Sierra

In general most insurance companies are supportive of going straight from diagnosis of obstructive sleep apnea to a trial APAP machine. That is because the machine is likely to cost less than the additional sleep study. If at all possible you want to do it as a trial, because you may or may not adapt well to using a PAP machine. The other option depending on your apnea severity may be the use of a dental appliance. They tend to be 2-3 times the cost, but also may be covered under your health care insurance rather than your dental insurance. Here is a link to an article that may be helpful in making a decision on what way to go. I think it is fair and well written based on my experience with PAP treatment. I have not tried the dental appliance (MAD) option.

Treating Sleep Apnea

Is he being treated for the sleep apnea? If he is then he should see his doctor and discuss what could be happening, and why the treatment is not working. If he is not being treated, then he should be making an appointment to see a sleep doctor.

I hear what you are saying, but I am not a big believer in conspiracy theories. Every once in a while you hear that big oil companies have a secret safe where they keep all of the 200 mile per gallon carburetors, and engines that run on water instead of gasoline. I think the reality is that we would not have for example the medications we have today if the drug industry did not fund the studies to prove they are safe and effective. It is government regulations that force them to do that, and they have to comply to get approval to market the drug. Yes, there have been studies which have exaggerated the benefits, and claims made that have proven to be false on closer examination. There is the example of the former British doctor Andrew Wakefield who published a study claiming MMR vaccine caused autism. It has since been withdrawn.

I think one could also make the argument that the UK National Health Services and their doctors are not totally unbiased. In the UK CPAP is a covered medical condition. They pay for the studies and the CPAP equipment. One could say that they are motivated to minimize the cost to the NHS. The UK not unlike Canada and Australia operate more of a "best buy" system of health care. Our costs are in the order of half what the US spends per capita on health care. And the ironic part is that being the highest per capita spender on health only puts the US in 45th position by country for life expectancy. I recall a while back that the UK restricted availability to heart bypass surgery, because they believed it it did not on average extend life. The UK are about 30th on the life expectancy list, while Canada and Australia are closer to 10th. Perhaps they are cutting a little too close to the bone in trying to save health care costs?

I think that a mild diagnosis of sleep apnea is not unlike pre-diabetes. Yes there are different ways of treating it and losing weight is a good idea for many reasons. Studies show the metformin which is a very inexpensive drug does a good job of reducing A1c, and often helps with weight loss. Is it needed for life? Sometimes yes, and other times no, and lifestyle changes addresses the issue. But to me withholding the metformin makes no sense. This is like apnea. If the individual has sleep issues, wants to try CPAP, and in many cases is willing to pay out of their pocket for it, then why not do it. The only risk I see is that if the discomfort factor of using one outweighs the apnea reduction benefit, then it may not be a good idea. Contrary to what that doctor claimed it is hard to imagine many cases of obstructive apnea at 15 that would not be improved with PAP treatment. The real question may be if there is an improvement in sleep quality, and is that improvement cost effective? The answer may be in the eye of the patient and the one that is paying for the treatment if it is not the patient.

Whether it is a problem or not depends on how bad the leaks are. If you go by the green happy face on the AirSense 10 machine you can be mislead. I have found that it takes a really bad leak before the red grumpy face shows. The best way to find out how much your mask is leaking is to copy your data from the AirSense to your computer and view the results in SleepyHead. It tells you what the leakage is all through the night, and when it exceeds the leak redline. When it goes over the leak redline ResMed claims that apnea detection is impaired, and as a result it does not increase pressure in response to potential apnea events it is not sure about. Then when the leak ends, the pressure is low and you can get a series of apnea events. So how the leaks affects things kind of depends on how bad they are. The other issue with a P10 is that one can open their mouth in the night and that can be a fairly large leak too. Again you can kind of tell that in SleepyHead.

In general with the P10 mask I try to sleep with my face on the outside of the pillow so the mask hangs over the edge of the pillow a bit. I think this prevents it from dislodging and leaking. I also use a fairly soft pillow with a down alternative fill. My feeling is that the down alternative does not push back like a foam or memory foam pillow. It gives a bit so as to not dislodge the mask.

But, your best bet is to download SleepyHead so you can see what is really happening. See this snips from SleepyHead. Both were with the P10 mask. In general I am happy when leaks stay below the 24 L/min leak redline. The graph gets grayed out when you go over.

Bad Night

Good Night

It strikes me that making a recommendation that mild sleep apnea (5-15 AHI) should not be treated, is like saying those who smoke 15 cigarettes a day are in no danger of getting lung cancer. It could be true. Or it could not be true. And you only know for sure when you get lung cancer, or die from something other than lung cancer.

I don't understand how a hose or mask that was washed thoroughly with vinegar, soap and water, and tap water rinsed could have anything infectious on/in it. If one washes the hose and mask weekly in this manner I would strongly suspect that the most clean it is through the week, would be right after it was cleaned.

Just to be clear, what they do is going to depend a lot on the clinic and your insurance, your country and region... Technically I believe it is quite possible to go directly from a diagnosis to an APAP machine, if there are no complicating factors. Whether they will do it or not may require some negotiation. I would go at it from the angle that you do not want to do another in lab titration test. Also, ask for the report and discuss whether there is any indication that an APAP would not work for you.

Sorry to hear you had a bad experience. I did my sleep study at home, and it did not go well either. I was very anxious as I was worried the test was going to say I needed to go on a PAP machine, and I really, really, did not want to. A few times I thought about getting up and throwing the whole thing out the window, but then thought about the cost, and decided against it. In any case I got through it, and they said it was enough for a diagnosis, and now I use an APAP every night.

The good news about your experience is that if they offered you a PAP machine at 1:00 AM they must have enough data for a diagnosis. And it would appear you have apnea to the degree it requires treatment, which perhaps is not such good news. But, apnea is treatable, and much better to have something you can do something about. The other good news is that the second half of the night was likely going to be a titration test to determine how much pressure you need for a CPAP. The titration test is not really necessary, unless they detected something unusual. Instead they could give you an automatic machine, APAP, and let you do a home trial at your own leisure. Just make sure they set it up in the office for you so you feel you are comfortable and getting enough air.

You should ask for a written copy of your sleep report so you know in detail what they found.

I use a nasal pillow mask all the time, along with mouth taping. I have a brand new AirFit F20 full face mask in my storage box, that I suppose I could use if I got a really bad cold. I dislike the mask so I really hope that situation never happens. If I am congested I just use one squirt of Walmart generic Otrivin in the affected side. I do try to minimize use of it, as it can cause a rebound effect. My experience is that with a nasal mask and mouth taping my nose stays clear all night if I start with a clear nose.

It looks like you now have good data in SleepyHead from Jan 7 on. From what I can see it appears to be only reporting unclassified and hypopnea events. Your AHI is not all that bad. Total time apnea seems on the higher side, but better recently. From the statistics page it looks like the machine is running pretty much at maximum 20 IPAP and 14 EPAP. There is not a lot one can tell from the statistics page beyond that. Similar with the Overview page. To tell more you would need to post your Daily Detail page. Bonjour may be able to help you better than I can with your BiLevel machine. It should be capable of going up to 25 cm of pressure, so the machine is not the limit. Your current setting of max IPAP of 20 is the limit. That said I noticed you reported you were suffering from Aerophagia, and that is often related to pressure. Perhaps once you get used to the pressure, an increase in pressure may be in order.