treating mild OSA

[cpappi]

hey guys!

recently done a sleep test and got my results back. just a bit confused on whether to go through with purchasing a CPAP (my doctor was skeptical and doesn't believe it will help)

results say i have mild sleep apnea with a AHI of 9 and my REM sleep is reduced to 14.5% (mean duration of apnoea and hypopnea was 28.2 seconds, longest apnoea lasted 33 secs and longest hypopnea lasted for 56.5 secs)

My symptoms include falling asleep in late afternoon at work (after around lunch), anxiety, panic attacks, short attention span

btw, I am a fit 24y/o male (far from overweight, just have a big neck)

any help would be appreciated

[ChicagoGranny]

just a bit confused on whether to go through with purchasing a CPAP (my doctor was skeptical and doesn't believe it will help)

Do you want your life to continue to be like this:

My symptoms include falling asleep in late afternoon at work (after around lunch), anxiety, panic attacks, short attention span

?
If not, get a CPAP and learn from this forum how to use it properly.

btw, I am a fit 24y/o male (far from overweight, just have a big neck)

"It's not the size of the neck on the outside, it's the size of the airway inside the neck."
- Dr. Mack Jones
There are plenty of us here who have slim necks and bodies.

BTW, obstructive sleep apnea is a progressive condition - it tends to worsen with age. So, now is the best time to start using CPAP and get ahead of the game.

[Mogy]

Hi cpappi,
The amount of REM during a sleep study can be reduced by the "First Night Effect."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925054/

With mild OSA there is a small possibility that a CPAP may help you but in most cases it will not.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163952/
They conclude:
"Individuals with mild OSA in this cohort do not have worse sleepiness, mood or quality of life in comparison to those without OSA."

There is a possibility that CPAP could make your sleep worse, especially if you have mild OSA with a low arousal threshold.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940420/
From this study:
"PAP may not fix their sleep-related respiratory disturbances, and conceivably, could make them worse."

I agree that you should start treating your mild OSA, but CPAP might not be the best course of action.
On Resmed's site they do not recommend starting with CPAP for mild sleep apnea.

Measuring the outside of a neck is much easier than measuring the inside(throat). There is a very strong correlation between neck size and OSA severity. That is why it is used.
Tongue/throat exercises have been shown to reduce the size of the neck as well as reduce your OSA.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402674/
They conclude"
"Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments."

There are several ways to reduce your OSA without using a CPAP. These methods typically work best for young people with mild OSA.
CPAP works best for people with moderate to severe OSA. Most of the people on this site have severe OSA that has been helped with CPAP. They will push CPAP even when there is a lot of evidence that it will not help someone with mild OSA. There is a current thread "Feeling worse on CPAP" that you might want to read. The poster that started the thread has mild OSA, (an AHI of 11)...

Cue the CPAP shills.

[Vinny V]

Interesting my apnea is mild on my test my ahi was 10...

that information has me thinking.

[zonker]

Cue the CPAP shills.

who, oddly enough, hang out in a forum called CPAPTALK.

[jnk...]

So-called "mild" OSA, as defined by AHI, can have a very severe effect on quality of life.

I am a life shill; PAP therapy gave me mine back.

[Vinny V]

So-called "mild" OSA, as defined by AHI, can have a very severe effect on quality of life.

I second that...
my mild osa has wrecked the quality of life... cant wait to get it back..

the list of symptoms are long and annoying

[jnk...]

Friends, Romans, Vinny V van Goghs, lend me your ears . . .

Medicine is confusing with its use of words like "severity" and "significant." Something of low "severity" and low "significance" can be VERY severe and VERY significant to a patient. One use of the word severity is about bell-curve measurements of populations. Individual people are not bell curves.

But in the case of sleep medicine, the AHI measurement of the "severity" of the OSA was never meant by early researchers to describe the severity of the problem for any given patient. Unfortunately, many docs and insurance entities either do not understand that fact or choose to ignore it. And that can confuse us as patients in trying to figure out what is so wrong with our sleep and breathing and whether anything can be done about it.

[ChicagoGranny]

Mogy

= one of the least trustworthy members of the forum. Can google studies and post excerpts, but has zero idea how to actually help someone.

[rionoirble]

Mine was considered mild if you average the entirety of my sleep, but was causing me to sit up gasping for air multiple times per night, which subsequently would give me a panic attack, which eventually led to me having anxiety BEFORE bedtime because I knew I was going to wake up having these events at night. I wasn't having severe daytime drowsiness or anything, I just knew I was starting to dread going to bed. I was also having to modify and closely control the position I slept in to minimize the events. That was enough to have an impact on my quality of life and I really had to push to get something done about it. I almost didn't even get a prescription, but based on the effect it was having on me the sleep doc signed off.

Since getting my APAP, I have no more anxiety associated with going to sleep, in fact it's the opposite, I can't wait to go to sleep. Much of my daytime anxiety has diminished as well and I've only had the machine a week. So yea, listen to your body and your mind. For me it's been a really easy transition and I've had very few issues with getting comfortable (although I like sleeping on my back, which I can do again, so that helps).

[kteague]

With mild OSA there is a small possibility that a CPAP may help you but in most cases it will not. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163952/ They conclude: "Individuals with mild OSA in this cohort do not have worse sleepiness, mood or quality of life in comparison to those without OSA."
...
There is a possibility that CPAP could make your sleep worse, especially if you have mild OSA with a low arousal threshold.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940420/ From this study: "PAP may not fix their sleep-related respiratory disturbances, and conceivably, could make them worse."
...
Cue the CPAP shills.

According to the first statement, those in the study group with mild OSA were not symptomatic, hence are not comparable to those like the OP (and like I was) whose symptoms affect quality of life.

The second statement relates to those with a low arousal threshold. No idea what percent of persons with mild OSA have a low arousal threshold, but those for whom that is not an issue are not represented in the statement.

I agree that CPAP may not be the only answer or even the best answer for everyone with mild OSA. But I can attest that CPAP unequivocally did address and resolve my once mild OSA. Am I the exception or the rule? Who knows? By definition, I am not a shill, as I am open about my partiality to CPAP as treatment for OSA, and have no interest in anyone else's financial gain. Just a CPAP user here who doesn't want to see anyone suffer needlessly as I did.

[Mogy]

Hi kteague,
Thanks for your response to my post.
My 'CPAP shill' comment was definitely not directed at you. I always enjoy your posts.
We do however disagree about the conclusions of the studies I posted.

You stated:
"According to the first statement, those in the study group with mild OSA were not symptomatic, hence are not comparable to those like the OP (and like I was) whose symptoms affect quality of life. "
I don't believe I said or implied that and I don't think the study says that.
The way I read it all of the people in the study had symptoms that are related to OSA.
From the study:
"Initial enrollment required age ≥ 18 years and clinical symptoms of OSA, as defined by American Academy of Sleep Medicine (AASM) criteria."
The study found that there was no statiscal difference in the symptoms experienced by the people with mild OSA and those without OSA.

[Mogy]

The second statement relates to those with a low arousal threshold. No idea what percent of persons with mild OSA have a low arousal threshold, but those for whom that is not an issue are not represented in the statement.

I am not sure what percent of persons with mild OSA have low arousal threshold either, but there is evidence that it plays an important role in young, fit people with OSA( like the OP).
One of a few studies:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098808/
It concludes:
"Our data suggest that airway anatomy/collapsibility plays a relatively greater pathogenic role in older adults, whereas a sensitive ventilatory control system is a more prominent trait in younger adults with obstructive sleep apnea."