CJireh

Mild sleep apnea

14 posts in this topic

So, I did all my pre-op testing and the last piece I was waiting to come in was the home sleep study.  It did come in and I have mild sleep apnea, they left a message on my cell phone that that is what I have and they are sending the order for a c-pap machine to my insurance company and I have to follow up w/ the sleep dr in 8 weeks.  WHAT?  I wanted to be days away from my surgery in 8 weeks!  Sigh.  Anyway, I called them back but got the machine, so I emailed my question (on my mychart site) asking do I HAVE to get the c-pap machine?  I have a friend at work who was diagnosed w/ mild SA and her dr said she didnt' need the machine and now that she lost 75# she doesn't have any trouble.  

Have any of you dealt with this diagnosis and still HAD to get the Cpap?  My insurance covers 70% of it, but that means hundreds of dollars still out of my pocket for it...and I won't be using it that long because theoretically it will go away when I lose weight.  It is was severe SA or even moderate SA, I would understand...but mild?  

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Sleep apnea is not a thing to leave untreated when you're heading into major surgery. Untreated or undertreated sleep apnea is one of the top suspects in unexplained deaths in the recovery room after surgery. If you have sleep apnea, even mild, you should tell your surgeon every time you see him/her.  There are ways to manage it if they're aware of it - less narcotics, more monitoring, waking you up sooner than they might another patient. Also, if you have a cpap machine, they will ask you to bring it with you, and will put it on for you in the recovery room and at night. 

 

 

Res Ipsa, BurgundyBoy and cinwa like this

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If they are a "bariatric center of excellence" (which is typically the case when the place mandates you to have a sleep study done), then yes, you will be expected to get and use the CPAP to treat your sleep apnea prior to surgery. Refusal can lead to them refusing surgery.

Upside, weight loss is often a cure for sleep apnea! Like Kio said, sleep apnea is not something to leave untreated, even if its mild. If you can, go to a CPAP store and ask to get fitted for different masks - there are many kinds out there now, and everyone has a different preference, and finding one that bothers you least is key to actually using the CPAP. 

BurgundyBoy, Res Ipsa and Gretta like this

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Trust me, get the CPAP.  I did not, and REALLY regretted it post-surgery.  I simply could not get enough oxygen while in recovery post surgery.  I was in recovery allll dayyyy....since they would not release me to my room because of my low oxygen levels.  The anesthesia really messes with your oxygen levels, so that on top of the sleep apnea was bad.  After many hours, the hospital finally tracked down a "spare" CPAP (ugh).  After 30 minutes, my oxygen levels were better and I could finally go to my hospital room.  I remained on oxygen overnight.  I was scared to doze off.  If I had known how the anesthesia would jack with my oxygen/sleep apnea, I would definitely have gotten a CPAP before surgery.

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I agree with @delilas and @Kio. (And see @TammyP note!). To address your reluctance to invest in something you may not need in the long run, you might clarify with your surgical team as to what this "mild" sleep apnea means and their attitude to your having surgery without it being addressed. I bet they will read you the riot act, but maybe not. 

I had more significant sleep apnea but cannot not tolerate the face mask, and so I was having a lot problems at home because of it - including daytime sleepiness, tired in the morning, racing heart (due to lack of oxygen) when I woke up in the middle of the night, etc. Once or twice I found myself falling asleep in the car on the way to work. Honestly it frightened the heck out of me. I was getting a massage once and fell asleep, and my therapist counted my lack of breathing for nearly 30 seconds. It frightened the heck out of her too. It was a major factor for me moving to surgery. 

*** You can buy silicone devices that fit over your tongue and pull it forward, which for most people (not all) reduces the obstruction they have in their throat. It is not as reliably good as cpap.  I bought two, one of which worked very well. If you go to Amazon and input "silicone tongue snoring" you'll get the list of devices. I used this because I could not tolerate a mask. Read the materials they provide so you understand how it works. They are also much less expensive than CPAP but then again don't work as well either. I slept really much better after buying and using one but it ameliorated, did not end, my sleep apnea. 

