AHI of 6 (hypopnea only)

[Guest]

I recently had a sleep study due to excessive sleepiness (unable to wake up in the morning without my husband forcing me - 2 hours of snoozing is common). I can manage forcing myself to get up and get through work, but the weekends are a joke. 12-18 hours sleeping a day is the norm on the weekends.

Thyroid, iron, etc ruled out. No big health issues - no snoring, small neck, low BMI, marathon runner, etc.

Sleep study results showed AHI of 6 - all obstructive hypopnea's. More happened when laying on the side than the back. Had a good amount of time in N3/"restorative" sleep though (35%).

Question is - can this mild case of apnea cause the drastic sleepiness effects that it is having on me? Considering that I'm getting good N3 restful sleep, I'm doubtful that the sleepiness is all due to the hypopneas.

Thoughts?

Thanks!

[-SWS]

You might research the possibility of Upper Airway Resistance Syndrome (UARS).

[Pugsy]

HMMMM... has anyone mentioned UARS to you?
Might want to do some research on it.
Upper Airway Resistance Syndrome.
http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome

Hey SWS..you beat me to it.

[-SWS]

HMMMM... has anyone mentioned UARS to you?
Might want to do some research on it.
Upper Airway Resistance Syndrome.
http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome

Hey SWS..you beat me to it.

I liked your post better---it had a link!

[Guest]

Thanks for the quick replies!!

Seems like snoring is somewhat required for UARS based on the link... I never really snore. I think in my sleep study I had one "snore".

Is this true?

If so... can an AHI of 6 really cause me to be soooooo tired? Maybe I'm in denial, but anything called "mild" makes me think just that... mild.

[-SWS]

Snoring is not a UARS diagnostic requirement:
http://chestjournal.chestpubs.org/conte ... /1654.long

PSG scoring of flow limitations accompanied by arousals are one means of diagnosing UARS. Esophageal manometry is a gold standard albeit less-common way of diagnosing UARS.

[Mary Z]

I had excessive daytime sleepiness as you describe. At it's worst I was falling sleep in the morning walking from the kitchen to the dining room with my breakfast. Could not drive or stay awake in appointments, long afternoon naps and not wanting to get up in the morning. On my first test my AHI was 5 (don't remember the breakdown). Even after treatment I needed Provigil to stay awake during the day. Took a multiple sleep latency test and was diagnosed with ideopathic hypersomnia which is just a fancy way of saying I slept too much. Lately I have stopped needing Provigil.
Were you approved for CPAP? I was given an option to try the machine and since my sleepiness was so severe I jumped at the chance to try 'PAP.

[Guest]

Yes, the doc asked if I wanted to try it.

I'm a little hesitant... being young and a newlywed and all... maybe I'm just in denial. I just cant see how an AHI of 6 can cause 18 hour sleep fests on the weekends.

The doc also said I have IH... trying to figure out if there is anything for that other than meds. Meds are helping a little.

[Guest]

Oh yeah, doc also reccomended a mouth piece.

I got one online to try before dumping $$$$$$ into a real dental device.

Ended up getting "ultimate stop snoring solution".

Anyone have experience with that??

[-SWS]

The doc also said I have IH... trying to figure out if there is anything for that other than meds. Meds are helping a little.

Well that's a hard one since any "idiopathic" diagnosis means the cause of symptoms is undetermined/unknown. And unfortunately there are many possible causes of hypersomnia: Search link to "causes of hypersomnia".

I just cant see how an AHI of 6 can cause 18 hour sleep fests on the weekends.

Well, how many arousals were noted in your PSG sleep study? And how was your sleep architecture in that same sleep study? Did your clinicians look for respiratory effort related arousals (RERAs)? Did you present excessive periodic limb movements, which can deteriorate sleep? Did you present pain-related alpha intrusions, which can deteriorate sleep? Did you grind your teeth excessively? That's known as bruxism, and it too can deteriorate sleep. There are quite a few conditions that can deteriorate sleep.

Was your sleep study performed at a clinic that primarily focuses on easy-to-diagnose apnea, while not focusing adequately on some of the less-common sleep disorders? Was your sleep study performed at home? If so then you need a sleep study in the lab with full PSG instrumentation, given your idiopathic diagnosis.

[Guest]

Total arousals = 60 (index of 12.5). 22 were respiratory, 34 were spontaneous, 1 snore, 3 PLM.

The architecture of the sleep was mentioned above (in terms of stages and % at each stage).

I was wired up to monitor teeth grinding - there is no mention of any grinding or bruxim in the study, not also no specific table or index for it. Doc also checked my teeth and didn't see anything remarkable.

Study was done at a sleep center - i believe they treat / investigate all disorders. Originally was there for suspect narcolepsy.

[Guest]

OOps, guess the sleep architucture wasn't mentioned before.

11% N1
40% N2
35% N3
13% REM

[-SWS]

Well, your sleep disordered breathing (SDB) and arousal rate are almost subclinical. But they are not subclinical. However, you're wondering why the severity of your hypersomnolence seems disproportionate for such mild SDB.

I noticed you slept less than five hours during your sleep study. A total arousal count of 60, yielding an index of 12.5, amounts to about 4.8 hours of sleep. That's more sleep than I can manage at a sleep study. But it brings up the question of sleep hygiene. Are you getting 8-to-9 hours of sleep during the work week? If not, you can accrue what is known as sleep debt, which can add more sleep pressure during the weekends to literally catch up on lost sleep. Add mild sleep-disordered-breathing inefficiencies to the equation, and your tendnency to accrue sleep debt becomes compounded.

A couple other possible areas to research include seasonal affective disorder (SAD) and circadian rhythm sleep disorder. Maybe other posters here can offer additional ideas. Good luck.

[Kohkie]

Remember that an AHI of 6 means you are potentially having an arousal every 10 minutes. Yes it's not as severe as someone having an arousal every minute or more but it's still difficult to get a decent nights sleep when you are aroused approximately every 10 minutes. Personally my AHI for last night was 4.3 and I knew it would be high because I had a really lousy night, and kept waking up and falling back asleep. Now that I have become accustomed to an AHI of 2 and under, I really notice anything up around 4 and 5. It makes me feel like I barely slept, and because of that I actually spent almost 9 hours in bed where normally I only sleep 6 to 7.5 hours and wake up feeling great. Personally I would try the CPAP. Even mild sleep apnea can cause problems. The only regret I have about being diagnosed with severe sleep apnea and being put on a CPAP is that I had to suffer for decades before it was diagnosed.

[SleepingUgly]

-SWS brings up a lot of important points.

BTW, did they break down your REM vs. NREM AHI? An AHI of 6 could mean that you had a very high AHI in REM but a lower one in NREM, averaging out to 6. Or it could mean it was 6 across the board.

Did they score RERAs? Is this an AHI or an RDI?

Did they use the AASM Recommended criteria for scoring hypopneas or the Alternative criteria? See this article:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635578/

I don't put much stock in these numbers. I was diagnosed with idiopathic hypersomnia for nearly two decades until I finally was diagnosed with OSA.

Try CPAP.