Tired - Low AHI - What To Do?

[DagganothKing]

Hello, I am fed up with sleep issues. Having had same issues for years, it only now occurred to me this is abnormal.
I found reddit sleep apnea group, and this board. Decided to go straight for a sleep study. Results:

* AHI - 2/hour
* RERA - 0.7/hour
* Arousal Index - 21/hour (classified as spontaneous arousals)
* Minimum SpO2 - 91%
* 5% REM sleep (one cycle between 2am and 3am, that's it)

Symptoms: daytime sleepiness, brain fog, depression and anxiety.
Sleep pattern: fall asleep like a log at 10 pm, wake up between 2-3 am and toss and turn.
More sleep results in being less alert.

Things I have tried: magnesium, melatonin, no electronics before bed for 1 hour, meditation,
reading, dim lights one hour before bed.

Anatomy: recessed jaw, teeth crowding, deviated septum, scalloped tongue.

I will get myself to a GP to ask for neurologist or sleep specialist, since the study was done in a different country
privately but I found this board education and wonder what people think. None of my doctors think it is respiratory issue
and more like depression, autonomic system disorder and so on. However, sleep deprivation causes those issues in the first place
and so little REM sleep is extremely alarming.

Looking for opinions.

[Julie]

If I understand you correctly, you're not on Cpap. Why not get a proper sleep study - your symptoms certainly qualify for apnea. Have you had a full lab check-up lately for e.g. glucose, cardiac issues, thyroid, etc. etc? Do you take meds (which)?

[DagganothKing]

Thank you both for replies.

I have done blood work on many parameters and all of them were normal, including thyroid, hormones, etc.
I went to cardiologist as well due to basically being scared that, IF sleep apnea is present, it causes damage to heart
over time and fortunately, besides being out of shape (Started running every day for 3 weeks already) no issues were found.

What else can be causing the arousals? Just looked a bit more into it, and leg movements are not an issue as well. I am also wondering, maybe,
there are folks from UK who know neurologists, sleep medicine specialists they could recommend?

[mangos21]

UARS can cause EEG arousals, reduced REM sleep and insomnia/frequent awakenings.. in fact that sounds like textbook UARS. so I wouldn't rule out sleep disordered breathing. many physicians aren't aware of what UARS is.. Frequently they'll just inappropriately chalk your symptoms up to depression because they didn't learn about UARS in medical school..

ASK them if they know of the disorder or have ever treated it. print off articles and show them that it exists. unfortunately, the end result is that you may be on your own. ask your doctor for a CPAP trial anyway, there isn't much harm to trying cpap at a low pressure like 7 and seeing how you react.

Some people might disagree with me here but if you really want to and can't find a doctor willing to help - get yourself a cpap from craigslist or a similar website if you have the means. and just try it yourself. I've communicated with a couple people in situations like yours who have done that and had their life dramatically turn around with PAP.

[ChicagoGranny]

Things I have tried: magnesium, melatonin, no electronics before bed for 1 hour, meditation,
reading, dim lights one hour before bed.

Here is a basic checklist:

- Practice good sleep hygiene (Google it and read several sources)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

CG

[ChicagoGranny]

DagganothKing

It would be good to have a consultation and examination by an ENT. Briefly tell him your story including that there are suspicions of sleep-disordered breathing. He will examine your tonsils, adenoids, nasal airway, vocal cords, shape of the palate and the condition and size of your soft palate and tongue. It's amazing how a good ENT can accurately predict sleep-disordered breathing through such an examination. He can also spot other problems.

What about your teeth? Do you have less than 32? Are your teeth crowded? These are indications of an underdeveloped jaw which results in a small airway and a high risk of sleep-disordered breathing.

[DagganothKing]

I have crowding in lower teeth. My wisdom teeth in lower jaw are impacted.
My upper jaw teeth are straight, however, wisdom teeth did not form at all in upper jaw. I bet,
the result would be similar to lower jaw, if formed.

I have all my teeth.

[ChicagoGranny]

I have crowding in lower teeth. My wisdom teeth in lower jaw are impacted.
My upper jaw teeth are straight, however, wisdom teeth did not form at all in upper jaw. I bet,
the result would be similar to lower jaw, if formed.

<snip>

That's typical of people with sleep-disordered breathing. If a poll were taken here, it would be certain that most people have similar teeth to yours.

Here are just some examples of causes for sleep apnea from anatomical point of view:

airway size
enlarged tonsils or adenoids
recessed lower jaw
narrow jaw
enlarged uvula
wide, thick or long tongue
deviated septum
chronic nasal allergies
elongated palate
high arched palate
excess airway tissue
short thick neck
obesity - if ones airway is already small, padding it with fat will further restrict the size of the airway making apnea worse.

[Notaffiliated8]

Do you drink alcohol? I used to drink heavily and waking at 3am was standard as it's the time your liver is really working. Even "moderate" drinking could be a cause

[kteague]

A few thoughts... Your description of your jaw anatomy sounds classic for causing trouble with breathing. One thing to wonder about a recessed jaw is whether it is simply underdeveloped or if is of expected size but is inset, encroaching and causing narrowing of the airway even beyond what we see in people who are dealing only with lax tissue or relaxed tongue issues. People whose inset jaw affects airway size don't have much leeway. Some people with this issue are able to stabilize their breathing with CPAP. If there is still trouble when using CPAP, your doctor can order tests to discern exactly how much room is in your airway. Severe cases might resort to the MMA surgical procedure to advance the lower jaw. I know only of one person who had this done. He said the surgery was hell but it saved his life. But that may not even relate to you. I'm getting ahead of myself.

