Low AHI, only hypopneas, could CPAP be worthwhile anyway?

[hypopniatic]

I had a sleep study done a month ago:
5 hours 30min asleep without CPAP:
- AHI of 7.8
- Only one apnea, 42 hypopnea events most of which lying on my back
- Oxygen saturation never dropped under 90%
- 116 micro arousals or 21 per hour

It was a split night study but there was not quite enough time to complete the titration testing so the doctor recommended another sleep study to dial in the pressure more accurately but said I also could try starting on an APAP and do another sleep study later if need be. I decided to get on using the machine right away.

I'm now 2 weeks into using my machine at the prescribed 8-20 pressure and I've yet to see any improvement in my symptoms (if anything it has gotten worse). Looking at the software my AHI has been around 2-3 of which only a fraction is apnea. I was skeptical all along but now I'm starting to lose all hope that this could be the answer to my symptoms. I've had extreme fatigue and brain fog which has been getting gradually worse. However, it isn't the "sleepy" kind of tiredness that I get throughout the day and I never nap or feel like actually falling asleep during the day. That would be another indication that it might not be sleep quality related..

I'm curious if there is anybody out there who has had similarly mild sleep study results and has gotten better with CPAP? What I've gathered from googling a ton it seems that it is not very common for people to treat this mild hypopnea with CPAP

[blackrock]

I had a sleep study done a month ago:
5 hours 30min asleep without CPAP:
- AHI of 7.8
- Only one apnea, 42 hypopnea events most of which lying on my back
- Oxygen saturation never dropped under 90%
- 116 micro arousals or 21 per hour

It was a split night study but there was not quite enough time to complete the titration testing so the doctor recommended another sleep study to dial in the pressure more accurately but said I also could try starting on an APAP and do another sleep study later if need be. I decided to get on using the machine right away.

I'm now 2 weeks into using my machine at the prescribed 8-20 pressure and I've yet to see any improvement in my symptoms (if anything it has gotten worse). Looking at the software my AHI has been around 2-3 of which only a fraction is apnea. I was skeptical all along but now I'm starting to lose all hope that this could be the answer to my symptoms. I've had extreme fatigue and brain fog which has been getting gradually worse. However, it isn't the "sleepy" kind of tiredness that I get throughout the day and I never nap or feel like actually falling asleep during the day. That would be another indication that it might not be sleep quality related..

I'm curious if there is anybody out there who has had similarly mild sleep study results and has gotten better with CPAP? What I've gathered from googling a ton it seems that it is not very common for people to treat this mild hypopnea with CPAP

Depends, in theory you r right the numbers are not abd and can be treated with soemthing else but CPAP.

What is your body weight, height, neck circumference.

Although your hyponeas are not many, you do have a lot of microarousals I am guessing they are RERA's. 21 an hour so one every 3 minutes. That could be causing your symptoms. I dont think an APAP will treat RERAs as it usually treats hypopneas and apneas (somebody correct me if i am worng). Google UARS.

On the other hand your symptoms could be completely not from sleep and be somehting else like depression stress, etc.


Why do you think your symptoms are worse?? is it cause you cannot sleep with the CPAP?

[library lady]

AHI includes hypopneas (Apnea+Hypopnea/time slept)... so I'd say CPAP use is still necessary - or at least worthwhile.

[echo]

I had an AHI over 30 but they were all hypopneas and no desats below 92%, and CPAP has made a HUGE difference.... once I fixed the mouth breathing.

What mask do you use? Do you have some data/graphs you can post?

[70sSanO]

I'm wondering about the prescribed 8-20 pressure. I don't know enough about hypopneas, but that sounds like a generic range without much forethought to your situation.

John

[hypopniatic]

What is your body weight, height, neck circumference.

I'm skinny (5 foot 11, 140 pounds) and in my late 20s male. Neck circumference 14 inches/35.5 cm. I have a small jaw and snore occasionally especially when drunk (haven't been drinking since I've gotten the sleep study done). Respiratory effort related arousal (as you brought up) seems like something I probably have, the doc def brought up the frequency of arousals as the main problem with my sleep and CPAP as a possible solution to cut down on the frequency.

