[Symptoms] Do I really need CPAP?

[herbie]

I've been folllowing this forum and find it quite helpful. 
I don't want to start arguments, just have a general question.
I see the problems many people with sleep apnea have.
I took a home sleep apnea test the day of a holiday. I ate much more than usual.
The results were what I thought slightly high. AHI 15.7, RI 18. Suspected pathological breathing disorder 16.
I'm no expert, but I didn't think this was too high.
The office I saw is basically in the business of setting up CPAP devices.

I'm 77 years old. I come up almost 0 in questionnaires. I usually exercise 5 or 6 days a week, walking an hour and half or a little less and riding an exercise bike an hour and a half. I'm not tired and have none of the grave systems I've seen on the board.

I'm seeing another sleep doctor in March, but I just wondered if I could have something mild. I wlll say I have sinus issues and was having a problem the night of the test. I'm seeing the other doctor because he's in a practive with a variety of specialists.

Just curious if anyone else has had serious apnea with no symptoms. Or if any treatment might be different for someone my age.

I appreciate any comments. As I said, I'm seeing another specialist in March.

Ed

[DaveSkvn]

Hi Herbie,

It seems a little odd that "I'm not tired and have none of the grave systems I've seen on the board." and yet you "took a home sleep apnea test". I guess there must have been a reason you took the test. Was a bed partner complaining about snoring / choking? Was there a blood pressure issue?

I guess the issue is once you have an apnea diagnosis, certainly where I am, that has "implications" for driving. If you go down the CPAP route, these days the machines monitor compliance and upload your usage to the cloud every morning - which is traceable.

As you may well know, an AHI of less than 5 is not considered medically significant. 5 to 15 is mild. 15 to 30 is moderate and above 30 is severe. Your AHI is just outside the mild range.

The main alternative to CPAP for milder cases is a mandibular advancement device/splint (like a mouthguard that keeps your jaw forward to keep the airways open a bit more). A "proper" MAD is made by a dentist/orthodontist and costs much the same as a CPAP machine but there are basic devices you can buy off ebay/amazon to give it a try for about $50. In my experience they won't last more than a week of use.

If you wish to avoid CPAP you'd have to discuss this with your doctor, focus on the relatively mild AHI value, if possible question the accuracy of the test (was it a $200 test off the internet? "The true value may well have been 10 to 12!") and suggest a trial of a MAD. Say you will buy a basic MAD kit to see how it goes and then get in touch with a dentist for the full version and then 'forget'. That way the doctor has documented the treatment of Apnea and you have avoided CPAP.

You do have to ask yourself why you had the test. I've been on blood pressure meds since I was 40 almost certainly due to apnea. "Turning blue" several times a night does not do your general health any good. The UK NHS (https://www.nhs.uk/conditions/sleep-apnoea/) - which would dearly love to avoid giving anyone a sleep study or a CPAP machine - says the following

Without treatment, sleep apnoea can lead to other problems including:

•     high blood pressure
  
•     a higher chance of having a stroke
  
•     type 2 diabetes
  
•     heart disease
  
•     depression or mood changes
  

[herbie]

Hi, DaveSkyn,

Thanks for the quick reply.I had the sleep apnea test because my cardiologist asked if my neck size has increased. He said that can be a sign of apnea.

No other symptoms, 0 in the apnea questionnaire. No snoring noises, no sleepiness during the day, etc. 

Thanks again I'll see what the sleep cinic doctor says when I see him in March.I do appreciate your advice.

[SarcasticDave94]

Correct, AHI 15.7 is moderate and indicates you'd benefit from CPAP style treatment.

[staceyburke]

An AHI of 15 means you stop breathing 15 times of (at least)  10 seconds in an hour for 8 hours.  That does not seem like a problem?

[herbie]

Thanks for the comment. 
I'll see what the doctor says in March.

[herbie]

Thanks.  
As I said earlier, I took the test after a huge holiday dinner, so I'm not sure about the results. 
I had an in-hospital test in 204 and moderate apnea was not found.

I'm 77 years old and I've read that treatement might be different for the elderly, which I must admitk I am,  so I'll see what the doctor I'm seeing in March thinjks.

Thanks again for your comment.

[Deborah K.]

I don't think eating a big dinner would make any difference in a sleep study.  I understand why you don't want to believe it, but you really do need a pap machine.

[Nightynite]

If you would download the free software Oscar here and use your machine for a week , the data will answer your question. Once you visually see it, then you will know for sure. It’s easy and free!

[herbie]

Hi, Deborah,

  I appreciate your concern. 
I don't have a problem with CPAP.
I just want to be sure that is the best solution for me.

I felt the doctor I saw was a one-person show, basically in the CPAP business.

I'm fortunate to live near several major teaching hospitals.

I will be seeing a doctor at a university sleep center. They have a variety of doctors so I'll be able to select an option that might be best for me.

Back in 2014 I finished the CT tests for lung cancer as an ex-smoker. They also tested my breathing, etc. It was all okay, but the doctor suggested I get an in-hospital  Apnea test.

They didn't find Apnea back then but did say I had "upper airway resistant syndrome.' The medical group recommended Provent, non-supine sleep, and mild weight loss.  I see Provent has been discontinued.

My internist at the time wasn't as thorough as my current one, so it all passed by.

I will mention this to the doctor I'll see in March at the sleep center.

As I  said, I really do appreciate the great prople on this board.

But my internist and cardiologist both think going to a sleep clinic is the next best step.

I really do appreciate how helpful everyone on this board is.

If you'd like I can come back in March and update everyone.

Thanks again,