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  • sleep apnea

    howdy,


    I have an mild sleep apnea, dont know if in US this is of any use, but EPWORTH 6, and woke 71 time at night. My sleep efficiency is pretty good though, 97%. There are two options on the table, use CPAP or surgury(since I have a small semptum deviation), I am inclined to follow the path of CPAP, do you have opnios about this situation?

    thanks

  • #2
    Have you discussed this with a sleep physician and gotten their recommendations?
    IG / YT

    Comment


    • #3
      In general, CPAP is preferable to surgery. And you can always get the surgery later. Unless there is some feature of your anatomy that makes surgery more likely to help than CPAP, it makes sense to me to try the CPAP first.

      Comment


      • #4
        Originally posted by jfsully View Post
        In general, CPAP is preferable to surgery. And you can always get the surgery later. Unless there is some feature of your anatomy that makes surgery more likely to help than CPAP, it makes sense to me to try the CPAP first.
        I agree that CPAP is usually preferable to surgery, but based on the limited information he provided I'm not sure he needs either, which is why I asked if he has consulted with the clinician who ordered the sleep study.
        Last edited by Austin Baraki; 03-16-2020, 02:10 AM.
        IG / YT

        Comment


        • #5
          Well, I assumed that he had a sleep study, given he has a specific # of arousals, so there is a sleep doc at least nominally involved, and that the “options on the table” were presented by a doc. BUT, this being the internet, you are of course correct that we should not assume anything.

          I WILL assume, though, that moderating web forums and having a social media presence has extinguished whatever naïveté you may have had about such things!

          Comment


          • #6
            Originally posted by Austin Baraki View Post

            I agree that CPAP is usually preferable to surgery, but based on the limited information he provided I'm not sure he needs either, which is why I asked if he has consulted with the clinician who ordered the sleep study.
            I had 2 doctors who requested to see the results, the otolaryngologist suggest surgery or CPAP, the pneumologist said, do nothing. I sleep 8-9 hours and still wake up felling tired, I tried to do some sleep hygiene, but had little results. The two options are too distant, so I want to get some advice

            Both follow me because recurring problems, the pneumologist asthma, the otolaryngologist misc problems. The idea is to get quality sleep and"""""" lift a little bit up my health"""", since I am most of the tired.

            Comment


            • #7

              Originally posted by jfsully View Post
              Well, I assumed that he had a sleep study, given he has a specific # of arousals, so there is a sleep doc at least nominally involved, and that the “options on the table” were presented by a doc. BUT, this being the internet, you are of course correct that we should not assume anything.

              I WILL assume, though, that moderating web forums and having a social media presence has extinguished whatever naïveté you may have had about such things!
              Yeah - you'd be amazed how often people pursue their own testing and then ask us to interpret their results and provide recommendations on the matter, without them having consulted a clinician on their own, and without us having adequate clinical history and data. For example, the classic "I went and got my testosterone labs checked, should I go on injection TRT or take X alternative treatment??"

              My reply was based on 1) the fact that an Epworth of 6 is not consistent with excessive daytime sleepiness (in fact, 6 is about the average score among normal / healthy adults), whereas a score > 10-15 would be more consistent with that seen in moderate OSA or other sleep disorders, 2) the evidence for PAP -- much less surgery -- in mild OSA is not particularly strong.

              There are, of course, specific / individual situations where therapy could still be considered (e.g. >10 arousals per hour and excessive daytime sleepiness), but such decisions would require significantly more clinical history and data than has been provided here.

              Originally posted by scampos View Post

              I had 2 doctors who requested to see the results, the otolaryngologist suggest surgery or CPAP, the pneumologist said, do nothing. I sleep 8-9 hours and still wake up felling tired, I tried to do some sleep hygiene, but had little results. The two options are too distant, so I want to get some advice

              Both follow me because recurring problems, the pneumologist asthma, the otolaryngologist misc problems. The idea is to get quality sleep and"""""" lift a little bit up my health"""", since I am most of the tired.
              Yeah. Based on the information you provided in the original post alone, it's not clear that you would get a ton of benefit from these treatments, but again -- without a lot more information (like the kind of information available to your specialists) it's hard to say for sure. If you were going to pursue something, the less invasive option (PAP) would be preferable as a first-line option compared to a more invasive, higher risk one (surgery).
              Last edited by Austin Baraki; 03-17-2020, 01:46 PM.
              IG / YT

              Comment


              • #8
                What is your AHI (apnea+hypopnea index)? If you meet criteria for OSA, even if mild, and want to try a CPAP, discuss w your doctor. If your AHI is normal, you are less likely to benefit from the CPAP, and probably should look for other ways to address your sleep problems. CBT for sleep may be helpful, medications possibly. But if you have non-restorative sleep, and even mild OSA, I think that CPAP is worth a try and should certainly be tried before surgery. Talk with your docs about it.

                Regarding Austin's followup, I think the Epworth is not as sensitive for OSA as we might like, as many people have learned to "power through" daytime fatigue with coffee and stubbornness. My personal experience with mild OSA is that CPAP is tremendously helpful for me. YMMV. And it's pretty benign to try.
                Last edited by jfsully; 03-17-2020, 01:53 PM.

