Moderate Apnea

[trish6hundred]

Hi eoinpat,
WELCOME! to the forum.!
Much success to you in getting your sleep problems taken care of.
Hang in there for more responses to your post.

[Sleepster]

A +H 48 (15,3)

That's an apnea-hypopnea index (AHI) of 15.3. In other words, an average of 15.3 events per hour. That's one event every 4 minutes, on average. Enough to totally prevent you from falling into the deeper levels of sleep required for you to live a normal life. Instead, it means a sleep-deprived life that ends early due to a heart attack or stroke.

An AHI of 5-15 is considered mild, 15-30 is moderate, so you are on the border. Either way, CPAP therapy is warranted. There is no doubt about this, all of the clinical evidence supports it. We have people on Apnea Board from countries all over the world and I've never heard of any standard other than this one.

If your AHI is 5 or above you need treatment, and CPAP therapy is the gold standard.

[DariaVader]

According to the Centers for Medicare & Medicaid Services criteria for the positive diagnosis and treatment of obstructive sleep apnea,[32] a positive test for OSA is established if either of the following criteria using the AHI or the RDI is met:

AHI or RDI greater than or equal to 15 events per hour, or
AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness (EDS); impaired cognition; mood disorders; insomnia; or documented hypertension, ischemic heart disease, or history of stroke

and

The AASM has developed its own criteria, as listed in the International Classification of Sleep Disorders: Diagnostic and Coding Manual, Second Edition.[4] At least 1 of the following criteria must apply for OSA to be diagnosed:

The patient reports daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and/or unintentional sleep episodes during wakefulness. The patient awakens with breath holding, gasping, or choking. The patient’s bed partner reports loud snoring, breathing interruptions, or both during the patient’s sleep.
Polysomnography (PSG) shows more than 5 scoreable respiratory events (eg, apneas, hypopneas, RERAs) per hour of sleep and/or evidence of respiratory effort during all or a portion of each respiratory event.
PSG shows more than 15 scorable respiratory events (eg, apneas, hypopneas, RERAs) per hour of sleep and/or evidence of respiratory effort during all or a portion of each respiratory event.
Another current sleep disorder, medical or neurologic disorder, medication use, or substance use does not better account for the patient’s condition.

Still, 15 is the line where they absolutely treat in the US. 5 + any symptom is also considered a treatable condition. With 15.x there should be no question of whether or not to treat, IMO.

[Gyddyup]

for what it's worth... my sleep doctor was initially going to send me to an ENT, saying i was 'too young' to to spend the rest of my life hooked up to a CPAP machine when surgery would most likely be a better option.

He then changed his mind after my first sleep study - yes surgery was still an option to make breathing easier but would make no difference to overcoming my sleep apnea.

[eoinpat]

Thanks for the advice everyone. It is much appreciated.
The difficulty really is that it seems the reading is very much on the borderline where a CPAP might be needed or not. I was asked questions at the start as to how tired I felt, and I think the decision not to proceed further may have been based on my replies. I don't fall asleep during the day, or every feel that it might happen while driving, so I suppose I did not really estimate that the problem was too significant. Having said that I do feel tired enough during the day - but I don't know if this is just 'normal' - as I am busy etc. Also, this has probably been going on for some time so I suppose that I think that whatever way I am now is 'normal' - and in fact, it might not really be. I think also the fact that the Oxygen levels weren't too disrupted and also that I look healthy overall, in addition to language difficutly when replying as to how tired I am (and my unsure as to what a 'normal' level of tiredness is) might all have prompted the consultant towards her advice, which in a nutshell, was that the results are not particularly significant.
The problem it seems to me with a borderline reading, is that it is hard to know what 'normal' tiredness is - particuarly as one probably has had this problem building up over time and so a certain level of tiredness now feels like 'normal' - I assume everyone else feels more or less the same, but that may not in fact be the case!

