10-30-2019, 10:49 PM
I feel horrible even while using APAP - advice?
37 year old male. Not overweight and never have been, no known health issues, fit body, 15" neck size and not a typical candidate for sleep apnea.
Since my early teenage years, I've felt exhausted. In-lab sleep study in March 2018 showed 4.7 AHI and 18.1 RDI. I only slept 2.75 hours for that whole sleep study and I honestly don't even remember sleeping at all. Buried in the back of the paperwork are my arousal indexes that nobody talked with me about:
REM: 2 total spontaneous. Arousal index of 18.5.
NREM: 44 respiratory, 10 snore and 77 spontaneous for a total of 131. Arousal index of 49.4.
Arousals: 45 Respiratory, 11 snore, 80 spontaneous for a total of 136. Arousal index: 49.3.
Awakenings: 2 snore, 2 spontaneous for a total of 30. Arousal index: 10.9.
Ar + Aw: 45 Respiratory, 13 snore and 108 spontaneous for a total of 166 arousals and awakenings combined over 2.75 hours. Arousal index: 60.2. No leg movements. No PLMS. No PLMS arousals. Something like 50 RERAs throughout the whole study.
Sleep doc said I didn't have sleep apnea because I was 0.3 AHI away from the required 5.0 AHI to diagnose it. Regarding the 18 RDI, he joked, "Good thing you have an active job or you'd be asleep in your chair if you had a desk job!" It wasn't funny. Yes, when I get off from work and take the bus home (I don't feel alert enough to drive and never have), I pop awake with hynogogic jerks like every minute because I'm dead tired. I also fall asleep in my computer chair at home and even in the car as a passenger. I have a person SPO2 monitor and have reviewed my pulse rate and oxygen levels throughout various nights. My oxygen levels never drop below the lower 90's, usually around 93 or so. My heart rate usually jumps to 90+ at various times throughout the night and sometimes goes as low as 42bpm.
After the in-lab sleep study, my ENT doc had a brain MRI done because I was having odd tremors that nobody could locate. I also had a CT scan of the sinuses. Deviated septum was noted and I also had enlarged turbinates. Had turbinate reduction surgery and septoplasty. Both were a complete success and my breaths are quick to inhale and exhale now. It used to take 2-3 seconds to inhale and exhale a breath. But it didn't help my sleep issues. Those tremors went away after a short time. Never figured out what they were. I went to a local clinic, they did blood work and I fainted for 15 minutes when they got half of a vial of blood. I had never done that in my life and I've had lots of blood tests. Woke up with everyone freaking out and I saw 60/60 blood pressure on the machine in front of me and my pulse rate was 52bpm. I've had people online suggest that I have UARS with the high RDI and low AHI, so they said that was likely something called vasovagal syncope somehow attributed to UARS.
I requested my own mail-order home sleep study (no doc referral required). 5.2AHI. Mild to moderate sleep apnea with a warning that it could be even worse than that because their home study isn't as accurate as in-lab. Longest apnea was 85 seconds. Hypopneas and apneas averaged about 20-30 seconds. Pulse rate shoots up to 90+ and drops down to lower 40's. Oxygen levels did not drop below the lower 90's, even with that 85 second apnea. No central sleep apnea was noted in the lab or in the home sleep study and both could detect it.
I used the home sleep study to go to my ENT doc because the sleep doc wanted me to keep coming back for visits and wasn't helping. They wouldn't give me a CPAP. The ENT doc wrote me a prescription to get the Air Sense 10 Autoset APAP that I had been researching and they wrote a general 4-20 pressure setting.
I've tried a few different masks. Best results were with the Dreamwear gel nasal pillows. One night I achieved a literal flat 0 AHI with 0L/Min leak rate and 0 centrals. I mouth tape using a couple of strips of paper tape because I'm prone to puffing air out of pursed lips if I don't. Don't want to try a mouth guard or dental appliance due to previous dental work. Over a period of weeks, I noticed that my max pressure always stopped at 8.9 on APAP. Starting and minimum pressure are 6.2. On bad nights, it can jump up to 10 max pressure. On regular nights, it always stops at 8.9. I typically average 0.5 to 1+ AHI. A "bad" night might be 1 to 1.5. I see Clear Airway events showing up in Oscar software, but I think it misdiagnoses them as central apneas when they're likely RERAs that it can't properly detect.
I'm popping awake a lot throughout the night (I record myself with a house security camera while sleeping) even with my APAP machine and numbers lower than most successful people tend to have. I have been a very "jumpy" person since I was a kid and still now at 37. Didn't get sleep study until the age of 36. High school was a big struggle. To this day, I still can't focus enough to drive a vehicle (scared I'll have a wreck - I feel that tired and unfocused even after a full night of sleep with the machine).
At this point, what steps should I take? Machine is lowering my AHI. Unknown if it is working on REM-related RERA's and/or UARS if I have it.
