Hypopnea questions

[Kaylis]

Hey all,

I've just found this website, and I'm thrilled to have such a great resource. Somewhere here I'm sure there is a detailed discussion of hypopnea specifically, but I haven't found it so I decided to start a thread and see what response I got.

I'm just 47 years old and the mother of two boys (9 and 5). We live in an old farm house in Southwestern VA. I've been diagnosed with Hypopnea, but not Apnea. On the initial sleep study (last September) my results showed that I not only had problems when I was asleep, but also when I was awake (though less so). I don't have the report where I can get to it at the moment, but another thing I remember that seemed significant was that my REM percentage was 0. I'm using a REMSTar Pro M series machine (with C-flex) with heated humidifier, and nasal pillows (can't find the package to give the specifics). At the moment I'm at a pressure of 13, though I started at a 9. About two months later my doctor raised it to 11 on my request because my sleep was better, but didn't feel like enough. I then raised it myself (someone showed me how) because my allergies were worse in the Spring and I wasn't sleeping as well again. The doctor said he likes to go by increments of 2, though I don't know why. My C-flex is at 3, but I vary it sometimes. I've been running an AHI of around 3.0 recently. I know how to check the data on the scrolling menu, but not anything else.

Anyway, I understand the definition of Hypopnea on the definitions page, but that doesn't mean I really have a handle on it. First, is there anywhere specific I can details of how it works and how it's similar/disimilar to Apnea? Also, I saw the research link about self-adjusting and Apnea, but is there any for Hypopnea specifically? How do I go about getting what I need to access whatever other info. my machine can tell me?

The other health issues I have are Fibromyalgia, Mild Myoclonus (diagnosed years ago in a sleep study, but didn't show up on this one), Asthma, Allergies, and High Blood Pressure. I know the Fibro is helped by the CPAP, but the Hypertension doesn't seem to be responding (I was hoping it would -- I'm on three meds).

Thanks in advance for any and all replies!

[BlackSpinner]

I don't have an answer for you but I am bumping it back up top.
Personally I assumed hypopnea were apnea wannabes and have ignored mine.

[Rustyolddude]

I don't have the report where I can get to it at the moment, but another thing I remember that seemed significant was that my REM percentage was 0.

You might want to dig out your report and post the details. Regarding the quote above, this is a prime indicator of Central apena if your regular OSA apneas become central apneas under CPAP pressure. A differnt form of xPAP machine machine is required. You might want to review this 3 part series just for educational purposes. http://www.vpapadaptsv.com/learn.html

[Pugsy]

APNEA = cessation of airflow for 10 seconds or greater.

HYPOPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.

I would think enough Hypopnea numbers would cause some problems with desats and such if they are frequent enough and come back to back or in clusters. They might be Apnea wannabies but they are significant enough to warrant police action by the machines so I might ignore a couple of them but I don't believe I would ignore a large number. Just because the blockage is not complete doesn't mean that damage isn't being done if O2 levels drop or the heart gets stressed.

One or two little hypopneas might not do any harm but stick 20 of them together in a relatively short period of time and they might be enough to cause some problems. They are events that warrant detection and documentation by sleep studies and xpap therapy so they must have some potential bite in their little wannabie mouths.

Just my opinion for what it is worth.

[ricochetv1]

http://en.wikipedia.org/wiki/Hypopnea

Our friend Mr. Wiki strikes again...

[BeanMeScot]

I only had one or 2 actual apneas during my sleep study and 1 central. It was all hypopneas. The "cure" is the same, though. CPAP. The hypopneas are one of the reasons I didn't originally think I had apnea. No one had ever told me I stopped breathing or gasped. Because I don't. I just snored. But low O2, is low O2.

[ricochetv1]

I only had one or 2 actual apneas during my sleep study and 1 central. It was all hypopneas. The "cure" is the same, though. CPAP. The hypopneas are one of the reasons I didn't originally think I had apnea. No one had ever told me I stopped breathing or gasped. Because I don't. I just snored. But low O2, is low O2.

I had more hypopnea events than apnea events. Overall, the lowest my O2 when to was 71%. That put me into the "Severe OSA" range.

[sleepyinstlouis]

http://en.wikipedia.org/wiki/Hypopnea

Our friend Mr. Wiki strikes again...

The wiki-foo, you haz it.

