Finished HST, possibly negative?

[deathscreton]

Yeah, I'd get a sleep study. If your insurance will pay for it, do it.

I agree, get a full sleep study.  Your report mentions Loss of Libido.  Sleep Apnea is known to result in very low Testosterone levels.  Whatever is wrong with you, you need more detailed tests than an in-home study.  Keep after the doctors, don't accept "I just don't know" for an answer.

I agree completely. I feel I should have done this in the first place, but with all my symptoms and everything pointing to it, along with my lack of knowledge, I felt the HST would have pointed right to it as the problem.

In any case, does the results point to something else besides OSA? I don't remember reading anything about having OSA with low AHI count. I know CA will not show on an HST. What other underlying issues could cause counts like this?

[trish6hundred]

Hi deathscreton,
WELCOME! to the forum.!
Hopefully, you are able to get a full sleep study arranged, good luck to you on your quest.

[Sleeprider]

The HST generally under scores AHI because there is no way to subtract time during the test when you are not asleep. You may well exceed 5 AHI with a clinical study. Something is going on that the test was unable to identify given the very low average and oxygen desatiratopm nadir. That is a high risk to your health and the cause needs further investigation. Think of the extra work your heart must must do, and the stress imposed by such a low blood oxygen level. Whether the cause is apnea or something else, it is relatively urgent that you resolve this issue.

Your body is not lying to you in communicating fatigue and other symptoms. You must investigate this aggressively. If a sleep test continues to show negative results, get a pulmonary, lung function, and cardiac workup including evaluation of blood CO2 (bicarbonate) levels, and whatever else your physician recommends based on the clinical study findings.

[deathscreton]

The HST generally under scores AHI because there is no way to subtract time during the test when you are not asleep.  You may well exceed 5 AHI with a clinical study.  Something is going on that the test was unable to identify given the very low average and oxygen desatiratopm nadir.  That is a high risk to your health and the cause needs further investigation.  Think of the extra work your heart must must do, and the stress imposed by such a low blood oxygen level.   Whether the cause is apnea or something else, it is relatively urgent that you resolve this issue.

Your  body is not lying to you in communicating fatigue and other symptoms.  You must investigate this aggressively.  If a sleep test continues to show negative results, get a pulmonary, lung function, and cardiac workup including evaluation of blood CO2 (bicarbonate) levels, and whatever else your physician recommends based on the clinical study findings.

As terrible as this might sound, this makes me extremely happy to hear. The fact that this test indicates a problem regardless of what initial results may say empowers me and my situation. There's a problem, and it's being acknowledged with proper evidence. I'll be sure to document what's been said here to use, if need be, for the future. 

So god damn reassuring.

Now you mentioned that sleep can't be subtracted when I'm not asleep. I don't ever remember waking up. Is that in reference to RERAs? That would be indicating CA as the issue correct?

That being said, I think the results speak for themselves regarding the heart stress. I spiked multiple times throughout the night, well past 100 BPM. If this is happening every night, I think that may as well explain my sleepiness on its own! Not to mention that I've read that spikes in BPM may indicate events that can't be recorded.

I know that the low oxygen indicates a problem as you said, but that could be anything from the way I sleep to how thick my neck is, right? Can any of those cause a significant drop we're seeing here? As for the CO2, are you thinking it could be OHS?

In any case, I feel like this has given me a reason to pick up an oximeter. I was thinking of the CMS 50D+ as it's affordable and records overnight. Software support is trash apparently, but it's either that, or the 100 dollar CMS 50F which I'm not too sure is all that different for a 60-70 dollar increase on the price tag. Any suggestions on that front?

Hi deathscreton,
WELCOME! to the forum.!
Hopefully, you are able to get a full sleep study arranged, good luck to you on your quest.

Hello Trish! Thank you for the welcome, and I'm definitely going to try and get one done. Hopefully this'll show us exactly what's going on.

I appreciate everyone's help with this. It's early in my attempt to be diagnosed, but this is long overdue.

[trish6hundred]

Hi deathscreton,
I look forward to hearing how you do with all of this.

[Sleeprider]

I know that the low oxygen indicates a problem as you said, but that could be anything from the way I sleep to how thick my neck is, right? Can any of those cause a significant drop we're seeing here? As for the CO2, are you thinking it could be OHS?

We often help members deal with positional therapy by recommending things like soft cervical collars or ergonomic pillows to eliminate the clusters of events that seem to happen when someone tucks their chin to the chest and this occludes the airway.  The difference it, it is associated with measurable events.  What we don't know is whether you have a large neck, have been observed snoring, stop breathing, have frequent arousals, night sweats, the need to get up at night to use the bathroom and a host of other problems frequently suffered by those with sleep apnea.  Also, is there any drug use or other known health problem that might contribute to low oxygen levels.  Do you have COPD or limited tidal volume?  There is a lot that the HST does not reveal, that a professional with an investigative interest in solving the problem would look at. 

