Mild apnea & oxygen levels.

[Cudos]

Hey gang looking for some opinions here.
How strong is the relation between o2 sats, hypopneas, and rera's. The reason I ask is this.

My sleep study had shown 14 events with a minimum low of 91.4 oxygen level. The report did not show obstructive, CA, Hyponea or Rera's, just events with some snoring.

I have taken 3 more oxygen level test while sleeping since starting cpap. The 2 that were take while NOT using Cpap were 92.4 and 92.9 for the average low.

The 1 time I have taken it while using Cpap was 93.3 for a average low. Now, of all the SH reports I've been doing on myself I see that most of my problems appear to hypopnea's and rera's with little to no obstructive or ca's. And seeing as my sleep study report (remmer) only showed 14 events I have no idea if they were Hypopnea's, rera's or otherwise.

I would have thought my oxygen levels would be lower having apnea. My doctor seems to think I do not need cpap and says my oxygen levels are fine. Of course there are days I feel rested and days i felt tired before cpap and on cpap now.

I was told i had mild apnea (sleep center) but with oxygen levels within acceptable levels and days where I feel rested "and" days where I also feel tired from poor sleep I am wondering whether I really do need therapy??? Add in the fact that my journey thus far on cpap has been less than outstanding it makes it even more confusing.

So in short, if most of my events are Hyponea's and rera's with acceptable oxygen levels would I still be better served using cpap even though my oxygen levels don't increase much at all on cpap? If, at the end of the day say in 6 months I don't feel any better than i did before which wasn't horrible "all the time" should I just quit cpap?

Of course the sleep center says I have to be on therapy and my GP kinda of rolls his eyes at the idea but says its up to me. I seem to be right in that sweet spot of needing or not needing it.

Thanks for listening

[Julie]

If your 02 levels are within a normal range then the point of Cpap is not to necessarily raise them even more, but only to counteract a range below normal should it appear, and that doesn't seem to have happened with you. Needing Cpap is based on proper testing, not justifying this or that.

[greatunclebill]

you didn't mention ahi. what was your sleep study ahi and what is sleepyhead saying your ahi is. mild sleep apnea only refers to the number range your ahi is in. if a person's o2 drops to 88 or below for a sum total of about 6 minutes for the whole night, supplemental o2 is usually added. your 91 and 92 averages mean that it is lower and higher. if you are at 92 with cpap, you probably need the cpap. i would look for a board certified pulmonologist sleep doctor that is hopefully board certified in sleep medicine.

[Cudos]

Hi guys, my sleep study showed 14, I'm assuming that's AHI?? but with no breakdown as to whether they were OB, CA, Hypo or Rera's. As i said my 2 oxygen reports without using cpap were 92.4 (basil spo2% 95.5) and 92.9 (basil spo2% 95.6). The one time with Cpap it was 93.3 (basil spo2 95.9)

So my oxygen levels don't appear to be better either way on or off cpap. And SH on cpap pretty much shows all Rera's or hyponea's which if i understand are not actual Apnea's, but wannabe's. It sucks when your doctor thinks you don't need it but the sleep clinic is pushing cpap, all because I snore once in a while, and the "14" number that came back from the study.

Just confusing, but seeing a I have the machines now anyways I will just learn to use them and keep charting my numbers and log how I feel but not be so obsessed as to think I'm going to die without it. I just don't want to do more harm than good because quite frankly I'm a wake way more in the night with the cpap and feel even less rested EVEN though yes I know it can takes months to show any benefit, assuming I really do it need it??

Thanks all

[Julie]

Well, wait a minute! Are you using Cpap because the clinic/lab told you to, or because your doctor prescribed it? If your doctor doesn't think you need it, or e.g. that if you don't sleep on your back you should be ok, then why are you not listening to him? The lab is not a doctor!

