[Diagnosis] Just diagnosed with mild OSA, overwhelmed and need some help

[tiredsam98]

Hi all, I've lurked on this forum for some time have been so impressed by how kind and helpful y'all are. I'm hoping to get some clarity on how I should move forward with treatment. 

Context
Male, 21 years old, healthy bodyweight, exercises regularly. I have been exhausted and foggy for almost as long as I can remember. No amount of sleep or caffeine seems to do the trick. I saw a psychiatrist about this issue in January of this year and got an ADHD diagnosis. Adderall has been able to keep me awake and has helped with my focus/brain fog, but I know its not addressing the root cause and has some nasty side effects.

I finally decided to take a home sleep study through Lofta (WatchPAT 2 device) and received my results last week. 

Diagnosis
Obstructive Sleep Apnea - Mild based on pAHI=6.1 pRDI=15.5 and O2 nadir of 91%
Recommended Therapy: Auto-CPAP (such as ResMed Airsense 10 Autoset) set  4-20cm with heated  humidity and mask/interface fitting

Sleep Study Results
5 hours 33 minutes total sleep time
15.4 RDI events per hour / 86 events during sleep
6.1 AHI events per hour / 34 events during sleep
O2 Sat: 91% minimum / 96% average / 100% maximum; 8 events where O2 desaturation was between 4-9%
Body Position Statistics
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Sleep Stage Statistics
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Why I'm overwhelmed? (my questions are underlined)

• I want to try therapy because I believe it can help. Although, the Lofta rep said I was a borderline case and that people often decline therapy with my numbers. So I question whether PAP therapy is necessary in my case.
  
• Any PAP would be effectively out-of-pocket. My insurance has a high-deductible. This isn't too much of an issue, feeling better is a priority of mine.
  
• I've read online that my AHI/RDI numbers could be consistent with UARS. I can't seem to find any good information on this and don't know how to evaluate that based on my data. Lofta was unhelpful in this regard. Any input from you all? Could my results suggest UARS?
  
• The Lofta rep said that a Bi-level machine would address OSA and UARS (if I had it). She recommended the ResMed Aircurve vauto, preset to IPAP 25 EPAP 6 PS 4. This device is significantly more expensive than the AirSense 10 Autoset. I am willing to spend more if it would lead to a better outcome. I was skeptical, however, that a rep for a CPAP sales company was giving me the most objective advice.  Any reason to believe I would see more of a benefit/more comfort with the AirCurve vs Airsense?
  

Thank you for any thoughts on these questions or other tips you can provide. Happy to provide any extra context, if needed.

[Gideon]

Since you are self paying you have 2 paths.
1. AirCurve VAuto, It will handle any obstructive issues that you have.

2. Start with AirSense AutoSet and see what it shows.
Either case I suggest a gently used machine. The machines should be able to be resold for near what you paid for them as long as you haven't put considerable hours on them.
Supplier #2 defines gently used as 1500 run hours or less.

Looking at the flow rate in zoomed detail will help us see what is going on and that is necessary if UARS is involved, and it very well could be. The trouble with UARS is there are no reported events associated with it.

[tiredsam98]

Thanks for the input. I'm leaning toward the Aircurve. Glad to hear your endorsement of a gently used machine, was unsure if that would be a wise purchase.

[SarcasticDave94]

I don't see an issue with a low hour machine. Check the Run Hours if you can. If it's from Supplier #2 it won't be an issue, but if it's from other sites then it could be a bit of a problem to verify.

[staceyburke]

I totally agree with Supplier #2. Super fast and I got an VAUTO for about 1000 less than new. My machine only had 250 hours. I don’t know how many hours your will have but a life span of 14000 to 15000 hours, 1500 would be good.

[Illorum]

According to the AASM and ICD-10, you have moderate sleep apnea given that your RDI is 15.4. Mild is 5-14.9, moderate is 15-29.9, and severe is 30+. Since your AHI is so low and RDI so high by comparison, this is usually called Upper Airway Resistance Syndrome or Non-hypoxic sleep disordered breathing.

Sleep disordered breathing is commonly misdiagnosed as ADHD.

UARS patients usually find better relief on Bilevel PAP devices such as the Aircurve 10 as they are more effective at treating flow limitations. I don't recommend you buy one from Lofta as they sell very expensive new machines. The other users have given good recommendations for a supplier of gently used low hour machines.

https://en.m.wikipedia.org/wiki/Upper_ai...e_syndrome


Some notes: AHI = Apnea Index + Hypopnea Index

RDI = Apnea Index + Hypopnea Index + Respiratory effort-related Arousals Index

Respiratory effort-related Arousals (RERAs) are the main respiratory disturbance in UARS patients. They really are in essence hypopneas, but for controversial Medicare related reasons they are counted as separate, even though they are as bad or worse than normal hyopneas from a neurological standpoint.

UARS is the more common manifestation of sleep-disordered breathing in younger age demographics. UARS patients outnumber OSA patients 3.75:1 in the 21-29 age category. The main distinction between OSA and UARS patients is sensory nerve function in the palatal mucosa: OSA patients have local neuropathy which prevents them from effectively responding to flow limitations, whereas UARS patients can respond very quickly without significant oxygen desaturation occurring.

Also here's something your average clinician won't tell you: there is no significant correlation between AHI and symptoms. Since the AASM's current hypopnea criteria so heavily relies on desaturation, and how fast one desaturates is a function of body mass, AHI is essentially just a measure of how much you weigh. You can read more about that here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855711/

[tiredsam98]

Thank you very much for your suggestions and information on UARS—all of which was new to me. It seems like the Aircurve 10 vauto, purchased from the supplier referenced above, is the best way to proceed. Will that unit have an sd card slot for me to use with OSCAR?

I am leaning toward trying a nasal pillow mask style first. Does that seem like a good first stop?

[Sleeprider]

You can give Supplier #2 a call and ask about a machine. The have an excellent reputation for providing very low hour machines with a warranty at a fair price. Ask the person you talk to about an SD card and they may throw it in. You will end up with a top notch bilevel for about the same price as the Airsense 10 CPAP new, and customer service is excellent.

I have found a number of machines by searching Craigslist listing using the SearchTempest search engine. You might get lucky using that tool. Craigslist has some higher risks and does not have any warranty, but it's there if you need it.

[Illorum]

Yes, the Aircurve 10 and all modern Resmed PAP devices have SD card ports and are compatible with OSCAR.

Nasal pillows are a great choice.

[Gideon]

Read the Mask Primer, see my signature, There are two schools of thought on masks trials, start with a Full Face Mask and work down, or as I suggested, start with Pillow Masks, the smallest, least intrusive of all masks, then nasal masks, and finally the full face masks. When it come to mouth breathing, there are many solutions, also outlined in the Mask Primer, in addition to the Full Face Mask.
Supplier 2 is a good, and often recommended source for used machines.