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Mild. vs Moderate OSA
#1
In 2002 I was diagnosed with mild OSA (AHI of 19) and went through the titration (I was only able to last less than 2 hours before I took off the mask and ended it). At that time I didn't think CPAP was worth the trouble.

In December I was diagnosed with moderate OSA and am now on CPAP therapy.

My question is: How do Dr's decide whether or not to recommend CPAP, particularly when the OSA is mild (and more importantly, whether insurance will cover it). I read somewhere else on this board that it could go either way depending on the severity of the diagnosis.
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#2
I don't get too excited about the terms such as "mild," vs "moderate," vs "severe" even. What I look to is what is going on in your life? Are you having sleep apnea related symptoms?

In my case I began to suspect I had a problem when I fell asleep driving home 6 blocks from the post office. Actually, I knew I had trouble being really sleepy when driving. But it was only after I had moved to the far regions of my house when I slept at night to keep from being bludgeoned by my wife and the kitties for snoring, ---- when the county commissioners threatened to levy a special tax on my house because I kept setting off the tsunami alerts..... Well, I could go on and on.

But yes, I did get the testing and they told me I had "mild" sleep apnea. Unless I was on my back in which case I had "forgetaboutit" sleep apnea. So they gave me a machine, and I would never go back to sleeping without it.. They will have to pry my mask from my cold dead nosie before I give up my machine.

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#3
CPAP machines and masks have come a long way since your first attempt. They are more comfortable and usually include humidifiers and heated hoses. An auto CPAP actually lets you use lower pressure, and can increase pressure as needed to resolve obstructive apnea. The biggest thing is to get a mask you can live with. Nasal pillows are light and don't cover your face. If you don't mouth-breath they are great. Be sure to try them if you can. Machines that give you therapy data can have a positive feedback and keep you going as you can visualize the benefits of therapy.
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#4
Well, first, Drs only report what the sleep study says, and make recommendations in the form of prescriptions. Insurance decides what they will pay for based partly on that, and partly on your test. Most insurance won't give you a xPAP with an AHI under 5, regardless of what the doc might think.

I am not sure if the patient has any say, other than lobbying the doc to word the report as much in favor of convincing insurance as possible, should you be right on the dividing line. My guess would be that that rarely would work either.

But this is sensible; it protects insurance from a rogue doc who just wants to xPAP everyone whether they need it or not, and keeps them on track. And HIPPA helps keep a rogue insurance co from not giving you what the doc reasonably recommends. Its never perfect, but it's what we have.

But mild, moderate, severe, are only buzzwords that oversimplify. Everyone's case is different, and nearly every case is much more complex than that. This is why we have the sleep doc in the first place, to make sense out of that complexity and prescribe the proper customized therapy.
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#5
An example of how meaningless the mild moderate severe words are.

I had a AHI of 15. Which is mild to moderate. However with every OA I have that lasts very long at all my 02 levels drop into the low sixties. And recovers slowly. So, though there are folks with much higher untreated AHI than me the O2 drop that fast and that low was a red flag for the Sleep Doc and alarming enough for my cardiologist to put me on O2 at night until the machine could be gotten to me.

In practical terms I was a zombie mentally for about 4 hours everyday untreated. By zombie I mean confused as to where I was for the first 30 min, unable to grasp a simple statement or question by my wife even.
lot of factors play into it and usually your AHI untreated is worse at home in your own bed with nothing hooked up to you than it is with even a home sleep study.

Alot of folks that really need to be on cpap arent because they dont sleep or dont sleep soundly enough to hit the magic 5 number that insurance arbitratily throws out. When they actually have 15 20 or more AHI when sleeping without the hardware tied to them.

My wife is one that with even a home sleep study only goes to 4.9 AHI because she only catnaps due to the stuff hooked to her.

But I can show you since shes self treated AHI of 6 7 8 when working her pressures with an auto under a min pressure of 8 and max of 15.
Once I got her pressures tweaked out shes below 1 most of the time. But her apena as far as AHI numbers go is worse than mine runnng min pressures of 6 or less to see where she would fall. More like 18 AHI when the sleepy study said less than 5.
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