AHI of 5 and disappointed

[RyanMW]

Hi all,

I've had classic apnea symptoms for a while now. I'm incredibly sleepy during the day, wake up feeling extremely sore, have no energy, difficulty losing weight, etc. I went for a sleep study and was very disappointed when my AHI was only 5.5, and my oxygen level fell to 90 at its lowest.

My doctor ordered a split sleep study test (with the CPAP mask) at my insistence, but doesn't really think it's necessary.

I'm disappointed because I was hoping to see a much higher AHI # and that I would finally be able to begin to fix my energy and sleep problems. I'm not sure where to go from here

[kaiasgram]

Ryan, do you know if your insurance would cover treatment with an AHI of 5.5? An AHI of 5 is diagnosed mild sleep apnea.

[Pugsy]

Bummer when we are looking for a real face and name to fight and can't find one.

Now I am not saying that you might have this...but it's possible...UARS Upper Airway Respirator Syndrome...google it and read up on it. Often with UARS the AHI and O2 numbers aren't horrible on the face of things. CPAP is still the treatment of choice though...but with AHI already low it's harder to evaluate success because you have to go by how you feel since the other OSA markers are already low.

Also remember that not all our physical ailments can be blamed on sleep apnea as much as we would like to so that we have a name and a face to blame and something tangible to fight.
Not every one who sleeps poorly has sleep apnea..there's long list of other sleep disordered breathing culprits.
Not to mention other causes of fatigue, or excessive daytime sleepiness....like meds, general health, insomnia, age, etc, etc.

[kaiasgram]

Another possibility -- you had an unusually "good" night on the night of your sleep study (in terms of your AHI).

Do you have a copy of your sleep study report? Does it have information about arousals, either spontaneous or respiratory effort related (RERAs)?

[RyanMW]

I have a copy that the ENT specialist gave to me when I saw him, but it doesn't have much information on it. I don't think this is the copy you are referring to. It only says "unspecified obstructive sleep apnea."

For more background, I'm 30, male, 5'8, 190 lbs. I could stand to lose weight, but I am very active and am now dieting and eating responsibly. I take a very small dosage of lexapro for anxiety and take no other medications or have any other health issues. I don't smoke, drink or do drugs.

[kaiasgram]

I have a copy that the ENT specialist gave to me when I saw him, but it doesn't have much information on it. I don't think this is the copy you are referring to. It only says "unspecified obstructive sleep apnea."

For more background, I'm 30, male, 5'8, 190 lbs. I could stand to lose weight, but I am very active and am now dieting and eating responsibly. I take a very small dosage of lexapro for anxiety and take no other medications or have any other health issues. I don't smoke, drink or do drugs.

It would be a good idea to get a copy of the full report. There might be some information in it that could be useful in terms of figuring out where to go next. You are entitled to a copy of the report.

[Pugsy]

Look up the known side effects for Lexapro.
Not saying 100% of the problem is the med but it has known side effects that mess with sleep and how we feel during the day. Might be contributing factor.
Dig deep when researching it.

[musculus]

You can have tons of RERAs but low AHI (in my case, <1). Your sleep doctor is not a very good one but as long as you can get CPAP prescription from him/her, it doesn't matter much.

[Guest]

You can have tons of RERAs but low AHI (in my case, <1). Your sleep doctor is not a very good one but as long as you can get CPAP prescription from him/her, it doesn't matter much.

Your AHI was <1, but CPAP has helped you?

[kteague]

I agree with those saying to get your detailed reports. They may hold helpful clues. Sometimes a sleep study is not fully representative of how one usually sleeps, particularly if all the sleep stages and sleep positions were not well represented. One thing you said jumped out at me - the part about "waking up sore". Could you be more specific about that?

[cathyf]

Another thing to be aware of is sleep architecture. I'm going to construct an example which illustrates how you could wake up dead from an AHI of 5.5! Suppose you slept for 6 hours during the test, with an AHI of 5.5 that means 33 events during the 6 hours. Suppose you only had 10 minutes (600 seconds) of REM sleep, and 30 of the 33 events were during that 10 minute time stretch. Next suppose that those events lasted 18 seconds each -- and 600/30 means they are 20 seconds apart. So, in other words, you spent 9 minutes not breathing over a 10 minute period. If the test on my hypothetical example were to break out rem and no-rem AHI, it would be 180 AHI for rem and 0.5 AHI for non-rem. It doesn't have to be REM sleep, either -- maybe you are taking your life in your hands each time you sleep on your back, and you only did that for a very short time in the test.