In-lab study and home study both said I don't have central sleep apnea, so I feel reasonably sure that I don't even though my machine shows centrals if the pressure goes up higher or if I have a bad night with a little higher AHI like 1-2.No odd limb movements noted on the in-lab study. Central apneas do show up on my sleep numbers in Oscar sometimes if I have a bad/unrestful night while using the machine. Even then, they're like 0.5 and happen only when I'm extremely tired from days before when I didn't rest well. When fully rested, I don't get them. They also seem to kick in when my machine kicks up the pressure, so I'm not convinced that I have central sleep apnea. Yet at the same time, there are times when I feel like my body just stops breathing for seemingly no reason at night and it doesn't seem like an apnea. It is like I turn over and "remember" to breathe or something. It seems like central, but I don't think it is central and results from the in-lab and home sleep study are not agreeing with that assumption either. Is there anything else other than central sleep apnea that can make you have pauses in your breathing that aren't obstructive?
I've noticed from my APAP results in the Oscar sleep software that my hypopneas/apneas happen after usually an hour or two of sleeping and start the most when I'm in deeper sleep after 2-3 hours. Since I only slept 2.75 hours for the in-lab study, they didn't see what may have been a bulk of them for the later half of the night in deeper sleep. Yet they did puck up the large amount of RERAs over that time.
Among that time for the in-lab study, I got 44 minutes of N1 sleep, 86.5 minutes of N2 sleep, 28.5 minutes of N3 and 6.5 minutes of REM sleep.
Latency results from in-lab study: N1: 4.1 minutes. N2: 20.1 minutes. N3: 116.6 minutes. REM: 228.6 minutes.
On my Air Sense 10, my obstructive apneas and hypopneas seem to be treated beautifully. 1 AHI or below every single night if I keep good sleep hygiene, very low leak rate typically between 4L/Min to 0L/Min with my Dreamwear mask. However, I feel that I am still exhausted and I have no idea why. Should I be adjusting pressure UP to treat those RERAs? Current minimum settings are 6.2 starting and minimum (for consistency) and max pressure set at 9.0 because my auto settings always go up to 8.9, so I simply set it for 9 as the bar to reach. If I let it go over that, I start getting central apneas, which I think may be possible misinterpreted RERA's.
Should I up my max pressure to a higher setting? I'm starting to think that the central apneas that show up do not matter and that's UARS after my obstructives are taken care of.
I wake up after 8+ hours feeling like I just went to bed, my heart is racing, my face feels flush and looks red, my eyes look red and tired, etc. Yet I do have days when I feel a bit energetic once I'm up. Right after work, once I board the bus to go home, I literally fall asleep on the bus. After 10-15 minutes, I wake up and I'm okay for the rest of the day, just tired.
I don't fit any of the symptoms of Narcolepsy. I'm going to get blood work in the near future. Does this sound like UARS or maybe something on top of sleep apnea?
Since my early teenage years, I've felt exhausted. In-lab sleep study in March 2018 showed 4.7 AHI and 18.1 RDI. I only slept 2.75 hours for that whole sleep study and I honestly don't even remember sleeping at all. Buried in the back of the paperwork are my arousal indexes that nobody talked with me about:
REM: 2 total spontaneous. Arousal index of 18.5.
NREM: 44 respiratory, 10 snore and 77 spontaneous for a total of 131. Arousal index of 49.4.
Arousals: 45 Respiratory, 11 snore, 80 spontaneous for a total of 136. Arousal index: 49.3.
Awakenings: 2 snore, 2 spontaneous for a total of 30. Arousal index: 10.9.
Ar + Aw: 45 Respiratory, 13 snore and 108 spontaneous for a total of 166 arousals and awakenings combined over 2.75 hours. Arousal index: 60.2. No leg movements. No PLMS. No PLMS arousals. Something like 50 RERAs throughout the whole study.
Sleep doc said I didn't have sleep apnea because I was 0.3 AHI away from the required 5.0 AHI to diagnose it. Regarding the 18 RDI, he joked, "Good thing you have an active job or you'd be asleep in your chair if you had a desk job!" It wasn't funny. Yes, when I get off from work and take the bus home (I don't feel alert enough to drive and never have), I pop awake with hynogogic jerks like every minute because I'm dead tired. I also fall asleep in my computer chair at home and even in the car as a passenger. I have a person SPO2 monitor and have reviewed my pulse rate and oxygen levels throughout various nights. My oxygen levels never drop below the lower 90's, usually around 93 or so. My heart rate usually jumps to 90+ at various times throughout the night and sometimes goes as low as 42bpm.
After the in-lab sleep study, my ENT doc had a brain MRI done because I was having odd tremors that nobody could locate. I also had a CT scan of the sinuses. Deviated septum was noted and I also had enlarged turbinates. Had turbinate reduction surgery and septoplasty. Both were a complete success and my breaths are quick to inhale and exhale now. It used to take 2-3 seconds to inhale and exhale a breath. But it didn't help my sleep issues. Those tremors went away after a short time. Never figured out what they were. I went to a local clinic, they did blood work and I fainted for 15 minutes when they got half of a vial of blood. I had never done that in my life and I've had lots of blood tests. Woke up with everyone freaking out and I saw 60/60 blood pressure on the machine in front of me and my pulse rate was 52bpm. I've had people online suggest that I have UARS with the high RDI and low AHI, so they said that was likely something called vasovagal syncope somehow attributed to UARS.
