Newbie. Hypopnea in REM. No Apnea and no oxygen desaturation

[CoreyW]

Hi everyone,

I’ve been getting the run around from docs and specialists all unsure of what will work for me.

I am young, healthy, active and skinny. I do have anxiety though. 

Unfortunately I don’t wake up refreshed and I grind my teeth through the night. I wake up with a dry mouth and drool on my pillow.

A sleep study showed an AHI of 16. All of which were hypopneas. The hypopnea events seem to be prevalent mainly in REM. Oxygen mean of 95.

What on earth is going on? My ENT said I could try a septoplasty, the sleep study place said I could trial CPAP, my doc said I could try anti anxiety pills. None were sure of the exact causes and whether these things would help.

So now I’ve got no idea what to do. Any help would be appreciated.

[Ratchick]

Hi there!

Sounds like doctors just doing their usual thing of not working together and recommending their own things!

You have disordered breathing, by the sound of it - do you have a full copy of your sleep study? That would be good to take a look at.

First off, I would say don't do the surgery. In the absence of seriously abnormal anatomy, it's nowhere near a guarantee of fixing any disordered breathing at night.

Secondly, if you're bruxing, I would look into getting something to at least protect your teeth at night from grinding (even if that's just a heat-and-mould-at-home style guard for now, because properly fitted bruxism guards are expensive, and PAP can often alleviate bruxism if it's related to sleep-disordered breathing).

Thirdly, sleep hygiene is definitely important, and if you have anxiety, then you might want to look into treatment for that. I would suggest that CBT (or similar programs) are usually a better plan than just long-term medication, but if you do need to go that route, something like an SSRI or SNRI would be a better option than a benzodiazepine or similar. Also, someone recently posted a link to an app: https://mobile.va.gov/app/cbt-i-coach and this might be helpful with your anxiety.

But really, it sounds like you need to be looking at CPAP for now - which hopefully will reduce your hypops and leave you feeling rested (and hopefully less anxious, as apnea and disordered sleep can worsen anxiety too).

Welcome to the board, and let us know if you have that sleep study in full. You should be able to ask your doctor for it, too.

[Dormeo]

Terrific post from Ratchick; just want to second everything she's written. I'm hoping you can post that sleep study.

[Melman]

If you get a prescription for CPAP be sure to insist on a Resmed Airsense 10 Autoset. It is the best machine. There are several Airsense 10 models. The autoset is the one to get. The other major supplier is Phillips Respironics. We have found that the PR dreamstation is not as effective formost people as the Resmed.

[clownbell]

Ratchick has mentioned an app at https://mobile.va.gov/app/cbt-i-coach. This app is provided by the US Veterans Administration but you do NOT have to be a vet to get the app. It is available on the app store, along with companion apps concerning mindfullness and anxiety. As you could guess, many vets have anxiety from combat -- but the app is designed for general use by anyone, not just vets. Highly recommended.

[CoreyW]

Thank you so much for the replies. It has given me quite a bit to think about.

I only got this test out of interest as I have for most of my life woken up tired. Now I have the anxiety of thinking I have been causing damage to myself by not getting it treated. So the anxiety cycle continues! I will check that app out though.

I will attach my sleep study to this post.

Happy to hear any thoughts on this.

Thanks again everyone

[Ratchick]

OK your AHI puts you in the moderate sleep apnea range. However, with zero obstructive apneas (and only 4 centrals) it's hard to tell if these hypopneas are central or obstructive. Most doctors will assume they're obstructive, but that doesn't necessarily mean they are. I would definitely suggest either a trial of CPAP or a CPAP titration at the sleep clinic. If you can get a loan temporarily of an APAP machine (ideally a Resmed 10 Auto as Melman already mentioned) then you can definitely get enough data (if you download OSCAR) for the board members here to be able to advise you on settings etc. Either way, it should be possible to test fairly easily if APAP/CPAP is going to help.

I know with anxiety it's hard to break that cycle but you're young, and your AHI isn't crazy high and is composed almost completely of hypopneas, with very little in the way of oxygen desaturation. As you're also otherwise young and fit, the chances of you doing yourself any harm at this point are not big, at all. I know that with anxiety it's impossible to just turn it off, but apnea isn't uncommon (and in fact, often mild apnea isn't treated with PAP anyway without symptoms like excessive daytime tiredness etc). Anxiety is the worst, though, and I know when it gets its claws into an idea, it's a nightmare trying to get them out again.

[CoreyW]

Thank Ratchick. I really appreciate your response. You have put my nerves at ease and given very helpful advice.

I’ll explore those options as I have nothing to lose by trying them. 

Thanks again for your thoughtful response.

[Ratchick]

No worries - if/when you get your machine, feel free to go ahead and download OSCAR and come back to let us know how it's going.