The point is that if you stop breathing for more than a couple of minutes, you are going to be dead. Even a low AHI can mean enough not-breathing time to do serious damage if it's all clustered together over a short enough time window.

The only way that anyone can tell if alarming things are hiding behind a bland average is by seeing the full breakout of sleep test data.

[Guest]

I agree with those saying to get your detailed reports. They may hold helpful clues. Sometimes a sleep study is not fully representative of how one usually sleeps, particularly if all the sleep stages and sleep positions were not well represented. One thing you said jumped out at me - the part about "waking up sore". Could you be more specific about that?

Sure. When I wake up, my back, chest, neck, and sometimes my arms and legs feel incredibly sore. It feels sort of like the way it feels when you have a flu or had worked out extremely hard the day before. It tapers off as the day progresses, and I end up feeling my best late at night as a result.

[Minky]

I feel like I can REALLY relate....

If you look at my posts you'll see a post from last week with my disappointing sleep study results. I also was really hoping for an AHI that would explain the extreme fatigue and sleep issues. I was referred to a sleep neurologist, whom I'll see in November. I got a diagnosis of chronic insomnia, PLMD, but no apnea. I did have a substantial AHI during REM, but since I got a whole 11 minutes of REM during the sleep study, the overall AHI was too low for my PCP to prescribe CPAP. People on this forum suggested that I may have UARS. Having looked into it I'm convinced that I have it and plan to push (beg) the sleep doc for a CPAP prescription even if my insurance won't cover it.

I also started taking an SSRI again after being off of it for about a year. The reason I stopped taking it is because it made the fatigue so much worse. However, I realized that I was really grouchy and started taking a tiny dose. I will say that it makes me a LOT more tired, to the point that I'm thinking of going off of it again.

I do have some advice that my PCP gave me that I thought was rather flimsy, but was willing to try anything. She told me that I really need to sleep on my side. I thought I did since I fall asleep and wake up on my side every day. My sleep study showed that I was on my back for most of the night. She told me to buy a body pillow, the kind that pregnant women use. I bought the Snoogle. It's GREAT. It's a long, firmly-stuffed pillow with one end that wraps (super comfortably) around your neck and the bottom end is L-shaped and goes between your knees. I find that it firmly anchors me on my side, keeps me from flailing my legs and blocks out a lot of light without interfering with my breathing at all. You can either hug the long part or turn the pillow around and run the long part along your spine. I find it more comfortable to hug it, but either way is very comfortable and keeps you on your side. I got it last Friday and threw it off of myself in the middle of the night, but stuck with it and after having slept with it for less than a week am sure that I can never be without it. I still do have some very serious sleep problems that need to be treated, but I feel a LOT better using this pillow. I'm still tired, but I do see a real difference.

Best wishes.

[Kennerly]

Minky wrote:

"I also started taking an SSRI again after being off of it for about a year. The reason I stopped taking it is because it made the fatigue so much worse. However, I realized that I was really grouchy and started taking a tiny dose. I will say that it makes me a LOT more tired, to the point that I'm thinking of going off of it again."

Don't know if this would be appropriate for your specific situation but there is an antidepressant that generally doesn't increase fatigue: Wellbutrin/Bupropion. If I recall correctly it is similar to but technically not an SSRI.

[Wulfman...]

Hi all,

I've had classic apnea symptoms for a while now. I'm incredibly sleepy during the day, wake up feeling extremely sore, have no energy, difficulty losing weight, etc. I went for a sleep study and was very disappointed when my AHI was only 5.5, and my oxygen level fell to 90 at its lowest.

My doctor ordered a split sleep study test (with the CPAP mask) at my insistence, but doesn't really think it's necessary.

I'm disappointed because I was hoping to see a much higher AHI # and that I would finally be able to begin to fix my energy and sleep problems. I'm not sure where to go from here

Just bypass the medical establishment and go it on your own. It's not hard to find lightly used machines and masks. Be sure to get a fully data-capable machine so you can monitor your therapy.

With a minimal investment, at least you'll know or have a better idea whether this is what your problem has been.
If you go at it in a calculated manner, a little "air" while you sleep won't hurt you at all.


Den

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