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REM Sleep Apnea


#1

Hello there. I had certain contradictions in my polysomnographic study with CPAP titration. I really need some advice from people who have been diagnosed with REM Sleep Apnea, and I need to know exactly what questions to ask my doctor (s). Also, is REM Sleep Apnea treatable and, if do, how? Originally, I was diagnosed with moderate sleep apnea (with an AHI of 15.4 and an RDI of 15.9); I had oxygen saturation down to 79 percent – with 7 percent of study time spent with SaO2 below 89 percent. During second sleep study, it was indicated in my sleep repot results that my “moderate OSA completely resolved with titration of CPAP to 8 cm” – even though my “OSA is significantly worse in REM with a REM AHI of 14.2.” This is something that really disturbs (AND puzzles) me. First of all, how can they say (or “find”) that my apnea is “completely resolved” when there is clearly a contradiction here? Secondly (and therefore), how do they address (or plan to address) the REM apnea? Can anyone here provide me with some sound advice so that I will know how to actually address my doctor (s) regarding this, along with how the doctors usually go about addressing this? Or is this simply something that will work itself out intime, and with diligent and daily use of a CPAP mask? I would appreciate any help that you can provide me – AND reassurance. Thank you SO much.


#2

Hi,
REM sleep is the part of sleep where your muscles are the most relaxed so many people have more events in REM sleep. During your titration study, the tech would have increased your pressure during REM sleep to control the events so it should be effective. In some cases where you need a significantly higher pressure in REM, then you may benefit from an AutoPAP device instead of just CPAP. That way, the machine would increase the pressure to what you need iin REM and non-REM sleep.


#3

Hi Pamela. Thank you so much for helping me out here. It is really good to know that REM sleep can also be addressed via AutoPAP. Presently, they are trying to get a regular CPAP machine approved by my insurance company. Once they get it approved (which they are having trouble doing, since the prescribing doctor’s notes are illegible), then am I simply “stuck with” the CPAP machine for quite a while, until I undergo still more sleep studies – which then force them to prescribe and order the PROPER AutoPAP machine for me? Do I have any “say” in this whatsoever, or as they say, will I just have to “go along for the ride?” Also, as a general rule, how long do insurance companies make a person wait before actually paying for yet another machine?


#4

Pamela, After re-reading your message, I just wanted to mention that unfortunately, my sleep tech did not check or reset my pressure at any time during the night; he just set it at 3 to 4 cm. and then seemed to go about his business for the rest of the night. It was only until the daytime tech came in that SHE reset the machine to the PROPER pressure – and that was at 6:30 in the morning; as a result, I wound up “sleeping in” – and she woke me up in the middle of REM sleep at 10:00 a.m. I think that is the reason I am so frustrated now. I also feel they could have done a better job in communicating with me about things but, hopefully, that will improve in time.


#5

Hi,
Your MD has to write a prescription for the machine. If the MD that interpreted your sleep study recommends an AutoPAP, they can write the script for that. Most Insurance companies will pay for a machine every 5 years but you may have a co-pay. Ask the company that you are getting the machine from before you take it from them.

Pam Gordon MHA, RRT-ACCS, RPSGT, CCSH, RST
Clinical Manager
Sleep & Neurodiagnostics Center
Lowell General Hospital, Saints Campus
1 Hospital Drive
Lowell, MA 01852
Office: 978 937-6046
Sleep Lab: 978 934-8373

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#6

Hi again, Pamela. I am really sorry I haven’t gotten back to you sooner. Thank you for all your contact information, by the way. I have an appt with a pulmonologist in another month (thank God!), and I know I will have a boatload of questions for HIM. In addition to wondering if I even have REM apnea, I have also had two gum surgeries as well as both hyperacusis and tinnitus – so I have THESE things on my mind, too; I say this because both my hyperacusis AND tinnitus were really getting better (and the tinnitus was gone altogether). However, once I started using the CPAP machine nine nights ago, the tinnitus is back and is getting worse. I am getting pretty concerned about this now. Also, to make matters worse, I have had a handful of concussions – which I read (according to numerous online sources) could really influence how the sleep apnea is even treated. Do you have any knowledge of, or suggestions for me concerning, the forementionex matters? Obviously, I have multiple things that I need addressed (although I wish that this weren’t the case), and I want to take one step forward instead of two steps back regarding ALL of these issues. By the way, I have both read and heard that.CPAP could make pre-existing dental problem worse – and I don’t want this to happen in addition to my hearing sensitivity becoming worse. Also, I have a friend who told me that she stopped using CPAP because her teeth had begun moving – and I have already experienced my teeth moving over a year ago BEFORE even using CPAP. I would appreciate any and all advice you can give me as a I wait a month for my. Initial doctor’s appt.


#7

Hi Pamela, I am having trouble editing my post. Bear with me as I try to get the hang of this website. Thanks so much.


#8

Hi,
I’m glad you are seeing a pulmonoligist. Hopefully, they are also a sleep MD. I have not had any issue with dental problems caused by my CPAP but I also wear a mouthguard due to Bruxism (I grind my teeth). You may need an in-lab study to determine if you have central sleep apnea caused by the concussions. REM related sleep apnea is usually treated with an Auto CPAP as you just need higher pressure than in non-REM. Many MDs are now ordering AutoPAP on the majority of patients as the insurance companies will not allow patients to have in lab titrations.
I’m not sure about the tinnitus.
Good luck and hang in there!
Pam


#9

Does anyone know if sleep apnea cause teeth decay?


#10

@arnieandcaroline13
Regarding tooth decay, saliva is its first line of defense because it neutralizes and washes away debris and acids from food in your mouth. Over time, when the mouth becomes dry from repeated episodes of sleep apnea and snoring, the absence of saliva reduces the ability of it to fight disease in the mouth. There is then the risk of oral bacterial infections, bad breath, a drying out of tooth sockets. Dry sockets can loosen teeth, and of course the oral bacteria causes tooth decay.

Hope this helps!

Theresa (MotherT)


#11

@MotherT covered the bases well here, just wanted to add that if you have problems with acid reflux (which can be linked to sleep apnea), you might also experience some dental erosion caused by the high acid environment it can cause in the oral cavity.