Hi I’ll try to keep this shortish without it being like an essay. My names matt I’m 28 and I’ve been struggling with sleep for 6 years now. It first started 6 years ago I gained a lot of weight and started snoring. Since then I have lost about 21kg in weight and the snoring had reduced to mild to moderate occasional snoring.
But I have still been struggling with sleep problems even after the weight loss and throughout the 6 years have had several sleep studies. 2 basic finger ones which came back negative. One polysomnograph which only recorded two hours of sleep and was told it came back negative.
I’ve rented a home sleep study with a cannula that goes up your nose to measure airflow and my ahi score was 8.6. I was then referred and had another home sleep study from the hospital which was a finger pulse oximetry thing and the doc said it came back negative that my o2 dropped to 95% and that it had to drop below 80% for treatment.
Recently I’ve had another home sleep test which I paid for and it showed snoring and a pRDI score of 40 ahi 3 and 8 awakenings during the night.
I think I have upper respiratory airway syndrome as my symptoms mimic that of sleep apnea but keep getting told I don’t have apnea. So I’ve had a consultation for laser assisted uvulo palatoplasty and the doc said I have narrow throat large tongue as there are bite marks. I also have a mild deviated septum but he said that this was not a big problem as the main area of concern is Mymensingh throat. He recommended that he uses a laser to cut in the middle of my uvula so that when I breathe the uvula splits into two allowing air to flow through.
I live in the uk and this costs £1980. I also have a letter from my gp (doctor) that allows me to buy a cpap machine privately. I’m not sure what to do and need advice please.
My main concern with the surgery is that my uvula is not enlarged so if it is split in two it will only create a small hole for airflow. Should I go ahead with surgery or buy a cpap? But I don’t really wanna use a cpap for the rest of my life either.
One advantage of a CPAP is that it reports back to you daily what your residual apnea is. And, you can look at your detailed results in a free software program called SleepyHead. I am not any kind of medical professional so can't give you any advice on that subject as to which would be better.
I see in the UK that the normal practice seems to be that you buy the CPAP through your National Health Services with the machine coming direct from the manufacturer? Not sure if that is the cheapest option but I see on the UK Amazon site that a good machine sells for £700.00. That is certainly cheaper than the surgery cost. But, yes you may have to use a CPAP for life. Another option to investigate is the dental appliance route for sleep apnea. Some dentists specialize in it, and would be able to give you a price. In Canada that is not a cheap option though, and you are always left wondering how effective it is, as you do not get any reporting from it other than your subjective feeling.
In any case if you decide to go the CPAP route, I would suggest the Auto machine and in particular this one:
If you have any questions about the CPAP route just ask.
Hi thanks for the reply. I can’t use a MAD because I suffer from TMJ and currently using a splint. Yea I’ve been looking at Apap machines found a decent website called eucpap.
Also don’t some people come off CPAP if they lose weight? Don’t people with central sleep apnea have to use it for life and not obstructive?
Some with significant weight reduction may get off CPAP, but I think for most they are on it for life, or just live with the untreated apnea. A CPAP or Auto CPAP is most effective in treating obstructive apnea because it uses air pressure to hold the breathing passages open. It can reduce the incidence of obstructive apnea, flow limitations, and snoring. However, pressure is not really effective in reducing central apnea, because the airway is open during a central apnea event. Most but not all machines are able to distinguish between obstructive and central apnea. The appropriate response is to increase pressure to reduce obstructive, but leave pressure alone if it is central apnea.
I checked out that CPAP website if it is this one.
The DreamStation Auto CPAP is a credible machine, but I would avoid the rest of the ones they have on the site. The F&P Icon is an old model and does not distinguish between obstructive and central events. The System One REMstar is an old model too. On the DreamStation be careful on the price. This one is priced without a humidifier, and that option adds £175 to the price.
The other credible machine is the ResMed AirSense 10 AutoSet that I gave you a link to. It has a built in humidifier so the price always includes it. There are two models, the standard and a For Her version. The For Her version is the better choice because it offers an optional extra response mode that can be more suitable for those needing lower pressure.
I would suggest the ResMed AirSense 10 AutoSet and the DreamStation Auto are the two top machines on the market. Of the two in my opinion the ResMed is better.
Hope that helps some,
I hope I am one of those people who can get off cpap! Wow thanks for taking the time to look at the website. Yeah most people have been suggesting the ResMed auto so I think I’ll go with that one.
