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[Diagnosis] Result from tests suggest problem but doctor says that it's normal
#1
Result from tests suggest problem but doctor says that it's normal
Hi.
I was having trouble sleeping and was often waking up during the night so I went to a sleep doctor to get a sleeping test done.
The doctor gave me a kit for performing the test at home, which I did.
The results say that during a sleep duration of 6 hours and 9 minutes, I had 9 full breathing pauses and 13 partial pauses, with a density of 4.1 per hour.
I had 49 instances where my oxygen decreased from a base of 99% to a minimum of 83%, and the percentage of times in which my oxygen was below 90% is 1.
During the test, I snored for 1.2% of the time.
The doctor said that these results are in the norm, that I don't have sleep apnea and that my problem is bad sleep practices, going to sleep too late, etc... and prescribed Melatonin.

However, I still worry, is it really normal to have 21 (9 + 13) breathing pauses during the night? And at some point my oxygen saturation was 83% which as far as I know, is really low.
Is there a reason for me to worry and question the doctor?
Thank you.
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#2
RE: Result from tests suggest problem but doctor says that it's normal
G'day anon111552. Welcome to Apnea Board.

I'll just go through some definitions first:

Apnea - a full or nearly full cessation of breathing for 10 seconds or more.
Hypopnea - a partial (typically >50%) closure of the airway for 10 seconds or more.
AI - Apnea Index - the number of apneas divided by the total time. In your case AI = 9 apneas / 6.15 hours = 1.46
AHI - Apnea - Hypopnea Index - the number of apneas plus hypopneas divided by total time: AHI = (9 + 13) / 6.15 = 3.57 (which is just slightly different from the 4.1 you recorded)

The main number the doctors look at is the AHI, apnea-hypopnea index. Anything below 5 is regarded as "normal" or "treated". However AHI is a pretty blunt tool and totally ignores a number of significant factors, such as the duration of each apnea (a 60 second apnea still counts as one event, just the same as a 10 second one). It also ignores whether the events were evenly spread trough the night or came in clusters.

We do have members who showed low AHIs on their sleep test who've gone on to get a CPAP machine and found it greatly improves their sleep quality even though they are "normal" within the accepted definition.

In your position, I'd ask for the full sleep test report, and ask your doctor to go through it line by line to identify factors such as I've just discussed. You could also post a copy here and we could make a comment. Make sure you erase any personal identification details before you post it.
DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Result from tests suggest problem but doctor says that it's normal
Thank you for your reply.


I got this information from the alleged "full report", I don't think they'll give me more than that but I'll try.

Would you say that even if I have a mild apnea, it's so mild that it can be cured by changing my life style - eating better + exercising (I'm not obese but a bit overweight) and having a better sleep schedule?
I want to try to avoid a CPAP machine if possible.

Is there any test that I can do by myself, without a kit? I have an Oxymeter (CMS-50D) but I don't know if it is reliable enough by itself.
Thank you.
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#4
RE: Result from tests suggest problem but doctor says that it's normal
Anon, the home sleep test tends to under estimate AHI because the events are divided by the entire time of the test, not just the time you were asleep. The test does not measure flow limitation, and can miss some important respiratory related arousal information, that a more sophisticated test can quantify. You probably took this test because you feel fatigue and may be aware of a snoring problem, and a home sleep study is an inexpensive screening tool, compared to clinical PSG.

Your results appear to be inconclusive, with evidence of a low level,of apnea, hypopnea, and SpO2 desaturation. Combined with how you feel, further testing may be warranted, if your doctor's suggestions do not improve your qualitative sense of wellness. I would give his recommendations a fair chance, but I'm skeptical you will feel much improvement over the next six months. If that turns out true, then pursue a more conclusive test, or consider self-treating. A new auto CPAP can be acquired without insurance for about $600.00 and a mask will add another $70.00. The sleep apnea and disturbance field is driven by insurance coverage, rather than need, so the quantitative measure of your problem may not fully reflect it's impact on your functional well being. You are the best judge of your needs.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Result from tests suggest problem but doctor says that it's normal
(11-18-2018, 05:47 AM)anon111552 Wrote: Thank you for your reply.

...

Would you say that even if I have a mild apnea, it's so mild that it can be cured by changing my life style - eating better + exercising (I'm not obese but a bit overweight) and having a better sleep schedule?
I want to try to avoid a CPAP machine if possible.

Is there any test that I can do by myself, without a kit? I have an Oxymeter (CMS-50D) but I don't know if it is reliable enough by itself.
Thank you.

To your first question, quite possibly.  How long would that take though?  How successful have you been at getting a better grip on your habits and changing them historically? Have you been on diets much of your adult life?  If you answer yes, the chances are good that this will not change, and that if you do have apnea somewhat dependent on weight it will remain to at least some degree, including hanging around the mild-to-moderate range.  Ideally, you don't want ANY apnea.  Once again, yes, quite possibly you could essentially eliminate what apnea you have by losing 10 kg, but is losing that weight and keeping it off a safe bet...for you? I ask this because poor sleep habits increase leptin production which, in turn, increases appetite.  Makes older folks chubby.  Especially if getting up off the chair and moving around for an hour, briskly would help, is something you don't seem to find yourself keen on doing lately.

Who doesn't want to avoid PAP therapy and all the contraptions that go with it?!?

Second question, you could try to self-titrate using a suitable machine.  It may show that you do have a measurable problem with apnea/hypopnea, and that it can correct it.  You would want to submit your results to a competent person who could then advise you on which way to go from there.  However, as suggested earlier, the gold standard for measuring your current condition is in the sleep lab undergoing what is called a polysomnography.
Serial Tapist
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#6
RE: Result from tests suggest problem but doctor says that it's normal
The Sleep Association says that people with an AHI as low as 3 should be treated, but insurance won't cover unless it is at least 5. Either question the doctor further, find another doctor, or get a used cpap that has full data capability and do-it-yourself. If it makes no difference, you can always sell the machine to get most/all of your money back.

I would never have qualified if I had a home test. I would have qualified for the low oxygen, but they fudged the numbers because it was a lot more paperwork.
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