[DariaVader]

Thanks for the advice everyone. It is much appreciated.
The difficulty really is that it seems the reading is very much on the borderline where a CPAP might be needed or not. I was asked questions at the start as to how tired I felt, and I think the decision not to proceed further may have been based on my replies. I don't fall asleep during the day, or every feel that it might happen while driving, so I suppose I did not really estimate that the problem was too significant. Having said that I do feel tired enough during the day - but I don't know if this is just 'normal' - as I am busy etc. Also, this has probably been going on for some time so I suppose that I think that whatever way I am now is 'normal' - and in fact, it might not really be. I think also the fact that the Oxygen levels weren't too disrupted and also that I look healthy overall, in addition to language difficutly when replying as to how tired I am (and my unsure as to what a 'normal' level of tiredness is) might all have prompted the consultant towards her advice, which in a nutshell, was that the results are not particularly significant.
The problem it seems to me with a borderline reading, is that it is hard to know what 'normal' tiredness is - particuarly as one probably has had this problem building up over time and so a certain level of tiredness now feels like 'normal' - I assume everyone else feels more or less the same, but that may not in fact be the case!

I would think that you are not just on the line. you are above the line - by a small amount. below the line, we also choose to treat if the person has developed high blood pressure, or some other tell tale effect already. I am not sure why you would want to wait for that to happen Sleep apnea causes all sorts of nasties in addition to tiredness when allowed to run untreated - why not nip it in the bud?

[Asjb]

eoinpat wrote:
quote: The consultant told me that I have moderate apnea - 15.3, but that a CPAP is not recommended unless the apnea is over 20.......
The consultation took place in Belgium......
I don't fall asleep during the day, or every feel that it might happen while driving, so I suppose I did not really estimate that the problem was too significant....... end quote.

Hello eoinpat.

I wonder if these definitions are a <Continental Europe> issue. I live in France and three doctors who see patients with sleep apnoea told me that my AHI of up to 15 (while on CPAP treatment) was <entirely acceptable>. I thought they were wrong and I spent many months trying to get the appropriate machine and settings for my situation.

A practical suggestion would be to google to find the Belgian health service, State, recommendations for treatment of sleep apnoea and/or any papers on Google Scholar that mention Belgium and sleep apnoea. If they all insist <In Belgium, no CPAP until AHI is more than 20> then this will be out of step with the USA etc but there's nothing you can do about that other than just try for a second opinion, emphasizing how much the fatigue adversely affects your life, or buy your own machine if you can do that.

I succeeded in the end by using treatment data from my machine (analysed with Sleepyhead software, which is free from this Board), asking advice from this forum and finding documentary evidence from elsewhere on the internet. I then presented my case to one of my doctors here in France who has nothing to do with sleep apnoea but who I knew trusted me. I recommend you try the same so that you can get some of your costs covered by a prescription for CPAP within an insured healthcare system, rather than pay for it yourself.

You are as you say <on the border> but you are not on the border between normal and mild, instead you are on the border between mild and moderate, and I agree with everyone on this forum who has so far recommended that you are treated with CPAP. I deeply wish I had started CPAP decades earlier - looking back, I had symptoms of sleep apnoea since adolescence but I didn't do anything about it... Now that I am on the right type of CPAP treatment for me, I can honestly say my life has been transformed for the better.

Like you, I never had daytime sleepiness either so my Epworth Score has always been normal. Instead I had abnormal, sometimes profound, fatigue - no energy for anything. This is hugely improved now. There is a little published evidence that women with SA have more fatigue, men have more sleepiness. There is also limited evidence that women tend to be more symptomatic at a lower AHI than men are.

I second the recommendations from others - to prevent serious, truly important, health problems later in life and to probably improve your fatigue now, I would recommend using an auto-CPAP machine (there is plenty of excellent advice available from ApneaBoard - I used to use a Resmed Airsense 10 Auto and can thoroughly recommend it) and then, if you do not continue under the care of a sleep doctor, use Sleepyhead software and advice from this forum to choose the best settings for you. There's nothing magical or daunting at all about setting a CPAP/APAP machine (although many sleep doctors and technicians will tell you otherwise...).

Your hypopnoeas should sort themselves promptly with CPAP/APAP.

After all, who would choose to spend 15.3 (your AHI) x 10 seconds (defined length of a hypopnoea) each hour being <throttled>? Not me!