I was diagnosed with Hypopnea as well and I had to do a lot of learning to explain to my husband just what my problem was. He's a pretty smart cookie to begin with, but sometimes those medical terms just confuse him more than he cares to admit. Now he just teases me and asks me if the Force is strong within me.

[Muse-Inc]

http://en.wikipedia.org/wiki/Hypopnea

Cool! Loved this part:

...Hypopneas can be either central (i.e., as part of a waxing and waning in breathing effort) or obstructive in origin. During an obstructive hypopnea, in comparison to an obstructive apnea, the airway is only partially closed. However, this closure is still enough to cause a physiological effect (i.e., an oxygen desaturation and/or an increase in breathing effort terminating in arousal).

A hypopnea index (HI) can be calculated by dividing the number of hypopneas by the number of hours of sleep. The apnea-hypopnea index (AHI) is an index of severity that combines apneas and hypopneas. Combining them both gives an overall severity of sleep apnea including sleep disruptions and desaturations (a low level of oxygen in the blood). The apnea-hypopnea index, like the apnea index and hypopnea index, is calculated by dividing the number of apneas and hypopneas by the number of hours of sleep. Another index that is used to measure sleep apnea is the respiratory disturbance index (RDI). The respiratory disturbance index is similar to the apnea-hypopnea index; however, it also includes respiratory events that do not technically meet the definitions of apneas or hypopneas, but do disrupt sleep...

I too had only hypops in my Sleep Study, but so many and enough blood oxygen desaturationI was diagnosed as severe.

[IACEYOU]

I too only had hypopneas (20 per hour) during my sleep test, and only one of them put me into an o2 level of 77%, which automatically made the sleep doctor label me as severe. I call BS, because 77% of my o2 readings were 90% or above, which according to my research is normal. The rest of my o2 readings (22.5%) were in the 80's. I also had zero hypopneas while sleeping on my side, which I usually do but was unable to 3/4th of the sleep study night due to all the stuff hooked up to me. I am 52, 6'3" tall, and fifty pounds overweight (working diligently on that), and snore, but do not snort etc, and I also do not have fatique issues etc. I have had high blood pressure problems my entire adult life, which is being treated. Also, I don't snore when my weight is down, which, as I mentioned, I'm doing very well at reducing, and my hypertension lessons at a lighter weight also.

What's my point here? My general physician is putting the full court press on me to get a CPAP machine and I refuse to get it. During my discussion with him I did not have the results of my sleep study and he had it and all he saw was the severe diagnosis. After he mailed me a copy I have had time to dissect it a bit (see above) and I respectively have to disagree with all this pressure to get this CPAP machine. My numbers and symptoms just do not warrant it, in my lay opinion.

I would appreciate any other lay opinions on my situation, and thanks for letting me rant.

ken

[twokatmew]

I would appreciate any other lay opinions on my situation, and thanks for letting me rant.

Well I suppose you're going to want to rant at me too, then. I had all hypopneas in my diag sleep study (with the exception of one central apnea) and was subsequently diagnosed with moderate OSA. From looking at your numbers, I'd say get the machine. It's going to take you a while to lose those 50lbs., and even then you still might be having events. Further, will you be able to keep the weight off? Sorry, but it sounds to me you just don't want the machine. I don't want it either, but it's a relatively simple fix -- no surgery, no pills, no injections -- just a mask on my face every night. After having lived with an ileostomy and peritonitis requiring several IV antibiotics twice daily for many, many months (then followed by more surgery), CPAP is not worth whining over IMNSHO. Get it. Your body will thank you in the long run.

BTW, welcome to the forum!

[IACEYOU]

Thanks for the welcome two. And no, I won't rant at you.

I know my original post makes it painfully obvious that I don't want to get on the machine. I only agreed to the sleep test because my doctor tried to get me to do it a couple of years ago, and has been fairly persistant. Why? Probably because of my high blood pressure and my fluctuating weight I suppose (from 215 to 265). The weight I attribute to loving food so damn much, and the HBP to my gene pool. I've been on some form of medication since age 17 (still quite thin for my moderate build back then and into my 20's, 30's and 40's). Besides those two factors I have no other quote unquote normal symptoms of sleep apnea.

