Sleep Apnea Questions

[disneyfanatic60]

My husband has been diagnosed with sleep apnea. I've known for quite some time but he only recently decided it was time to see a doctor. The doctor arranged for a machine to be delivered to our home to "monitor" his sleep. It was nothing more than a clamp that went over his finger as he slept. A monitor showed two sets of numbers. I noticed when he would stop breathing the number would drop to the low 60's.

He had the monitor overnight last Tuesday. On Friday, he received a call that they were delivering a CPAP machine to our home on Monday morning. I wasn't expecting this. I thought he would first have to go for a sleep study and then the CPAP machine. So I figured the monitor must have showed he "was really bad" and they skipped it.

So now the CPAP machine is here and I realize it is just a nose piece (just the two small airways below his nose). The problem is my husband is a "mouth breather" and always has been. He cannot breath through his nose at all. He said he told the doctor that during the initial visit. It seems so bizarre to me that they are forcing air up his nasal passage. It seems to me to be defeating the purpose of the CPAP machine.

When I questioned him, he told me the equipment company rep told him to try the nose piece first. If after a few weeks there is no significant change, he would THEN have to go in for a sleep study. This seems so backward and wrong unless I am missing something. If after the sleep study is done, they would then fit him with a full mouth mask.

Can anyone fill in any blanks for me on this? Does this seem logical? Is something just wrong here or is this normal?

 

[DisneyGirl4188]

I used to do sleep studies and this doesn't seem right.

Usually, a base study is done to make sure he has apnea. There are several other reasons he could have sleep issues.

After it is determined that he does have apnea, another study is done to determine what type of mask he'll need and the pressure he'll use. After that, then he should have the CPAP delivered.

If he is a mouth breather, then he can wear a strap around his head to keep the mouth closed.

If you have any questions, PM me.

 

[minniecarousel]

hmmmm....everyone that I know who uses a CPAP has the full mouth/nose mask. I guess just follow directions. He will have a follow-up, so they can adjust it then.

Good luck to him.

 

[Bella the Ball 360]

My husband just did the sleep study and as the tech put it when he asked if he needed it after the study..."you went to visit Jesus too many times". Anyway he told him that first they try the least restrictive machine b/c if you go for the nose and mouth machine there is no place to go to if it does not work.

 

[JR6ooo4]

my wife uses the nose plugs only. she did get a mouth piece one time, I'm pretty sure. So that should be an option.

one other note concerning air travel. All/most medical equipment is exempt from rules governing the number of cary-on items.

Mikeeee

 

[BirdsOfPreyDave]

Sounds strange that they did his study in the home. I had my first sleep study a few weeks ago - a sleep over at the hospital with more wires pasted to me than I could count. (One of which was the thing on my finger you described.)

I actually just went to see the doctor this afternoon for the results. I averaged 31 sleep apnea episodes every hour, so they classified me as having a significant case. I have to go back in a few weeks for a second study (earliest availability for a bed in the lab), during which they'll test to see the correct pressure on the CPAP to keep my airway open. This will determine the prescription for the CPAP.

As far as the nose-piece question, this is the type of mask I hope to get. I have a beard and a mustache, so a full face mask won't seal very well. The mask that presses up into the nose is the only option.

I asked the doctor the same question about mouth breathing. I usually breath through the mouth, too. Her response was that, by nature, people will breath through their noses when they sleep. It is only when the brain senses it isn't getting enough oxygen that it signals you to open your mouth. It may take some time to adjust, but the machine should be totally effective without a full face mask.

 

[I loveStitchnippyjon]

I had the two studies at the sleep lab too. The second visit, we tried out several styles of mask. The very first one covered my whole nose and mouth, and I discovered that I have major claustrophobia with these masks, no matter what the size.
I use the one that is only under my nose, and after a few months, I couldn't sleep without it! Even a short nap on the sofa is impossible because as soon as I doze off I feel like I can't breathe. So....I guess I really needed that CPAP!

 

[Duckfan-in-Chicago]

The correct way to breath is thru the nose. Some apnea is caused by not enough air flow thru the nose and mouth breathing combined with the tongue sliding back and/or big tonsils etc. I went 32 years without really breathing thru my nose. I've had numerous surgeries and I'm doing pretty good now.

 

[mrsmom]

My dd 13 has had sleep apnea (due to palete surgery )for 5 yrs and she has been on a cpap machine since, she has a soft mask that just covers her whole nosenot her mouth. and she hasn't had any problems with it. But she always has sleep studies .infact another one next friday to see if they need to change her pressure on the machine. I would say for a sleep study in the hospital or sleep lab.
Kim

 

[MouseJunkie]

I know I have this without the test. I'm 99.9% positive of it. There is just something that freaks me out about having that mask over my face or something up my nose. I don't suppose there are any other options. I'm hoping to go do the test eventually, but right now I don't have any insurance. Although, would Insurance even cover a sleep study?