Luckily I had no problems after surgery in recovery, and now my SA is gone with my nearly 80 lb. weight loss. I continued to use the silicone device in the hospital and for several months after surgery. When I wake up now in the middle of the night I count my resting pulse, and instead of the 90+ I had as it raced, I am always below 55 now. And I rarely if ever snore now. And I am rested when I wake up.... and the list of good signs goes on and on. 

BUT BUT BUT there are people who post here who did not know they had significant SA, and had to stay in the hospital longer and had a rocky recovery room period and had to go to the ICU (!!!) because they could not keep their oxygen level up. @delilas's advice about finding the right mask is very good. 

Edited by BurgundyBoy
added ref to TammyP
Res Ipsa likes this

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Thanks for the info....I really want to see the report from the test I took to see how bad it was but I assumed it was not a big deal since they called it "mild".  My husband just got laid off last month (department dissolved) and though he got a good severance package, I don't want to be in a place of spending unwisely, but I know we'd both agree it was worth it for my health if it was necessary, I just want to make sure it is.

 

this is what the nurse at my surgeon's office said:

" I sent an email to the sleep department provider to see if they will "clear" you for surgery without you getting the Cpap machine. If they say that you are "cleared" for surgery without the machine, you can forego getting the machine. If they will not clear you without proof that you are using the machine then you will need to get the machine, use it for 2-4 weeks, have them check to make sure it is working properly and then they will clear you. 

You can not set up a surgery date until all of the clearances are completed. Your lab work is complete, your cardiology and psychiatry clearances are also complete. As soon as I hear back from the sleep center staff, I will send your name over to the scheduler to contact you  re: setting up a surgery date. (Provided they clear you without the cpap). If you need to get the cpap, then the scheduler will contact you after sleep medicine clears you"

 

Edited by CJireh

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29 minutes ago, CJireh said:

Thanks for the info....I really want to see the report from the test I took to see how bad it was but I assumed it was not a big deal since they called it "mild".  My husband just got laid off last month (department dissolved) and though he got a good severance package, I don't want to be in a place of spending unwisely, but I know we'd both agree it was worth it for my health if it was necessary, I just want to make sure it is.

 

this is what the nurse at my surgeon's office said:

" I sent an email to the sleep department provider to see if they will "clear" you for surgery without you getting the Cpap machine. If they say that you are "cleared" for surgery without the machine, you can forego getting the machine. If they will not clear you without proof that you are using the machine then you will need to get the machine, use it for 2-4 weeks, have them check to make sure it is working properly and then they will clear you. 

You can not set up a surgery date until all of the clearances are completed. Your lab work is complete, your cardiology and psychiatry clearances are also complete. As soon as I hear back from the sleep center staff, I will send your name over to the scheduler to contact you  re: setting up a surgery date. (Provided they clear you without the cpap). If you need to get the cpap, then the scheduler will contact you after sleep medicine clears you"

 

well, that is straight-forward. Your surgical team is relying upon the expertise of the pulmonary / sleep docs. 

I did some internet research (so treat this with a grain of salt). I can find no published evidence that treating mild sleep apnea ("without daytime sleepiness") with CPAP changes any health outcomes. this article argues that the right thing to do for mild sleep apnea is lose weight. http://www.medscape.com/viewarticle/867537

this has changed my orientation to your situation. I would call the sleep practice and argue that if they won't clear you, they need to (1) provide the evidence that CPAP will change your health outcomes (which may be hard for them to do), and (2) tell you why losing a lot of weight shouldn't be the primary direction of treating your sleep apnea. Everyone seems to argue that weight loss should be the primary treatment for mild sleep apnea. 