I'm glad it's easy for you to wear the machine, and from what I've read a central apnea episode is one of the more severe types, is that right? If I wasn't sleeping restfully and feeling fine every day I'd be more concerned. Yes, it will be a few months losing that weight, but as long as I stick to side sleeping (remember - no arousals during side sleeping) and continuing to eat right and increase exercising, I think I'm fine without the machine. Perhaps my view is too prejudiced against the mask etc, but if I really do have a handle on what I consider mild hypopnea caused by weight gain then I feel justified. I also find it hard to believe that wearing a CPAP machine will cure my HBP or keep me from gaining weight back. I'm of the opinion that that is a me problem and not a sleep/o2 level problem.

But I came to this site to get other views and opinions, and I will gladly listen.

[Catnap]

I had mostly hypopneas during my sleep study, also. I also have high blood pressure which was very refractive to treatment (i.e., no matter what combination of meds, it wouldn't stay in the normal range). After I started CPAP, my blood pressure stabilized and remains under good control with one medication, for the first time in many years. Also, I lost weight once I started CPAP with no deliberate effort; I attribute it to the increase in energy, but there is some research that indicates that sleep problems may contribute to obesity fairly directly. My own thinking would be, if you don't trust your sleep doc enough to try CPAP on her/his recommendation, take your study results to another one for a second opinion. Maybe the second opinion will agree with your thinking, maybe not. At least you will feel more confident that you are/are not taking a serious health risk.

[IACEYOU]

I had mostly hypopneas during my sleep study, also. I also have high blood pressure which was very refractive to treatment (i.e., no matter what combination of meds, it wouldn't stay in the normal range). After I started CPAP, my blood pressure stabilized and remains under good control with one medication, for the first time in many years. Also, I lost weight once I started CPAP with no deliberate effort; I attribute it to the increase in energy, but there is some research that indicates that sleep problems may contribute to obesity fairly directly. My own thinking would be, if you don't trust your sleep doc enough to try CPAP on her/his recommendation, take your study results to another one for a second opinion. Maybe the second opinion will agree with your thinking, maybe not. At least you will feel more confident that you are/are not taking a serious health risk.

I have thought about a second opinion. At first it seems like it would be a betrayal, but I suppose most docs are used to it, and I, the customer, always comes first I suppose. I've been with my doc for almost 20 years now. Makes it harder to do that.

[twokatmew]

Well ... I didn't mean to imply that CPAP therapy is easy. It's not, certainly not at first. I'm about to finish my second month, and I'm still struggling with a too-high AHI. I've spent a small fortune on a variety of masks, and I still haven't found one that really works for me. But ... it's better than the alternative, and I have hopes that eventually I'll find the right mask/pressure that will make this therapy work well for me.

CPAP won't necessarily cure high blood pressure, but it ought to help quite a bit. I know of two people who've been able to go off their HBP meds after getting treatment for OSA. Do you really feel great and full of energy? Sometimes things creep up on us. You might feel better with CPAP therapy. I didn't realize just how exhausted I was until the last few months before I had my sleep study. Even though my therapy is not optimized, I am feeling better most days. I also don't get up to pee at night so much, either. In my family HBP, heart disease and diabetes are rampant. Everyone snores, snorts and gasps. Yet no one will get tested. I rarely snore, and if I do it's very lightly. I don't have HBP. Yet I'm the one with OSA. It's very possible to have it and not know it. What would it cost to try CPAP therapy and see how you feel? Besides -- then you could list your cool equipment in your profile, like the rest of us.

A couple years ago a friend's husband died in his sleep while away at a retreat with friends. He was 49, very fit and seemingly very healthy. He had plenty of energy and was a jogger. COD was cardiac arrest, and although no one knows for sure, his wife believes he had sleep apnea, now that she knows more about the condition. Apparently he did snore, snort and gasp in his sleep.

As far as central sleep apnea goes, one central apnea is meaningless. My titration study showed several more centrals, but they can go away once the patient gets used to CPAP (or so I've read). I suppose my doc will look deeper if my AHI is still too high once I find the perfect, leak-free mask.

I also agree with Catnap's suggestion of getting a second opinion. If your doc gets bent out of shape, you don't want that doc anyway. I don't ask for a second opinion very often, but the couple times I have, both docs welcomed it. Good docs want to see you get proper treatment, whether it's from them or someone else. A doc who feels threatened by a second opinion is one I'd stay away from....

Anyway, I'll get off my soap box now.