 

[DisneyGirl4188]

I know I have this without the test. I'm 99.9% positive of it. There is just something that freaks me out about having that mask over my face or something up my nose. I don't suppose there are any other options. I'm hoping to go do the test eventually, but right now I don't have any insurance. Although, would Insurance even cover a sleep study?

Insurance will cover it.


Sleep apnea can lead to many health problems (stroke, heart attack, high blood pressure, etc).

A lot of people are worried about the masks, but most of the patients I had got used to it really fast and said they never slept better.

 

[BirdsOfPreyDave]

I know I have this without the test. I'm 99.9% positive of it. There is just something that freaks me out about having that mask over my face or something up my nose. I don't suppose there are any other options. I'm hoping to go do the test eventually, but right now I don't have any insurance. Although, would Insurance even cover a sleep study?

There are other options, but the CPAP is apparently the one that's usually recommended. On my HMO, the CPAP machine is fully covered. So are the office consults. I just need to pay a Specialist Office Visit co-pay. I haven't received the bill for the overnight stay in the hospital's sleep lab yet, but I'm expecting it will only cost me my in-patient co-pay rate.

According to a brochure they gave me, there are other options besides the CPAP. There is a dental device that looks similar to the mouth guard a football player or boxer wears. Wearing it aligns your mouth to keep the throat open. These need to be fitted by a specialized dentist, and cost from $1000 - $4000. According to my doctor, these are not covered by most insurance plans.

In extreme cases, there is an option for surgery to remove part of the pallet. However, the brouchure warned about side effects. I can't remember the specifics, but it was something about "leaking" down the wrong pipe when drinking.

In the most severe cases, a traceotomy may be needed. This is a hole in the neck, through which you breath when you're sleeping. It's closed and covered by clothing during the day. I guess you need to have a good collection of turtle necks, though.

 

[MouseJunkie]

Insurance will cover it.


Sleep apnea can lead to many health problems (stroke, heart attack, high blood pressure, etc).

A lot of people are worried about the masks, but most of the patients I had got used to it really fast and said they never slept better.

Thanks for the info. I plan to do this some day soon. I would love to know what it's like to wake up rested. I'm sure I would feel a lot better during the day too. I tend to get really tired and have a tough time staying alert in the afternoon. It probably doesn't help that I'm borderline anemic at times either.

 

[JCJRSmith]

I have OSA, and I have counselled other OSA patients in the past. Your husband needs a new doctor, one who will pay attention to the patient.

 

[Stephres]

My dad had the sleep study at the place and his machine has a mask with an elastic strap around it (which he complained about to no end!). Good luck!

 

[hiwaygal]

I have to agree that the "test" your husband had seems a bit...ummm...ineffective. There should be quite a bit more involved.

There are literally hundreds of mask styles. Your husband should contact the insurance company to see how often he can change masks to find one that works for him. Regardless of what the doctor prescribes, if the mask is not comfortable or he doesn't wear it, then the machine is useless. On the advice of my supplier, I requested that my doctor write a prescription for my mask that said "mask of patient preference" or something like that.

While I also thought I was a mouth breather, I have since found out that is not the case. Your husband may find this out too as he gets used to the machine and pressure.

I'd like to invite you to a thread on the Coping and Compassion board about Sleep Apnea: http://www.disboards.com/showthread.php?t=1275439

My second sleep study (where they were determining the correct pressure) I started out with a full mask. Within an hour I had claustrophobic problems. I ended up with a nasal mask. I've tried one like the one you are describing but the pressure I use was too high and it became uncomfortable for me. I've been using the nasal mask for almost a year now.

According to a brochure they gave me, there are other options besides the CPAP. There is a dental device that looks similar to the mouth guard a football player or boxer wears. Wearing it aligns your mouth to keep the throat open. These need to be fitted by a specialized dentist, and cost from $1000 - $4000. According to my doctor, these are not covered by most insurance plans.

My dentist also said that these are not as effective for "higher pressures". In other words, it's for rather light cases of sleep apnea. He was ready to offer me one of these 'til he heard how many episodes I was having.

 

[RoyalCanadian]

For the life of me, I don't know how a doctor could make a proper prescription for a CPAP machine with the test the OP mentions her husband experienced. It's one thing to detect the apneas, and it's another thing to check the blood oxygen levels -- but there is no way that the finger monitor would be able to provide the prescribing doctor with any information regarding the level of pressure necessary to keep the airway open.

That is what the CPAP machine is all about. Those of us suffering from OSA experience the collapse of our airways while we are sleeping and it is the constant positive air pressure that keeps the airway open and allows air to pass into our lungs. Amazing technology, really. Whoever came up with the idea for the CPAP machine should get a Nobel prize for economics -- the boost to worker productivity must be phenomenal.

I use the "nasal pillow" mask mentioned. I too was a mouth breather but my body quickly adapted to the nose only mask. It has to adapt immediately, as it is physically impossible to breathe through the mouth with air being pumped through the nose. I tried the nose and mouth mask during the test and found it tremendously claustrophobic. YMMV -- as someone else has pointed out, there are literally hundreds of different kinds of masks available. Different strokes for different folks. What works for me will not necessarily be the best fit for someone else.

