Mild OSA

[WG426]

Hello!
I was recently diagnosed with mild OSA with an AHI of 6. All events were hypopneas in nature and all events occurred during the two REM periods I had while in the sleep study. I slept for a total of 5.5 hours and woke up a total of 97X, of that, 32 were hypopneas. I should mention that I am a 31 year old female, 5'3" and 110 lbs. I am an avid runner. I complained of feeling tired (not fatigued) for the past 7 years! Due to being a registered medical assistant, I've had lots of access to physicians and medical care. After every blood test was repeated over and over, I was finally referred to a sleep medicine physician at Yale to rule out narcolepsy. My nap study did not reveal narcolepsy but my overnight study revealed mild sleep apnea. It is thought to be caused by my deviated septum. I can't really get advice on how I should treat the apnea since it is so mild in nature. The dentist who I was referred to for a mouth piece said it will not help if my hypopneas are due to septum deviation. As far as my symptoms go, I am mostly just tired/ drowsy, have unrefreshing sleep, sometimes (rarely of as lately) feel a little damp on the collar os my tee shirt at night, and wake up w a wicked sore throat. It seems I do not qualify for a CPAP. Has anyone else with mild apnea been treated with a CPAP and have found it successful? I'd prefer not to have my nose fractured and fixed if I could get away with using a CPAP, as my deviation doesn't cause me sinus infections, etc.

I should mention my 02 baseline was 97 and during the hypopneas the lowest was 89 percent. Of the 5.5 hours I slept, 6 minutes was spent below 90 percent 02.

[HoseCrusher]

CAN you benefit? Yes.

Will the slight benefit completely resolve your tiredness? Probably not, but it will help.

[Pugsy]

The overall AHI was 6...what was the AHI when in REM?
You can figure it by figuring up how much time was in REM and extrapolating to make it hourly and do the same with the apnea events...and come up with a REM AHI. Sometimes they do it for you on the sleep study report. Separate AHI number just for REM.

My OSA is worse in REM...a little worse than yours in non REM.
In REM it was 53 per hour...in non REM 12.

Mine is mild in non REM but severe in REM...and cpap has helped a lot.

The sore throat thing...that's from snoring and it will help that too.

I wouldn't want my nose broken either especially if there is no guarantee that the apnea was from the nose issues.

It's quite common for OSA to be worse in REM (and when sleeping on our backs). While we can often control sleeping position we can't control REM.
If it were me and I was in your shoes I would at least try cpap. There's a good chance it will help.

Do it now while you are young and maybe avoid getting to be like I am... Not to mention the misery in between.
It's worth at least trying. If insurance won't cover it there are ways of getting the equipment without insurance that don't break the bank.

[WTG426]

The overall AHI was 6...what was the AHI when in REM?
You can figure it by figuring up how much time was in REM and extrapolating to make it hourly and do the same with the apnea events...and come up with a REM AHI. Sometimes they do it for you on the sleep study report. Separate AHI number just for REM.

My OSA is worse in REM...a little worse than yours in non REM.
In REM it was 53 per hour...in non REM 12.

Mine is mild in non REM but severe in REM...and cpap has helped a lot.

The sore throat thing...that's from snoring and it will help that too.

I wouldn't want my nose broken either especially if there is no guarantee that the apnea was from the nose issues.

It's quite common for OSA to be worse in REM (and when sleeping on our backs). While we can often control sleeping position we can't control REM.
If it were me and I was in your shoes I would at least try cpap. There's a good chance it will help.

Do it now while you are young and maybe avoid getting to be like I am... Not to mention the misery in between.
It's worth at least trying. If insurance won't cover it there are ways of getting the equipment without insurance that don't break the bank.

Ok, I think I'm posting back correctly LOL
I have my report but don't have access to it at the moment. I believe my total REM time was 72 minutes. My husband reports no shoring on my end, as well as the sleep report, but I am a super mouth breather, which is likely the cause of my sore throat. The dentist said I shouldn't be tired with an AHI of 6.

[Pugsy]

The dentist said I shouldn't be tired with an AHI of 6.

