AI 20, yet no apnea?

[chris_lucy@live.com]

Hello, so i recently underwent a level 1 sleepstudy/ titration and although my arousal index was 20.1 an hour they claimed there was no sleep disorder breathing. The doctor who reviewed my sleep study is saying that this study was inconclusive and would not explain why im so tired and fatigued. What should my next move be?

[Miss Emerita]

Hello, Chris. This is a frustrating spot to find yourself in, isn't it? Do you have a copy of your sleep study? If not, please get one and post it here, after removing identifying information. (In the U.S., you have a legal right to receive a copy of the study -- the whole thing, not just a summary report.) After people take a look, they might have some ideas for you.

Could you also let us know what medications you take and what other medical workups you've had in light of your fatigue?

[Pugsy]

Hey folks....OP is in New Zealand and they do things differently down there.

What is a level 1 sleep study? I understand 2 through 4 home studies....did you have an in lab sleep study? Is that what you are calling a level 1?

There are 2 types of arousals....those related to the airway and those are called respiratory event related arousals.
and there are what is called spontaneous arousals which pretty much means they don't know exactly what caused them but they aren't related to the airway causing a problem.

Lots of spontaneous arousals are a problem...anything that wakes us up often is a problem but they aren't always from airway restrictive issues.
Spontaneous arousals...anything from medication side effects to other health issues to just crappy sleep or the cat walking across a person or a loud noise or whatever. These folks usually complain of being "light sleepers"...least little thing wakes them up kind of thing.

So arousals can be from anything in the world...and not always from some sort of apnea event or airway related event.

You have crappy sleep....lots of arousals but it's not airway related.

All this assuming you had a sleep study where they could tell for sure you were asleep or not.

[Illorum]

How old are you? Normal arousal index increases by age - 20 would be normal for someone 50+. See table 2. If you're significantly younger than that, then it's possible you had a lot of RERAs or hypopneas with arousals that weren't scored, depending on whether they chose to score RERAs or the definition of hypopnea used.

That being said, current concepts of "Arousal" as defined by the AASM are rather rigid and dated. There are variants of sleep disordered breathing where people have normal arousal indices but have flow limitations that lead to cyclic alternating pattern A phase microarousals that leads to fatigue and nonrestorative sleep.