Initial Sleep Study Results

[LakeGuy85]

New member, I'm a 37 yr/old male, 220 lbs. Have been suffering from low T (250), slightly high blood pressure, and anxiety/depression for the last 3-4 years. Finally convinced my GP to order a sleep study and did an in-home study via Alice NightOne was conducted couple weeks back. Just got the results, they are attached. My questions:

1) Should I go straight to a CPAP based on this test or now do an in-lab study? The sleep clinic I'm using is moving to CPAP right away, no more testing.
2) How severe is this sleep apnea? With these numbers, could I see an improvement in the ailments above with a CPAP?
3) It looks like my OAI # was fairly low, but somehow my AHI # was high anyway?
3) I make a decent living and don't cut corners financially when it comes to my health. What are the absolute best CPAP equipment and software that I should be looking for here to begin treatment?


Glad to have found this forum as I being my journey.

[Pugsy]

Welcome to the forum.

The hyponea count is what earned you the diagnosis.

OAs....80 to 100% reduction in air flow (breathing) due to airway tissues blocking the passageway. Must last at least 10 seconds to earn a flag.

Central apnea...reduction in air flow from lack of effort...hold your breath for 10 seconds...that's a 10 second central....no air is moving but it's not because of the airway tissues blocking anything...it's from lack of effort.

Hyponeas...reduction in air flow from 40 to 79% from the airway tissues blocking the passageway. Again must last at least 10 seconds to earn a flag.

It seems like more and more insurance and doctors are going straight to cpap and using an apap (auto adjusting pressure) machine to figure out pressure requirements. It will work fine for the majority of people with OSA and the in lab stuff can always be done later should a problem pop up that can't be handled easily with some minor tweaking of the settings.
It's what I wish I had done 10 years ago but it wasn't that common back then.. As it was I slept horribly the night of the sleep titration study where they tried to determine the pressures I needed and they ended up getting it wrong and I had to do the titration myself at home anyway with my apap.

Check out the Sticky at the top of the Announcements section "newbies please read"....I explain the software in the first few posts I made. SleepyHead or OSCAR (based on SleepyHead)...free and works well with the most commonly used machines.

As far as the "best" one....Look at the one I have in my signature line and don't let the "for Her" part scare you off. It actually has 3 different modes of operation and that extra mode might come in handy...it's designed for problem that can affect men just as easily as women.

Get a ResMed AirSense 10 AutoSet or the for Her AutoSet.
Since we don't know pressure needs....it's exhale relief is superior to the Respironics IMHO and I have used both brands.
It's quieter in general...though it's not like the Respironics is horribly noisy.

[JDS74]

Going directly to a CPAP machine bypasses the pressure titration that would allow the machine correctly to fit your treatment needs.
That's OK if the machine you get or are provided is an auto machine that can be used to do the titration and figure out your correct pressures.
Using the CPAP (with effective treatment) may help with the blood pressure and may help with the depression with a big IF.

1) If the blood pressure rise is a result of the disturbed sleep you are experiencing, then it could come down as you sleep gets more restful..
2) If the depression is a misdiagnosis in which the tiredness, lack of energy, foggy thinking are all part of the same disturbed sleep effects and not actual depression, then good quality sleep can help with these symptoms. If it is not the result of SDB, then probably there may not be any significant improvement (I'm off the reservation here with no experience with actual depression so take this answer with a large grain of salt.)

If this cost is on your dime, then I would suggest getting a bi-level machine so that the possibility of pressure intolerance is covered by being able to have a significant reduction the exhale pressure while keeping the therapeutic pressure on inhale. It will cost more but not a huge amount.

If some third party is paying, then just a plain old auto-adjusting CPAP is the best you can hope for. Press really hard for a machine that report detailed information on usage not just hours of use.

As for the brand, because you have no prior usage of any CPAP machine, it's a coin toss as to which manufacturer to use.
I use Philips-Respironics machines and like the results. Others will comment that ResMed machines are your best bet. I don't think there is any significant difference between the two. For your first machine, buying outright from a local supplier (DME) is recommended because they can provide local support for usage and adjustment questions. That will tend toward one manufacturer or another as having a DME close by my dictate which brand you choose. Some handle Respironics, others handle ResMed.

Welcome to the journey.

[LakeGuy85]

Thanks for those quick responses! Let me consolidate my question again: Based on this in-home test, is it now acceptable/standard procedure for me to begin on a APAP/CPAP machine versus dive deeper into diagnostics and maybe do an in-lab study? And if going to CPAP/APAP now, I guess these machines will be able to monitor my improvements and I'll be able to look at the reports to see if they're actually making a difference? I don't know, I'm only 37 y/o so it just seems like a big, big commitment to be doing a CPAP/APAP for the rest of my life based on this in-home study that showed a low amount obstructive apneas but a high amount of hypopneas, you know?

Do people like me with hypopneas tend to also benefit from CPAP/APAP treatment?

[LakeGuy85]

If this cost is on your dime, then I would suggest getting a bi-level machine so that the possibility of pressure intolerance is covered by being able to have a significant reduction the exhale pressure while keeping the therapeutic pressure on inhale. It will cost more but not a huge amount.

So not all APAP machines are bi-level? Can you give me an example link of a make/model that would have all features and be considered top-of-the-line? Thank you!

[SDBud]

2) How severe is this sleep apnea? With these numbers, could I see an improvement in the ailments above with a CPAP?