I requested my own mail-order home sleep study (no doc referral required). 5.2AHI. Mild to moderate sleep apnea with a warning that it could be even worse than that because their home study isn't as accurate as in-lab. Longest apnea was 85 seconds. Hypopneas and apneas averaged about 20-30 seconds. Pulse rate shoots up to 90+ and drops down to lower 40's. Oxygen levels did not drop below the lower 90's, even with that 85 second apnea. No central sleep apnea was noted in the lab or in the home sleep study and both could detect it.
I used the home sleep study to go to my ENT doc because the sleep doc wanted me to keep coming back for visits and wasn't helping. They wouldn't give me a CPAP. The ENT doc wrote me a prescription to get the Air Sense 10 Autoset APAP that I had been researching and they wrote a general 4-20 pressure setting.
I've tried a few different masks. Best results were with the Dreamwear gel nasal pillows. One night I achieved a literal flat 0 AHI with 0L/Min leak rate and 0 centrals. I mouth tape using a couple of strips of paper tape because I'm prone to puffing air out of pursed lips if I don't. Don't want to try a mouth guard or dental appliance due to previous dental work. Over a period of weeks, I noticed that my max pressure always stopped at 8.9 on APAP. Starting and minimum pressure are 6.2. On bad nights, it can jump up to 10 max pressure. On regular nights, it always stops at 8.9. I typically average 0.5 to 1+ AHI. A "bad" night might be 1 to 1.5. I see Clear Airway events showing up in Oscar software, but I think it misdiagnoses them as central apneas when they're likely RERAs that it can't properly detect.
I'm popping awake a lot throughout the night (I record myself with a house security camera while sleeping) even with my APAP machine and numbers lower than most successful people tend to have. I have been a very "jumpy" person since I was a kid and still now at 37. Didn't get sleep study until the age of 36. High school was a big struggle. To this day, I still can't focus enough to drive a vehicle (scared I'll have a wreck - I feel that tired and unfocused even after a full night of sleep with the machine).
At this point, what steps should I take? Machine is lowering my AHI. Unknown if it is working on REM-related RERA's and/or UARS if I have it.
In-lab study and home study both said I don't have central sleep apnea, so I feel reasonably sure that I don't even though my machine shows centrals if the pressure goes up higher or if I have a bad night with a little higher AHI like 1-2.No odd limb movements noted on the in-lab study. Central apneas do show up on my sleep numbers in Oscar sometimes if I have a bad/unrestful night while using the machine. Even then, they're like 0.5 and happen only when I'm extremely tired from days before when I didn't rest well. When fully rested, I don't get them. They also seem to kick in when my machine kicks up the pressure, so I'm not convinced that I have central sleep apnea. Yet at the same time, there are times when I feel like my body just stops breathing for seemingly no reason at night and it doesn't seem like an apnea. It is like I turn over and "remember" to breathe or something. It seems like central, but I don't think it is central and results from the in-lab and home sleep study are not agreeing with that assumption either. Is there anything else other than central sleep apnea that can make you have pauses in your breathing that aren't obstructive?
I've noticed from my APAP results in the Oscar sleep software that my hypopneas/apneas happen after usually an hour or two of sleeping and start the most when I'm in deeper sleep after 2-3 hours. Since I only slept 2.75 hours for the in-lab study, they didn't see what may have been a bulk of them for the later half of the night in deeper sleep. Yet they did puck up the large amount of RERAs over that time.
Among that time for the in-lab study, I got 44 minutes of N1 sleep, 86.5 minutes of N2 sleep, 28.5 minutes of N3 and 6.5 minutes of REM sleep.
Latency results from in-lab study: N1: 4.1 minutes. N2: 20.1 minutes. N3: 116.6 minutes. REM: 228.6 minutes.
On my Air Sense 10, my obstructive apneas and hypopneas seem to be treated beautifully. 1 AHI or below every single night if I keep good sleep hygiene, very low leak rate typically between 4L/Min to 0L/Min with my Dreamwear mask. However, I feel that I am still exhausted and I have no idea why. Should I be adjusting pressure UP to treat those RERAs? Current minimum settings are 6.2 starting and minimum (for consistency) and max pressure set at 9.0 because my auto settings always go up to 8.9, so I simply set it for 9 as the bar to reach. If I let it go over that, I start getting central apneas, which I think may be possible misinterpreted RERA's.
Should I up my max pressure to a higher setting? I'm starting to think that the central apneas that show up do not matter and that's UARS after my obstructives are taken care of.
I wake up after 8+ hours feeling like I just went to bed, my heart is racing, my face feels flush and looks red, my eyes look red and tired, etc. Yet I do have days when I feel a bit energetic once I'm up. Right after work, once I board the bus to go home, I literally fall asleep on the bus. After 10-15 minutes, I wake up and I'm okay for the rest of the day, just tired.
I don't fit any of the symptoms of Narcolepsy. I'm going to get blood work in the near future. Does this sound like UARS or maybe something on top of sleep apnea?
