Arousals

Do what degree to apena events wake a person up? I have a consistently low AHI (around 2) but I don't feel well (tired a lot). Looking at the video of my sleep it looks like I "thrash" when I have an apnea event. I shake my head back and forth, change positions, sometimes move my arms about. It doesn't happen all the time but more often than not I'll see a reaction on the tape.

Is it a normal to do this?

Correct me if I'm wrong but an AHI of 5 per hour or lower is considered "normal". If a person is being awakened 5 times per hour, how does he get any sleep at all? Who could tolerate this?

Careful of using video as a diagnostic tool. I used video to self-diagnose and fortunately decided to ignore what I saw on the tape which seemed normal to the untrained eye. I had an AHI of 58 in my sleep study.

Before my exam, I only ever had one waking event that I recalled. It was extremely severe sense of suffocating and got my adrenaline flowing in a panic. Otherwise, I had no recollection of those events.

CA HoseHead, just out of curiosity, was this a video taken during your sleep evaulation or a home video you set up yourself? My question has no bearing on your observation or question, just curious is all. A friend in MD was offered a copy of the video done during her sleep study. When I asked my sleep lab about one I was told the video was just of the head and just to be able to tell when we changed position and what position we were in - which I didn't really believe. My friend and I, both being the same age, had some good giggles remembering an old black and white TV commercial in fast motion of a man in bed, thrashing all night, tearing the bed covers off. Neither of us remembers what the commercial was for!

It's a video that I set up myself.

I agree that video to self-diagnose doesn't work. I'm not using it to diagnose myself, only to debug my ongoing CPAP therapy. I have a data-capable machine and I watch the video and follow along on the report. It's very helpful.

Just from my own very limited experience, I don't think diagnosing apnea from a tape would work. If respiratory effort continues in apnea then the rise and fall of the chest would continue, and you can't see the flow of air on a tape. I often (but not always) react to an apnea event, but I react to other things as well. The only reason I know it's an apnea event is that I see it on the report.

My memory experiences are similar. I apnea a lot and remember virtually nothing. The panicked feeling you describe is familiar to me.

There is a lot of important stuff going on while I sleep, things I need to know about and deal with. Apnea events, desats, flow limitations, arousals -- all of this is happening and when I wake up all I remember is showing up for work in my underwear. Sigh...

Giggle. My apologies ... but showing up for work in your underwear??? Sounds like every little girl's nightmare of walking to school and realizing w/horror half way there that she didn't have any underwear on!!!! (That was back in the days when girls HAD to wear skirts or dresses to school).

Sobering up now .... have you ever requested and gotten a copy of the full scored data summary report w/condensed graphs from both or all of your sleep evaluations AND titrations? They might prove interesting and add some additional clues. In the USA you have a LEGAL RIGHT to those copies due to HIPAA.

>>have you ever requested and gotten a copy of the full scored data summary report w/condensed graphs from both or all of your sleep evaluations AND titrations? They might prove interesting and add some additional clues. In the USA you have a LEGAL RIGHT to those copies due to HIPAA.

If that stuff existed I am sure there would be something interesting on it. I have an HMO. I got sent home with a device that had a nasal cannula to measure airflow, a position sensor, a chest expansion sensor and a pulse oximeter. After I was diagnosed I was sent home again with an APAP with data capability.

With the exception of the pulse oximeter (which I am thinking about getting) I have all the stuff at home in my "redneck sleep lab".

Deleted

Well, no wonder no one can get your CPAP therapy right! No one has any REAL idea of just what sleep disorders you may have!!! IF at all possible you really would benefit from AT LEAST an in-lab sleep evaluation. You do have a legal right under HIPAA to a copy of the downloaded printouts from that "in home sleep evaluation" which might be better than nothing.

ca_hosehead wrote:Do what degree to apena events wake a person up? I have a consistently low AHI (around 2) but I don't feel well (tired a lot). Looking at the video of my sleep it looks like I "thrash" when I have an apnea event. I shake my head back and forth, change positions, sometimes move my arms about. It doesn't happen all the time but more often than not I'll see a reaction on the tape.

Is it a normal to do this?

Correct me if I'm wrong but an AHI of 5 per hour or lower is considered "normal". If a person is being awakened 5 times per hour, how does he get any sleep at all? Who could tolerate this?

Do you have the Encore Pro of Encore Viewer software......or are you getting your data from the LCD?
If you have (or could get) Encore Pro, you could use James Skinner's Encore Pro Analyzer to determine how long your apneas are lasting.
What is your pressure setting/range?

Den

hey ca_hosehead -- just some random thoughts and observations --

- There are 2 effects in OSA: arousals which fragment your sleep, and blood oxygen (SPO2) desaturation which means your body doesn't get enough oxygen. Both will cause you to be tired, and will wear down your body.

So even if your AHI is low, there are quite a few other possibilities:

- In addition to apnea's and hypopnea's, you can have additional respiratory-related arousals due to spO2 desaturation (not enough to cause SPO2 desat but wakes you up)
- In addition to respiratory-related arousals you can have arousals due to movement (e.g. PLMD - periodic limb movement disorder) - do you notice movement at other times than during apnea events?
- Duration of apnea & more importantly spO2 desaturation will correlate with how bad you feel, regardless of the number of arousals. An AHI of 2 ain't bad, but it isn't the whole story, if each event lasts a minute and your blood oxygen plummets!
- Are you using your machine in Auto mode? Some people do much better at a fixed pressure. The continuous change in pressure can also cause arousals (and therefore wrecked sleep!)

Hmm I realized that I wrote this for the question I thought you asked, not for the one that you actually did. Anyway, I echo Slinky - you should have a full sleep study if you can - probably there are some other issues that are going on, that aren't captured by your video, the APAP, and the initial at-home test. Can you go back to your HMO and tell them that this therapy just aint workin for ya, and get them to pay for a full sleep study?? It's been a couple of years already, no? You should DEMAND a proper sleep study, in fact!

You might want to get (rent) an SP02 monitor in the meantime, to see how your oxygen levels are looking.

ca_hosehead wrote:There is a lot of important stuff going on while I sleep, things I need to know about and deal with. Apnea events, desats, flow limitations, arousals -- all of this is happening and when I wake up all I remember is showing up for work in my underwear. Sigh...

yikes! i hope you haevn't actually done that....!
As for the apneas, desats, flow lims etc... do you have some charts you can post up here? maybe there are some clues there?