What we see is a serious problem with oxygen destaturation that an oximeter would repeatedly confirm.  That may be helpful, but it won't get to the root cause.  Assuming your oxygen levels are normal in waking hours, a sleep study should be able to identify a cause for low oxygen in your sleep.  You may or ma not be diagnosed with a specific form a sleep apnea, but you have sleep disordered breathing with potentially serious consequences.  It's certainly worth investigating, and you're probably going to need the help of professionals and people who can observe and monitor your sleep to find the answer.   

HST is a screening tool with serious limitations.  It revealed a problem, but was unable to diagnose or classify it.  The next step is an observed sleep study that is capable of diagnosis. One last thing, do not settle for a band-aid solution like using oxygen. Identify the problem and solve it. A PSG will identify respiratory events and sleep arousals that the HST cannot identify. It may very well turn out that CPAP is a solution for you, or that your problem is upper airway resistance syndrome (UARS) that HST cannot measure.

[deathscreton]

I know that the low oxygen indicates a problem as you said, but that could be anything from the way I sleep to how thick my neck is, right? Can any of those cause a significant drop we're seeing here? As for the CO2, are you thinking it could be OHS?

We often help members deal with positional therapy by recommending things like soft cervical collars or ergonomic pillows to eliminate the clusters of events that seem to happen when someone tucks their chin to the chest and this occludes the airway.  The difference it, it is associated with measurable events.  What we don't know is whether you have a large neck, have been observed snoring, stop breathing, have frequent arousals, night sweats, the need to get up at night to use the bathroom and a host of other problems frequently suffered by those with sleep apnea.  Also, is there any drug use or other known health problem that might contribute to low oxygen levels.  Do you have COPD or limited tidal volume?  There is a lot that the HST does not reveal, that a professional with an investigative interest in solving the problem would look at. 

What we see is a serious problem with oxygen destaturation that an oximeter would repeatedly confirm.  That may be helpful, but it won't get to the root cause.  Assuming your oxygen levels are normal in waking hours, a sleep study should be able to identify a cause for low oxygen in your sleep.  You may or ma not be diagnosed with a specific form a sleep apnea, but you have sleep disordered breathing with potentially serious consequences.  It's certainly worth investigating, and you're probably going to need the help of professionals and people who can observe and monitor your sleep to find the answer.   

HST is a screening tool with serious limitations.  It revealed a problem, but was unable to diagnose or classify it.  The next step is an observed sleep study that is capable of diagnosis.  One last thing, do not settle for a band-aid solution like using oxygen. Identify the problem and solve it.  A PSG will identify respiratory events and sleep arousals that the HST cannot identify.  It may very well turn out that CPAP is a solution for you, or that your problem is upper airway resistance syndrome (UARS) that HST cannot measure.

My GF just did a rough measurement of my neck with a tape measure and came up with 17 1/2 inches. I've been tempted to reach out to the doctor who did the interpretation as speaking with a board certified sleep doctor seems like a reallllly good idea at the moment. 
GF has heard me snore in bed; when at her folks house, I often end up falling asleep on the couch and the parents have heard me snore(they usually have to wake me up when they're watching TV cause I'm too loud apparently. I've never been aware of my snoring).
She's seen me stop breathing and has woken me up a few times as a result to be sure I was still around.
I couldn't tell you if I've had frequent arousals. What I can say is I've gotten up to use the restroom or eat, that doesn't happen very often though. Maybe once every few weeks. 
No night sweats that I can remember. As for drug usage, the only drugs I'm on is benadryl and the associated immunotherapy that I just recently started a few weeks back. Health problems? I'm heavy for my size, but BMI is a sh*t indicator for many reasons. Never been diagnosed with COPD or whatever limited tidal volume is(never heard of this before, i'll have to look it up).

I'm not aware of my oxygen levels during waking hours. I've never had reason to be. Wouldn't this be a good one to get a device so I can keep an eye on it and possibly keep record of my ups and down? 

You probably weren't expecting answers for those, but I had'em! That and it'll help for me to keep a record next I speak to a doctor or specialist. Never hurts to have some answers. 

And I understand, no band-aid solutions. I've read some of the horror stories on this forum about people who get gipped left and right by doctors, specialist and DMEs alike. Thankfully, I have these resources at hand to help avoid similar problems in the future to the best of my abilities. Also, it should be mentioned that the HST was done with an ApneaLink Air. I've read (and been told) that these "multi-channel" tests are typically well received, HST or not, and can test for CA. The problem is the report it generates doesn't mention any type of effort stats, but the data the device uploads does.