Now that’s sorted it’s just the question of what mask should I get. I don’t think I should use nasal pillows as I suffer from chronic rhinitis. I’m a side sleeper btw so nasal mask and chin strap or full face mask? Also you can mix and match masks right? Like I don’t have to get a ResMed one just because I have a ResMed machine?
First the easy question. Virtually all of the masks use a standard size fitting and are interchangeable. The travel size AirMini machine uses special masks, but outside of that you can use a ResMed, Respironics (DreamStation), or F&P mask, and others.
The very difficult question is which mask. I think probably one of the most popular masks on the market is the ResMed AirFit P10 nasal pillow. That is the one I started out with, and had some issues with it not staying on my head at night, and also that I was opening my mouth in the night. I do suffer from some nasal congestion and that turned out to not be an issue. The machine blowing air directly into your nose seems to keep everything clear over the night.
Next I tried a Full Face Mirage Quattro. I could not make it seal, and it is very bulky and seemed to get knocked out of place when side sleeping. After that the ResMed AirFit F20 full face and while it was better, I still had leaks, had some bridge of nose irritation, and could not get comfortable with it. I tried my wife's Mirage FX Nasal mask, and it was better than the full face masks, but it had leak problems and comfort issues. Then I tried a F&P Brevida nasal pillow mask which seems to get good reviews. I had some nose irritation from it and it seemed more sensitive to being dislodged when changing sleeping positions. I then went back to my AirFit P10, and now use a chin strap to keep my mouth closed and in addition I tape my mouth closed with 1" paper medical tape (3M Nexcare). The chin strap goes on second and holds the mask in place quite well. Sounds awful but it is the most comfortable arrangement I have come up with. My wife is now using the Brevida mask instead of the Mirage FX and she likes it better. It leaks much less than the FX.
That said a mask is a very personal fit issue. If it is at all possible I would try and get one from a place that does returns or exchanges. You can find many reviews of masks at the CPAP.com website. But if it comes down to just trying one, I think I would go with the AirFit P10. You buy it as a fit pack and it comes with three sizes of inserts. You can try each to see which fits best.
Hi,
Thanks for the advice I will look on cpap.com for reviews.
The other thing to look for on cpap.com is the sales ranking for each mask. This website in the description of each mask gives the % of masks sold of this specific one compared to all masks they sell of that type. It lets you know how popular each mask is. However, at the end of the day the mask that is the most popular may not be the best for you. We tend to be all different. The proof is in the pudding.
Hi just one final question should I avoid nasal pillows if I suffer from chronic rhinitis? Or is it ok with a humidifier and heated tube?
My experience is that I have been able to cope with nasal congestion while using a nasal mask. As I said before I make sure my nose is clear before I go to bed. Occasionally I use one squirt of Otrivin in one nostril. A humidifier and heated tube should help. I generally wake up with my nasal passages fairly clear, and I have never had to get up in the night to clear my nose.
I think there are some breathing advantages to a nasal mask while avoiding mouth breathing. However what you probably don't know is if you can keep your mouth closed and avoid mouth breathing during sleep. The lower the pressure used generally the easier it is to keep your mouth closed. But if worst comes to worst, you can tape your mouth, and there may be some advantages to that in preference to using a full face mask. And the reality of CPAP is that most have to try more than one mask before they are happy. See this video on mouth taping. I've been doing it for a few months now.
Thanks I think I’ll just get nasal cushion mask. Also I’ve got experience taping my mouth shut for a few years so I’m cool with that. Although I’ve recenlty had a splint made for Tmj and I tried taping my mouth but then I felt like it made my sleep worst less space for tongue and I can feel it blocking my airway. Should I still wear the splint along with cpap therapy? I’ve heard teeth grinding stops with treatment.
Here are some links I found for another poster who may be suffering from UARS, if you have not already seen them. If you go the CPAP route the preference seems to be to use a nasal or nasal pillow mask to treat UARS.
I recently stumbled on this paper from ResMed which does a deep dive into the differences in the For Her algorithm in their AutoSet For Her model. Interestingly it is optimized for those who may suffer more from UARS and less from obstructive apnea, and may be quite effective for UARS regardless of sex. The mode is optional and you can still set the machine to standard AutoSet mode.
Obstructive Sleep Apnea in Women: Specific Issues and Interventions
