Planning Home Sleep Study to Confirm Apnea

[ptandjb]

Researched the Wiki board as recommended, getting better at reading sleep study report. AHI and RDI were both listed as 8.6, comprised of 5 OSAs and 52 Hypopneas totalling 57 events in 7.8 hours after the report subtracted the time I was upright. I surmise this is as the dental specialist phrased it on my dental appliance evaluation visit when he reviewed the sleep study report, "light apnea". He declined to offer the appliance unless I had a really serious teeth cleaning to remove stains from black coffee and stopped drinking coffee to control future staining. I get get good dental care and practice dental hygiene as recommended by my regular dentist, but I am not prepared to give up coffee. So also given my TMJ history I will pass on the dental appliance option. If some intervention is needed in the future it will be a CPAP device, but I do not think I am at that point yet.

When I am eating properly as I am now I am feeling well rested and awake during the day until around 8PM when falling asleep reclining on the couch watching TV is not rare. Some nights I sleep for six hours unbroken, other nights I wake up for no apparent reason after an hour or two of sleep which are probably RERAs, but none occurred in sleep study. I try not to sleep supine but on either left or right side, as when my wife typically wakes me for snoring I find myself on my back.

I can recall in past years when the weight passed 215 it got harder to breathe in activity. When I had a later period of weight loss and went below 215 my breathing got noticeably easier. A few years ago when weight climbed back above 215, breathing got to be work again while awake. I am now slowly approaching 215, currently 222. If I continue on the current course, I will pass 215 on my way to under 200 next year, with expected improvement in breathing once again. The 64 thousand dollar question is, will this weight loss if achieved also reduce sleep apnea events to a sub-clinical level? If so, since I am currently feeling well rested in daylight hours most of the time, is it OK to do nothing about the apnea other then lifestyle changes while the weight comes down to see it that brings the AHI/RHI down sufficiently? Opinions welcome, it is understood nothing said here can be construed as medical advice.

[sonicboom]

Understanding the Results

The Takeaway
The Apnea Hypopnea Index (AHI) and (my emphasis added) oxygen desaturation levels are used to indicate the severity of obstructive sleep apnea.
Apnea Hypopnea Index (AHI)
The AHI is the number of apneas or hypopneas recorded during the study per hour of sleep. It is generally expressed as the number of events per hour. Based on the AHI, the severity of OSA is classified as follows:

None/Minimal: AHI < 5 per hour
Mild: AHI ≥ 5, but < 15 per hour
Moderate: AHI ≥ 15, but < 30 per hour
Severe: AHI ≥ 30 per hour
Sometimes the Respiratory Disturbance Index (RDI) is used. This can be confusing because the RDI includes not only apneas and hypopneas, but may also include other, more subtle, breathing irregularities. This means a person's RDI can be higher than his or her AHI.

Oxygen Desaturation
Reductions in blood oxygen levels (desaturation) are recorded during polysomnography or limited channel monitoring. At sea level, a normal blood oxygen level (saturation) is usually 96 - 97%. Although there are no generally accepted classifications for severity of oxygen desaturation, reductions to not less than 90% usually are considered mild. Dips into the 80 - 89% range can be considered moderate, and those below 80% are severe.

http://healthysleep.med.harvard.edu/slee...ng-results

One thing missing from your results is whether and to what extent you had oxygen desaturation reductions of significance. This is part of the clinical picture.

From the results you posted you have mild OSA. Everyone responds differently to weight loss and OSA so it is not a sure bet that your mild OSA will be relieved by losing weight alone. If it were me id start the cpap, keep losing weight, then track your daily results using the software available here (Sleepyhead for instance). If losing weight cures your OSA then you can stop the therapy. in the meantime using therepy might just prevent you from developing other untreated OSA medical issues such as hypertension or Afib, or diabetes. Just my thoughts.

[ptandjb]

The oximetry distribution report section of the sleep report is a bit skewed because it includes 3 anomalous events. The first two were brief periods when I got up for a minute or two for the bathroom then laid back down which twice initiated SpO2 levels as low as 78. These were due to lung function impairment issues. At the end in the morning I got and went downstairs and laid down on the sofa before turning off the Alice PDx recorder, triggering a third oxygen drop. Oxygen average was 91 for the night. 97% of the time oxygen below 95, 16% of the time was below 90. I was under 85 for only a total of 2 minutes while awake and moving around. Looking at the graph it looks like most of the 16% below 90 was in fact very close to 90.