Your numbers are VERY good, many don't get that low WITH therapy.

A CPAP machine might help with the hypopneas, and if it's offered, can't see any reason to NOT try it.

[Okie bipap]

The most highly recommended machines are the Resmed Air Sense 10 AutoSet and AutoSet For Her. Some people prefer the Philips Dreamwear Auto CPAP machine.

[Pugsy]

People often poo poo off cpap because they "only have hyponeas and not real OAs".....big mistake to do that.
Remember the definitions I gave you above...
do you really think that the damage done by a hyponea that is 75 % reduction in air flow but lasts for 45 seconds ...isn't as big of a deal as an OA that is 81% reduction that lasts 11 seconds???

There is a reason that hyponeas are included in the diagnosis criteria....they can be just as nasty as OAs in terms of disturbing sleep and even oxygen level desats.

Kaiser has been doing the home study and dispensing apap machines instead of in lab titrations for years now.
They save the in lab stuff for the people with problems. Majority of people won't need an in lab follow up.

[LakeGuy85]

2) How severe is this sleep apnea? With these numbers, could I see an improvement in the ailments above with a CPAP?

Your numbers are VERY good, many don't get that low WITH therapy.

A CPAP machine might help with the hypopneas, and if it's offered, can't see any reason to NOT try it.

OK, so if I'm borderline, would it make sense to maybe get retested via in-home study in 6-12 months if I lost 20 lbs of weight and got into better shape? Maybe I would test OK and not even need a CPAP/APAP at that point? Or would the APAP monitoring tell me itself that maybe I could try going off it at some point?

[Smargie]

I understand your hesitation to use CPAP. It's a big commitment, takes a lot of getting used to and isn't very sexy.

Your AHI puts you in the moderate category. My first sleep study (in lab) showed an AHI of 18, most of which were hypopneas, like you. Though some people would love to have an AHI as low as yours, in my case after a week of treatment with an auto CPAP my AHI went way up and spiraled out of control (55 average). Now I'm on an expensive bi-level machine called an ASV.

I wouldn't ignore this. Even if it doesn't cure your other problems, sleep apnea is hard on your body. You are not sleeping well, and getting a good night's sleep may not cure your depression and anxiety, but it will make you feel a lot better (clearer, more energy, better concentration, etc.).

I would think that your doctor would order a CPAP based on your results and your insurance will cover most of the cost. You can always buy a fancier one later, and it's good to have a back up. You do have some say in which brand and model of machine you can get, though it has to be based on the prescription. The DME will likely choose one for you and not offer other options, but you have a right to request what you want.

Is it hard for you to sleep on your side? I noticed that most of your hypopneas occurred while you were on your back.

It's possible that losing weight would improve your apnea, though you don't have to be overweight to have sleep apnea. An APAP will adjust to your needs, but getting a lower score wouldn't be diagnostic...it could be that your apnea is better or it could mean that the machine is controlling it well.

[zonker]

I understand your hesitation to use CPAP. It's a big commitment, takes a lot of getting used to and isn't very sexy.

Your AHI puts you in the moderate category. My first sleep study (in lab) showed an AHI of 18, most of which were hypopneas, like you. Though some people would love to have an AHI as low as yours, in my case after a week of treatment with an auto CPAP my AHI went way up and spiraled out of control (55 average). Now I'm on an expensive bi-level machine called an ASV.

I wouldn't ignore this. Even if it doesn't cure your other problems, sleep apnea is hard on your body. You are not sleeping well, and getting a good night's sleep may not cure your depression and anxiety, but it will make you feel a lot better (clearer, more energy, better concentration, etc.).

I would think that your doctor would order a CPAP based on your results and your insurance will cover most of the cost. You can always buy a fancier one later, and it's good to have a back up. You do have some say in which brand and model of machine you can get, though it has to be based on the prescription. The DME will likely choose one for you and not offer other options, but you have a right to request what you want.

Is it hard for you to sleep on your side? I noticed that most of your hypopneas occurred while you were on your back.

It's possible that losing weight would improve your apnea, though you don't have to be overweight to have sleep apnea. An APAP will adjust to your needs, but getting a lower score wouldn't be diagnostic...it could be that your apnea is better or it could mean that the machine is controlling it well.

+1

[LakeGuy85]

For the mask, as a newbie should I start off with a nose only or a mouth/nose one? I have always had trouble breathing through my nose, especially while laying down, and that might be contributing to my issue. I had a rhino/septoplasy done last year to help, and it helped some, but I still get a congested nose while laying down. As such, should I go with a mask to force air down my mouth in case my nose is what's closing up here? Or would forcing it through the nose be better?

[Smargie]

It sounds like a full mask would be more effective and comfortable for you. Forcing it down your nose would probably just make the mask leak. And if you tend to breathe with your mouth open anyway, using a nasal mask would make the air bypass your windpipe and come out through your mouth. The air doesn't have to go through your nose to be effective.

[Pugsy]

The machine doesn't force air anywhere....you still have to initiate the breath.
It won't blow open any blockage anywhere...it won't even blow up a balloon at 20 cm pressure.
It's just not that powerful.

[NoOnesPerfect]

The machine doesn't force air anywhere....you still have to initiate the breath.
It won't blow open any blockage anywhere...it won't even blow up a balloon at 20 cm pressure.
It's just not that powerful.

Such an important point - the pressure helps to keep the airway open to prevent an apnea, it doesn’t force open a closed airway to “cure” one.