Well that's an overall over the entire night's average for one thing...and having crappy REM sleep just by itself will mess with how a person feels.
And how about I go over to his house and wake him up every 10 minutes (that's what the AHI of 6 means all night average)...every hour all night long and see just how tired he is or isn't.

I bet he won't be feeling so great.

[WTG426]

The dentist said I shouldn't be tired with an AHI of 6.

Well that's an overall over the entire night's average for one thing...and having crappy REM sleep just by itself will mess with how a person feels.
And how about I go over to his house and wake him up every 10 minutes (that's what the AHI of 6 means all night average)...every hour all night long and see just how tired he is or isn't.

I bet he won't be feeling so great.

Right? He felt my test was "overscored" and never heard of sweating from hypopneas! Super frustrating bc after I received my results indicating mild apnea it was a sense of relief to know that after all those years I finally had an answer!

[Pugsy]

Hyponeas aren't as benign as some people thing they are..."only hyponea and not a real Obstructive apnea".

Here's the deal ..the hyponea are some where between 40 and 80 reduction in airflow that lasts 10 seconds or more.
There are still a very potential disturbing factor towards sleep itself...that's how come we count them for one thing.

And another thing...a reduction in airflow of 79% gets a hyponea name card...a reduction of 81 % get an obstructive apnea name card.
In terms of what it does to the body or your sleep...that 2 % difference doesn't mean a thing.

[Julie]

.

[WTG426]

Hyponeas aren't as benign as some people thing they are..."only hyponea and not a real Obstructive apnea".

Here's the deal ..the hyponea are some where between 40 and 80 reduction in airflow that lasts 10 seconds or more.
There are still a very potential disturbing factor towards sleep itself...that's how come we count them for one thing.

And another thing...a reduction in airflow of 79% gets a hyponea name card...a reduction of 81 % get an obstructive apnea name card.
In terms of what it does to the body or your sleep...that 2 % difference doesn't mean a thing.

...agreed! And from what I know as far as 02 is concerned, 89% is less than desirable.

[jnk...]

Some general rules of thumb based on my personal opinions:

1. Never ask a dentist to interpret your sleep-study results (unless also an actual AASM sleep doc), and never ask a sleep doc to pull one of your teeth (unless also an actual ADA dentist).

2. Give CPAP the full shot before any surgery; surgical pain is only worth it when the less painful options are considered less effective.

3. Most all septums are deviated to one extent or another.

4. "Mild" OSA has medical meaning but is not considered by most experts to be the definitive indication of how much one's sleep is affected by breathing or how much one's sleep might be corrected by PAP.

5. Breathing is only one thing that can make one's sleep less than optimal. So, often, the idea is to fix sleep-breathing first to get that aspect out of the way before figuring out what else may be a factor in the sleep issues. There is no way to know whether sleep-breathing has been fixed if there is no nightly data.

6. Many dental approaches to improving sleep-breathing, such as oral devices, are often more expensive in the long run than a nice PAP machine that would provide efficacy data that can be used to monitor the effectiveness of the PAP. No oral device will give you that.

7. Most non-PAP approaches to sleep-breathing help about half the people half the time to improve their problem by 50 percent, even when used properly and diligently. (Which, according to my personal form of math, makes non-PAP approaches about 12.5% effective by comparison to proper, diligent PAP.) I believe properly, diligently used PAP has a better percentage chance of completely eliminating the significant sleep-breathing problems of most people, even those with an untreated-AHI under 10. Just my opinion, that. (And my math, as always is HIGHLY suspect, since I have no sources, and wouldn't understand the sources even if I had them.)

-jnk

[WTG426]

Some general rules of thumb based on my personal opinions:

1. Never ask a dentist to interpret your sleep-study results (unless also an actual AASM sleep doc), and never ask a sleep doc to pull one of your teeth (unless also an actual ADA dentist).

2. Give CPAP the full shot before any surgery; surgical pain is only worth it when the less painful options are considered less effective.

3. Most all septums are deviated to one extent or another.

4. "Mild" OSA has medical meaning but is not considered by most experts to be the definitive indication of how much one's sleep is affected by breathing or how much one's sleep might be corrected by PAP.

