This is driving me nuts

Julie wrote:Hi - when I said we could help with Cpap, I meant in terms of adjusting to using it, recommending equipment, and answering any questions you might have about using it. As far as insurance, etc. goes, that's between you and them, but members do compare notes here and share experiences about it.

Your medical records should absolutely be available (from your doctor) for years - it would be illegal if they were not - six mos. is nothing. And many of us were diagnosed with mild apnea, but that doesn't mean we don't need Cpap or that we don't use it, plus apnea tends to get worse with age (over a long time though), and sometimes with weight gain.

You really should follow up on things because even a 'mild' diagnosis means you have some problem, and it's important that you be treated... where is your doctor in all of this - why hasn't he/she given you a prescription to get a machine and mask?

I have seen my doctor twice since my study and he told me "we don't treat mild apnea" and that I just had to loose weight and that fix it.

You have a right to your results by law - get them and we'll help you decipher just how 'mild' it is (or isn't) and how to deal with it.

Your doctor is terribly ignorant and you need to find another one - your life could be at risk (I'm not being dramatic, it's true).

Losing weight to get rid of apnea is backward - the apnea is likely the reason for the weight and makes losing it difficult, plus it generally doesn't work.

Julie wrote:You have a right to your results by law - get them and we'll help you decipher just how 'mild' it is (or isn't) and how to deal with it.

Your doctor is terribly ignorant and you need to find another one - your life could be at risk (I'm not being dramatic, it's true).

Losing weight to get rid of apnea is backward - the apnea is likely the reason for the weight and makes losing it difficult, plus it generally doesn't work.

I know about the life span thing, my Grandmother died of stroke in 2001 because she didn't want to wear her cpap

pettyfan45 wrote:
how do know how I would go about getting the full results or if they would even still have them because the test was over 6 months ago (don't know if they are allowed to discard them after so long)
I don't know much you guys would be able to help me get a CPAP because I have Missouri Medicaid so I think a Dr in here in Missouri would have to put me on it or if it would even be covered seeing how I have mild apnea

Mild Apnea still qualifies for CPAP; my apnea score at my sleep test was 11; anything over 5 should be treated with a CPAP machine... Medicare covers it, and any insurance that covers it usually follows Medicare guidelines and requirements. You do need a prescription to get a machine, were you given a script? If not, request one.

As for your records, they are probably still available; call your sleep center or your MD to find out how to get it. By law, we are entitled to copies of our reports, and the information retained usually goes back quite a few years... case in point, my doctors still have my records from early childhood, and I'm now 70.
I recently found out about a diagnosis that I was never told about, that has been in my charts since 1949... go figure. Whether my parents were told, I will never know.

This OP really needs to be treated with xPAP NOW.

Whether one agrees with the notion that weight loss will reduce apnea, xPAP works, no matter one's BMI.

pettyfan45 wrote:I co-host a podcast on Wednesday nights

Good for you! How did you get interested in NASCAR?

I was at a party some years ago and a little man came and stood about 10 feet from me and I noticed a lot of people turned and were staring at him. I asked the guy standing beside me who that was. He got a good laugh and said it was Dale Earnhardt Jr.

pettyfan45 wrote: I have all but 4 of my teeth (they were removed because they were impacted) and I have an overbite but but never had brace.

You are a typical obstructive apnea patient. You lost teeth because your jaw is underdeveloped and there was not room for all 32 teeth. And an undersized jaw means your airway is most likely small and subject to collapsing when you sleep. Now this is not for sure, but it does mean you are not likely to be cured of sleep apnea by losing weight.

I always cringe when I see someone with mild sleep apnea not treated. Even if weight loss is a possible long term solution, to not prescribe treatment at the present is condemning the patient to months or even years of living with the same symptoms that made them seek help, not to mention possibly accumulating damage. There's so much more to this diagnosis than a count. Duration of events, desats, and arousals can play a role in how badly one is affected by their "mild" sleep apnea. Without seeing the report one can't say for sure, but it is common for a study to not fully reflect the severity of the apnea. Sleeping in the lab conditions often means one didn't sleep as much or as well as they do at home, so fewer events showed up. And if the study didn't capture REM while supine, it may very well have not captured the worst case scenario. Now, if a person was on the lower end of mild and their events were seen to be mostly positional, I could see a doctor saying you don't need treatment, just take measures to stay off your back. Aside from that, I think a person who is symptomatic enough to seek medical help needs symptom resolution while waiting to see what other measures might help.

kteague wrote:I always cringe when I see someone with mild sleep apnea not treated. Even if weight loss is a possible long term solution, to not prescribe treatment at the present is condemning the patient to months or even years of living with the same symptoms that made them seek help, not to mention possibly accumulating damage. There's so much more to this diagnosis than a count. Duration of events, desats, and arousals can play a role in how badly one is affected by their "mild" sleep apnea. Without seeing the report one can't say for sure, but it is common for a study to not fully reflect the severity of the apnea. Sleeping in the lab conditions often means one didn't sleep as much or as well as they do at home, so fewer events showed up. And if the study didn't capture REM while supine, it may very well have not captured the worst case scenario. Now, if a person was on the lower end of mild and their events were seen to be mostly positional, I could see a doctor saying you don't need treatment, just take measures to stay off your back. Aside from that, I think a person who is symptomatic enough to seek medical help needs symptom resolution while waiting to see what other measures might help.

