Been sent my full results for mild sleep apnea.

[Pugsy]

Hey Rick...what are the odds that someone could get a type II home sleep study done in the UK?

[Geer1]

Under 5 AHI is considered normal, 5-15 is mild so you are at the low end of mild for number of apneas/hypopneas. Your oxygen level appears normal and did not drop to a troublesome level, it doesn't appear that sleep disordered breathing is the likely cause of your tiredness.

The note regarding pulse variability and arousals is interesting and you should ask your doctor for an in clinic sleep analysis to determine the cause. You are tired and this test gave you proof that there appears to be something wrong with your sleep. This type of home test is only able to determine breathing related disorders and not the other numerous causes of pour quality sleep.

There are sleep apps that can record your snoring, you could videotape yourself sleeping too. You might hear or see something obvious that you can then bring to doctors attention.

If you take medication research or ask your doctor if it could be causing sleep issues.

Since your heart rate seems to be an issues you could ask your doctor for a holter test to more accurately test your heart rate and confirm the variability is only during sleep.

I'm not sold the rhinitis would be the cause of arousals if it isn't causing apnea, hypopnea or oxygen desaturation events. That said you should try and figure out what the issue is and seeing a different ENT is the obvious way to do that. Have you been tested for allergies? Laryngoscope? Sinus CT? Nasal swab? Tried long term regular nasal rinses and corticosteroids? Bought and used a humidifier or dehumidifier? If you are sure it is an issue keep on pushing for more tests to try and figure out what is causing it, too many doctors give up after only testing for the easy more common causes.

One other thing to consider is how you feel you slept during the sleep study? Did you have a normal nights sleep or have trouble sleeping because of having the equipment hooked up to you?

[palerider]

Under 5 AHI is considered normal,

By *DOCTORS*, but an AHI of 5 is pretty crap. It's like having someone poke you with a sharp stick every 12 minutes all night long. You won't get restful, recuperative sleep like that, no matter whether you, or doctors, say it's "normal".

[rick blaine]

Pugsy asked:
"What are the odds that someone could get a type II home sleep study done in the UK?"

Within the NHS: – slim. In my area, fewer that one in ten possible-sleep-apnea patients gets an in-hospital sleep-lab study. Usually only the more difficult or unusual cases.

With a really severe or unusual case, the clinical argument would be that the in-hospital study is a necessity, given the need to know what's going on. Ie, a complete and accurate diagnosis is not possible without a sleep-lab study. And some doctor, usually at consultant level, would have to make an 'individual funding request'. Ie, make the case on paper for extra money to be spent. More than is spent on the 'standard treatment' as set out by the National Institute for Health and Care Excellence.

On a 'private medicine' basis: – as soon as you like – and as long as you carry private medical insurance, or can pay out of your own pocket. (They may discreetly check your credit rating before accepting you )

In the London area:

BUPA is a medical insurance company which owns and runs their own hospitals, and they offer in-hospital 'nocturnal polysomnography'.

One location: Cromwell Hospital, London. Referral must be from a GP. Dialing from within the UK: 020 7460 5700

HCA Healthcare is a medical insurance company which runs the Sleep Centre at London Bridge Hospital, and they offer 'full montage EEG polysomnography'

Location: London Bridge, London. Referral must be from a GP. Dialing from within the UK: 020 7407 3100

There are other sleep labs in the private-medicine sector elsewhere in the UK, but not that many. From memory, there's a couple in the Brighton area, on the South coast.

I don't know what the typical fee is, but I suspect something like £1800 if the patient is not already with an insurance company.

[Jamaicandon]

Pugsy asked:
"What are the odds that someone could get a type II home sleep study done in the UK?"

Within the NHS: – slim. In my area, fewer that one in ten possible-sleep-apnea patients gets an in-hospital sleep-lab study. Usually only the more difficult or unusual cases.

With a really severe or unusual case, the clinical argument would be that the in-hospital study is a necessity, given the need to know what's going on. Ie, a complete and accurate diagnosis is not possible without a sleep-lab study. And some doctor, usually at consultant level, would have to make an 'individual funding request'. Ie, make the case on paper for extra money to be spent. More than is spent on the 'standard treatment' as set out by the National Institute for Health and Care Excellence.

