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Newbie - mild apnea due to anatomy, central and hypopnea
#1
My primary care doc had me do a home sleep study since I have late afternoon sleepiness, have been falling asleep around 8pm at night and wake around 4:30 (obviously because I get so sleepy so early). This has been going on since about July. I have never had sleeping problems before and always fall asleep easily and rarely wake during the night (that I know about!).

So I was diagnosed with mild sleep apnea via the home study procedure. My AHI/hour came back at 6 and I had a few readings of low O2 levels. In using my ResMed AirSense 10 autoset since 12/23, I have only gotten a few central events and a few hypopnea events. No obstructive events. No snoring. I do need to lose 10 pounds (which I gained in the last 6 months) but have never been overweight and I exercise daily. My energy level has been down for the last 6 months.

My sleep doctor says my apnea is due to my crowded throat/small mouth and I do agree since I have trouble swallowing large pills and my mouth has to be propped open if any dental work is needed in the back of my mouth (always been that way). I'm also concerned that it could be due to subclinical hypothyrodisim since my TSH is a bit elevated but not outside the "normal range". I also have some symptoms of hypothyroidism. I find it a bit odd that all of a sudden (last 6 months) I have had these issues, but never before. If it's anatomical, then I'd think it would have shown up before now at the age of 47.

I feel a bit better already from my cpap use, although I have had a few nights where I wake up and take the airfit nasal pillow mask off because it bugs me and I can't fall back asleep.

I have my recheck appt. next week so I'll see what they say about my results so far.

Just curious if any one out there is also on cpap due to your anatomical structure of your throat/neck/mouth.

Thanks!

   
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#2
Hi kareypdx,
WELCOME! to the forum.!
It's good to hear that you are doing fairly well with your CPAP therapy. The only thing is, you should sleep with the mask on all the time you are asleep. If you wake up and find that you have taken your mask off, put it back on and go back to sleep. Otherwise, your body is going to have a harder time fully adjusting to the mask.
Hang in there for more answers to your question and much success to you with your CPAP therapy.
trish6hundred
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#3
Thanks! I do usually put it back on. Two nights, I simply could not get back to sleep with it on and so I did leave it off.
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#4
Could be a combination of things... probably is. Small throat + extra 10 lbs = smaller throat.... There is correlation between thyroid issues and apnea, and like many things it is likely a circular correlation where they both exacerbate the other. The important thing is to treat the apnea, since it will lead to even more problems given free reign. If your TSH is in the upper level of the normal range, IMO it is not normal. the range is known to be too wide. You should find a good endocrinologist. If PDX means Portland, OHSU is a great place to get treated for both apnea and endocrinology.
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#5
by the way, low Vitamin D is correlated with both hypothyroid and apnea along with a myriad of other fun things and is extremely common in the northern states.
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#6
Thanks DariaVader...low D is my other problem! Had it tested for the first time before Thanksgiving and it's REALLY low. I'm actually switching primary care doctors this coming week as I feel like my old doctor isn't listening to me completely and not taking my concerns seriously, but rather pushing them off as not a big deal which bugged me. I probably have a combo of things going on and like you said the circular connection between elevated TSH, apnea and even low D. Thanks for the tip about OHSU. I am in Portland!
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#7
(01-01-2015, 11:18 AM)kareypdx Wrote: My primary care doc had me do a home sleep study since I have late afternoon sleepiness, have been falling asleep around 8pm at night and wake around 4:30 (obviously because I get so sleepy so early). This has been going on since about July. I have never had sleeping problems before and always fall asleep easily and rarely wake during the night (that I know about!).

So I was diagnosed with mild sleep apnea via the home study procedure. My AHI/hour came back at 6 and I had a few readings of low O2 levels. In using my ResMed AirSense 10 autoset since 12/23, I have only gotten a few central events and a few hypopnea events. No obstructive events. No snoring. I do need to lose 10 pounds (which I gained in the last 6 months) but have never been overweight and I exercise daily. My energy level has been down for the last 6 months.

My sleep doctor says my apnea is due to my crowded throat/small mouth and I do agree since I have trouble swallowing large pills and my mouth has to be propped open if any dental work is needed in the back of my mouth (always been that way). I'm also concerned that it could be due to subclinical hypothyrodisim since my TSH is a bit elevated but not outside the "normal range". I also have some symptoms of hypothyroidism. I find it a bit odd that all of a sudden (last 6 months) I have had these issues, but never before. If it's anatomical, then I'd think it would have shown up before now at the age of 47.

I feel a bit better already from my cpap use, although I have had a few nights where I wake up and take the airfit nasal pillow mask off because it bugs me and I can't fall back asleep.

I have my recheck appt. next week so I'll see what they say about my results so far.

Just curious if any one out there is also on cpap due to your anatomical structure of your throat/neck/mouth.

Thanks!

