newbie, 35 arousal/hour, very mild apnea

hi,

I have spent a few hours reading posts on this board, but I thought I should post since my situation may be different from many of you being that I have very mild sleep apnea (they said to set my CPAP to a 6) but my arousal index is very high, at about 35 per hour. I do not know anyone that uses a cpap, so I am just looking for advice. I have tried the respironics m series pro w/ cflex during my mask fitting and thought it to be very comfortable when using the swift LT nasal pillow mask (of course I actually have no idea because I have not slept with it yet....can't get the cpap til monday). My main problem seems to be that my turbinates always have inflammation (allergies, not sure what else is wrong...i have tried allergy shots, every pill/spray nasonex nasacourt affrin allegra clariton etc) and I have always been a mouth breather. I tried an in office procedure using electrocaudery to shrink the turbinates, which didn't really solve the problem, which is why I am now going to try CPAP. I always wake up with dry mouth, and know I have been breathing out of my mouth. During the sleep study ( I have had 2 now), I was able to breath through my nose, and it felt like the cpap with nasal pillows helped open up my nose.

I was wondering if there was anyone on this board with a similar situation of very mild apnea and a large arousal index, (the doc also mentioned some alpha delta sleep disorder) that could offer me advice on the machine, which mask works best for them as a mouthbreather, or if cpap has been helpful for this type of problem! I am only 22 years old, and am getting my doctorate in school and I am sick of fighting falling asleep in every single lecture!

thank you for your time!

Jay,
We're missing something here in your report, so I'll try to clarify some basic terms:
Apnea - is when you stop breathing for more than 10 seconds and your oxygen drops. When you go to a sleep study, they count your apneas.
Hypopnea is when your breathing becomes 50% shallower, and your oxygen drop. When you to to a sleep study they count your hypopneas too.
The they add the apneas and hypopneas, divide them by the number of hours you slept, and the resulting number is your apnea hypopnea index. This is called AHI - and it is this that defines the severity of your OSA (obstructive sleep apnea). The pressure you need to keep your airway open does not indicate the severity of your OSA.

Now, some people may have arousal caused by breathing disruptions that are not serious enough to be considered apnea or hypopnea. Those people may have Respiratory Effort Related Arousals - a high Respiratory Disturbance Index - with a low AHI. An arousal index of 35 is severe.

So what are your arousals a result of - apneas? hypopneas? Or are they RERAs?

People often resort to mouth breathing because of their sleep disordered breathing. Their snoring irritates their airway, and a vicious cycle develops out of that - with an airway inflammation.

When you are on cpap you breath filtered air - some of us use a fine particle filter - and you are suppose to have a heated humidifier. Filtered and humidifed air can bring great relief to your irritated airway.

Mask fit is something very personal. And some people discover that while on cpap, they have become nose breathers.

Sounds like you have basically the same thing I have. I was scheduled for the turbinate thing, but got a cold and it was cancelled. I then decided I didn't want it. I have a very narrow nose that with the slightest inflammation seems to be virtually blocked. I wear a nose strip. I wish Breathe-Right strips could be considered a fashion accessory so I could wear one all the time. I only joined the forum last month and in that time many mouth breathing/dry mouth topics have been addressed, so there is plenty of information for you to peruse. It sounds like you have or will be getting the same set up I have. If you were successful with the nasal pillows during the sleep study, perhaps they will be as good at home.

My apnea hypopnea index according to the Rx that I have with me says RDI 10. I am not positive what my arousals are from, although I do know that my oxygen levels during the sleep study stayed very high (in both sleep studies i completed), from what i remember they were like 97% (or close to it). I know for sure they never dropped down to 90. What would an RDI of 10 indicate?
thanks

An RDI of 10 is mild - you original description of mild apnea, with many arousals was right on.
O.

jaymp04 wrote:My apnea hypopnea index according to the Rx that I have with me says RDI 10. I am not positive what my arousals are from, although I do know that my oxygen levels during the sleep study stayed very high (in both sleep studies i completed), from what i remember they were like 97% (or close to it). I know for sure they never dropped down to 90. What would an RDI of 10 indicate?
thanks

You do need to use cpap, Jay. With a high arousal index and O2 levels staying up nicely, it sounds like you may have "UARS" (Upper Airway Resistance Syndrome.) At the least hint of airway collapse, your brain is arousing you to breathe better. Arousing you before your O2 can drop badly. Arousals fragment sleep architecture -- giving you poor sleep instead of good restful sleep. UARS is treated with CPAP too.

