Arousals and tiredness. Sleep test attached.

[tiredman]

I'm trying to understand why I'm so tired and fatigued despite my low numbers. Polysomnogram below. REM at 6%, while the normal range is 19-37%. I had about 100 arousals through the night. Seems like a lot to me. But many of you have AHI of 20,30,50+. I'm wondering what percentage of those result in arousals and hence sleep fragmentation. If I had those numbers and every one of them resulted in arousal I'd probably be catatonic.

AHI is low (5.7), but there are a number of arousals (RAI 15.3). Normal O2 saturation. Every one of my breathing events registered as an arousal on the EEG (disregulated nervous system?). I may have PTSD and I do have a heightened startle response and heightened response to stress in general. I've read about PTSD being linked to OSA--arousals happen more easily when the nervous system is hypersensitive to stress.

Questions for you all:

Do apneas/hypopneas usually result in arousals for most of you?

Do most of you with OSA have low REM?


(This polysomnogram is from a few years ago and my symptoms have worsened since.)

[palerider]

Do apneas/hypopneas usually result in arousals for most of you?

Do most of you with OSA have low REM?

yes, otherwise you'd die from apneas. however, most people don't remember the arousals, they're so tired they're passed out, but the arousals happen.

hard to have rem when you're so frequently being roused.

[tiredman]

Do apneas/hypopneas usually result in arousals for most of you?

Do most of you with OSA have low REM?

yes, otherwise you'd die from apneas.

Of course, that makes sense. I guess where I was going with that question is: do some people experience arousals while in REM and remain in REM? Or do arousals always take you out of REM?

[Julie]

Just curious about why you're asking specifically... what are you thinking about re this?

[tiredman]

Just curious about why you're asking specifically... what are you thinking about re this?

I'm asking because I'm trying to determine whether sleep disordered breathing (SDB) is causing my symptoms, or if it's something else.

I've seen a couple ENT/sleep docs, first one said he thought my tiredness could be caused by SDB. Got a second opinion and he said I should look for other causes because my AHI was low. I did not show him the test I posted here, because that one is old. The newer one I showed him reported an AHI of 9 (but it has less detailed data than the older one). Granted, I don't think he looked over my test well enough, he just glanced at it, and we did not talk about my low REM and UARS, or arousals in general. I am going back to him and am going to bring it up.

My opinion is that the SDB is causing the tiredness. But I do have depression and anxiety (which I think is caused/exacerbated by poor sleep) and depression can cause tiredness and fatigue as well.

I'm trying to get a sense of what degree arousals and low REM affect daytime fatigue and tiredness, and if my level of SDB could be causing my symptoms.

[palerider]

I guess where I was going with that question is: do some people experience arousals while in REM and remain in REM? Or do arousals always take you out of REM?

without an eeg hooked up to your head, there's no way of knowing.... none at all.

[bellab]

Just curious about why you're asking specifically... what are you thinking about re this?

he said I should look for other causes because my AHI was low. I did not show him the test I posted here, because that one is old. The newer one I showed him reported an AHI of 9

AHI of 9 is still mild sleep apnea. My home sleep study showed an AHI of 8, and just like you it was all hyponea as apposed to any obstructive events. I started using an apap, and I have definitely seen great improvements. My sleepyhead data from my machine DOES show obstructive apneas, which is interesting considering my home sleep study apparently didn't, but my AHI is always under 2 and very often under 1, and I'm feeling great, I'm much more awake whereas before I was falling asleep at the wheel.

My AHI may have been pretty low compared to some of the other numbers I've seen, but the affects on my life were IMO severe. I couldn't function at all, I couldn't make it through the work day and I couldn't drive to/from work without nodding off and finding myself in the opposite lane.

I haven't had any of those issues since starting apap...so I don't think you should consider your number "too low" - 5 and over is sleep apnea, you're in the mild sleep apnea range and your doctor should be looking at getting you set up with a cpap.

[Jay Aitchsee]

Tiredman, as Palerider says, you need to be monitored by an eeg to know for sure what is happening in your sleep. But, by definition, an arousal is a change to a lighter stage of sleep, which, if it lasts long enough, will result in wake.

In my case, with moderate apnea, sleep studies indicate a "normal" amount of REM, but decreased Deep, so I guess the answer to your question, "do people with OSA have decreased REM?", is, not necessarily.

Here's a link to an article that discusses how some external factors could affect various sleep stages which you may find interesting:
http://healthysleep.med.harvard.edu/hea ... al-factors