On a 'private medicine' basis: – as soon as you like – and as long as you carry private medical insurance, or can pay out of your own pocket. (They may discreetly check your credit rating before accepting you )

In the London area:

BUPA is a medical insurance company which owns and runs their own hospitals, and they offer in-hospital 'nocturnal polysomnography'.

One location: Cromwell Hospital, London. Referral must be from a GP. Dialing from within the UK: 020 7460 5700

HCA Healthcare is a medical insurance company which runs the Sleep Centre at London Bridge Hospital, and they offer 'full montage EEG polysomnography'

Location: London Bridge, London. Referral must be from a GP. Dialing from within the UK: 020 7407 3100

There are other sleep labs in the private-medicine sector elsewhere in the UK, but not that many. From memory, there's a couple in the Brighton area, on the South coast.

I don't know what the typical fee is, but I suspect something like £1800 if the patient is not already with an insurance company.

Hey, thanks for all your help.

https://imgur.com/a/eFXERr2

The above link is from my sleep app, you can see instances of my snoring and when they occur, can we glean any insight from this?

[rick blaine]

Hi Jamaicandon,

I'm not familiar with this app, but after a few minutes of study, I note that.

a. You are having episodes of deep sleep, and a total of 34 pc of the time at that.

Sleep experts will tell you that it is during deep sleep that most of the tissue repair and restorative effects go on. And it's especially when periods of deep sleep are interrupted or prevented – say, by apneas – that the patient wakes up feeling tired and unrefreshed.

b. According to this chart, the amount of snoring goes down when you are in deep sleep.

So: you snore – that's for sure – but the alteration of the 'geometry' of your airway that goes with snoring isn't happening, or is happening less, while you are in deep sleep.

c. You can't tell from this chart whether or not any of the snoring immediately progresses to an apnea.

That's my sixpence-worth (US equivalent, two cents ) about this chart.

In addition, if you add in that your Apnea-Hypopnea-Index – the hourly average of breath interruptions lasting more than ten seconds – is 6 – just inside the mild-to-moderate category – then there are some who might say your sleep is not that poor. Or if you feel it is, then the poor quality is coming from some factor other than apneas and not enough time in delta-wave sleep.

As I said before, I think you should go back to your GP, so that he or she can (a) do a complete blood work-up – which is the first step in looking for other possible causes for fatigue – and (b) send you back to ENT because the rhinitis is still bothering you.

You didn't say what the ENT department offered you before, or in what way it didn't help. But it might be that, in addition to their treatment – whatever it was – you might have to change what the doctors call your life-style – what you eat and drink – and your personal environment.

The analogy is with kids and asthma. Sure, the docs can dish out inhalers – blue, brown, purple. But if there are still bed-mites and bed-mites crap in the pillows and in the curtains and on the carpet, the child is going to keep getting triggered. And the inhalers can't do much about it. So special pillows, blinds instead of curtains, and no carpets in the kid's room.

It could be something in your home – or even your job – which is a major part of the rhinitis. There's a thing called Farmers' Lung – a mold infection – and sometimes it can mean the farmer or farm-hand has to change jobs. Likewise, people who work 'in the print' and make big lithographic plates have to work with acid ... and the fumes. And even with good air-change, it still gets bad enough for some guys that they have to find another line of work.

You can discuss possible life-style and personal environment changes with your GP or the staff at the ENT.

[Bjjpapi]

That “sleep” app for Android is great for audio recording and keeping decent track of HR if used with a wearable device. I wouldn’t trust it for sleep stage analysis.

[Jamaicandon]

Hi Jamaicandon,

I'm not familiar with this app, but after a few minutes of study, I note that.

a. You are having episodes of deep sleep, and a total of 34 pc of the time at that.

Sleep experts will tell you that it is during deep sleep that most of the tissue repair and restorative effects go on. And it's especially when periods of deep sleep are interrupted or prevented – say, by apneas – that the patient wakes up feeling tired and unrefreshed.

b. According to this chart, the amount of snoring goes down when you are in deep sleep.

So: you snore – that's for sure – but the alteration of the 'geometry' of your airway that goes with snoring isn't happening, or is happening less, while you are in deep sleep.

c. You can't tell from this chart whether or not any of the snoring immediately progresses to an apnea.

That's my sixpence-worth (US equivalent, two cents ) about this chart.