By the way, it sounded like you might be thinking that the amount of pressure you were prescribe ( 6 cm H20) is because you have "mild" (the RDI of 10 )sleep apnea. That you have mild sleep apnea and are prescribed a low pressure is just a coincidence in your case. Some people with severe sleep apnea need only a low pressure to keep their airway open. Some with mild sleep apnea need a very high pressure. The amount of pressure it takes to keep the airway open depends on a person's anatomy -- not on the diagnosis of mild, moderate, severe.

Welcome to the message board, Jay, and good luck with your treatment!


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Upper Airway Resistance Syndrome
Links to info about UARS:

http://www.clevelandclinicmeded.com/dis ... /sleep.htm
UARS is discussed about halfway down the page at that site.

ncbi about UARS

http://www.chestjournal.org/cgi/content/full/115/4/1127

http://ajrccm.atsjournals.org/cgi/conte ... 161/5/1412

http://ajrccm.atsjournals.org/cgi/conte ... 161/5/1413



New Here/Need help with Sleep Study Results
sleepydave (RRT, RPSGT, manager of an accredited sleep lab) is the same person who goes by the nickname "StillAnotherGuest" on this board.

In that thread:
___________________

sleepydave
Moderator [apneasupport.org]
Joined: 05 Jul 2005
Posts: 813
Location: In the Sleep Laboratory


What's UARS?

Hi Arline!
UARS is the acronym for Upper Airway Resistance Syndrome. It is characterized by respiratory events that are not severe enough to be classified as apneas or hypopneas still cause arousals. These respiratory events can be snores or minor narrowing of the airway, but the increased negative intrathoracic pressure trying to draw air through the restricted airway, as well as the arousals, can cause the same havoc as plain old OSA.
Here's an interesting blurb that should perk your ears up:

UARS

So it's still nothing to sneeze at.
Sure, continue to gather more info, including maybe seeing an ENT. Also keep in mind that surgery of the upper airway can have some significant associated hazards, so don't make that decision lightly.
See what the CPAP results bring, then maybe go from there.

sleepydave
__________________

Well, I certainly thought that a 6 was because my apnea wasn't severe.

Thanks for the clue-in!

Thank you so much for the information! It is all starting to make more sense now. After my first sleep study they diagnosed me with UARS, but I could not find much information about it, and even with this diagnosis they did not offer me a CPAP! I guess it is a very good thing then that my brain is alerting me before my O2 levels drop significantly,which definitely explains my symptoms....I do not fall asleep talking with someone, but other than that, I feel like someone with narcolepsy. I feel extremely fatigued all day and find myself constantly fighting falling asleep in any passive situation (lectures, sitting in a car, studying, etc.) I can't believe how helpful this forum has been so far...and I can't wait to get my cpap!

Another question.....I was told I also may have an alpha intrusion or alpha delta sleep disorder. The doctor told me that normally someone gets delta waves, which is the most restorative part of the sleep cycle, and I have alpha waves mixed in with delta waves. I believe she said this occurs in sleep stage 3. Does anyone know if this is tied into UARS/apnea? Is there a chance a cpap will solve both of these issues, or is the alpha intrusion disorder something that is completely separate?

Dunno. I *think* that one of the common ways a person can have alpha wave intrusions is if they have pain while sleeping. Like arthritis or back pain. There are probably many other causes of alpha intrusions, but I don't know what they are.

I am very young (22) and have no chronic pain or arthritis or any problems like that. I guess I will just try and get some more info from the doc when I go in for a follow up in 6 weeks