Mixed Sleep apnea

coleyown

PEB Forum Veteran
Registered Member
#1
I went in for my sleep study and I have mixed sleep apnea which means I will need to use a Bipap machine instead of Cpap. With a Cpap you can still deploy but not so with a Bipap not even with a wavier. So my question is this Will that mean I will get refereed to a MEB?
 

smacinnes40

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Registered Member
#4
just curious where did you do this, cause I also have the same situation but they think because of the meds I am taking. I was told in order to test for centrals the military usually do not have a test center for it, it would need to go to special study clinic.

How high was your OHI and Centrals.

Mine with the CPAP is 6.0 average and central 3-4 average.
 

coleyown

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Registered Member
#5
I got referred to a Sleep study clinic and had all my test done there. They did ask me about meds but I am not on any so thats not the cause also mentioned high altitude, also not the case and drug use which is also not the case. So I have more test to do with the Bipap machine to fit it for me. Dont have my results in front of me so cant answer the last.
 

usafaviator

PEB Forum Veteran
#6
OSA w/ BIPAP will most certainly get you a MEB, especially if your AHI's are high and the condition affects your daily duties. As you stated, and are correct, BIPAP usage is not permitted in theater, so you already have that working against you if you are trying to be retained (or for you if you are looking to separate). I started with a CPAP, then (over the course of a few months of the CPAP not working) had to transition to BIPAP with oxygen. My OSA is in conjunction with some pretty heafty lung damage.

smachinnes40, you are correct...typically the military refers sm's out to civilian sleep centers, which (in my opinion) is the way it should be. OSA is deadly and should be properly diagnosed and treated, especially when dealing with central or mixed OSA, as the cause of central OSA comes from inaccuracies/inability of the brain to tell the lungs to function while sleeping, whereas obstructive sleep apnea is caused (typically) by a blockage of the throat by collapsing of the pallet/throat/tounge etc. while sleeping. The reason the BIPAP (aka BPAP) is crucial for central or mixed OSA is because it operates more like a ventilator, not only forcing you to breathe when you go apenic, but also controls the pressure to match the resistance (titration), much unlike the CPAP that just keeps a constant pressure. In my experiences, I couldn't handle the constant pressure of the CPAP ramming air down my throat, and it usually ended up getting ripped off and thrown across the room at night. Due to the titration of the BIPAP, I can handle it now (although having the mask on my face still sucks, even after almost 2 years of treating my OSA).

If you have mixed OSA, the odds are slim that the condition is caused by medication. However, central OSA standalone can be caused or aggravated by certain meds. Also consider requesting a nocturnal pulse oximetry test to determine if the machine/treatment is working for you. Be advised to proceed with caution with requesting this test, as the results can hurt your case if you are trying to be retained.;)
 

coleyown

PEB Forum Veteran
Registered Member
#7
Thanks usafaviator I did my BIPAP and it was a lot better. I felt the same way with the CPAP had to rip it off a few times when they had me try it. I just took my Sleep Study results to the hospital and she left for about 30 mins and came back and was like yeah we will put in the order for your CPAP and I had to walk her thru the paper work and tell her no it says BIPAP. Then I asked about the permanent profile and she said yeah but it wont be a big deal you just need to take it with you where ever you go or deploy. So again I had to inform her that no with a BIPAP you can not deploy with it. I offer to show her where it states that but she said she will research it herself. So we will see if see can figure it out herself or if I am going to have to walk her thru this whole process.
 

coleyown

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Registered Member
#8
I have a question about Sleep apnea. As stated above I have both central and obstructive Sleep apnea. I know DOD doesn't give anything for obstructive but with central and needing a BIPAP machine I was wondering if anyone has heard of them giving a % for that.
 

usafaviator

PEB Forum Veteran
#9
Although the VASRD denotes obstructive, any apnea requiring a CPAP/BIPAP is 50% VA. Note that central apnea is quite a bit more dangerous than obstructive. However, the military rarely considers apnea unfitting on their side, but CPAP vs BIPAP and the deployment issues with the BIPAP can weigh pretty heavily on an unfit finding. They also look to see if the machine is helping the symptoms or not (daytime fatigue, memory issues, etc.). Just my experience.
 