Best wishes to the OP and her spouse as they begin treatment for OSA. Another poster has expressed a desire to experience what it is like to awake feeling rested. I can attest that it is one of the best feelings on the face of the earth. I no longer have to drink loads of Coca-Cola or eat high sugar foods to give me the caffeine and sugar rush to get me through the next couple of hours. I no longer need to take a 45 minute nap at lunch to get through the afternoon -- with another nap needed when I get home to make it through the evening before I go to bed at night. I used to get up every hour to visit the bathroom and get a drink of water -- I was incredibly dehydrated each night because I was breathing through my mouth. It was a vicious circle -- drink water, go to sleep, breathe through my mouth, get dehydrated, wake up because I have to go to the bathroom because I had some water an hour ago, drink water, REPEAT.

 

[themarquis]

It sounds like the mask they gave him was a "nasal pillow" system. I have severe OSA, and this is the kind of mask I use. I have gone back and forth with a number of different mask, but the nasal pillows are the only ones I can sleep with. They are just fine for some people.

However, if he really cannot breathe out of his nose at night, obviously, the nasal pillows are not going to work (dumb dr.! ). It really sounds to me like the doctor (and possibly your insurance company??) are really jerking him around. He absolutely needs at least two overnight sleep studies in the lab (one without a mask, one with). I have heard about those at-home testing devices, and my understanding was that they were useful for people who couldn't get a lab study covered or didn't want to do a lab study. The standard protocol is a real lab study!

As other people have pointed out, there are tons of different masks out there, and he should be allowed to choose among them, not just be forced to wear one in particular. There are lots of masks made specifically for mouth breathers (a chin strap might also work for him) Most insurance co.s will cover a certain number of masks per year, so in the first year, he may try out a few before he finds one that works for him. If for some reason, your insurance is giving him a lot of problems, you can purchase a mask online -- either used or new. There are tons available for fairly reasonable prices (I actually have two sitting around here that I didn't like that I keep meaning to try to sell or give away! Anyone who needs a mask should PM me!!).

But it sounds like there are three steps immediately ahead for him 1) get a real sleep study and 2) get an appointment with the doctor and share his concerns and 3)find out what dme (durable medical equipment) company you are allowed to go to and get an appointment with them! They have respiratory techs there who will help him with the mask issue, even if the dr. keeps jerking him around.

good luck -- keep fighting and you'll get what you need.

 

[Mickey527]

I was diagnosed with sleep apnea in 1998. I was told I stopped breathing 38 times an hour. I can't fathom that,it just seems like so many episodes per hour. I was never offered the CPAP, the Dr immediately talked about surgery.
I had my uvula removed (the dangly thing in the back of my throat, get your minds out of there). He also scrapped my tonsils and adenoids. He said he didn't remove them, just scrapped some tissue off.
He also told me when I woke up that he noticed I had a deviated septum so he fixed that. I have noticed trouble breathing through my nose ever since.
Since then I have had frequent bronchitis. I get a cold and it goes right into bronchitis, at least 8 times a year. I also have trouble breathing, and am seeing a pulmonologist now. My resting blood oxygen O2 Sat rate is 94 and when I walk a little it goes down to 82. Not sure if this is related but it started right after I had the surgery. I had just graduated from nursing school so I thought my being sick so often was from the sick people, but I am on disability now and still get bronchitis every month or so.
I also have swallowing problems and frequently choke on liquids. I have to be aware of when I have food or liquids in my mouth and make sure to swallow before talking or breathing otherwise the food or liquid slides down my throat and into my lungs.
I wish I had known about the CPAP machine or more about sleep apnea then because I would have never had the surgery. Unfortunately sleep apnea was not as well known or treated then so I suffer from it.
I also still have problems with sleep, I wake frequently, gasping for breath. I also am always tired and have headaches when I wake up. I also snore like a truck driver even though the Dr said I would never snore again without my uvula.
My Dr is plaqnning another sleep study once we resolve the breathing problems I am having now. I am hoping that I can get a CPAP and it will resolve some of the problems.

 

[BirdsOfPreyDave]

I can attest that it is one of the best feelings on the face of the earth. I no longer have to drink loads of Coca-Cola or eat high sugar foods to give me the caffeine and sugar rush to get me through the next couple of hours. I no longer need to take a 45 minute nap at lunch to get through the afternoon -- with another nap needed when I get home to make it through the evening before I go to bed at night. I used to get up every hour to visit the bathroom and get a drink of water -- I was incredibly dehydrated each night because I was breathing through my mouth. It was a vicious circle -- drink water, go to sleep, breathe through my mouth, get dehydrated, wake up because I have to go to the bathroom because I had some water an hour ago, drink water, REPEAT.

Have you been spying on me? You just described my life to a tea.