Sleep study can be valuable even if it doesn't reveal apnea

[cayenne]

Over the past several months (well, actually a lot longer), I started noticing recurring symptoms appearing - voice changes, sore throat in the morning, fluid in my mouth when I awoke, awoke coughing, difficulty sleeping, runny nose (allergies are bad news), and now for the past few months a dry cough that comes and goes throughout the day. My friends say it's longer. Some of these symptoms come and go, but they seem to be getting more frequent. When they aren't present, I'm hopeful whatever the problem was my body dealt with it and now things are back to normal. All of these seemed to be on par with diagnosed GERD/Allergies, and I'd learned to live with stuff like this. I wasn't really aware of how frequent or bad things had become. Things got gradually but nevertheless progressively worse. I started having times when driving and not know where I was or where I was going. I'd look at the street signs, and in a minute it would all come back and I'd be on my way. It was spookiest the first time it happened, but I learned to cope with it and didn't know what to do. If I went to a doctor I felt they would think I was making it up. The same thing happened in conversations. I'd suddenly find myself in the middle of face to face conversations and not know what had been said. I adapted to this, with strategies like "I'm sorry, what was that again?" I kept telling myself if I just got better sleep this wouldn't happen. I really didn't know how to do that; I have the blackout curtain, try to have a consistent bedtime, and so forth. Finally, I woke up at a traffic light with the car behind me honking, and I realized I needed help. At that point, I thought GERD was causing the sleeping problems, so I saw my GI doctor. He said to stay on the PPI (30mg omeprazole). By this point, I decided to keep a sleep diary. The first night I didn't sleep at all. The second night, 2 hours of sleep, but I remember dreaming. I didn't realize my sleep was that bad, so I went to see a sleep doctor (turned out to be a neurophychiatrist specializing in sleep) who works with a local sleep clinic. His questionnaire had bed head elevation on it, and so I elevated the head of my bed. It also asked questions I couldn't answer about things I do while sleeping. He said to pull over and rest if I was tired instead of driving. I'm not sure how to tell how tired I am any more. He wanted me to do a "split" sleep study. I started researching sleep apnea more and more, and found a lot of scary info about it (e.g. I have had two whiplashes and was diagnosed with major depression after each), everyone in my family dies of strokes or heart problems. The more I learned about sleep apnea, the more spooked I got. After the sleep study (dr prescribed ambien for the study since I also have insomnia -- doubt I'd have been able to sleep all hooked up to those wires without it), I awoke with acid in my mouth. Darn gerd! In the followup, the doctor said there was no diagnosis of sleep apnea (overall average AHI was 4.1, and other sleep parameters didn't correlate with apnea). Whew! He wanted to help me with the insomnia, and gave me some information and good recommendations, and wanted me to keep a sleep diary. We briefly discussed sleeping medication, but I told him I don't like drugs. Sleeping pills aren't a very good long term solution. I really want to fix the underlying problem. I see him in a couple weeks. The whole appointment felt rushed, and I was having trouble concentrating, and he was asking me questions I was having trouble answering like was I tired versus sleepy (or was it fatigued??) I don't know what the difference is in all of these, so I just shrugged. I got back to my workplace and started thinking about the whole thing. I called the office and went in and picked a copy of my sleep study results. The receptionist said they forgot to schedule me for another sleep study. Huh? The doctor hadn't said anything about that. ? So I didn't schedule one. With more time, I had a chance to look over the study results. There was some very useful information in there that the doctor didn't really spend any time on. I sure didn't realize how much I sleep on my back. The front of the report says there is no sleep apnea. The back page says there is mild sleep apnea. Huh? When I look at the numbers [hope I got these right - they are from memory], my supine AHI is 6.1/6.9 but my side AHI is 2.2. My sleep stage diagram has some good rem sleep and arousal index seems low, but I dug around online and discovered ambien suppresses arousals. My spo2 didn't really dip below 90%, so I'm looking at these results and thinking maybe I have very mild positional apnea, and the breathing events aren't impacting the spo2 that much but they are possibly aggravating the gerd. The first night I tried wedging large pillows behind my back to try and stay on my side. I awoke facing the pillows, so that didn't work. I dug around online and it seems there are several ways to fix this -- and something I could do that night was try sleeping with a full backpack on. Last night, I grabbed my backpack (I'm an avid hiker - at a minimum I go out no matter what every weekend for a full day). The shoulder strap dug into my neck when I tried to lie down so I tied the pack to myself using some nylon webbing I had with my scrambling gear. I only got 4 1/2 hours of sleep, but I felt very good this morning and no sore throat. I don't really have a question per se but wanted to submit this in the hopes that someday someone else may find it and it helps them in some way, since many of the suggestions on this board have helped me already. The admonitions to get a copy of the sleep study are well worth heeding -- even if what the dr is looking for isn't clearly there. I'm still yawning at times during the day, and fighting off random urges to sleep, and dealing with the dry cough and the difficulty concentrating, but I'm optimistic about the backpack solution to the darn gerd and the help the dr is giving me with the insomnia. I'm disappointed so much of my medical care is governed by the policies of the insurance company; I'm not just another patient and I do care enough about my own well being and my job to pay out of pocket for medical care the insurance company won't cover. I just need to know what to do.