Welcome kareypdx, just on taking the mask off, don't feel too guilty about is, we all do it especially at the start as we get used to it.
Our faces are not used to having things covering them.
It takes time but eventually it starts to become second nature and most of us find that we can't sleep without a CPAP once we really get used to it. Kepp at it and well done so far Smile
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#8
First, low D is easy to fix. Everyone should probably be taking D3 supplements, according to my GP.

Second, you may have the mildest SA I have ever heard of being treated. There are people who are indeed in treatment who would kill to have a treated AHI as low as your untreated one. I am not saying you should not be treated, because therapy will probably still benefit you. But insurance regularly will refuse tests that come back with an AHI of 5 or less, so that gives you an idea where the line is for separating sufferers from non-sufferers. Take that same test again and the odds are not all that in favor of it being over the line, as there is a large margin of error. So maybe the symptoms that lead to the test does not completely imply that OSA is really the entire story of why. There may be more to the story, and it is common to think once there is a diagnosis that this is the entire story; it may not be, especially since your condition is so mild.

I guess it is possible the weight was enough to push you over the line and cause the OSA for the first time, but it is exceptionally mild, regardless. You may have had a preponderance for this for some time and not realized it. I think I had OSA for decades, based on the snore reports I would get, but it was only in the last couple of years that I had the daytime sleepiness and other symptoms, which is also why I went untreated for so long.

Third, many SA sufferers are sufferers due to anatomical reasons, in fact the great majority are. I also have the small-mouth small-throat syndrome and my dentist hates to see me coming, but that particular thing is a small subset of the anatomical reasons for OSA. That your airway can't stay open without PAP is almost a textbook definition of what causes OSA, and the fact that this is typically anatomical is nearly synonymous with OSA.

Please try to stay with it; there is an adjustment curve, but you should be able to get over that hump, and you are part way there already. Its like learning to swim; some take to it easily, some take a long time to learn it, and some just quit trying. But then this is much more important than learning to swim.
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#9
I also kind of wondered about needing treatment because of coming in at 6 AHI/hour on the home sleep study, since 5 is the cut-off. That was the worst night's sleep I ever had with everything connected the way it was and always knowing to push the button when I woke up or moved around. I'm going to address that with my sleep doc at my appt. on Tuesday. I'd like to try the test again at home and see if it really comes in the same. I still think there is another underlying cause for my daytime sleepiness. I am never tired when I get up and get up energized and ready to start the day (pre and post cpap).

Looks like my insurance will cover the cpap treatment, but I do want to make sure there isn't something else going on besides anatomy, like having mild hypothyroid symptoms, low D, etc. I'm taking a D supplement now since it's hard to get any sun up here in Portland at this time of year. Or at least sun where you feel comfortable being outside (sunny and 32 degrees isn't to fun!).

I've done better the past few nights, nose pillows have stayed on. Had one really bad incident where my nostrils being painful woke me up. Felt like someone had taken a vice grip to my nostrils! But I didn't give up since I have heard the nose sometimes just needs to toughen up with using the pillows.

Thanks for all the support, advice and help!
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#10
(01-01-2015, 11:18 AM)kareypdx Wrote: So I was diagnosed with mild sleep apnea via the home study procedure. My AHI/hour came back at 6 and I had a few readings of low O2 levels. In using my ResMed AirSense 10 autoset since 12/23, I have only gotten a few central events and a few hypopnea events. No obstructive events. No snoring.

Hi kareypdx,

Congratulations on your very successful CPAP therapy. In my view, you clearly need the machine and it is clearly helping. Your AHI is very low when being treated, and your number of clear airway (central) apneas per hour is completely negligible.


(01-01-2015, 11:18 AM)kareypdx Wrote: I feel a bit better already from my cpap use, although I have had a few nights where I wake up and take the airfit nasal pillow mask off because it bugs me and I can't fall back asleep.

It is not at all surprising that sometimes CPAP therapy bugs you: your Pressure settings are wide open, 4 to 20. These are the machine's default settings, but after the first week or two, most people find it more comfortable to have the Minimum Pressure setting a little higher.

Your Minimum Pressure setting of 4 cm H2O is probably too low to be comfortable, now that your breathing muscles have gotten stronger and accustomed to CPAP therapy. I suggest you ask that it be raised to 5 for a week and then to 6 for a month or for as long as it remains comfortable. Or do it yourself. Although the Pressure Settings can only be adjusted from within the sooper sekrit Clinician Menu, raising the Minimum Pressure is usually considered a comfort option, to be adjusted by the Clinician to achieve the best patient comfort.

Also, the highest Pressure your machine has yet needed is about 16 cm H2O. If you find the machine is ever waking you up with Large Leak (which is more likely when the Pressure gets high), you may want to consider asking that the Max Pressure be lowered, closer to 16.

It is likely that the times when the pressure gets very high are the times when you are flat on your back or the times during REM (Rapid Eye Movement, dreaming), or both (REM sleep while on your back). These are usually the worst cases for Obstructive Sleep Apnea. If you can manage to always stay off your back while sleeping, the pressure may never need to go very high at all.

Take care,
---- Vaughn



Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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