...just been told I have Apnea and very confused.

[SwissTruffle]

Dear Forum,

I am just back from my doctor who discussed the results of my sleep study.
The diagnose is Obstructive Apnea with a incident rate of 44 during the study.

I am very confused and wondered if anyone can please answer me a couple of questions which I didn't feel my doctor has addressed with me sufficiently.
My doctor immediately referred me to get a CPAP machine and this has worried me because it felt like this option is the 'standard' and 'default' option to treat Apnea "for the rest of my life". I am 49 years of age.

My questions to the forum are:
1. Is the CPAP solution the best first line of treatment? Is it realistic to ever come off this machine after a trial period of 1 or 2 months? In other words: can it cure?
2. Do I need to be worried that a short trial with a CPAP will make me "dependent" on this device?
3. Why has my doctor dismissed surgery straight away? Frankly, I would have signed up for this option instantly rather than agreeing to a night time device that appears to become my permanent companion. I understand that surgery is invasive but this would have been my preferred option.
4. Why has my doctor not elaborated on my "narrow nose" that prevents me from getting sufficient air through my nostrils. He said it wouldn't make a difference to fix this. What can I make of this comment???

All is very confusing to me right now...
Any comments and answers are appreciated as I am struggling to come to terms with this diagnosis.

Thanks in advance!

[Sleeprider]

SwissTruffle, welcome to Apnea Board. With a obstructive apnea rate of 44 per hour you certainly have a need for CPAP. We see many people that try alternatives to CPAP including implants (INSPIRE), surgery and lifestyle changes. None has the efficacy, low cost and ease of use that CPAP has. The easiest way to get started is actually to obtain an auto CPAP and optimize the pressure to provide comfortable sleep with effective therapy. All of us have been in your position of questioning whether this therapy is for the rest of my life, and after some time, the benefits of better sleep and health replace any ideas of quitting. You won't know how bad sleep was before therapy until you have enjoyed the better sleep, less bathroom trips, and more alert waking hours that comes with successful therapy.

1. CPAP is by far the preferred first line of treatment and works for the majority of individuals that tolerate the therapy. It is not a cure, but a treatment and there is no reason to think you will ever not need CPAP unless you can change the underlying physiology that causes you to obstruct in a significant way. That said, some people have apnea clusters that relate to head and neck alignment (chin-tucking) and this form of obstructive apnea can respond to positional changes or a soft cervical collar.

2. Your dependence on CPAP is not an addiction to positive pressure, but that fact it effectively resolves the problem and quitting will result in sleep apnea returning at the same rate as if you had never used CPAP. Most of us are reluctant to accept that discomfort after enjoying better sleep.

3. Surgery is rarely more than 50% successful, and in your case would still leave you with AHI over 20 per hour. It is expensive, painful and most people with sleep disordered breathing achieve better results with CPAP.

4. A narrow nose or other upper airway restriction can result in a reduction of flow (flow limitation) which makes it harder to get air in, and can increase negative pressure in the airway which may increase susceptibility to apnea. Nasal CPAP will expand the tissues in the nose and make it easier to breathe, and the Resmed Airsense 10 series actually offers bilevel pressure (higher inhale pressure, lower exhale pressure) using EPR (exhale pressure support) that effectively mitigates flow limitation. It is by far the best option for a comfortable CPAP experience.

5. You didn't ask, but you probably snore, and anyone that can tolerate sleeping in the same room as you will be very relieved once you start this therapy.

[DaveCar]

44 events/hr is pretty high. You probably have periods in the day when you're completely wiped out, napping etc ?
You're going to be blown away (pun ?) how well you will feel , if one of these machines work for you. It's like night and day.
That being said, yes its a chore. Need to bring it travelling, need to clean it regularly, filters, water for humidity tank, etc.
My wife loves that I'm off of death's doorstep, no more extreme snoring , and I stopped flailing at night (hitting her often).

I did manage to shed 50 pounds of body weight, and my AHI numbers improved. But other physical issues can cause it too, it seems (not everyone on cpap is heavy). I always assumed that surgery in the throat area to simply "remove" the cause of apneas would be far too risky when a solution like a bedside machine is available.

[SleeplessinPgh]

I, too, was confused initially, and hated the idea of using CPAP for the rest of my life. Two things made me a believer: (1) My sleep is much better now, giving me more energy. (2) My husband was concerned about my struggling to breathe at night. He's now relieved and happy.

[staceyburke]

I was a high school coach. I went to meets in a van with 8 kids. In the middle of Denver, after driving 4 hours I dozed off to sleep. Had not the student saw I had fallen asleep, I’m sure I would have killed someone. As soon as I got home I got a sleep study and was on Cpap before the next weekend.

