed with mild Apnea PAP is a life thing. But that life just got better and longer.

Welcome to the club.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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