I hope it all works out well for you.

[eoinpat]

Thanks everyone for your replies, and asbj for all the information about your experience in France. I suppose I hadn't taken the health risks seriously enought (heart, blood pressure etc), and was only thinking of sleep apnoea in terms of fatigue. But like I said, I am even unsure about that - if i am a 'normal' level of fatigue given my level of activity, of if my energy is lower than it should be. Also, it seems that my oxygen saturation levels didn't go below 90% so I think that made me think that it isn't so serious.
But considering all the expertise already on this forum it would seem that the long term health risks are more serious than I had realized.
I suppose my difficutly with the idea of using CPAP is the 'hassle' involved, and also the fact that a lot of people seem to find it quite difficult to use correctly. But this may just be innate laziness on my part! Would the oral device be also an option at this moderate level?
I know that I need to do some more research, and clearly I need to treat the matter a little more seriously than I have so far - and thank you all very much for all the invaluable information.

[Asjb]

... I suppose I hadn't taken the health risks seriously enought (heart, blood pressure etc), and was only thinking of sleep apnoea in terms of fatigue.... Also, it seems that my oxygen saturation levels didn't go below 90% so I think that made me think that it isn't so serious....
I suppose my difficulty with the idea of using CPAP is the 'hassle' involved, and also the fact that a lot of people seem to find it quite difficult to use correctly....

Hello again. Just had a thought - if the ENT consultation you said you were advised to obtain shows nothing necessitating treatment (and <nothing> would be the common finding - ENT abnormalities that are treatable, by surgery or other means, and thereby cure a person's sleep apnoea, are rare) - then you could perhaps ask the sleep consultant you saw to borrow a machine for say a month. If it brings your AHI down to well-normal and resolves your fatigue, you would then have a powerful case for obtaining a prescription for your own machine. I know they have loan machines available in France, I don't know about Belgium.

Oxygen desaturations that don't go below 90% are relatively peaceful for the cardiovascular system, but how much better if they are both rare events and they don't go below 93% or 94% etc - which can be achieved with effective CPAP.

Starting on CPAP is <a hassle> but I found it settled very quickly, within two weeks, to being a non-invasive peaceful routine. Starting it up each night and cleaning the equipment etc takes maybe a total of 15 minutes a week, and looking through say one week's-worth of data on a computer takes less than 15 minutes. And all the kit packs into a little shoulder bag for my frequent trips, including hassle-free air travel.

I can truly say I would fight *very* hard if anyone tried to take my machine away from me! - but I do appreciate that my diagnostic AHI (58) was such that I had no sensible choice at all about starting CPAP and you have a more finely-tuned decision to make with your AHI of 15. But then again my AHI when I was your age may have only been 15 - if only I had ever asked for testing...

Your comment about a lot of people having problems with CPAP may just reflect? what I think is a typical Patient Forum issue, no matter what the malady, of people contacting forums when they are in trouble, and not contacting forums when everything is going well!

I hope you will shortly have all the information you need to make your decision.

[eoinpat]

Thanks yet again for your very comprehensive reply asbj. It is interesting what your experience in France had been, and the idea of trying out a machine for a month is a good one.

But...
today there was an interesting development. I went to the ENT consultant as I had been advised to do. Totally not expecting that it would be of any use, as I am confident I don't have any nasal/throat/ear problems. And indeed, the ENT consultant confirmed that all is in order on that front.

But this consultant had worked in a sleep clinic in Germany for quite some time, and was very familiar with apnoea. She looked at the report and immediately noted that over 90% of my respiratory events happen while I am on my back. She suggested that in her experience my problem could be resolved if I can 'train' myself not to sleep on my back. She told me that there are expensive jackets etc that can be bought, but recommended instead that I find a small backpack and go to sleep wearing that - hopefully whenever I go to turn onto my back the backpack will prevent me from doing so. According to her after 40 days or so of this I should, hopefully, have managed to retrain myself out of sleeping on my back.

Could it possibly be this simple?! I am very optimistic about this, but wonder if it is too good to be true! Has anyone else any experience of doing this?

Thank you all yet again!