[Treatment] Newly diagnosed and I have some questions

[Ash1631]

Thanks in advance for your help. 
 
History: I am 61 years old, 6' 0", 156#, and work out 30+ minutes/day aerobically and I am an avid recreational hiker/camper in the PNW mountains. I was diagnosed with afib about a year ago with a structurally normal heart on echo and I am well controlled on diltiazem 120mg ER BID/flecainide 60 mg BID. My doctor ordered a sleep study based solely on the afib/SA statistical link. I am very rested in the morning and I have absolutely no daytime lethargy/drowsiness (even without coffee—can’t have caffeine anymore).
 
My apnea hypopnea index (AHI) was 15 on my back and 5.75 on my side. My average oxygen level was 95% and my lowest oxygen level was 90% during the study. I am now wearing an inflatable device which prevents back-sleeping and my wife says it has worked like a charm--absolutely eliminated snoring. She says she hasn't heard a peep since I started wearing it so she’s a fan.
 
I will assume that since I am now sleeping exclusively on side my apnea score is 5.75. The sleep center associated with my hospital is all gung-ho to start me on CPAP or a MA device. This seems like massive overkill to me. Using either of these modalities to reduce my AHI from the present 5.75 to say, 3 or 4, fails any test of cost/benefit in my mind. 
 
Questions: Should I have another sleep study done before proceeding with treatment? If so and the results show side sleeping only and an AHI of 5-6, does that justify treatment? (My cardiologist wasn't much help--he said I should do whatever I'm comfortable with). 
 
I am a veterinarian by trade, and sleep apnea is not an issue I deal with in my patients, so I covet the advice of those of you who have firsthand experience. Thanks again, Jeff

[mesenteria]

Hi.  Several of us here have the same history: runners, hikers, skiers from the time we were young bucks, we got older, we had sudden-onset of heart arrhythmias, and when nothing else could be put under our thumbs, and of those of our health care providers, the last resort was to submit to a sleep lab.  Happened to me.  In my case, I was just into 'severe' territory at AHI of 31.  I seem to remember my daughter complaining that I snored like a diesel locomotive on start-up.  

Apnea is apnea.  If it could in the least be the progenitor of your atrial fibrillation, you would be very wise to cave and to begin to treat it.  Look at it this way: my cardio guy told me my heart is 'irritable'.  It doesn't like me any more...or something about me.  Turns out, after years of hard competitive running, and some hard mountain cycling, that it had turned up its yellow card on me.  The thing is, apnea is just one of the events that can cause us to have crappy sleep.  There are also flow limitations and other things that can cause us to rarely cascade down through the levels of sleep that we need to negotiate nightly, several times.  Do you know that you DON'T have any of that?    I'm not saying have another sleep study.  I'm saying deal constructively with what you know, what you should accept for the foreseeable future, and get on with developing a regimen that at least maintains what you still got going for you in the way of health.

[Dormeo]

It’s good that you feel rested during the day, and I see why you raise the question.

But as mesenteria says, part of the answer concerns your long-term health. Especially with a known heart condition, you might well want to lower your risks of the kinds of health problems with which apnea is strongly associated.

Another thought I’ll add: what have you got to lose by trying? Of course, if the costs to you would be high relative to your resources, that’s certainly something to weigh. But if that wouldn’t stop you, then why not just try it for a while and see what you think?

If you decide to give it a try, come back here for advice and support. I’ve found this to be an incredibly helpful forum.

[jaswilliams]

If you decide to get further treatment I suggest an apap machine as it can tell you who your doing every night where as a mad device has no form of measurement for effectiveness

[slowriter]

So no daytime symptoms and no side effects from the meds?

Not sure if it's significant, but did you get an RDI number from the initial study?

FWIW, in the past 10 years, I had two bouts of AFib that landed me in the ER. Never even occurred to me or docs could have been brought on by SBD, but in both cases I woke up in AFib.

I've only recently been diagnosed with UARS, with a moderate RDI, but pretty low HDI similar to your's.

[SarcasticDave94]

Hi Ash1631 / Jeff,
Welcome to Apnea Board.

I'd suggest whatever report you took the AHI numbers from should be requested from the doctor or the entity that produced the report. BTW I'm referring to a full detailed report, not a summary.

This gains you two things: you have a report copy for yourself. Second you can post that here after personal info is redacted. There will be quite a bit more data than just supine and side AHI. Not being sarcastic despite my handle, this data translates to events happening while you're asleep, and there are possibly things going on that AHI data only can't possibly tell us what's going on.

Certainly, maybe that data reveals AHI of 5 something and that's it. But my guess is there's more to it. And that's on top of your A-Fib. If this were myself, I'd look at all that data and find out the whole picture.

[Ash1631]

Thanks for the replies. Is there an acronym list on this site? I'm am not fluent with language of sleep apnea yet.

[SarcasticDave94]

Likely this should meet your request for acronym definitions. Found HERE in our wiki.

[hearsay73]

I can totally understand why you are asking whether going into CPAP therapy is worth it when the results of your sleep study show a marked improvement when you are sleeping on your side. Based on what you have stated, you feel very well rested in the morning and don't have any daytime sleepiness which is one of the major tell tale signs of sleep apnea. If I were on your shoes I would totally ask the same thing.

Your AHI of 5.75 to 15 reveals that, while you are still in the mild sleep apnea territory, you are in the upper range of mild bordering already on moderate so you should also take that into consideration. That said, being in the mild sleep apnea range opens you up to more options for treating sleep apnea with CPAP as only one of them. The fact that the sleep center is all gung ho on starting you on CPAP therapy without offering you other options other than CPAP would give me pause as it shows that they possibly have something to gain from your CPAP purchase.

You've already discovered that the device which keeps you from sleeping on your back has helped and that's a step in the right direction. Something to consider though is whether sleeping on your side sustainable for you? A MAD device is another option which won't restrict you to one sleeping position but there are a lot of MAD devices to choose from and the only way to weed out the ineffective ones is to try them on during a sleep study. 

You've already mentioned that your cardio wasn't much help so if I were you I would find a good and competent doc specializing in sleep medicine to look at your sleep study and explore with you some options aside from CPAP. A lot of us here had sleep doctors who were incompetent and just concerned with $$$ but some good ones do exist out there. The good ones will offer you a rational and well though out justification as to why you need (or don't need) CPAP therapy.

[Ash1631]

slowriter: No detectable side effects on the diltiazem/flecainide. I did have side effects from an earlier trial with a beta blocker. My afib was paroxysmal. I have never required hospitalization or conversion. It usually showed up during very strenuous exercise, like steep climbs at altitude, and would return to sinus rhythm after 5-10 seconds of rest. No afib issues on my present medications. I have no daytime symptoms of SA. I am well rested (and no caffeine use either). I can drive long distances or read late in the evening without issue, as examples. I will try and get the entire sleep study 
 
hearsay73: I have an initial appointment to pursue treatment with an mandibular advancement device on Sept 13. Both cpap and the oral appliance were recommended for my level of SA and I chose that over the cpap. My reasoning is that since I have no symptoms of sleep apnea my treatment will have no discernable outward benefit and so, being realistic, my long-term compliance will probably be better with the OA. It is also portable for use while I'm enjoying the great outdoors.