Treatment Standards/Diagnostic Criteria

There are problems in the Sleep Medicine Field wrt to Diagnostic Standards and Treatment Criteria.
Simply put, AHI is a crude and inaccurate a measurement tool. Plus, patients can have a deceptively low overall AHI and yet still have a very high AHI during REM sleep, even to the point of being unable to sustain REM sleep, which can have devastating cognitive impact over the long term.

Even the criteria for determining the number of apneas is problematic. Most insurers require that an apnea last 10 seconds or more, but that standard was developed in men. Women and children will often have shorter duration apneas, and hence their apneas may be undercounted.

Similarly, some insurers/labs require a 4% O2 desaturation rate, while others will accept 3%. Many fewer people will be determined to be positive for Sleep Apnea at the 4% desaturation requirement, notwithstanding that they are still having many respiratory arousals. And again, women and children may be under-diagnosed because they tend to desaturate less.

These are important policy issues because they determine whether insurance will pay for testing an treatment and financial considerations can often be a major hurdle to achieving treatment.

Better, clinically outcome oriented criteria, are urgently needed. Accordingly, there are studies underway to measure the cardiac impact of apneas and determine whether better diagnostic and treatment criteria can be developed based on those measurements.

Have you run into problems related to diagnostic criteria or standards in being diagnosed or treated? If so, were you able to work around it and achieve successful treatment?

I agree there are issues. In the UK they do not even recognize apnea in the 5-15 AHI range as requiring treatment. Treatment starts there at 15. Some places count RERA, and others do not. I suspect one of the issues is that it is not an exact science. My wife was treated for sleep apnea before me and was diagnosed with a really high AHI of I recall 83 or so. To her a CPAP has been a Godsend and she now averages 0.66 for AHI. I was coerced into getting tested by my doctor and my wife. If did not have a sleeping problem, but I knew that I snored (so the wife said!). I was diagnosed at an AHI of 37. I can't say that at least initially the CPAP was any kind of Godsend for me. It was much more annoyance than help. And it did not help all that much as the majority of my apnea is central. But, I toughed it out, and after many different settings on the machine, 5 different masks, 3-4 different chin straps, and now mouth taping, I settled on an arrangement that works quite well. Not 100% sure that my sleeping has improved all that much, but I no longer snore, and average 0.85 for AHI.

I think some come to the CPAP solution looking for the silver bullet to cure sleeping problems that may or may not be caused by apnea. Often there are many factors. I have concluded that one should focus on the quality of sleep not the number of hours sleeping. And a quality of sleep is achieved by doing all the sleeping at night in one stretch of 7-8 hours, with no napping during the day. One site that I have found helpful is Sleepwell - It is No Dream. The project was founded by a Canadian university professor in pharmacy that wanted to help seniors get off sleeping pills for their sleep. He found that many of the falls that seniors have are related to their use of sleeping pills. He advocates using Cognitive Behavioural Therapy for Insomnia (CBTi).

I have never been in favor of lessening the parameters, and I am very dubious about any process that brings more women and children into the domain of the sleep industry.

I believe that much of what is currently accepted as fact regarding Apnea, especially what is defined as mild Apnea, is based on a cumulative consensus built on probabilities and assumptions.

It seems to me that we are already at the point where the vast majority of men could be diagnosed with Apnea, to what purpose?

Are we aiming to inflict CPAP therapy on everybody?

I've cared for children with severe Apnea and yes it is a serious concern but is CPAP the answer?

Regarding women, why would their oxygen levels need to be different or the duration of their events?

I fail to understand why we would want to rig the diagnostic process to equal the genders when it comes to the numbers of supposed Apnea victims.

Surely the diagnostic process for women and children should be based on symptoms connected to proven health outcomes.

The heart monitoring process sounds interesting but once again it is founded, at least in part, on assumptions.

Wouldn't minor discomforts and dreams also alter the heart responses?

Many things impact heart function when we are sleeping.

Even if we could isolate and quantify some of the causes it might not directly establish a proven link to long-term health implications.

It seems to me that exercise, stress, and stimulation, are so closely related that the labels are interchangeable, at least within reasonable parameters.