They really need to add more factors to the definition of the categories. For example, somebody with fewer events may have fewer because they are longer, and thus allowing the oxygen saturation to get really bad. My mom had a much lower ahi than I did, but her events were longer and her desats went much lower than mine. She was listed as moderate, but even with a straight pressure of 10, I discovered events going over a minute long. That has to be severe, not moderate.

Then there are the people who are aroused enough to breathe that many events get prevented before making the criteria. If you are awake, you can't have sleep apnea events, right? But being awake all night, or most of it, is no solution. So, even though there aren't many oxygen desats, if there are tons of arousals, then there is a serious problem there too.

Unlike my mom, I didn't have huge oxygen desats. I spent only 13% of the time below 90%, and my lowest level was 84%. Not into the low 70s like my mom. But my number of events was destroying my sleep. Averaging 79 an hour without reaching deep sleep or REM. Probably worse if a whole night was recorded. I was struggling all night to keep breathing. But, because I had a high number of events, my severe rating was more clear than my mom's true severe situation.

Here is the report that was sent to my doctor, I have an appointment with my neurologist (see him about my CP/leg pain) on the July 31st and I can see if he can set me up with another study to see if my weight lost has helped at all. That said I do not know if he can because I do not if he has experience with sleep medicine at all. Worst case I go see a new primary doctor, right?
He says he sleeps all night, but still feels tired in the morning. He
has an Epworth sleep score of 17. His family complains of loud snoring. He has a history of cerebral
palsy and leg pain. Body mass index of 35. Neck circumference of 17 ¾ inches.

The patient was studied in a diagnostic fashion on 12/28/2014 from 2233 to 0456. The total record time
was 377 minutes. Total sleep time was only 160 minutes. Sleep efficiency was poor at 42%. Sleep
latency was 135 minutes. REM latency was 128 minutes.

IMPRESSION:
1. Mild obstructive sleep apnea with an apnea-hypopnea index of 14, respiratory disturbance index
just starting in the moderate range at 16. This is based off 36 hypopneas and RERA index of 2.
2. Mild nocturnal desaturations. Average saturation was 96, but the low was only to 90%.
3. Mild arousal index of 13. That stated, obviously the patient's sleep efficiency was poor for the
nighttime. He did not fall asleep until 0100 in the morning and then had multiple awakenings with
all the wires and all and then slept for a little time after 0300.
4. Snoring at 152 per hour.
5. No isolated periodic leg movements.
6. Some mild tachycardia. Average heart rate was 81, low of 60, but the high of 129, little spikes
above 100.

RECOMMENDATIONS: Clinical correlation will be needed. No significant desaturation for the nighttime.
Mild sleep apnea. The patient's BMI is 35 and only 22 years of age. If it is possible to lose weight, I
would strongly consider that first and see if he can get his weight down since he is not desaturating with
what has been associated with the highest morbidity and mortality of sleep apnea. If he can get his
weight down and then probably restudy and show that it is okay, then I would go that way.

In the same since that he cannot or his weight goes up further, then consideration for treating his
underlying obstructive sleep apnea.

kteague wrote:I always cringe when I see someone with mild sleep apnea not treated. Even if weight loss is a possible long term solution, to not prescribe treatment at the present is condemning the patient to months or even years of living with the same symptoms that made them seek help, not to mention possibly accumulating damage. There's so much more to this diagnosis than a count. Duration of events, desats, and arousals can play a role in how badly one is affected by their "mild" sleep apnea. Without seeing the report one can't say for sure, but it is common for a study to not fully reflect the severity of the apnea. Sleeping in the lab conditions often means one didn't sleep as much or as well as they do at home, so fewer events showed up. And if the study didn't capture REM while supine, it may very well have not captured the worst case scenario. Now, if a person was on the lower end of mild and their events were seen to be mostly positional, I could see a doctor saying you don't need treatment, just take measures to stay off your back. Aside from that, I think a person who is symptomatic enough to seek medical help needs symptom resolution while waiting to see what other measures might help.

Funny thing about that, I have always been a side sleeper (even as a baby). So I doubt they got many if any measurements at all on my back. The only way I sleep on my back is if I take something to make me go to sleep or if by chance roll over like there (but my family have told me I don't lay like that for long)

pettyfan45 wrote:Here is the report that was sent to my doctor, I have an appointment with my neurologist (see him about my CP/leg pain) on the July 31st and I can see if he can set me up with another study to see if my weight lost has helped at all. That said I do not know if he can because I do not if he has experience with sleep medicine at all. Worst case I go see a new primary doctor, right?
He says he sleeps all night, but still feels tired in the morning. He
has an Epworth sleep score of 17. His family complains of loud snoring. He has a history of cerebral
palsy and leg pain. Body mass index of 35. Neck circumference of 17 ¾ inches.