The discomfort of the Alice PDx equipment severely disrupted restful sleep as apparent from my state of exhaustion in the morning. A big question for me is did this cause me to have worse sleep results than if the recording was non-intrusive? Or would more restful restorative sleep as is typical cause me to relax and have even more AHI events then I did with the sleep study's disruption of normal restful sleep?

[sonicboom]

Good questions. The only way to know for sure would be to start cpap and track your data over a couple of weeks. You have nothing to lose by doing this and everything to gain.

[DariaVader]

the more deeply you sleep, the more events you would have. The reason many apneacs dont have higher ahi during testing is because we dont sleep during their silly test and some of us have trained ourselves not to sleep at all (or at least not the beneficial deeper sleep and rem) which is why they look at more than ahi.

[ptandjb]

Another day passes, on steep learning curve on apnea, reading and watching online educational videos. This is where I am today: I have mild sleep apnea as measured by the springtime at-home Alice PDx sleep test, AHI of 8.7, but I suspect the actual AHI to be higher as my sleep then was substantially impaired by the equipment and thus spent less time in the most relaxed state of sleep. I have retrognathia as a family genetic trait (recessed lower jaw) that predisposes people toward apnea. My father and a younger brother have/had major OSA. While my sleep study report says 16% of the time blood oxygen was 85-90%, it is too difficult to read the faint compressed paper printout to see how far below 90% the 16% time was. I keep seeing references to "the magic 88%". I am aware that apnea events may not necessarily register a drop in oxygen, but this will be valuable data in its own right that I do not now have.

I do not currently have a script for a CPAP, and there is another issue. I was diagnosed a few years ago with high functioning autism aka Asperger’s syndrome. One of my consequences of being on the autistic spectrum is I have hypersensitivity to physical contact and stimulation, making it difficult to tolerate items in physical contact. For example, I find it very difficult to wear eyeglasses, belts or shoes for any significant period of time. The chances are high that I would not be able to adapt to a CPAP device. Also may be difficult to tolerate oral device that also increases risk of TMJ pain recurrence. So I will only try these interventions if unsuccessful doing every other remedial action first. My Epworth Sleepiness Scale test was a 2, and as I am feeling well rested almost all days, I am estimating I am not now at high risk of health consequences in the short term at my current degree of apnea. As I am in the process of a successful slow long term weight loss lifestyle, I am inclined to wait to see how my steady weight loss improves the apnea.

In the short term will continue to work on gathering more actionable data. As I have impaired lung function as a separate issue for which an oximeter is essential, I will upgrade my current oximeter to a data gathering CMS-50E with the dedicated "CMS-50E Remote Sensor". a 5 foot extension to a more comfortable attachment clip that will make it much easier to avoid falloffs. Google 'CMS-50E Remote Sensor' and you will find the only medical supply house with this remote sensor. I will buy the actual oximeter from another vendor for much less than this vendor. This way I can review the night's data for any oxygen desaturation events and correlate the timing to the video/audio record that I will make. I will place the face of the remotely positioned CMS-50E display where it will be picked up by the camcorder that will capture body position and movements. A remote microphone will placed where hopefully all breathing will be audibly recorded.

My younger brother could not tolerate any CPAP device in years of trying, and says he makes do with positional treatment keeping off his back. However I suspect his heart attack this year at age 59 and at low ideal weight has something to do with his sleep apnea not being sufficiently treated.

I will have data results in a couple of weeks.

[sonicboom]

One of the great things about current CPAP treatment is the ability of the masks to be very unobtrusive. For instance, if you are able to wear the nasal pillows, like the Airfit P10 or the new Dreamware mask, nasal prongs and tube behind the head rather than in front, you may be able to tolerate the minimal contact. Again, you have nothing to lose by trying. You could easily get a script and then go into your DME's office and try on these various masks. You can then try at home as well. If it works, great. If it doesn't at least you tried.