Emerald89

PEB Forum Veteran
Registered Member
#10
I am getting a referral to take part in a sleep study .....Can anyone break down exactly what happens and what they are looking for/ whats determines you have sleep apnea? Thanks yall!!
 

usafaviator

PEB Forum Veteran
#11
I am getting a referral to take part in a sleep study .....Can anyone break down exactly what happens and what they are looking for/ whats determines you have sleep apnea? Thanks yall!!
You will check in, fill out a few forms. They have rooms like a hotel type suite (quality of bed/room varies by location). They hook a crap load of sensors to your body and you try to go to sleep. Tests are usually scheduled for overnight stays to keep in line with your circadian rhythm. When you wake up, they take all the sensors off and send you home. Your doc will get the study report a couple of days later and have you come in to review it.
The test determines how many times per hour you stop breathing (apnea) and how long each episode lasts and how it affects your oxygen levels, respiration rate, heart rate, etc. Additionally, they have the ability to monitor brain waves and determine if you have central apnea, obstructive or mixed. The severity of your apnea (if you have it) is based upon how many times per hour you stop breathing. For example, I stop breathing 49 times per hour, or just short of once per minute, and durations last 5-15 seconds each...I have severe apnea. For the test, there is nothing to do on your part but show up, go to sleep, wake up and go home. The test doesn't start until the machines determine that you are sleeping (brain wave activity/respiration and pulse the formula).
If it is determined that you have apnea, you will be prescribed a CPAP machine...then the real fun starts. I've been on CPAP/BIPAP for about 2 years now and it still sucks (actually, blows:D).
 

coleyown

PEB Forum Veteran
Registered Member
#12
So just when I thought I would finally receive my BIPAP machine something else happens, I go to my primary care doc to talk about the machine and MEB. But she tells me she talked to a military sleep doctor and she wants me to talk to him. Here is the email he sent me.

blank name informed me of your sleep issues. I think there
is significant room for improvement in your care. And, I don't think you
need either a BIPAP or undergo an MEB. Not only can we make you better
medically, but an MEB for this is honestly not in your best interest. I can
explain this more over the phone.

From my understanding surgery is the only other way to fix this and then that's not even for sure. I informed blank name doctor that I would like to just go ahead with the med board but she wants me to talk to this person first. Was really hoping to get that BIPAP machine soon but looks like i will have to wait.
 

Bigben

PEB Forum Veteran
Registered Member
#13
I've sleep apnea for about 6 years now and sleep with a CPAP every night. When ever you do get a sleep study and if they have you put on a CPAP, you will most likely were found with sleep apnea. This is a very bad disease if not taken cared of.
 

coleyown

PEB Forum Veteran
Registered Member
#14
Yeah I already did my sleep study and I have sleep apnea. I was referred to a civilian doctor who found I have central and obstructive sleep apnea. CPAP wont work for me I need a BIPAP machine. Which should put me thru a med board but now they want me to go talk to another doctor prob to find some way around a BIPAP.
 

usafaviator

PEB Forum Veteran
#15
From my understanding surgery is the only other way to fix this and then that's not even for sure.
Surgery is only for obstructive apnea. There is no surgery for central. So, if you have mixed apnea, surgery is somewhat useless...it could possibly fix the obstructive apnea in your throat, but there is no fix for the central apnea (brainwave/nervous system). Many (most) people with mixed or primarily central apnea tend to progress to BIPAP (BPAP), and in worse stages a ventilator is required. The BIPAP is one step below a ventilator and performs similar functions of a ventilator. However, if the apnea is your only issue (no pulmonary issues), a BIPAP should suffice.
 

Jason Perry

Benevolent Leader
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#16
I know DOD doesn't give anything for obstructive but with central and needing a BIPAP machine I was wondering if anyone has heard of them giving a % for that.
Untrue. I had a client get an unfit finding for OSA two months ago. Yes, it is rare. In the case I am talking about, there was severe residual daytime sleepiness combined with use of stimulants. So, it was really "OSA plus" that resulted in the unfit finding. However, the point is that while "just OSA with CPAP" normally is not going to be enough to expect an unfit finding, depending on severity and residuals, it is possible to be found unfit for OSA.
 

maparker

Staff Member
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Registered Member
#17
OSA was found unfit all the time back when the Services were getting away with rating at 0% under illegal non VASRD rating criteria. Now that it must be rated per the VASRD is rarely gets an unfit finding. Gee, I wonder why.

Mike
 

Jeremy Pretty

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Registered Member
#18
Hello! I have OSA with Bipap. I got unfit rating on my MEB and got medically retired because of that and ankle problems. (Ankles only 10%) Dont be shocked if you get a unfit got BIPAP. I found some DoD reg that stated that if you had a Bipap you were not deployable. I forgot what reg it was because it was a while ago but I originally had a CPAP, I complained that I wasnt getting good sleep with it, they sent me to a different sleep study, found out my apnea was worse than the first one showed, put me on BIPAP and my god is it amazing. Oh and I only get like 5 hours of sleep a night now but i'm way awake. I will go find my MEB decision I think it mentioned something about why it was unfitting.
 

Jeremy Pretty

PEB Forum Veteran
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#19
Here is a scan of my MEB. "This condition is unfiting with a BIPAP machine." So it appears that on the AF side, BIPAP == Unfitting.
 

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maparker

Staff Member
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#20
I wonder why the BIPAP makes one unfit but a CPAP does not in too many cases. What the difference in terms of the machines impact on fitness?

Mike
 
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