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Long-term health Qs

Posted by Djabiuk on January 06, 2005 at 06:48:16:

I live in a West African country where there are surely neither sleep disorder medical professionals nor equipment. During a recent leave to the US, I had a split-night sleep study done at the University of Michigan's sleep clinic, the results of which were forwarded to me and are summarized below. After this study, I was prescribed (and outfitted with) a CPAP system with which I have returned to Africa. Because (with the exception of the second half of the night of my sleep study, when the technician came in and put the CPAP on me after I was already asleep) I have not yet been able to sleep with the CPAP on (more than 20 hours trying, over the course of 12 nights), I am wondering (a) what else I can do, (b) what are the health risks (by which I mean, not just category of risk—high blood pressure, e.g.—but degree of risk) and how much would successful CPAP use reduce them/it.

The ironic short term outcome of my apnea diagnosis is that I am sleeping much less well than I used to. I have always been a “good sleeper”, meaning that I go to sleep easily and (as far as my conscious awareness is concerned) sleep well throughout the night. I have never had any of what I’ve come to recognize as the typical apneic complaints: I’ve never fallen asleep when I didn’t want to (and certainly not in a meeting or at the wheel), do not take naps regularly, no morning headaches, no high blood pressure. I do feel fatigued often but not in a way that is evidently excessive for a hard-working parent of two young children (which is to say not noticeably more than my peers). In other words, I can imagine having more energy, but lack of energy does not stop me from fulfilling all my work and family responsibilities or enjoying tennis and other recreation activities. I do get sick (colds and the like) more often than some, including my wife, but again, probably not outside a normal range; although I am not someone to go to work when sick, I don’t believe I’ve ever needed to take more than five sick days in a given year. In short, I have none of the symptoms that would have pushed me to have a sleep study done had it not been for my spouse expressing concern about my breathing cessation during sleep (and my desire to stop snoring, so as to stop interfering with my wife’s sleep).

I do not recognize myself in any of the testimonials of apneics that I have watched or read, all of which describe noticeable immediate increases in alertness and wakeful well-being after using CPAP. Because my “before” is so much less bad (in terms of my symptoms) than it seems to be for many with similar sleep study results, it seems unlikely that my “after”, should I manage to sleep with the CPAP, will be a dramatic improvement.

Which means that my motivation to keep trying to use the CPAP is based solely on the desire to reduce my long term health risks (about which I am quite uncertain/fuzzy) and the desire to stop snoring (for which there may be other solutions that don’t require such an uncomfortable and chronic treatment). I am making my best effort to habituate myself to the CPAP, which I find remarkably uncomfortable, especially once it ramps up to 13, but I would also like to know more about the likely consequences of continued inability to do so and/or other options. One of my greatest frustrations in reading through the information available on-line has been the vagueness and lack of clear or precise information about the predictable outcomes of my apparent condition. Lots of vague warnings but precious little information. My apnea is clearly severe in terms of the number of obstructions per minute, but it is also clearly much less severe in terms of keeping me from getting to REM sleep (I dream every night) and/or causing immediate symptoms—no morning headaches, no falling asleep before bedtime, no alertness problems, etc.

Age: 40 yrs

Sex: male

BMI: 30.4 (6’ 4”, 250 lbs.)

RDI: 80

Saturated O2 down to 80% during sleep study (don’t know how much of a drop that represented)

Pressure required to eliminate obstruction: 13 cm

I suppose that weight loss is the first recommendation that any doctor would make, and I intend to pursue that course--like a lot of former athletes, I have had trouble adjusting appetite to lifestyle, which has gotten less and less active, and my weight has consequently climbed slowly but steadily from 210 pounds fifteen years ago to 250 about five years ago, where I’ve stayed more or less since then. Although I know that there are more reasons than just apnea to lose forty or fifty pounds, I suppose that I am a little bit sceptical, given my RDI and required CPAP pressure, that losing weight will rid me entirely of my apnea. On the other hand, believing that it would might provide me with the motivation necessary to lose those pounds, so maybe you should tell me it will.

I have two hypothetical questions which might give me a better idea of the long-term effects my condition:

Although I know that it would be best to do both, imagine that I had to choose between staying at my current weight, with full CPAP compliance, or losing fifty pounds but not using the CPAP. Which scenario would lead to better long-term health outcomes, on average?

If I were a pack-a-day smoker (I don’t smoke at all, in fact), which of the following behaviour modifications would you advise more strongly (again, assuming you had to choose one, based on probable long-term health outcomes):
smoking cessation without CPAP use;
Full CPAP compliance with no smoking cessation.

I am sorry to have been so long-winded, but I am feeling quite frustrated, both by my inability to sleep with the CPAP (I wear it at least an hour every night, but cannot fall asleep) and with the vagueness of the information I get from doctors and the internet.


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