[Treatment] Cpap vs Surgery

[ElasticFrust]

I was diagnosed with sleep apnea (AHI~25) more than a year ago, and  bought a RESMED9 Elite (Nasal Mask).  While my sleep approved a bit but not even remotely like it used to be (even thought the machine shows a great success- AHI is constantly < 3 with pressure of 5-8 cm H2O). I still very tired, in fact it seems I sleep better during those nights where my AHI is relatively high (closer to 3) than in those where it low (usually, less than 1).  I'm getting quite depressed, and get angrier much more easily than before. I also feel that I'm not as sharp as I used to be. I'm only 31 yo which seems quite young to have such a horrible sleep.  I also suffer from GERD, but I had it almost a decade before I was diganosed with sleep apnea. I'm overweight but until the last two years I was relatively active, and now, since I barely sleep well it's just to hard. I'm thinking of getting some surgery, and would like to hear any ideas you may have.

[Walla Walla]

If your still tired after using a CPAP I don't think surgery is the answer. Besides it only has a 30% success rate and is very painful.

You might want to check with a Doctor about other causes for your fatigue. There can be many reasons that aren't connected to CPAP.

[ElasticFrust]

The point is that it all started (my lousy sleeping) roughly around the time I was diagnosed with apnea. While it is possible there are other reasons to it, I still think these are related, especially since I have experienced a long and hard adjustment to the machine. Cross this with fact the when I seem to have a better sleep (very low AHI) i actually fell worse than those times when I have have what seems to be  (on paper) not as good a sleep, I think I'm still porely adjusted to the machine, or smothing. My doctor only looks at the machine results and says everything is fine. Thought I have some psychological issues so he sent me to a psychologist that said everything is fine and that she doesn't understand why I'm there :/  Blood tests are consistently good.

Has anyone here have had the surgery ot knows someone who has? any pros or cons aside the price and pain?

[AshSF]

Since your pressure range is not too high, you can try a couple of approaches:
1) raise the minimum pressure of your APAP range. A pressure of 4 is really really low. Most people tolerate a start pressure of 7 or 8 just fine.
2) go on a constant pressure which is = 95%ile pressure your apap shows. A lot of people do well on constant pressure than on apap. The steep pressure rises of ResMed may be messing with your sleep architecture.

AHI is just one of the metrics and a xpap can only measure this one. Some people need a higher pressure to not only keep AHI low but also to ensure better oxygenation which needs an oximeter to measure.

If none of these work, then maybe a bilevel titration or as ASV titration is in order.

[Snorzz]

Waiting on sleep study score, hope to get on CPAP, so not much help there.  A couple of things abt GERD; it may be allergies that drain down the back of your throat & make the stomach too acid.  I now use Equate Chlortabs from Walmart when my throat feels a little sore and the stomach gets upset.  I do use generic zyrtec at times, but the main problem seems to be sinus drainage down into the stomach.  My gastroenterologist had me on Prevacid for 6 yrs and it depleted my liver of B12(host of problems from that); he thot I had reflux.

[kiwii]

The very first thing to do is post an image of your SleepyHead chart.

I read your other thread and see that you've never had your charts evaluated. There could very well be an easy fix, but no one can help without actually seeing your data.

[SarcasticDave94]

I had considered surgery as one option to resolve sleep apnea. But I decided that after lots of reading research material, and comments about these, it could help some but positive results seemed limited.

I did go through the bariatric sleeve surgery to reduce weight, which helped tremendously, but I still have need of xPap therapy. My particular machine is an ASV.

Dave


PS I'm also in agreement with needing to see charts.

[Apnea Infant]

The point is that it all started (my lousy sleeping) roughly around the time I was diagnosed with apnea. While it is possible there are other reasons to it, I still think these are related, especially since I have experienced a long and hard adjustment to the machine. Cross this with fact the when I seem to have a better sleep (very low AHI) i actually fell worse than those times when I have have what seems to be  (on paper) not as good a sleep, I think I'm still porely adjusted to the machine, or smothing. My doctor only looks at the machine results and says everything is fine. Thought I have some psychological issues so he sent me to a psychologist that said everything is fine and that she doesn't understand why I'm there :/  Blood tests are consistently good.

Has anyone here have had the surgery ot knows someone who has? any pros or cons aside the price and pain?

Hello ElasticFrust

You have had many good replies to both your threads and I cannot add more to it except to relate my own experience with PAP therapy. 

Before that, can I ask what it was that made you to get a sleep study and a diagnosis? Was it that you were already showing signs and symptoms of possible untreated sleep apnea? I presume this was proposed by health professionals? I only ask as my own reasons for pressing for a sleep study was slightly different in that my brother recognised my symptoms and refused to stop nagging me till I was safely on PAP therapy which he had been for about 10 years.

Starting PAP therapy and waiting to get the beneficial effects, for most of us, was a long process. That said, your journey started in Feb 2016 and well over a year before my journey commenced although I knew I was suffering well before then and was in this long long process of diagnosis in the UK. Like for you, the start of my journey was so so painful, lonely and frustrating. I was looking forward to therapy desperately but it did not work at first, my sleep was really wrecked by it and I was not improving. However the experienced guys and gals here were fabulous in 'holding my hand' through the lonely nights and tough days. My situation however is a simple condition of pure obstructive apnea. Of course there were some nights of RERAs, Hypopnea, Central apneas, flow limits etc etc. Now my PAP therapy is working and I can relate that it is giving me my wakeful and energised life back.

My situation was plain and simple BUT however as I have read in this forum this is not the case for quite a few of us. I have kept up with HalfAsleep's woes and her battles with even getting appropriate sleep studies for what many here believe is Complex Apnea. There is also SarcasticDave who started with CPAP, graduated onto BIPAP and is now happily on an ASV machine to treat his complex apnea. I have also read of Josephdfco's case where it is believed despite a good sleep study, he probably has been dispensed the wrong machine.

What I am trying to say is, despite the medical profession's best attempts in diagnosing and treating us, actually dialling ourselves into optimum therapy has been, in many cases, through the persistence and doggedness of some of the members here with others helping and supporting them along the way.

We have noted you have not uploaded any sleepyhead data even though you refer to the statistics. Might it be a good idea to let some other very very experienced and really really helpful and benevolent members here interpret to see if it is more complex than you think? If you are concerned with privacy, and quite a few of us are, there is no requirement to divulge more than you need to. We are always asked to ensure any private information is omitted or redacted.

I hope you will and that you get the answers you require to enable restful and restorative sleep.

[HalfAsleep]

Yep...SleepyHead your data tonight and post charts here. Types of events and pressure settings are key factors in restful sleep. We get that info from SleepyHead, make adjustments, and see how the adjustments chart up.

[KSMatthew]

My recollection from when I looked into surgery:

It's considered successful if it drops your AHI by 50%. There's a possibility that you would still need CPAP after surgery. There is also a pretty high percentage (40%-50%?) that within a year, you'll be back to whatever AHI you had before surgery.

That was about 10-12 years ago, the numbers might be better now.