[Diagnosis] Noob: Is Sleep Apnea the Problem?

[bguppy]

I've been having pretty serious daytime fatigue for a few years now. Last summer I did a home study and was told I had "mild sleep apnea not likely to be helped by CPAP". I got a TAP device instead - I started using it at the beginning of the year and have had it at the max adjustment setting for about two months. So far no improvement in fatigue or apparent sleep quality, though my wife says it has significantly reduced my snoring.

I typically get about 7 - 7.5 hours of sleep per night, though most nights it feels like I'm not sleeping very deeply and I frequently wake up or "almost" wake up.

A few questions:

- Does the reduction in snoring with no reduction in symptoms rule out sleep apnea as a cause?
- I wouldn't classify my fatigue most days as "mild" (though I suppose it's all relative; I'm sure many people have it much worse) - is there any relationship between sleep apnea severity and symptom severity?
- For that matter how exactly is sleep apnea "severity" defined?
- How accurate / reliable are home studies? Is it possible my sleep apnea is worse than reported?
- If CPAP can help with moderate / severe sleep apnea why wouldn't it help with mild apnea?


I'm still leaning towards thinking that sleep apnea is the problem and that I should pursue CPAP or some other further intervention. Do you guys agree or should I look for another explanation?

[sonicboom]

I've been having pretty serious daytime fatigue for a few years now. Last summer I did a home study and was told I had "mild sleep apnea not likely to be helped by CPAP". 

What was your actual AHI on the study?  Who told you CPAP wouldn't help?  It seems to me that since the device you are using has not helped you have nothing to lose in trying CPAP (fixed pressure)/APAP (auto adjusting pressure).  Most here would recommend APAP because it can be set to a fixed pressure if needed.  Conversely, CPAP can never auto adjust your pressure.  Give it a good month or two to see how you feel.  All things xPAP related can be found on this site from choosing your equipment to self adjusting the settings to optimize your therapy.  You came to the right place.

[Crimson Nape]

Hi bguppy! -

I'm trying to answer your questions in the order that you presented them.

Here are the levels of Sleep Apnea (AHI levels):
Mild: 5-14
Moderate 15-29
Severe: 30+

I feel that they are a little misleading and are better suited for bragging rights as to how bad you have apnea.  Still it has to be measured somehow.   Most insurance companies will only cover treatment if your AHI (apnea level) is 20 or higher.
I went for years without realizing that I had a problem. I was only tested when my blood pressure couldn't be controlled with any medications.  My AHI turned out to be 90.  It never really bothered me.

Snoring may be part of sleep apnea but is not a requirement.  There are several types of apnea that would preclude snoring.

Home studies are not as complete as a lab study due to the fact that you're not connected to an EEG in a home study.  Still both are a one night snapshot of your sleeping patterns in which you usually don't sleep normally anyway.

The prescribing pressure will be adjusted to address apnea severity.
Good luck!

[bguppy]

Thanks for the quick responses. It definitely sounds like I need to pursue more options for sleep apnea treatment.

My diagnosis was given to me over the phone by a receptionist who was either reading off a piece of paper or relaying something from memory, so I don't know where "not likely to be helped by CPAP" originated. I'm not too thrilled with the doctor / office I've been working with so I'll try to find someone better. I imagine I'll need to talk to an ENT and / or sleep specialist at some point anyway.

I'll see if I can get the data from the study. To give you an idea of my knowledge of this subject, I had to look up the term AHI - I'm pretty sure they never told me what the number was.

Thanks again for the replies.

[trish6hundred]

Hi bguppy,
WELCOME! to the forum.!
Good luck to you as you start looking into CPAP therapy.
Hang in there for more responses to your post, and let us know of your progress.

[sonicboom]

You as the patient are entitled to copies of all of your test results and records. A simple request to the facility should get you the results. Once received return here with the info for more guidance. In the meantime peruse all things apnea related around here. The following is a good place to start - it contains a link to a video.

http://www.apneaboard.com/forums/Thread-...-Breathing

[bguppy]

Got my lab results - here is what it says:

Overall, the patient had 42 apneas, 10 obstructive and 7 central, and 25 hypopneas giving an apnea index of 2.2, a hypopnea index of 3.2 and an apnea and hyponea [sic] index (AHI) of 5.4. The patient's central index was 0.9. In the supine position the patient had an AHI of 9.3 compared to non-supine where the AHI was 2.3. Snore was present 17.9% of the sleep time.

On room air the patient's average oximetry was 93%. The patient went as low as 87%. The patient spent 0 minutes less than 89%.

The part about the supine index is interesting - I had no idea I ever slept on my back. I find it uncomfortable so I never consciously do it. I always go to sleep on my left side and usually wake up on my stomach.