The patient was studied in a diagnostic fashion on 12/28/2014 from 2233 to 0456. The total record time
was 377 minutes. Total sleep time was only 160 minutes. Sleep efficiency was poor at 42%. Sleep
latency was 135 minutes. REM latency was 128 minutes.

IMPRESSION:
1. Mild obstructive sleep apnea with an apnea-hypopnea index of 14, respiratory disturbance index
just starting in the moderate range at 16. This is based off 36 hypopneas and RERA index of 2.
2. Mild nocturnal desaturations. Average saturation was 96, but the low was only to 90%.
3. Mild arousal index of 13. That stated, obviously the patient's sleep efficiency was poor for the
nighttime. He did not fall asleep until 0100 in the morning and then had multiple awakenings with
all the wires and all and then slept for a little time after 0300.
4. Snoring at 152 per hour.
5. No isolated periodic leg movements.
6. Some mild tachycardia. Average heart rate was 81, low of 60, but the high of 129, little spikes
above 100.

RECOMMENDATIONS: Clinical correlation will be needed. No significant desaturation for the nighttime.
Mild sleep apnea. The patient's BMI is 35 and only 22 years of age. If it is possible to lose weight, I
would strongly consider that first and see if he can get his weight down since he is not desaturating with
what has been associated with the highest morbidity and mortality of sleep apnea. If he can get his
weight down and then probably restudy and show that it is okay, then I would go that way.

In the same since that he cannot or his weight goes up further, then consideration for treating his
underlying obstructive sleep apnea.

I can se why the doctor recommended weight-loss first. Your sleep apnea is disturbing your sleep, causing sleep fragmentation and disrupting your REM sleep. You're not getting enough restful sleep and your body is constantly experiencing elevated cortisol. But you're not at the point where you're risking developing comorbid health-conditions or physical damage. You still need to get it treated, as untreated sleep apnea can get progressively worse. I'd recommend trying a jaw-appliance or a sleep apnea pillow, which forces your head to sleep in way conducive to having your airway open. If you can get a CPAP machine, go for it. But I'd follow the doctors recommendation of losing weight. There are other benefits, besides sleep apnea remission. Including improving your ADHD symptoms and concentration issues.

FYI

There is no such thing as a sleep apnea pillow, though there are Cpap pillows with cutouts to accommodate masks. What I think he meant was - soft cervical collars that keep your head up, airway more open and jaw more closed.

There are no 'jaw appliances', though there are dental devices that some people find helpful, if not as effective as Cpap.

And there is no such thing as 'sleep apnea remission'! You either have it or you don't.

This particular poster is on a tear to make everyone believe your apnea will go away if you just lose some weight, and no amount of reasoning or research will sway him. Just be aware.

Julie wrote:FYI

There is no such thing as a sleep apnea pillow, though there are Cpap pillows with cutouts to accommodate masks. What I think he meant was - soft cervical collars that keep your head up, airway more open and jaw more closed.

There are no 'jaw appliances', though there are dental devices that some people find helpful, if not as effective as Cpap.

And there is no such thing as 'sleep apnea remission'! You either have it or you don't.

This particular poster is on a tear to make everyone believe your apnea will go away if you just lose some weight, and no amount of reasoning or research will sway him. Just be aware.

the soft cervical collars do not look comperable to sleep in at all.
Also about dental devices, would something like PureSleep help or is that just for snoring and not apnea. If I have to go to a dentist that could an issue because my insurance would not cover that (if I was under 18 they would) and I have a broken tooth I have that been needing fixed for years now and the cheapest estimate I got for that is over $160 (that I don't have) and I might have to go in more than one time, I don't even want to know what they would charge for a apnea device.

Julie wrote: And there is no such thing as 'sleep apnea remission'! You either have it or you don't.

Yes, lets just ignore research on the subject for our convinence.

Julie wrote: This particular poster is on a tear to make everyone believe your apnea will go away if you just lose some weight, and no amount of reasoning or research will sway him. Just be aware.

This is such rigid and inflexible thinking on your part and everyone else who follows the same belief. Just because you were disappointed that your condition is permanent doesn't mean it's some sort of scientific law. I've already cited actual research, which shows that obesity-related sleep apnoea(specifically the mild degree) can potentially remit with significant weight loss. What have you cited and pointed to? Anecdotal stories and the general experiences of one cohort/clinical subgroup who have sleep apnea. I can't help that you seem bent on ignoring any research out there that goes contrary to your own belief, experience and understanding of sleep apnea.

Anyway this thread isn't about our disagreements. Let Pettyfan45 find out for himself, on whether continued weight loss will help him with sleep apnoea or not.

Julie wrote:This particular poster is on a tear to make everyone believe your apnea will go away if you just lose some weight, and no amount of reasoning or research will sway him. Just be aware.

I still think that particular poster is just trolling.