About your sleep study... It did not prove you don't have sleep apnea. It just shows a limited data capture. In many people, events are worst during REM. Do you know if the few events you had were during REM? Who knows how many events you might have racked up with a normal amount of REM. Also, were you supine sleeping during your events and for the whole time of study? Many also have more events when back sleeping. So, a potential worst case scenario is supine while in REM. If you didn't have a substantial amount of time studied supine in REM, you have no idea what your AHI could be on nights when you sleep better than in the lab.

Of course I can't say if you actually have a worse case of OSA than what has thusfar been diagnosed. But I'd need more evidence to the contrary rather than accept inconclusive results.

[jweeks]

Hi,

It will be interesting to see what you learn when you meet with your doctors. I would second the recommendation to look into UARS. I have something similar (issue with my autonomic nervous system not sending a strong enough signal to breathe), so I have a somewhat normal looking sleep study but I wake up feeling like a zombie with mental fog. My machine makes sure I breathe deeply enough, and that makes all the difference. An item you mentioned is tossing & turning. I did that a lot due to some minor pain in my hips (bursitis from over use). I would keep switching sides and while the pain was very mild, it was just enough to partially wake me up when I turned over. Taking one of the PM medications (Tylenol PM in my case) took care of that issue.

-john-

[DagganothKing]

A few thoughts... Your description of your jaw anatomy sounds classic for causing trouble with breathing. One thing to wonder about a recessed jaw is whether it is simply underdeveloped or if is of expected size but is inset, encroaching and causing narrowing of the airway even beyond what we see in people who are dealing only with lax tissue or relaxed tongue issues. People whose inset jaw affects airway size don't have much leeway. Some people with this issue are able to stabilize their breathing with CPAP. If there is still trouble when using CPAP, your doctor can order tests to discern exactly how much room is in your airway. Severe cases might resort to the MMA surgical procedure to advance the lower jaw. I know only of one person who had this done. He said the surgery was hell but it saved his life. But that may not even relate to you. I'm getting ahead of myself.

About your sleep study... It did not prove you don't have sleep apnea. It just shows a limited data capture. In many people, events are worst during REM. Do you know if the few events you had were during REM? Who knows how many events you might have racked up with a normal amount of REM. Also, were you supine sleeping during your events and for the whole time of study? Many also have more events when back sleeping. So, a potential worst case scenario is supine while in REM. If you didn't have a substantial amount of time studied supine in REM, you have no idea what your AHI could be on nights when you sleep better than in the lab.

Of course I can't say if you actually have a worse case of OSA than what has thusfar been diagnosed. But I'd need more evidence to the contrary rather than accept inconclusive results.

Well, I did some research and it is more complicated than that. Basically, some people tend to develop more vertical face than horizontal (preferable). This means, there is less
space for teeth on the dental arch because the bone mass grew vertically, not horizontally. However, it still has a problem of the lower jaw being trapped behind upper jaw,
the issue is caused by upper jaw not growing forward enough, hence trapping the lower jaw, which makes it seem retruded and set back. The only way anatomically is to move upper jaw
forward, which for now seems impossible without surgery.

I communicated with a dentist from Australia who helps people with sleep apnea, using a SOMA appliance. Shown him the photos and he said the jaw is retruded with not that much chin.
I also have a confirmed deviated septum from ENT. What is interesting is my wisdom teeth in upper jaw did not form at all. I only have lower wisdom teeth and they do not have enough space
to erupt. What it does is tips those wisdom teeth and then they push on the others making them crowd. I saw the x-ray of the teeth structure, but not my airway photos yet. I will need to ask
doctor for that.

According to my data, most episodes were in NREM sleep. However, it does not prove much because I did not have much REM in the first place.
In that brief period, there were 4 sponteneous arousals in REM but no apneas, hypoapneas. As for position of the sleep period, my AHI was 3.1 on left side,
1.1 on back and 1.5 on right side.

Look, I simply don't reach REM sleep much at all. It is evidenced by the study, my inability to dream and memory issues.

Also, are you saying that CPAP won't help people who have bony structures ramming the airway? I thought sleep apnea is mostly anatomy issue.

[ChicagoGranny]

Also, are you saying that CPAP won't help people who have bony structures ramming the airway?

Forget about "bony structures". It seems a safe assumption that you breathe during the day. When you fall asleep, the muscles in the airway relax, and the airway partially or fully collapses. A properly working CPAP system will splint the airway open when you are sleeping.

[kteague]

No, I wasn't saying that CPAP won't work. Just that there can be exceptions. We had a young man on here about 10 years ago who posted his xrays and there was a lot of discussion on the subject. Anything I know about this topic is second and third hand, so please don't consider my contributions authorative. It sounds like you are very well researched and I hope it leads you to some answers.