[Cudos]

My doctor feels that I don't fit the profile. Large neck, heavy, plummeting oxygen levels. But he saw the sleep study with the 14 AHI, again no breakdown and said If I really wanted a script he would write it but feels sleep clinics are more of a racket (recently) the ever before.

The sleep clinic says my snoring events and my score of 14 suggest i need therapy. They convinced because i do snore from time to time and they say snoring is NOT normal and a sign of sleep apnea, but my understanding is sleep apnea effects O2 levels which in my case are not terrible which my GP keeps mentioning.

So i snore from time to time. Somedays I'm more tired, somedays not. O2 seems within accpetable levels. So is snoring periodically normal or not?? it's like the chicken and the egg conundrum.

Is the cpap designed to thwart low oxygen of which mine is not quite there. I don't snore ever on cpap but my o2 doesn't really change either. I guess it will boil down to how I feel after giving cpap a real shot.

[Julie]

How many nights have you successfully slept on your sides most of the night vs flipping onto your back? Have you tried wearing a backpk temporarily to help you adjust? Or used foam wedges in behind? It could make all the difference, but without your experimenting for at least a few nights no one can say much as things stand. You may still need Cpap, but without testing to see if your apnea is only 'positional'...

Snoring is a symptom, and while it may be great if you don't snore on some nights, or you do, don't use that as a guide to whether or not you need Cpap... big mistake!

[Cudos]

Thanks julie, I think I can be successful sleeping mostly on my sides, i tend to wake up that way , usually with sore shoulders from side sleeping. My wife would say I snore only on my back periodically (doc said I have a soft uvula) but my wife nudges me to turn over. Good advice Julie, I am going to monitor my o2 levels while trying to ensure I stay on my sides using my wife to let me know if she here's any snoring.

If i can ensure I stay on my side, and I don't snore (much) and my O2 levels stay within a decent range does that mean I can avoid the Cpap and that i don't have Apnea? or does that mean I can control my Apnea?

Is it possible to have mild apnea but controllable without Cpap?

Thank-You

[Julie]

Hi - have you tried a new mattress?

In any case, I suggest you try making Cpap work for a while (your doctor's take on what a likely candidate would be is not only out of date, but fairly useless without a lab study and/or Sleepyhead software assessment). Forget 02 stats for now as they are not 'everything' at all. Your Cpap low pressure setting may be too low to be effective (why you still snore - as a symptom of it) so you might try raising it by 1-2 cms for a few nights to see what happens. But in any case, as I said, if you have a prescription (not just a lab tech's say so) for Cpap then you'd need another study to rule out the need for Cpap. If your MD won't play though, and you still don't feel rested, find another doctor, either a licensed 'sleep' doctor, a pulmonologist or neurologist. But please stop trying to get out of using Cpap based solely on 02 stats.

But the best thing to do here is download Sleepyhead and let us see (and interpret for you) what it shows.

[Cudos]

Thanks Julie, I do have SH loaded. Have to wait on replacing the mattress, king size and newer

I'm going to have to just perform my own experiments and log my findings. I would like to get my machine set up to where it appears I'm doing well and go from there. At least I can monitor my O2 sats and not be panicking about numbers and compliance.

Thanks again

[Pugsy]

Sometimes it isn't all about Oxygen levels...sometimes its about arousals or minor low level awakenings that we don't always remember waking up.

Sometimes it's not all about AHI either....a person can have a relatively low AHI but with a large number of arousals (those RERAs could be a sign of an arousal and hyponeas can still cause arousals or sleep disturbances) and when we have arousals the sleep architecture gets messed with and we don't get the needed progression of the various sleep stages and the needed normal amount in each stage.

As to the question of whether or not you really need cpap...probably from strictly O2 stand point you don't but a person doesn't have to have low O2 to need cpap. Not everyone has significant desats. I have a friend whose AHI was in the 60s and her O2 never dropped below 94%.
Sometimes just the snoring will disturb a person's sleep so much that they don't get good quality sleep and cpap just for snoring alone might be prescribed.

