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Second opinion

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timetoplay +0 points · almost 3 years ago Original Poster

Thanks everyone for your help I was able to get a copy of the original study it’s now just a matter of going down and picking it up I also set up an appointment with a different sleep center and told them the situation unfortunately they can no get me in until after the new year

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Sierra +0 points · almost 3 years ago Sleep Patron

With the report you may be able to calculate for yourself what your AHI is. It should be the total number of central apnea, obstructive apnea, and hypopnea events divided by the number of hours you slept.

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timetoplay +0 points · almost 3 years ago Original Poster

As soon as I have it in hand I’ll see if I can’t figure it out

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Sierra +0 points · almost 3 years ago Sleep Patron

I had a look at my sleep report. Total apnea events include obstructive, central, unclassified, and hypopnea. They totaled 268 for my night. Time in bed was 7.22 hours. That resulted in an AHI of 268/7.22 or 37.1. However, I suspect I never really slept more than about half that time in bed, so if one was to only consider sleep time, AHI could have been double what was reported. In other words a sleep study may under report the real apnea frequency by a significant amount depending on sleep time. Normally one does not have apnea events when awake.

The other thing to consider is that some sleep studies report another type of event called a RERA (Respiratory Effort Related Arousal). When that gets added into the mix the total is then called an RDI instead of a AHI. So, you may see that on your report. Medicare and most states in the US will not diagnose sleep apnea based on RDI, only AHI. Most insurance companies follow in line with that. But, some insurance companies will diagnose and cover apnea costs if AHI is <5, but RDI is >5. A higher RDI may have been what influenced the doctor to push you over the 5 for AHI so you would not have an insurance problem.

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SleepDent +0 points · almost 3 years ago Sleep Commentator

I am a dentist working in dental sleep medicine. Well, I guess that your story shows the inadvertent danger of getting into medical testing and then getting caught up in the licensure system with no easy way out. Maybe, rather than fighting the system, the easiest way out might to get an oral sleep apnea appliance. It is much more comfortable for most people that CPAP and should handle what minimal sleep apnea you have quite easily. The appliances are compact and very portable. Arthur B. Luisi, Jr., D.M.D.

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Biguglygremlin +0 points · almost 3 years ago Sleep Enthusiast

Hi SleepDent,

How far up the range does it work? Can it be combined with weight loss and surgery to treat more severe apnea?

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SleepDent +0 points · almost 3 years ago Sleep Commentator

Well, The American Association of Sleep Medicine recommends oral appliances as a valid alternative to CPAP for mild to moderate cases. That would put the diagnosed AHI at a maximum of 30. Oral appliances are less effective for severe sleep apnea, but not necessarily hopeless. My sense of it is that you would get a good result(treatment AHI less than 5) in about 30% of the severe cases. Typically, sleep doctors will try oral appliances for severe patients, who are CPAP intolerant, because they may get a somewhat decent result and some treatment is often better than none. Arthur B. Luisi, Jr., D.M.D.

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Biguglygremlin +0 points · almost 3 years ago Sleep Enthusiast

So can I presume that even severe apnea could be significantly reduced if the goal wasn't necessarily to get as low as 5? Or does it somehow escalate other risks with severe cases?

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SleepDent +0 points · almost 3 years ago Sleep Commentator

Well, you actually get into some philosophical and judgement issues when treating severe OSA with oral appliances. In my own practice, I have had some stunning successes with oral appliances when treating severe sleep apnea. On the other hand, I have also had some absolute failures. By absolute failures, I mean that the baseline AHI was, say 50 and the oral appliance reduced it to 49. You never know. There is less data on treating severe OSA with oral appliances than mild to moderate. Historically, the TAP appliances have been as good as any for treating severe OSA. They will get the AHI down below 5 about 30% of the time. They will get the AHI down below 10 with total abolition of symptoms about 50% of the time. And they will reduce the AHI at least 50% to less than 20 about 69% of the time. This is in the hands of a very skilled sleep dentist with excellent technique. These figures would not be replicated by Mr. Average Dentist using the TAP. And these figures are certainly not a joke. They really don't escalate any risks except for the patient to be overly complacent about his situation. Clearly, you would like the treatment to be good enough so that the patient is not in clear and present danger of getting a heart attack or a stroke. There is no total consensus on how low the AHI has to get to take heart attack and stroke off the table. I best guess is that a fair number of practitioners would say that below 20 could be that point. So, I would say that, if a severe OSA patient uses an OA gets that gets him down to an AHI of, say, 19, vs. a baseline of 58 and he is less symptomatic and in less danger of getting a stroke or heart attack, you have done him some good. Actually, I have seen some data for the O2Oasys appliance with special tongue buttons and a nasal dilator that suggest that it may do far better against severe OSA than any previous appliances, but the data is too preliminary to be sure. Arthur B. Luisi, Jr.D.M.D.

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Biguglygremlin +0 points · almost 3 years ago Sleep Enthusiast

Thank you so much for taking the trouble to provide that information SleepDent.

I could have spent days browsing endless reviews and reports without getting close to a credible assessment.

So there might still be hope for some of us fossils to escape from the machines if we do everything we can to deal with all the relevant factors and especially if the new developments pan out.

Subject of course to a healthy bank account and being able to find a skilled professional in our relative locations.

I know that it conflicts with the purpose of this forum but I would happily make significant sacrifices and take considerable risk to escape from the world of CPAP.

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Sierra +0 points · almost 3 years ago Sleep Patron

All I can think of in response is that I am a big Star Trek fan, especially the original TV shows. Shatner is a Canadian.

Resistance is Futile!

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Biguglygremlin +0 points · almost 3 years ago Sleep Enthusiast

Live long and prosper Sierra! :)

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