Mild sleep apnea, Do i need CPAP or other options?

[jonnyo]

    42 year old
use to be professional triathlete (pro athletes)
have put on 50lbs
not as fit as i use to

I went to my doctor for a issue not related to sleep. I m a great sleeper, pass out in 2-3min and wake up in the morning. I would not say i wake up fresh as i only have time to sleep 4-6h a night. 3 little kids, my own buisness, active etc. But historically, i always sleep great. I do snore but my wife never notice any stopping breathing. 

Because of a high hematocrit (47%), my doctor ask for a sleep study done in canada. They made me sleep for 2 nights with a oximeter and the return value where in the range of 12-15 AHI/h   and lowest Sat at 83%.  I wasnt super happy with this study as the testing machine they give me with wires was very annoying so i sleep on my back the all night. I never sleep on my back usually...very annoying. 

So i decided to do a normal night myself with a oximeter watch i purchased myself. Result where better with 
AHI 7.5
basal o2 93.6 %
minimum 88%
avg low o2 91.9%

my day time spo2 is usually 95-96%. 

The sleep lab is putting a lot of pressure on me to purchase a CPap machine from them. They want 2500$ and said if i dont have insurrance, they could lower the price a little. i find this ridicoulous. They are very pressure oriented to sell me a machine. They also loan me one for 1 month to try. my reason for asking advice is i feel like this is a money making sleep lab....they are very sell oriented and pushy. 

here s a oscar file of last night sleep on the CPAP.  not sure if i made the setting right?

[Gideon]

Welcome to the forum.

Do you have a full copy of your diagnostic study?  Did it mention Central Apnea?  Can you post a redacted copy of it here?

You said 12-15 AHI, that says you need to be treated.  

Your treatment meats all of your doctors' wishes as your AHI is under 5.

How do you feel?  Any issues?  

I see an OK but slightly high flow limits.  I'd have you add EPR to know it down but that I suspect will increase your CA/Central Apnea.  Seeing a 2-minute view of some of your central apnea will help us understand what is going on.

[jonnyo]

The  at home study was a simply oximeter report so not a real sleep study. There was no mention of CA....simple data of the AHI, and SPO2 data.  the reason i wasnt in 100% agreement with the results is sleeping on my back because i was concern to disconnect the oximeter made the results a lot worst then my normal sleeping patern. 

if i have a Ahi 7.5 without cpap on a daily basis.... how necessary is the CPAP?

As for how i feel. I sleep a lot better without the CPAP vs with it. As for how i feel, i cant really say i feel any different with or without. i dont see the positive impact other mention with CPAP so far. but i m not against using a cpap machine if it s best for me. But so far...i dont notice anything positive. I feel like i had no issue with my speed to start with. But i m very willing to learn and do what s right.     

[Gideon]

See how your flow rate is diminishing prior to the start of the central and again slowly increasing to a peak? That tells me that these are real Centrals and are likely being driven by your CO2 levels.

An AHI of 5 means that, on average, your sleep is being disturbed every 12 minutes, 7.5 every 8 minutes. Can you live with that?

[mesenteria]

Jonnyo, sleep apnea comes in several forms, not just the kind where you choke and can't get enough O2.  There is such a thing as central apnea where your brain doesn't send signals to breathe, and you slowly suffocate.  Eventually you do breathe, but often it's at the expense of sleep....good sleep.  You already don't get enough since 6 hrs is about the minimum to stay healthy for long periods.  If you are constantly waking to deal with oxygen starvation because you 'forget' to breathe, your sleep is TERRIBLE...not 'good' as you think it is.

You need a proper sleep study, or else just accept that all those low oxygen levels mean you do have a treatable problem.  You might get by with a self-titrating machine like the Air Curve or Autoset, but a sleep lab might tell us more and how to go about dealing with it.

BTW, even though the 'treated' point is an AHI of <5.0 each night, reliably, the fact is that on this forum we strive to get people below 2.0 if we can help at all. Most people eventually find themselves well below 5.0 and feeling better than if they felt they could/should live with something much closer to 5.0. Your desats are really very worrisome. How long to they last when they get into the <90 range? That could be a problem all by itself...the length of times you are down there.

[jonnyo]

thank you for the advise. greatly appreciated. i will ask my doctor for a proper sleep study. 

sleep lab report 
- longest desaturation under 90% was 2min:20secondes
- 30min total night time under 90% during the night. 

When i did my own test without cpap and sleeping in my normal position (prone and lateral)
-longest desaturation under 90% is 36 secondes. 
-3min:30sec total night time under 90%


i m really wondering if my high Hematocrit is what sending me to those lower numbers? i remember passing days in the 83-85% SPO2 sat on Mt Everest and body getting use to fonction at those numbers and producing a lot of red blood cells to compensate for altitude.

[70sSanO]

Getting back to your machine. A Resmed Airsense 10 Autoset for $2500 is way too much. Get a prescription (script) and go online.

That machine with humidifier tank should go for $900 (US) or less. A mask is another $100/$150 and maybe another $40 for a heated hose.

But, first post some data so you can get a better recommendation.

John

[jaswilliams]

Are you at altitude? There is such a thing as altitude induced CA's