                Comment


                • #9
                  Originally posted by jfsully View Post
                  What is your AHI (apnea+hypopnea index)? If you meet criteria for OSA, even if mild, and want to try a CPAP, discuss w your doctor. If your AHI is normal, you are less likely to benefit from the CPAP, and probably should look for other ways to address your sleep problems. CBT for sleep may be helpful, medications possibly. But if you have non-restorative sleep, and even mild OSA, I think that CPAP is worth a try and should certainly be tried before surgery. Talk with your docs about it.

                  Regarding Austin's followup, I think the Epworth is not as sensitive for OSA as we might like, as many people have learned to "power through" daytime fatigue with coffee and stubbornness. My personal experience with mild OSA is that CPAP is tremendously helpful for me. YMMV. And it's pretty benign to try.
                  I would agree with this (assuming the fatigue has been adequately evaluated in general, so we aren't trying to treat undiagnosed hypothyroidism as mild OSA, for example).
                  IG / YT

                  Comment


                  • #10
                    Originally posted by jfsully View Post
                    What is your AHI (apnea+hypopnea index)? If you meet criteria for OSA, even if mild, and want to try a CPAP, discuss w your doctor. If your AHI is normal, you are less likely to benefit from the CPAP, and probably should look for other ways to address your sleep problems. CBT for sleep may be helpful, medications possibly. But if you have non-restorative sleep, and even mild OSA, I think that CPAP is worth a try and should certainly be tried before surgery. Talk with your docs about it.

                    Regarding Austin's followup, I think the Epworth is not as sensitive for OSA as we might like, as many people have learned to "power through" daytime fatigue with coffee and stubbornness. My personal experience with mild OSA is that CPAP is tremendously helpful for me. YMMV. And it's pretty benign to try.
                    total was 11,0/hour, where 9,6 apnea/hour and 1,5 hypopnea/hour I think it is a mild OSA. Yeah, I am the stubborn type, If i am too tired, I just drink a coca-cola zero, plus I am not good describing symptoms/what I am felling. The concluion/result was mild apnea / hypopnea.

                    Comment


                    • #11
                      Originally posted by Austin Baraki View Post


                      Yeah - you'd be amazed how often people pursue their own testing and then ask us to interpret their results and provide recommendations on the matter, without them having consulted a clinician on their own, and without us having adequate clinical history and data. For example, the classic "I went and got my testosterone labs checked, should I go on injection TRT or take X alternative treatment??"

                      My reply was based on 1) the fact that an Epworth of 6 is not consistent with excessive daytime sleepiness (in fact, 6 is about the average score among normal / healthy adults), whereas a score > 10-15 would be more consistent with that seen in moderate OSA or other sleep disorders, 2) the evidence for PAP -- much less surgery -- in mild OSA is not particularly strong.

                      There are, of course, specific / individual situations where therapy could still be considered (e.g. >10 arousals per hour and excessive daytime sleepiness), but such decisions would require significantly more clinical history and data than has been provided here.



                      Yeah. Based on the information you provided in the original post alone, it's not clear that you would get a ton of benefit from these treatments, but again -- without a lot more information (like the kind of information available to your specialists) it's hard to say for sure. If you were going to pursue something, the less invasive option (PAP) would be preferable as a first-line option compared to a more invasive, higher risk one (surgery).
                      yeah, I am just confused beacause it was two complete different perspectives from two doctores who can "read" the test. I just posted some more infos, but if you cant say much more, thank you, it was a big help!

                      Comment


                      • #12
                        Originally posted by scampos View Post

                        total was 11,0/hour, where 9,6 apnea/hour and 1,5 hypopnea/hour I think it is a mild OSA. Yeah, I am the stubborn type, If i am too tired, I just drink a coca-cola zero, plus I am not good describing symptoms/what I am felling. The concluion/result was mild apnea / hypopnea.
                        This would indeed be considered mild OSA. Austin is dead on, of course, that other causes of fatigue should be ruled out (hypothyroidism, anemia, etc), but if you and your doc are confident that sleep quality is the issue, I would give CPAP a try. If you had a split-night study in a sleep lab, they would prbably have already tried you on a CPAP, but you didn't mention this.

                        Generally, I think OSA is underdiagnosed and undertreated, and that people overlook and minimize the long-term consequences to OSA and to being chronically tired. I'm biased based on my own experience, of course, but I have seen a number of patients have tremendous results from treating their OSA. And the ones who don't tend to fall into the "couldn't get used to the mask immediately so I didn't use it" category.

                        Of course, I'm not your doctor, but I think you should try the CPAP.

                        Comment


                        • #13
                          Originally posted by jfsully View Post
                          Generally, I think OSA is underdiagnosed and undertreated, and that people overlook and minimize the long-term consequences to OSA and to being chronically tired. I'm biased based on my own experience, of course, but I have seen a number of patients have tremendous results from treating their OSA. And the ones who don't tend to fall into the "couldn't get used to the mask immediately so I didn't use it" category.
                          Definitely agree.
                          IG / YT

                          Comment

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