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OSA went away, and now back after 10 years
Hey Folks,

I am new to the board... have been reading quite a bit, but this is my first post.  So, hello.

Background: After a concerning surgical event 11 years ago, I was tested and found to have moderate OSA.  Went on an auto CPAP with settings of 7-12 cmH2O.   Had difficulty with it - getting used to the mask - but CPAP appeared to help.  So, all good.

18 months later, I had a seven hour surgery.   During this period my old sleep doc left practice and I ended up with a new doc.  I do not remember what prompted a visit with the doc 18 months in, but he did an at-home study, and discovered the OSAs had ceased.   His guess was being intubated for 7 hours had something to do with it.

Now, 10 years later, the OSAs are back.   Someone who has apnea observed my breathing stop repeatedly over a couple of hour period.  In addition, I've gained 60 pounds over the past 18 months and have also possibly developed gout, which is proving difficult to remedy.

Has anyone heard of intubation as "curing" OSA?  I'm curious about this point.

I'm scheduled for another at-home study in two weeks, followed by another appointment with a new sleep doc.  Will see what that shows.

Have been using my old CPAP, and while I'm still in the midst of the get used to it struggle, it appears to be helping.

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Intubation as a cure? First I've heard of it. My guess is the home study was wrong. You'd be better off with an in lab study.
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(07-11-2018, 05:07 PM)Walla Walla Wrote: My guess is the home study was wrong.  You'd be better off with an in lab study.

Hey Walla Walla,

Thanks.  I agree with you about the lab- vs. home-study.  I suspect the decision is insurance driven.  

Are you in WW?   If you are, do you have any info on sleep docs and labs in western Washington?  I live next to Mt. Baker.  My old sleep doc is now running Swedish, and now w/ an RN/NP at UW.

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Sorry I'm not familiar with whats available on the west side. Good luck though.
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If you have pretty good insurance, then getting a clinical sleep study and new CPAP through a DME makes sense. This gives you a current untreated baseline diagnostic AHI, and if you get lucky, you get a 2-part study to get your CPAP pressure sorted in one night. The alternative is just to buy a new Resmed Airsense 10 Autoset through discount channels at $500 to $620 and have full data and the best machine on the market. Mask costs should be about $70. Not encouraging you to go without prescription, but that is the price of a complete setup if you cut-out the middleman.
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Of course your costs could end up much higher if Central Apnea is involved. In that case you'd be stuck with an APAP that won't help you.

Just something to consider before you buy on your own.
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Thanks, Walla Walla.

How does a 2-part sleep study work - i.e., evaluating the apnea and titrating a CPAP/solution?   In the past, I did them separately.  I want to address this as quickly as possible.  If I was mis-dxed when told I no longer had OSA ten years ago.... well, that *really* is an effective argument for getting this resolved - oh, really, given it is ten years, the material difference in waiting a month or so is nil.  

Also, appreciate the suggestions on apap machines.   I suspect the real value, besides hardware, usability, and build, is how the s/w handles events... and it's good to know what is considered the really, good machine.   My old machine was a Redmed Series M, which I thought was good. 

I've been using the old machine for the past week, and it feels like it is helping.  It's showing my AHI's at 2.4... not great, but not far from great either.  I'm using an slightly deteriorating mask, so perhaps that is involved.  If I had CSA, would an apap even help?? 

Anyway, appreciate your input!
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(07-11-2018, 09:33 PM)Mountain Head Wrote: Thanks, Walla Walla.

How does a 2-part sleep study work - i.e., evaluating the apnea and titrating a CPAP/solution? 
They wake you up in the middle of the night and put a CPAP mask on you. At least that is how my attended lab study worked.

In my case, I had a hard time getting to sleep during both segments, so they really didn't get all that much data, and they never got a good titration.
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(07-11-2018, 04:30 PM)Mountain Head Wrote:  In addition, I've gained 60 pounds over the past 18 months

Oh, yes. Me too. Be sure to have your Cortisol levels checked. 
Mine are off the charts but I'm only 3 weeks into CPAP therapy - cortisol makes you fat, you can't lose weight, weakens your muscles, and results in Cushing Syndrome (healthline.com/health/cushing-syndrome)
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Cortisol levels fluctuate with stress. Liver problems also can cause elevated cortisol.  Stress encourages the production, well really the OVERproduction, of epinephrine, or adrenaline as it is called on the left end of the Atlantic.  Weight gain can have many causes.  If it's not related to water retention, it is related to how many calories one consumes over how man calories one expends, all per unit of time.  It can also be hormonal in ways other than renal (water retention).

Elevated cortisol affects vascular health and efficiency, and can lead to a reduction in the immune response, principally the body's production of Interleukin II.  If that gets suppressed chronically, it's not good.  At all.

We have to remember that our individual parts can't practically be treated without thinking in terms of 'systems'....of which our bodies are examples.  It's best to take both a wholistic and a holistic approach to manipulations that we intend to be salutary.  A prime example for people on this board would be either gaining or losing a substantial part of their body mass and then experiencing unhappy, or even very happy, changes to their apnea scores as a result.  Or experiencing no measurable change in apnea, but developing heart problems or vascular problems.

Fortunately, such changes tend to take place over protracted time periods, so we have a chance to correct them in a measured way.  One step at a time, as they say.

It's good to see you here, and welcome.
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