If I request this data, is there any software that will read it? Is SleepyHead capable of doing this? I fully assume having the raw data available to me would greatly improve my insight to the issues I'm having.

EDIT: My fault. For as much as I like saying I'm computer literate, I sure don't act like it. A quick google search for the ApneaLink Air manual guide shows that it stores its files just like most of ResMed's devices, EDF+ format, which SleepyHead will happily take apparently. I'm going to reach back out to the Sleep Study and see if they'll provide these files if I ask nicely enough, then toy with SleepyHead while at work. I'll be damned if I don't have the information I want thats possibly available to me.

[chill]

As terrible as this might sound, this makes me extremely happy to hear. The fact that this test indicates a problem regardless of what initial results may say empowers me and my situation. 

I stood up and cheered when the neurologist told me that I had a tumour on my spinal cord (benign).  I felt much the same when I was given my beloved CPAP machine.  Knowing that there is both a cause and a solution for your troubles is a wonderful thing!

[deathscreton]

As terrible as this might sound, this makes me extremely happy to hear. The fact that this test indicates a problem regardless of what initial results may say empowers me and my situation. 

I stood up and cheered when the neurologist told me that I had a tumour on my spinal cord (benign).  I felt much the same when I was given my beloved CPAP machine.  Knowing that there is both a cause and a solution for your troubles is a wonderful thing!

That's about how I feel. I may not have my direct answer, but at least I have a direction. I'm gonna keep working on it; I wanna know what a day full of energy is like. Lol

[deathscreton]

Apologies for the double post, but I can't edit my last post for some reason. Must be some kinda limitation placed on the forums....

In any case, I've been staring at my results that's posted on the third post of this thread when I noticed something odd.

I was peering at https://airview.resmed.com/resources/wel...lo_eng.pdf which details the inner workings of the device used for the HST and how the specific software works. It even details what the acronyms are and how they're calculated. I looked through this PDF to learn what FL and FS's were(for those too lazy to look, they're Flow Limitations without snores(FL) and Flow Limitations with snores(FS)) and realized that I had a recorded 8900 breathes throughout the night with MORE THAN HALF of those being limited without snoring(FL = 5883). On the left under Indices, that shows up as 66% of my total breathes while sleeping to be limited in flow. This specific study group states that 60% is considered normal, while 40% of FS is considered normal. I've seen normals usually be considered 10% lower than what's specified here, not to mention that the amount of times this FL occurs, it could most definitely account for the low oxy sat we're seeing here.

This brings me to the desat levels. As pointed out by Rider, the levels are insane at the nadir, but it's the AMOUNT of destats that worry me. The ApneaLink Air qualifies a desat as a 4% drop in oxygen level meaning that over the course of the night, I experience rapid drops of oxygen saturation multiple times, 65 if we're keeping count. This in itself, while high isn't extreme as seen in patients afflicted with OSA or CA(I've seen reports so far as high as almost 300 desat events). However, this doesn't count anything below 4%, meaning along with all the times I experienced an FL, I dropped anywhere from 1-3% in my sat levels.... 6000 times during my sleep. f*** me man. I never once went above 97%(which may not be true for daytime measurements as the evaluation started maybe ten minutes after the recording started)during my sleep with an average of 91% throughout the night.

Without EEG or ECG recording to detect sleep state or muscle movement, of course the FLs I experienced wouldn't show up as Hypopneas, as they shouldn't. They would show up as RERAs. The kicker is that 30 of the FLs I experienced DID register and show up in the test. Everything here points to increased resistance for whatever reason, whether that be weight, neck size or because I have sh**ty nostrils. Adding that to the spikes of heart rate and you have some good ol' lookin' UARS(without accounting for other physiological problems). The only thing I DON'T have is the stress stats and breath waveforms, which should hopefully pop up sometime tomorrow. What I'm predicting is that my stress stat shouldn't be out of whack, especially considering the sleep group didn't mention it. I DO expect shallow breathing, odd patterns of stress that matches with the BPM and saturation, possibly indicating arousals at peak points. What would truly help would be a breathing waveform. Hopefully the data includes this as well.

tl;dr: I think my HST, however limited in information, may indicate that I have UARS based on the FL count, low but present amount of hypopneas, oxy sat and BPM.

What do you think? And If I'm wrong about anything in here, please correct me. I don't want to talk out of my ass, as I'm only using what I've learned here, that other forum(autoword says no apparently) and the internet. It's easy to misunderstand something I'm new to.