[LSAT]

If the backpack works for you...try a smaller "fanny pack" with a couple of tennis balls in it. It may be more comfortable.

[Wonderbeastlett]

I just got diagnosed last month. My ahi was 6.1 and Lowest O2sat was 90%. My sleep center called and said I was negative! I said well I don't how that could be because my symptoms were very strong. I had severe fatigue, headaches, heartburn at night, sleep paralysis and nightmares! I asked for another evaluation of my test. They had a second and third doctor look at it and although my numbers are low they said yes I do have OSA and it is possible for numbers this low to cause severe symptoms!

If you feel what your doing is working keep doing it! You might want a second opinion. OSA gets worse with age and so it might be a good idea to have treatment. If I wouldn't have had a second and third opinion I would still be feeling like crap!

[ChicagoGranny]

I have read that false negatives are common.

Some doctors even call it "the first-night effect".

"Our study confirms that an important number of patients presented false-negative results on night one, which turned out to be more frequent among severe cases," he said. "This underscores the need for a second test recording when the results of night one are negative."

[cayenne]

You might want a second opinion. OSA gets worse with age and so it might be a good idea to have treatment.

Yeah, that thought's been nagging at the back of my head -- and there are other factors too, like the season and allergies that don't help. I don't want to do another study soon and have another false negative ('cause the allergies are under control) then really have an issue next winter/spring. I'm trying to figure out a way I can tell what's going on. And what really spooks me is when I relax my throat muscles (while lying supine) my throat closes off completely. I don't know if this is a good indicator or not. It was pretty clear the dr was puzzled at the results because he felt my throat and looked at my tongue and then the numbers and scratched his head. I'll ask him about it when I see him next; that will give me time to give sleeping on my side a fair trial.

turned out to be more frequent among severe cases

Ack! I hope that's not what's going on here.

[cayenne]

Eight years later I wanted to discuss what happened in case someone ran into this old thread. I continued to sleep on my side and everything seemed great for a few years. I saw a pulminologist for an unrelated issue and he asked about apnea and I told him the story above, and he asked if I was satisfied with side sleeping and I was at the time. Fast forward to late last summer and I fell asleep at the wheel again, passenger woke me up I was halfway in the lane of oncoming traffic. At that point I debated what to do, as I had planned to revisit the topic after 10 years (absent any formal advice I could find). While I was debating, I went to my dentist and the hygienist asked me about apnea, and said it looked like I was high risk from examining my mouth. I told her I'd already had a sleep test, and she admonished me to get another since it had been over 5 years and I was high risk. I finally got the results this morning, AHI > 27 on a home sleep test, my consultation is later this week.

[weiss27md]

What is your new sleep study results mostly, CAs, OSAs? I have a low AHI like yours used to be. I also have GERD. I bought a Bilevel on my own with no improvement. AHI on sleep study 5.5 and 8.3. Lowest I can get on my VAuto is usually around 2-3 AHI but I still feel the same, actually still getting worse. Those are all CAs left too. I think mine is from reflux and possibly caffeine. I will be quitting caffeine completely and not eating too late. Think I'm just not getting enough deep sleep.

[chunkyfrog]

This was one of the most frightening effects of untreated apnea:
" . . . having times when driving and not know where I was or where I was going. I'd look at the street signs, and in a minute it would all come back . . . "
This effect went away after only a few days of successful cpap use.
This type of improvement is worth whatever effort it takes.
Keep on keeping on--you are worth it!

[cayenne]

What is your new sleep study results mostly, CAs, OSAs?

Mostly OSA

Capture.PNG (51.62 KiB) Viewed 1697 times

CPAP Machine arrives on Tuesday, looking forward to it!!