My sleep quality is definitely variable and I do remember my sleep test night being better than average. I'd guess my average AHI is higher than reported but I have no idea how much higher.

I watched the video you posted and have been reading the wiki. I've had a couple of symptoms that I haven't seen mentioned anywhere yet:

- A significant decrease in aerobic capacity (as defined by the relationship between running pace and heart rate). I first noticed this about 5 years ago before I started getting really tired - my running pace at a given heart rate slowed down by about two minutes per mile (that's a LOT). At this point I couldn't tell you what my aerobic capacity is like because I'm too tired to run, and I've found that running in spite of my fatigue just makes it worse.

- "Brain zaps" - this is a common symptom of stopping SSRIs, but I haven't taken an SSRI in four years, and I only get them when my sleep has been particularly bad.

Has anyone experienced either of these?

[Kuthullu]

Got my lab results - here is what it says:

Overall, the patient had 42 apneas, 10 obstructive and 7 central, and 25 hypopneas giving an apnea index of 2.2, a hypopnea index of 3.2 and an apnea and hyponea [sic] index (AHI) of 5.4. The patient's central index was 0.9. In the supine position the patient had an AHI of 9.3 compared to non-supine where the AHI was 2.3. Snore was present 17.9% of the sleep time.

On room air the patient's average oximetry was 93%. The patient went as low as 87%. The patient spent 0 minutes less than 89%.

The part about the supine index is interesting - I had no idea I ever slept on my back. I find it uncomfortable so I never consciously do it. I always go to sleep on my left side and usually wake up on my stomach.

My sleep quality is definitely variable and I do remember my sleep test night being better than average. I'd guess my average AHI is higher than reported but I have no idea how much higher.

I watched the video you posted and have been reading the wiki. I've had a couple of symptoms that I haven't seen mentioned anywhere yet:

- A significant decrease in aerobic capacity (as defined by the relationship between running pace and heart rate). I first noticed this about 5 years ago before I started getting really tired - my running pace at a given heart rate slowed down by about two minutes per mile (that's a LOT). At this point I couldn't tell you what my aerobic capacity is like because I'm too tired to run, and I've found that running in spite of my fatigue just makes it worse.

- "Brain zaps" - this is a common symptom of stopping SSRIs, but I haven't taken an SSRI in four years, and I only get them when my sleep has been particularly bad.

Has anyone experienced either of these?

Hello, bguppy.

I have a AHI of 89.6, but I do not have any tiredness or "brain zapping", just some enormous snoring.
Your AHI is low and an xPAP would probably not help much, as it works basically trying to detect and avoid apneas before they happen. I find it a very expensive machine and intrusive treatment just for the snoring...

When I had my sleep test, it was done in a lab without any xPAP, and there was a graph that showed my sleep position with oxigenation, apneas and several other data.

Maybe you can ask some labs what kind of report they will do and what data they will collect and re-do the test, with tritration (this will tell you if you will benefit from xPAP and what pressure is right for you)

[bguppy]

I did a home study because my insurance doesn't cover lab study, so the information I got was pretty limited. After seeing my report and your responses I'm starting to doubt that sleep apnea is the problem after all. I'll see if I can get another home study done with the TAP device - that could rule out sleep apnea.

Do most people with sleep apnea not have problems with excessive fatigue or have any awareness that they're not sleeping well? I can definitely tell I'm not sleeping deeply a lot of the time, and my daytime fatigue is pretty bad.

I also tend to wake up well before my alarm goes off and am unable to go back to sleep - is that a common sleep apnea-related problem?

I'm also curious to know whether anyone else out there has had the aerobic capacity problem.

[Kuthullu]

Do most people with sleep apnea not have problems with excessive fatigue or have any awareness that they're not sleeping well? I can definitely tell I'm not sleeping deeply a lot of the time, and my daytime fatigue is pretty bad.

I also tend to wake up well before my alarm goes off and am unable to go back to sleep - is that a common sleep apnea-related problem?

I'm also curious to know whether anyone else out there has had the aerobic capacity problem.

Yes, tiredness, sleepness and fatigue are pretty common symptoms, and are closely related to sleep deprivation and low oxygenation due to apneas... Most people goes for doctors because of this, in fact. But in your case it may be another cause or the exam was poorly done and your AHI is higher than that exam shows...

I'm by no way an expert or anything, but I also have this this problem about wakening before the alarm goes off, and I relate it to little awakenings I have because of my apnea (I stop breathing, my blood CO2 saturates, my brain send message to my muscles to "shake up and wake up" so I can breath again. If this happens close to your wake up time, you simply don't fall asleep again... That's my theory...

Try taking some pictures of your exams and posting them here, for everybody to comment on them...