another sleep study, different results--opinion

[svh]

So, back in the Fall of 2006, I had my first sleep study, which resulted in CPAP, which I used faithfully for years. Then, last year, my marriage broke up, and I lost 40 pounds (20% of my body weight). My CPAP did not seem to be working as well--I was waking tired, had more headaches, etc., so I got another sleep study to see what had changed (hoping, of course, that I no longer needed the CPAP!) Alas, I do still need it. I didn't have enough apneas by the right time of night to set the titration phase of the sleep study into effect, so I didn't get a new pressure. I've got a new APAP machine (S9) coming by mail Tuesday, with which to home titrate, which should be interesting.

Here's my question, though:

In my 2006 sleep study, I had 14 obstructive apneas and 193 hypopneas, for an AHI of 41.2, lowest oxygen sat=92%

In my 2010 sleep study I had 2 obstructive apneas and 157 hypopneas, for an AHI of 29.7, lowest oxygen sat=96%

It seems to me that hypopneas are my biggest problem. I'm wondering, given that fact, do hypopneas need a higher or lower pressure to correct than apneas? Or should I just not worry about the distinction? Even during the day, I don't think I breathe as deeply as I should. I often find myself taking "catch-up" breaths. I'm just wondering what the best way to deal with this kind of problem is....

Thanks in advance!

[Rogue Uvula]

In my 2010 sleep study I had 2 obstructive apneas and 157 hypopneas, for an AHI of 29.7, lowest oxygen sat=96%

Someone else will have to answer your bigger question, but a lowest oxygen saturation of 96% is such a very high number, that I wonder if you really have an issue.
Mine was 89% and the doctor said that was "borderline". My question is are apneas & hypopneas really an issue if you have a lowest SpO2 of 96%?

[svh]

I guess it's an issue because the events wake me up, so my sleep is inefficient, and I'm tired all the time. I agree it's lucky my oxygen numbers are good, but I still don't feel good....

[Emilia]

I, too, have almost all hypopneas. I just slept my 4th night with my auto machine, and while the first three nights required a 95th %tile pressure of 8.5, surprisingly, last night that pressure was only 7 with an AHI of 3. So, I seem to require minimal pressure to keep my events at bay, and I do feel a bit better today than I did yesterday after a night with an AHI of 5.5. It appears that even a tiny difference in results makes a difference in how I feel. Of course it is only day 5 of my therapy....so take this FWIW. My O2 was low during my study -- bottomed out at 76%. I hope to begin monitoring that soon, too.

I should have my full data software today (I hope!), and once I have that installed I will be able to see more clearly how my nights look.....

Best of luck.... keep us posted!

[svh]

Thanks so much! THis group was so helpful to me when I first started out with CPAP almost 5 years ago. I'm hoping I can get things running smoothly again, as I'm getting really tired.

[Rogue Uvula]

I guess it's an issue because the events wake me up, so my sleep is inefficient, and I'm tired all the time. I agree it's lucky my oxygen numbers are good, but I still don't feel good....

Hmmm, as much as I hate to recommend medications, you might want to consider a "sleep aid" such as Ambien rather than a CPAP machine. Perhaps that is dangerous. I guess your doc should know.

Take this with a grain of salt - it is a sample of one;
My wife was having difficulty sleeping through the night and her chiropractor recommended a walk and some stretches before going to bed (I think the goal is to increase Serotonin levels). The results have been amazing - she falls asleep quickly and has slept through stuff like me messing with a leaky mask that would have easily awoken her before. It was a dramatic difference and her sleep has been consistent for over a month now!

[Emilia]

IMHO you can't ignore that many hypopneas. These events are apnea wanna be's.... and left untreated, may evolve into apneas. I think using a CPAP is essential for your good health. Research shows that as we get older, SA can worsen so I'd be reticent to stop using the therapy. Even though your O2 is good, having that many events is a problem. Shallow breathing means your lungs are not working to capacity and that, in and of itself, is not good. CPAP is forcing you to exercise those breathing muscles more, to your benefit. I, too, find I don't breathe deeply enough even during the day. I was aware yesterday, after just three nights on the machine, that my daytime breathing seemed a tad better.

You should explore all of this, discuss it in detail with your sleep doc, and most importantly, do research and become knowledgable about how this affects your well being.

[svh]

Thank you both--I really appreciate everyone's help. I have used sleep aides in the past, and I know my doctor is reluctant to prescribe them as any sort of long-term solution. According to the sleep study, I officially have moderate to severe apnea, based on my numbers. The sleep doctor always reduces that to moderate because of my oxygen levels, but with that on my record, my pcp just says I need to use CPAP, as it's the most effective method to deal with this stuff. I may not like it, but I think that's the way it is.

That said, I no longer travel for weekends with my machine, as I feel I can go that long without it.

FWIW, I definitely snore....I've always been a very light sleeper, too. Which is the cause and which is the effect? Who knows?

[DoriC]

Hi, do you have a copy of your sleep study? Were you sleeping on your back? What was your titration? What is your pressure setting? I'm sure you'll get some help here from others. I wouldn't take any sleep aids(JMHO) until you've exhausted all the other equipment tweaks which are usually necessary. Certainly, meds are never a substitute for cpap therapy which is what you need for a long healthy life. Good luck and keep us posted.

[svh]

I do have both sleep studies, yes. I did sleep on my back some of the time, and that was clearly worse, but even sleeping on my side I had events, enough to merit a diagnosis.

I did not use CPAP at my latest study (even though it was supposed to be a split study), since I didn't reach the apnea threshold in time. The letter with the results suggested I go back for another night to do the titration, or that I get an APAP to titrate at home. I chose option B.

Up to now, I've been using my CPAP at a pressure of 9.5.

[Emilia]

Do you have the software for your machine? If you can get that, you will be able to see all the detailed data on your sleep/events/pressure/leaks. Others who use your machine can help you with getting the link to a site from which you can download it.

[svh]

Thank you--yes, people have PM'd me with the link. I haven't actually got the machine yet--it's due to arrive on Tuesday. I am currently using nothing, since my old CPAP machine (M-Series Pro) died last Thursday.

[Janknitz]

I think that dropping O2 sats are a long term effect of apneas and hypopneas. In other words, you have these apneas and hypopneas now, but if you go untreated your condition will worsen because all those arousals are causing damage to your body in the form of higher cortisol levels and all the other downstream effects of poor sleep. Eventually, this cumulative trauma to your body will reduce oxygen efficiency. So just because your 02 sats are good NOW doesn't mean they will stay that way if you go untreated.

You need to treat the hypopneas, and CPAP is the best way. Sleep meds will NOT correct sleep disordered breathing.

[Rogue Uvula]

Thanks Emilia and Kanknitz for the explanation of the need for CPAP even with good o2 levels!

[NotMuffy]

In my 2010 sleep study I had 2 obstructive apneas and 157 hypopneas, for an AHI of 29.7, lowest oxygen sat=96%

How can that be? Scoring requirement (recommended) for hypopnea is 4%, but a baseline saturation of 100% is virtually impossible. For that matter, the alternative definition (3%), requiring a baseline of 99%, is just about as impossible. Something's screwy...

..unless they're doing "or arousals"...

I think those hypopneas need to be put under the magnifying glass...

NM