In addition, if you add in that your Apnea-Hypopnea-Index – the hourly average of breath interruptions lasting more than ten seconds – is 6 – just inside the mild-to-moderate category – then there are some who might say your sleep is not that poor. Or if you feel it is, then the poor quality is coming from some factor other than apneas and not enough time in delta-wave sleep.

As I said before, I think you should go back to your GP, so that he or she can (a) do a complete blood work-up – which is the first step in looking for other possible causes for fatigue – and (b) send you back to ENT because the rhinitis is still bothering you.

You didn't say what the ENT department offered you before, or in what way it didn't help. But it might be that, in addition to their treatment – whatever it was – you might have to change what the doctors call your life-style – what you eat and drink – and your personal environment.

The analogy is with kids and asthma. Sure, the docs can dish out inhalers – blue, brown, purple. But if there are still bed-mites and bed-mites crap in the pillows and in the curtains and on the carpet, the child is going to keep getting triggered. And the inhalers can't do much about it. So special pillows, blinds instead of curtains, and no carpets in the kid's room.

It could be something in your home – or even your job – which is a major part of the rhinitis. There's a thing called Farmers' Lung – a mold infection – and sometimes it can mean the farmer or farm-hand has to change jobs. Likewise, people who work 'in the print' and make big lithographic plates have to work with acid ... and the fumes. And even with good air-change, it still gets bad enough for some guys that they have to find another line of work.

You can discuss possible life-style and personal environment changes with your GP or the staff at the ENT.

Thanks for this, I will be more informed when I go to my gp.

As I wont be issued a cpap, are there any wearables I can use to track my sleep

[Geer1]

You could purchase an oximeter to measure heart rate and blood oxygen. Can also use a webcam to record yourself sleep, either get or make one that works in infrared or do what I did and sleep with lights on and eye mask(like people use on airplanes). I could see myself taking breaths, what appeared to be shallow breathing(was hard to tell I was even breathing), times where II took a deep breath and multiple times I woke up. All supporting my current diagnosis of sleep apnea.

I could be wrong but I don’t believe there are any accurate personal sleep quality devices for home use to get accurate information like is done in an in clinic sleep study. In order to get that information you need brain and muscle sensors etc. Most apps just go off sound. I tried using apps a few times and nothing looked odd but after sleep test I found out I have moderate sleep apnea and severe oxygen desaturation.

I would push your doctor for extra tests, you already have a sleep study indicating some sort of sleep issue. That should be enough to warrant further investigation by your doctor. If not hunt around and try to find a private option that is reasonably priced, probably still need a referral from doctor for that though.

When healthcare is public like it is for you and I (Canada in my case), you have to fight to get proper diagnosis/treatment. You have the data, fight with doctors until they pursue other tests.

[chunkyfrog]

In summary,, "be a pest. " Sometimes it is our only chance.
Just be a nice, respectful pest--whining is permitted.

[Jamaicandon]

https://imgur.com/hQ5gZ7a


https://imgur.com/cd03oGb


Just got a fit bit, it shows that I am waking up many times in the night and like every night my heart rate is spiking way above my resting heart rate.


I've used it for around 2 weeks and every day is the same.... heart rate spiking like this and waking up multiple times in the night..

Hi Jamaicandon,

I'm not familiar with this app, but after a few minutes of study, I note that.

a. You are having episodes of deep sleep, and a total of 34 pc of the time at that.

Sleep experts will tell you that it is during deep sleep that most of the tissue repair and restorative effects go on. And it's especially when periods of deep sleep are interrupted or prevented – say, by apneas – that the patient wakes up feeling tired and unrefreshed.

b. According to this chart, the amount of snoring goes down when you are in deep sleep.

So: you snore – that's for sure – but the alteration of the 'geometry' of your airway that goes with snoring isn't happening, or is happening less, while you are in deep sleep.

c. You can't tell from this chart whether or not any of the snoring immediately progresses to an apnea.

That's my sixpence-worth (US equivalent, two cents ) about this chart.

In addition, if you add in that your Apnea-Hypopnea-Index – the hourly average of breath interruptions lasting more than ten seconds – is 6 – just inside the mild-to-moderate category – then there are some who might say your sleep is not that poor. Or if you feel it is, then the poor quality is coming from some factor other than apneas and not enough time in delta-wave sleep.

