My Wife's Sleep Apnea

Sleep Lab Study 09/17/07

Diagnosis: Severe Obstructive Sleep Apnea (AHI 81.3)

CPAP Since 9/21/07

Settings: CPAP, 12 cm H₂O

It was about 6 months after I had started using CPAP that suspected my wife had sleep apnea as well.  She falls asleep watching TV quite frequently.  She's also had couple car accidents due to sleepiness.  Previously, I attributed her symptoms to medication and ignored the possibility of sleep apnea as a cause.  I've read studies that some forms of pain medication are associated with sleep apnea.  I also read a study where subjects with a history of closed head injury had higher incidences of sleep apnea.  My wife suffered a closed head injury many years ago that left her in a coma for 2 weeks and neurological damage.  After much encouragement and several cancelled appointments my wife finally had a sleep study. Our sleep doctor diagnosed her with severe obstructive sleep apnea although her study included central sleep apnea events as well.

My experience with durable medical equipment (DME) suppliers as a sleep apnea patient has been miserable.  I had my wife try Binson's medical supply as I do not prefer my DME.  I don't know who is to blame as our doctor prescribed a bare bones Fisher & Paykel machine without any data recording or expiratory relief.  After my own experience, literature review, and reading the Sleep Apnea forum I decided we would purchase our own CPAP machine.  We purchased a Resmed Elite.  We rented a cpap machine from Binson's until my wife's arrived.  At present, I'm trying to fix a billing error where Binson's charged us and our insurance for a CPAP humidifier.  Binson's would not let us rent a humidifier.  At least my DME provided my CPAP machine with a humidifier.  When we picked up my wife's rental from Binson's they brought out a new humidifier and were going to bill us for it.  I told them we had already purchased a CPAP with humidifier.  I had them correct her bill but they charged us anyways.

I've haven't had a sleep study through current sleep medicine doctor.  It sounds like my wife had a better experience than I did however I think the technician did not select the proper mask.  My wife had difficulty wearing her nasal mask even after Binson's had adjusted it for her.  We must have spent hours readjusting her mask that first night.  It was either too tight or leaky.  Moreover, I saw air leaking out of my wife's mouth once she was asleep.  Binson's provided us a chin strap which I placed on my wife however air still leaked through her mouth.  I didn't even bother going back to Binson's and purchased my wife a Mirage Quattro full face mask elsewhere.  We watched the video included with the mask, spent hours adjusting/readjusting her mask unit we got a decent seal--small leaks but nothing compared to the mouth leak.

After my wife began using her new Resmed Elite CPAP, I was puzzled by the machine's data.  It claimed she had an AHI of 96?!!  For several days I read her AHI off the machine with similar results.  I thought something was wrong with her machine so we traded our CPAP machines.  Even my machine claimed she had similar AHIs.  That's when I became interested in seeing my wife's sleep study.  What was going on?  We went back to our sleep doctor and showed him the data off her CPAP machine.  He said it had to be artifact.  He said CPAP machines with data capability are overly sensitive and interpret noise as apneic events.

I'm not sure what exactly my wife does when she sleeps to fool her CPAP machine in believing she has apneic episodes.  She does sigh frequently in her sleep.  I know she makes strange noises while she is awake that sound like she's clearing her throat.  When she talks to people who aren't familiar with her they are often puzzled by that noise--they don't know where the sound is coming from or that she's making it.  She also moves her arms while she sleeps (something like sleepwalking).  I'll watch her sleep and it appears she's doing something purposeful with her hands like eating or picking something up.

I've reminded my wife several times to wear her CPAP in bed or not sleep outside the bedroom.  She doesn't feel the necessity to wear it like I do even though her AHI is twice mine.  She also gets out of bed without turning off her CPAP machine.  I ask her, "doesn't that blast of air bother you when you take off your mask without turning off the machine?"  She's a heavy sleeper and it takes a good half hour before she's fully alert once she wakes up.

My Wife's CPAP Data (40 Day Summary):

0.35-0.41 is not good.  The mask needs adjustment.  I'm not sure if my wife leaving the CPAP on after she takes it off has anything to do with this number.

Treatment Pressure while using my AutoSet (8cm H2O min/ 16cm H2O max)

AHI, AI, and HI (skewed by artifact we hope)

Reference:

    Castriotta, R. J., Wilde, M. C., Lai, J. M., Atanasov, S., Masel, B. E., Kuna, S. T. (2007). Prevalence and consequences of sleep disorders in traumatic brain injury. Journal of Clinical Sleep Medicine, 3 (4), 349-356.