Low Score - Does this smell funny to you?

[Madzamboni]

So, I have been slowly battling a "sleepy" feeling during the day that has been getting worse and worse for years. Over the past two its started to get really annoying and as of January it's interfering with my daily life. I have to take a nap at lunch daily (I work from home) and can easily take a 2 hour nap on a weekend and force myself to wake up.

I've adjusted medications, especially Lexapro, which can lead to drowsiness but I am on a stupidly low dose. I've lost weight (20 lbs and going), eat better, and go to the gym 3-5 days a week for an hour first thing in the morning. I get a minimum of 6 hours a sleep a night, usually 8.

My doctor pretty much told me on a 90 day follow up she was almost certain I had sleep apnea and sent me for a test. When I heard that I DID have Apnea I almost teared up because we know the cause and we now had something to attack. But then I got details.

My score was a 6.5, barely over normal. I stopped breathing only 4 times (Due to constricted airway as well as my brain not firing things right) but I have hypopnea (Shallow breathing) a total of 37 times. (All in a roughly 6 hour period). My blood oxygen dropped to 85%.

I am actually discouraged. My friends that have apnea will stop breathing 4 times in 5 minutes and I am at the very low end of the scale. (I think 4 and lower is normal). The blood Oxygen level being 85% I could see as a problem.

But scoring so low, do you really think this could be root cause or am I chasing a red herring? As sleepy and as difficult as this is I expected to be off the charts.

I go for a CPAP Tritration next Tuesday to put on a CPAP and dial in the setting but I am not hopeful.

Thoughts?

Thank you in advance.

[kaiasgram]

Be hopeful. There isn't a perfect correlation between severity and symptoms.

If you want to post a copy of your sleep study (name whited out), we can give you more feedback. Severity refers only to frequency of events but does not factor in the duration of those events, nor how much blood oxygen dropped. Your sleep can also be disrupted many times during the night if you have arousals (getting pulled out of deeper stages of sleep) due to respiratory efforts and events.

We've had folks diagnosed with mild sleep apnea report significant improvement of symptoms after getting on CPAP treatment.

Welcome to the forum.

[Madzamboni]

Well that is somewhat encouraging, thank you. I am still skeptical, but what can proceeding forward hurt.

[WildMtnHoney]

I don't think we have to be "off the charts" to be feeling poorly.

I was at 5.5. I had a total of 5 central apneas, 3 obstructive apneas, and 31 hypopneas during my sleep study that qualified me for a sleep study, but because nearly all of that happened during REM, they calculated my REM AHI at 38, and used that number as part of diagnosis (along with the fact that my O2 got as low as 74% and stayed around 91% for most of the night).

However, I do get what you're saying.

I am actually doing a home O2 sat study for the Dr tonight, and I'm hoping for a "bad" night, because I'm still not feeling as well as I want to be, and I want the numbers to back that up. My guess is that you want the data to reflect how you feel, too.

Unfortunately/fortunately, I've been tracking SpO2 on my own at night, and I know it's not that bad. Sure it dips, and there are quite a few areas below 90, and, yeah, it gets below 88 for a few seconds every night - but that is *seconds* not the minutes we were seeing before. So it is very unlikely that the data the dr sees from tonight's recording will echo what I feel.

All that said, I *think* CPAP works. I know my MIL swears by it. My husband reports fewer instances of waking and finding me not breathing (I've never really been much of a snorer) and I have had fewer drowning/avalanche/quicksand dreams this week in particular, which means less waking up gasping for air.

[kaiasgram]

Well that is somewhat encouraging, thank you. I am still skeptical, but what can proceeding forward hurt.

Right -- proceeding forward with treatment sounds like a good plan.

I added a little more to my previous post -- remember, frequency of events is only one piece of the puzzle. And don't think hypopneas are insignificant just because they're not complete obstructions.

[kteague]

Look at the details of your report. Maybe it is right on target for your normal night, but sometimes the lab testing night is not fully representative of your usual sleep. Just all the external stimuli can make one not sleep as well as at home, thus not show as much problematic breathing. Once thing to look for is if you got a substantial amount of all the sleep stages, particularly REM. Not always, but often apnea is worse in REM. Also, were they able to capture you in REM while supine? That is considered the "worst case scenario". Another consideration is if there were lots of limb movements not related to respiratory events. Those with an unrelated limb movement problem may not get a full picture of the severity of their sleep apnea. And check your results to see if your apnea might be positional. Some see a significant difference between side and supine sleeping. When one is so close to the borderline diagnostically it doesn't hurt to put your mind at ease about pursuing treatment. You are truly in the discovery phase. Knowledge is power. Or you can get titrated and use the machine and not have to be bothered with a whole lot of figuring things out.