If you had moderate or severe sleep apnea there is clear, clear evidence that CPAP decreases the bad stuff. Apparently 16.5% of the US male public has mild sleep apnea but no one is suggesting there should be a mass campaign to get CPAP to them. 

Please consider letting the Forum know, through your posts, how this ends up. Hope this has been helpful to your thinking. 

 

 

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I, also was researching it today and found the same thing....that there isn't conclusive studies about HAVING to treat MILD sleep apnea.  I am with you, if it were moderate/severe, I am all over a c-pap machine! But with it being mild, I am just so not sure it is necessary.  Granted, if I had a magic ball to see into the future and I was having problems w/ my O2 levels after surgery, I'd get the machine tonight!!!! -_-

 

I will keep you posted

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I am STILL waiting for my sleep dr to get back to my bariatric dr and then for them to get back to me as to whether or not i need to get the cpap and be on it for a while before the surgery.  the waiting it killing me but i have been waiting since i decided in June so i shouldn't stress....I just want an answer (but I don't want a fast one if it is the answer I don't want!!! LOL!)

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darn! I got the answer today:

Dr. Dogrhami said that you can NOT be cleared by sleep without proof of compliance with CPAP. You will need to reach out to the sleep department to discuss getting a Cpap machine and making a follow up appointment for clearance. You will not be able to schedule a surgery date until the sleep clearance is done. 

That means I have to get the machine, get set up on it, and then use it for 4 wks then have a follow up visit and THEN I can get cleared for the surgery :angry:  Now I am just frustrated and discouraged (and annoyed!).  

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So sorry to hear it, CJ!  I think the 4 weeks is a little excessive, honestly.  I feel better knowing you'll have the CPAP on in the recovery room and the hospital after surgery, but safety after surgery doesn't depend on compliance BEFORE surgery.  That's just weird.  I wonder if there's any way you could get them to trim down the pre-surgical compliance period if you talked to the doctor herself?

Just a point of reference for post-surgical need: My intubation didn't go particularly well, and I came out of surgery with a very sore, irritated, swollen throat. Even today when I take a breath it sometimes catches in my throat because of the swelling, and I have to swallow to get around it.  It's possible the CPAP is necessary not because someone has severe sleep apnea, but because intubation can make even mild sleep apnea worse for a time.

My surgery was also delayed by factors outside of my control - only 2 weeks, but it still sucked.  I'm sorry you're having to deal with this!

 

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My program insisted on the 4 weeks before as well, and when I asked why they explained that it often takes awhile to get it fine tuned and working optimally.  Also, they want to make sure you're going to be compliant and use it regularly as you will continue to be at risk as long as you are taking any narcotic pain meds which depress respiration.  My program actually had a patient die at home when he took pain meds and then laid down to rest.  Never woke up.  That's why they are so picky.

I decided that as much as I didn't want to have a CPAP I really didn't want to be dead either so just sucked it up and did it.  Happy to say I was able to stop using the CPAP after losing the first 60 pounds or so.  It was expensive but life is priceless.

cinwa likes this

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well, geesh, when you say that, I can see why they insist...thanks for the insight

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3 hours ago, Kio said:

Just a point of reference for post-surgical need: My intubation didn't go particularly well, and I came out of surgery with a very sore, irritated, swollen throat. Even today when I take a breath it sometimes catches in my throat because of the swelling, and I have to swallow to get around it.  It's possible the CPAP is necessary not because someone has severe sleep apnea, but because intubation can make even mild sleep apnea worse for a time.

 

Kio, thanks for reminding me of that....the whole REASON my sleep dr ordered the test for me (since I had NO symptoms and slept well) is because my esophagus is very small and he said for that reason alone, I could have trouble breathing when I am on my back....GOOD CALL then if he wants me to have it to be able to BREATHE especially on narcotics!!!  Thanks for reminding me of that, I was just annoyed and forgot about the "petite" throat I have (which makes me laugh, nothing about me is petite, but my throat, evidently!!! Hahaha!)

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