Side sleeping might just do the trick and probably worth investigating.

You might also have UARS going on which makes it real hard to measure improvement with just data points from either the AHI or the O2 levels because often with UARS the AHI isn't all that horrible and O2 levels are normal.

[Cudos]

Thank-You Pugsy

Those rera's and hypopnea's that seem to dominate in my case are interesting. I certainly notice the awakenings or shifting more with the cpap on. I don't notice them when I don't have the cpap on, doesn't mean they are not happening but I'm 100% sure I'm awake more with Cpap and given my difficulty in getting used to it may explain the arousals being scored as rera and hypopnea's??

I'm going to keep going with my Cpap and trying to find the sweet spot so that I have a good comparison should i want to try and alter my sleep position while also watching my sat levels. That along with hopefully no snoring should give me a better idea of where i fall with regards to the severity of my apnea and whether or not I can manage without Cpap.

I am happy I have the Cpap, my gut tells me that i probably have mild to very mild apnea which I may or may not be able to control without therapy. My experiments and time will tell. It may very be that it becomes easier to use the Cpap than it is to maintain an Apnea free night of sleep.

Just trying to understand what my body really needs here. Thanks everyone for your patience

[BlackSpinner]

Just think about it AHI 14 that means the equivalent of 14 times per hour someone shakes your shoulder or kicks you = every 4.28 minutes

You should call the lab / doctor and get a copy of your study.

[greatunclebill]

■ Number of apneas and/or hypopneas per hour of sleep (or study time)
■ Reflects the severity of sleep apnea
AHI = 0–5 Normal range
AHI = 5–15 Mild sleep apnea
AHI = 15–30 Moderate sleep apnea
AHI > 30 Severe sleep apnea

you are at the high end of mild, higher than alot of people. get used to using the machine. a real sleep doctor will not take you off of it. in some cases like yours, the tech's know more than the doctor.

[zoocrewphoto]

Sometimes it isn't all about Oxygen levels...sometimes its about arousals or minor low level awakenings that we don't always remember waking up.

Sometimes it's not all about AHI either....a person can have a relatively low AHI but with a large number of arousals (those RERAs could be a sign of an arousal and hyponeas can still cause arousals or sleep disturbances) and when we have arousals the sleep architecture gets messed with and we don't get the needed progression of the various sleep stages and the needed normal amount in each stage.

As to the question of whether or not you really need cpap...probably from strictly O2 stand point you don't but a person doesn't have to have low O2 to need cpap. Not everyone has significant desats. I have a friend whose AHI was in the 60s and her O2 never dropped below 94%.
Sometimes just the snoring will disturb a person's sleep so much that they don't get good quality sleep and cpap just for snoring alone might be prescribed.

I just wanted to add to this. Some of us are so good at preventing oxygen loss that we wake up at the tiniest problem. We don't remember it, but basically the brain stays alert and refuses to let us sleep deeply for fear of suffocating. So, instead of long events with bad oxygen desaturation, we have very short events that don't cause oxygen desaturation, but do disturb sleep. In my sleep study, I had 273 events in less than 2 1/2 hours. I had an ahi of 79 without ever reaching deep sleep or REM. Most of my events were short (10-13 seconds). Just enough to keep me from sleeping well.

Also keep in mind that an event must be 10 seconds or longer to qualify. If you have a lot of 9 second events, they won't show up. Yet, you could be experiencing very poor sleep.

One more thing to add. Snoring is not always present in sleep apnea. Both my mom and i have obstructive sleep apnea. We are both severe. We have the same machine, same mask, similar pressure ranges. I had an ahi of 79+ with lots of short events and very bad snoring. She had a much lower ahi with longer events and much lower oxygen saturation levels. She has long events in clusters. she does NOT snore. AT ALL. Without cpap, she looks like death. No snoring,, no gasping, nothing. Looking at her sleep, you would assume central events rather than obstructive. But she has great success with an apap.