Sleep apnea is nothing to mess with - get it taken care of as soon as possible.

[Sleepster]

1. Is the CPAP solution the best first line of treatment? Is it realistic to ever come off this machine after a trial period of 1 or 2 months? In other words: can it cure?

CPAP is indeed the first line of treatment. It has a much higher success rate in treating the affliction, assuming the patient uses the CPAP machine. It cannot cure. It is a therapy, not a cure. It is possible that use of a CPAP machine will give you the extra energy you need to exercise, eat right, and lose weight. The weight loss may cure the apnea, but it may not.

2. Do I need to be worried that a short trial with a CPAP will make me "dependent" on this device?

No. All it does is help you breathe. If you stop using it you will be right back where you were when you started it.

3. Why has my doctor dismissed surgery straight away? Frankly, I would have signed up for this option instantly rather than agreeing to a night time device that appears to become my permanent companion. I understand that surgery is invasive but this would have been my preferred option.

The surgery could leave you right where you are now, in need of a CPAP machine. It does not enjoy a high success rate. Plus, the recovery is long and difficult and may leave you with life-long problems swallowing your food.

4. Why has my doctor not elaborated on my "narrow nose" that prevents me from getting sufficient air through my nostrils. He said it wouldn't make a difference to fix this. What can I make of this comment???

The obstruction to breathing is in your throat, not your nose.

Another factor to consider is your overall health. By treating your sleep apnea you increase the chances of a longer life, decrease the chances of stroke or cardiovascular disease, and enjoy a better quality of life.

[SwissTruffle]

Thank you all for your input so far. Really appreciated!

Unfortunately, this situation has caught me totally off guard as I was referred to a sleep study for my nasal canal problems.
Very little did I expect to be confronted with such a life changing diagnosis.


It didn't help that my doctor was very laissez faire about the whole situation! In one sentence he tried to comfort me by stating that "diabetes is not a problem these days either!".
He has not even mentioned a nose canal correction today - which I expected to discuss next as it was the trigger for the sleep study in the first place.


I was totally unprepared to have a discussion about Abnea - in fact it never crossed my mind until today! Being in this state of numbness and startled I couldn't even come up with meaningful questions. All I have on my mind is me looking like a Frankenstein creation at night. I am even too scared to tell my partner right now...

I hear that surgery is expensive and has a small success rate, but I don't want to dismiss it! At this very moment - hours after the diagnosis - I would jump on the idea to have surgery tomorrow!

Your posts have also triggered new worries and concerns... with so many devices available, will the hospital team (I think it is a third party) provide me with a selection of machines? with the correct device for me? How many 'trials' do I have to embark on to find the 'right' machine for me? Can I buy them myself?

Feeling very sorry for myself right now...  it just came so unexpected and appears to be heavily life changing to me...

[DaveCar]

" looking like a Frankenstein creation at night. I am even too scared to tell my partner "

Life throws curveballs, for sure. I looked at it this way - that curveball could have been something far more difficult to "hit" like cancer or a stroke, vehicle accident ending in a disabling injury, and so on. Some people have to carry around oxygen tanks, some people use wheelchairs, some people go blind. Slipping on a mask for the night is pretty low on the self-conscious, but you're correct in thinking that its "there".. your partner will have to get used to sleeping with the jet fighter pilot.
Imho, approach it matter of factly.. that this is what the medical team is saying needs to be done if you wish to remain healthy and that you're going to try it for a while. That breaks the ice, and doesnt imply a lifelong period (although, it may turn out to be, why push that on them immediately ?).

[SarcasticDave94]

What do you see?
Answers below.

Image of those that accept CPAP as helpful, treating comfortably with PAP mask, better sleep



Image of those that are afraid that they'll be tortured, or scarred for life from the evil CPAP mask monster, ahhhh!




Some that face using CPAP have a choice, use it accepting it with a better longer life, or refuse to be chained to a mask and die early.

All the answers in other posts I agree with.
Welcome to Apnea Board, we'll help you adjust if you do your part.

[NelsonM]

I'm sorry that you were diagnosed with sleep apnea, it's not great. OTOH it's good to know what's going on with you because you can now work to fix it. For me the improvement in my life was enormous, life-changing.

For your research you can read up on various treatment options including several things that involve surgery. My diagnosis was similar to yours and I started with CPAP. Mostly because it seemed the simplest, most cost effective, and least invasive. The surgical options are all more or less permanent or at least difficult to reverse. Oral appliances are expensive and often don't work. Some other simple things (like a wedge pillow) helped some but weren't enough to treat my severe obstructive sleep apnea. CPAP doesn't work for everyone either. But for me it has worked great, literally from the very first night I had a marked improvement both in objective data (like blood oxygen) and just how I felt.

I hope you find a treatment that works for you!