5. Breathing is only one thing that can make one's sleep less than optimal. So, often, the idea is to fix sleep-breathing first to get that aspect out of the way before figuring out what else may be a factor in the sleep issues. There is no way to know whether sleep-breathing has been fixed if there is no nightly data.

6. Many dental approaches to improving sleep-breathing, such as oral devices, are often more expensive in the long run than a nice PAP machine that would provide efficacy data that can be used to monitor the effectiveness of the PAP. No oral device will give you that.

7. Most non-PAP approaches to sleep-breathing help about half the people half the time to improve their problem by 50 percent, even when used properly and diligently. (Which, according to my personal form of math, makes non-PAP approaches about 12.5% effective by comparison to proper, diligent PAP.) I believe properly, diligently used PAP has a better percentage chance of completely eliminating the significant sleep-breathing problems of most people, even those with an untreated-AHI under 10. Just my opinion, that. (And my math, as always is HIGHLY suspect, since I have no sources, and wouldn't understand the sources even if I had them.)

-jnk

-- the dentist I was referred to is also an AASM sleep doc and performs "at home" sleep tests. I had my sleep study at Yale because I work for Yale related facility and that is what my insurance would pay for. He is also the dentist who was going to make my sleep appliance.
-- yes, most do have deviated septums, but some are most definitely worse than others (this I know for certain from working in the field)

Thank you for your help.

[jnk...]

Then the dentist must agree wholeheartedly with the AASM position on appliance vs PAP:

http://www.aasmnet.org/articles.aspx?id=5695

My opinion as a nobody based on nothing more than a few lectures by AASM ENTs is that if a deviated septum causes daytime issues, go for it. Otherwise PAP first.

That said, patient preference is important, and something is often better than nothing.

An AHI over five should qualify you to try PAP. Maybe the test was overscored, but on nights you eat late or have wine or a cold, you might have scored a 15. Even some with an AHI below five benefit from PAP. The trick is getting payers to cover the trial.

[WTG426]

Then the dentist must agree wholeheartedly with the AASM position on appliance vs PAP:



My opinion as a nobody based on nothing more than a few lectures by AASM ENTs is that if a deviated septum causes daytime issues, go for it. Otherwise PAP first.

That said, patient preference is important, and something is often better than nothing.

An AHI over five should qualify you to try PAP. Maybe the test was overscored, but on nights you eat late or have wine or a cold, you might have scored a 15. Even some with an AHI below five benefit from PAP. The trick is getting payers to cover the trial.

Thanks! I agree regarding getting insurer to pay for the pap, that might be the hard part and that something is better than nothing. I pulled up my sleep report and it reads...

Hypopnea index total: 5.8
RDI: 5.8
Breathing: the apnea-hypopnea index was 6/ hr. The rem ahi 26/ hr. The supine ahi was 0/ hr. Respiratory events were mostly hypopneas in nature. Goes on to say I had no PLMs and about my O2 sats.
Impression: obstructive sleep apnea. Overall AHI 6/ hour, arterial saturation nadir of 89% and then it goes on to say in other words how my nap study didn't show narcolepsy and why.




What's an RDI compared to an AHI?

[Pugsy]

For understanding the terms shown in your sleep study.
http://adventures-in-hosehead-land.blog ... -test.html

Your overall AHI may not be overly exciting but the REM is. That's what bought you the diagnosis. Over 30 is considered severe.
We typically have several separate REM cycles during the night.

[SnoringInOregon]

What's an RDI compared to an AHI?

The AHI is the sum of Apnea plus Hypopnea.

The RDI is the sum of Apnea plus Hypopnea plus something called RERA (respiratory-effort related arousal).

In your case you didn't have any RERA events because if you did your RDI would have been higher than your AHI. So you don't need to worry about them.

In my case, with my initial CPAP setup, I had a good AHI but a lousy RDI. This meant that my body was struggling to breathe and I would be partially waking up ("arousal" ) to help myself breathe. Fortunately a slight increase to my CPAP pressure cleaned up the RERAs. So they're often easy to deal with.