On the other hand your symptoms could be completely not from sleep and be somehting else like depression stress, etc.

Yea, I've been looking into other possibilities and will continue to. I'm still having hope that my condition might at least somewhat improve with CPAP even if most of the cause of my symptoms might lie elsewhere.

Why do you think your symptoms are worse?? is it cause you cannot sleep with the CPAP?

Yes, I'd say I'm feeling slightly worse probably because I'm not falling asleep as easily as without the mask and wake up more often having to adjust the mask or taking more time to get up to go to the bathroom. I've probably worn the mask around 90% of my total sleep time so far. One night I took the mask off during the night and slept most of the night without the mask and woke up feeling unusually bad (indication the CPAP might be doing some good?). On the whole I'm probably pretty tolerant in terms of the discomfort of CPAP compared to most.

[blackrock]

What is your body weight, height, neck circumference.

I'm skinny (5 foot 11, 140 pounds) and in my late 20s male. Neck circumference 14 inches/35.5 cm. I have a small jaw and snore occasionally especially when drunk (haven't been drinking since I've gotten the sleep study done). Respiratory effort related arousal (as you brought up) seems like something I probably have, the doc def brought up the frequency of arousals as the main problem with my sleep and CPAP as a possible solution to cut down on the frequency.

On the other hand your symptoms could be completely not from sleep and be somehting else like depression stress, etc.

Yea, I've been looking into other possibilities and will continue to. I'm still having hope that my condition might at least somewhat improve with CPAP even if most of the cause of my symptoms might lie elsewhere.

Why do you think your symptoms are worse?? is it cause you cannot sleep with the CPAP?

Yes, I'd say I'm feeling slightly worse probably because I'm not falling asleep as easily as without the mask and wake up more often having to adjust the mask or taking more time to get up to go to the bathroom. I've probably worn the mask around 90% of my total sleep time so far. One night I took the mask off during the night and slept most of the night without the mask and woke up feeling unusually bad (indication the CPAP might be doing some good?). On the whole I'm probably pretty tolerant in terms of the discomfort of CPAP compared to most.

You sound a lot like me. I am 29. AHI of 7.7 on home sleep study, am 148 lbs (5 feet 8 inches).

Tell you what do you have any nasal congestion, deviated septum? frequent sinus infections or allergies?/ Try sleeping with a breathe right strip and see if that helps?? Also what do you thnk about looking into a dental apparatus??

[hypopniatic]

I had an AHI over 30 but they were all hypopneas and no desats below 92%, and CPAP has made a HUGE difference.... once I fixed the mouth breathing.

What kind of arousal frequency did you have during the study if you remember? Although your untreated AHI is was much higher than mine it does give some comfort knowing that CPAP was effective for just hypopneas with no desat problem.

What mask do you use?

You can see my equipment below, I've added them to my info. I got the aloha nasal pillow but also I've been using Resmed Nasal mask on some nights as my nostrils get quite sore sometimes from the nasal pillow(gotta get better at finding the sweet spot in adjusting the straps I think).

Do you have some data/graphs you can post?

Here's some data

[hypopniatic]

You sound a lot like me. I am 29. AHI of 7.7 on home sleep study, am 148 lbs (5 feet 8 inches).

Tell you what do you have any nasal congestion, deviated septum? frequent sinus infections or allergies?/ Try sleeping with a breathe right strip and see if that helps?? Also what do you thnk about looking into a dental apparatus??

No allergies and nasal congestion very infrequently. I use to have nasal congestion more frequently years ago and used breathe right for a while to see if it might help with sleep quality but I didn't notice anything. I actually used breathe right strip once with my CPAP the other night since I had slightly stuffy nose but it wasn't so bad that I couldn't have done without it easily. Nose airway is prolly not where my issue lies.

I've looked a bit into dental apparatuses but me having to wear a retainer would probably not work together with one.

Have you seen an improvement in symptoms with your CPAP treatment? If so how long did it take to notice?

[hypopniatic]

I'm wondering about the prescribed 8-20 pressure. I don't know enough about hypopneas, but that sounds like a generic range without much forethought to your situation.

John

Yea, I was wondering that too. So far the machine has never gone over 12 pressure and it's been 9 or under 95% of the time.