Now, all that said, mild sleep apnea can still be disruptive to sleep, and thus impair daytime functioning. How many of your events, whether apnea or hypopnea, caused arousals? Even at the minimum criteria for diagnosis, it's easy to see that sleep is not restful. Comparing severity is not linear. The person with fewer events may have longer duration or lower desats. A person with many events may find they are brief with smaller desats, but with more arousals, or sleep disruptions. So many variables. Your situation is affecting your life, so it is important to you.

I see some others have posted while I was typing. Hope you are gaining some clarity.

[archangle]

Be really careful to get a good data capable CPAP machine so you or your doctor can monitor your actual therapy.

There's information in the Useful Links in my signature line at the bottom of this post to help avoid getting screwed by the DME and the system with the wrong machine.

[Julie]

There's something called positional apnea (which K. Teague alluded to) where someone who otherwise wouldn't score on testing does so when back sleeping, and or if side sleeping tends to keep their head down, thus blocking their airway more than is good for them (especially if the airway's on the small side). People have successfully not used Cpap but gotten better by a) not back sleeping (if necessary using pillows, etc. in behind to keep off their backs, and b) wearing a small, soft cervical collar that keeps their heads from falling forward, alleviates any snoring that might occur, keeps their jaw more closed so they're less likely to mouth breathe, and their airways are automatically kept more open. I wouldn't assume that's your case, but I'd certainly want to experiment for a week at least to see if you feel any better and if so, possibly get another test to confirm the results as others have done. And if it applies, losing excess weight may help as well, though on its own, that won't be as likely.. but with the above regimen, could make a difference.

[LSAT]

My score was a 6.5, barely over normal. I stopped breathing only 4 times (Due to constricted airway as well as my brain not firing things right) but I have hypopnea (Shallow breathing) a total of 37 times. (All in a roughly 6 hour period). My blood oxygen dropped to 85%.
.

Hypopnias are not necessarily only shallow breathing......they also indicate a partial blockage of air. 37 partial or full blockages are causing your O2 level to drop.

[Darth Lady]

My score was a 6.5, barely over normal. I stopped breathing only 4 times (Due to constricted airway as well as my brain not firing things right) but I have hypopnea (Shallow breathing) a total of 37 times. (All in a roughly 6 hour period). My blood oxygen dropped to 85%.
.

Hypopnias are not necessarily only shallow breathing......they also indicate a partial blockage of air. 37 partial or full blockages are causing your O2 level to drop.

And don't forget, you can have events that are, say, 9 seconds long instead of 10; they won't count toward your AHI score, but will make you just as perfectly miserable as if they did count. You might have an "RDI" (Respiratory Disturbance Index) on your study that would reflect this. Redacting and posting your sleep study if you have it could let people here give you more precise advice.

[Madzamboni]

1. Thank you for all the input, I do have a lot to digest.
2. Next step is to get my sleep study results. My doctor has it now, but I will ask for a copy. It looks like I need more detail to give before others can truly weigh in.

I do have a follow-up question:
I did ask at the study if I had to sleep on my back. I was a back sleeper most of my life but my snoring would wake me up. Now I am a side and stomach sleeper. The tech told me it was perfectly fine to sleep on my side during the study. I know once or twice I did wake up on my back. But for most of the study I was on my side.

Would slide sleeping skew my results?

[Julie]

Only in a good way.

[Pugsy]

Side sleeping could possibly skew the results if you happen to be one of those people whose OSA is much worse when they sleep on their back and not so remarkable when they sleep on their side.
The same holds true for REM stage sleep too.
Not everyone though but enough that it is far from rare and is actually quite common.
My OSA isn't really worse or better with either sleeping position but there's a remarkable difference between REM and non REM sleep. It wouldn't be uncommon at all for you to have the same thing go on between supine and side sleeping.

Your sleep study in the lab would have documented the sleeping position though and if you spent any time at all on your back then that would be documented and the AHI for supine sleeping should have also been documented.
It's possible for a supine sleeping AHI to be higher but offset by a lower side sleeping AHI if more time was spent side sleeping.

Get a copy of that sleep study that shows the sleep stages and sleeping positions and breakdowns in each and you will have a better idea just how much sleeping on your back might impact things.