As I said before, I think you should go back to your GP, so that he or she can (a) do a complete blood work-up – which is the first step in looking for other possible causes for fatigue – and (b) send you back to ENT because the rhinitis is still bothering you.

You didn't say what the ENT department offered you before, or in what way it didn't help. But it might be that, in addition to their treatment – whatever it was – you might have to change what the doctors call your life-style – what you eat and drink – and your personal environment.

The analogy is with kids and asthma. Sure, the docs can dish out inhalers – blue, brown, purple. But if there are still bed-mites and bed-mites crap in the pillows and in the curtains and on the carpet, the child is going to keep getting triggered. And the inhalers can't do much about it. So special pillows, blinds instead of curtains, and no carpets in the kid's room.

It could be something in your home – or even your job – which is a major part of the rhinitis. There's a thing called Farmers' Lung – a mold infection – and sometimes it can mean the farmer or farm-hand has to change jobs. Likewise, people who work 'in the print' and make big lithographic plates have to work with acid ... and the fumes. And even with good air-change, it still gets bad enough for some guys that they have to find another line of work.

You can discuss possible life-style and personal environment changes with your GP or the staff at the ENT.

[Hopeful2]

It seems I have similar situation as was put on CPAP therapy for mild to moderate sleep apnea by a pulmonologist. But the results were from a home study. After seeing the pulmonologist and starting therapy I decided to see ENT because of my chronic nasal congestion at night due to allergies. I now wish I had gone to ENT first. I was allergy tested and will start allergy shots.
I find CPAP therapy difficult with the congestion and can not get much sleep wearing apparatus. It’s a shame because when my nasal passages are clear I find the therapy a bit helpful but I dip not think I can get proper results because I can not use it enough. I am just getting by at the moment and waiting to see what my pulmonologist says this week about whether to continue therapy or stop.
I use saline spray every day and night and also am trying various decongestant nasal sprays to see if I can get more relief from congestion and therefore sleep much better . I start allergy shots next month and ENT says it can take 6-12 months to see a difference. I was also diagnosed with a deviated septum, inflammation among other technical terms I cannot recall that all contribute to congestion. Allergy shots are first recommended before septum surgery. Good luck and I hope you get answers !!

[Jamaicandon]

It seems I have similar situation as was put on CPAP therapy for mild to moderate sleep apnea by a pulmonologist. But the results were from a home study. After seeing the pulmonologist and starting therapy I decided to see ENT because of my chronic nasal congestion at night due to allergies. I now wish I had gone to ENT first. I was allergy tested and will start allergy shots.
I find CPAP therapy difficult with the congestion and can not get much sleep wearing apparatus. It’s a shame because when my nasal passages are clear I find the therapy a bit helpful but I dip not think I can get proper results because I can not use it enough. I am just getting by at the moment and waiting to see what my pulmonologist says this week about whether to continue therapy or stop.
I use saline spray every day and night and also am trying various decongestant nasal sprays to see if I can get more relief from congestion and therefore sleep much better . I start allergy shots next month and ENT says it can take 6-12 months to see a difference. I was also diagnosed with a deviated septum, inflammation among other technical terms I cannot recall that all contribute to congestion. Allergy shots are first recommended before septum surgery. Good luck and I hope you get answers !!

Did your heart rate spike like mine? What was your ahi?

[Geer1]

Heart rate spiking is normal in OSA (within reason).

First step: Blockage occurs restricting ability to breath.
Second step: Oxygen levels start to drop.
Third step: Brain says uh oh something is wrong. Gives body a shot of adrenaline which increases heart rate, causes arousal etc.

Treat the OSA and heart rate should calm down. If it doesn’t then start looking into it more (cardiologist etc).

[Jamaicandon]

Heart rate spiking is normal in OSA (within reason).

First step: Blockage occurs restricting ability to breath.
Second step: Oxygen levels start to drop.
Third step: Brain says uh oh something is wrong. Gives body a shot of adrenaline which increases heart rate, causes arousal etc.

Treat the OSA and heart rate should calm down. If it doesn’t then start looking into it more (cardiologist etc).

I've been told I'm not severe enough, but I wake multiple times a hour every day according to fitbit... and my heart rate is spiking like crazy all night every night.