[blackrock]

I'm wondering about the prescribed 8-20 pressure. I don't know enough about hypopneas, but that sounds like a generic range without much forethought to your situation.

John

Yea, I was wondering that too. So far the machine has never gone over 12 pressure and it's been 9 or under 95% of the time.

sent you a pm

[Colombia]

I have been using my CPAP for over three years with positive results the first year.
The last two years have not been as good. I'm tired most of the day and wake-up at 3:00 AM every morning.
I almost never have an apnea and my AHI stays between 3-6.

I had my Vitamin D tested and it came back at 23 Ng. According to many experts a reading of 60-80 Ng is recommended for individuals suffering from Sleep Apnea. Every expert seems to have a different opinion.


Dr. Stasha Gominak has now been treating patients for two years with vitamin D and magnesium with great success including the elimination of the CPAP device.

Vitamin D Hormone http://drgominak.com/vitamin-d

[Colombia]

I would really like to know more about the relationship between Sleep Apnea and Vitamin D. I will continue using my CPAP, but will address the question of low Vitamin D in my case.

I would appreciate comments from anyone else having a low Vitamin D/Serum Level count.

By Dr. Gominak

What hap­pens when we don’t get par­a­lyzed correctly?

Two com­mon sleep dis­or­ders seem to result from a mal­func­tion­ing paral­y­sis switch. We can be “too par­a­lyzed”, which results in “sleep apnea”, or “not par­a­lyzed enough” which leads to leg move­ments called “Peri­odic Limb Move­ments of Sleep”. Often both hap­pen in the same per­son. In order to explain this obser­va­tion I pic­ture the paral­y­sis switch more like a speedome­ter nee­dle. When it’s not work­ing right, instead of cruise con­trol, 55 mph, the nee­dle is wob­bling back and forth between “a lit­tle too par­a­lyzed” and “a lit­tle not par­a­lyzed enough”. If the mouth and throat are slightly too par­a­lyzed, as we suck in air our throat col­lapses, pre­vent­ing the flow of air. The brain senses that there is no air flow­ing and it wakes us up to light sleep. As soon as we get to light sleep we are no longer par­a­lyzed, we open the air­way again and then fall back into deep sleep. Even though this saved our life, every time we wake to light sleep and move a lit­tle, the repair crew stops work­ing. If the nor­mal repair phase is fre­quently bro­ken up by episodes of wak­ing to light sleep the repair can­not hap­pen nor­mally. Every part of the body that’s still mov­ing or “tensed up” doesn’t get fixed and those parts may hurt when you wake up.

[wut]

HYPOPNIATIC --- About how many hours of sleep do you usually get per night, and are you a light sleeper?

- AHI of 7.8
- Only one apnea, 42 hypopnea events most of which lying on my back
- Oxygen saturation never dropped under 90%
- 116 micro arousals or 21 per hour

Your situation is too familiar. I've been diagnosed with UARS and haven't yet found the machine effective. MD thinks I need very high pressures, even though AHI as measured by the machine is usually 1 or less. On APAP, my machine never went higher than 11, and on BiPAP, rarely above 17 IPAP. If I could tolerate more pressure without aerophagia, I would increase IPAP more...

[echo]

I had an AHI over 30 but they were all hypopneas and no desats below 92%, and CPAP has made a HUGE difference.... once I fixed the mouth breathing.

What kind of arousal frequency did you have during the study if you remember? Although your untreated AHI is was much higher than mine it does give some comfort knowing that CPAP was effective for just hypopneas with no desat problem.

I had quite a few arousals, some respiratory related, others spontaneous. I'd need to look up the exact #s but somewhere in the 35-40 range (per hour). During my titration study I still had quite a few spontaneous arousals if I remember correctly.

Perhaps related to that, I've never done well APAP mode, so I use straight CPAP mode.

Do you wake up with a dry mouth/throat now? Mouth breathing/leaking can be a cause of not feeling better on cpap (I'm not sure if they show up as Leaks on all machines).

Hopefully others can give comments on your summary data. Overall leaks look ok but the averages may not be telling the whole story. Bottom pressure could potentially go up a notch too.

(Added: I use a pressure of 10.5 cm fyi).