Obstructive Sleep Apnea without snoring

DreamDiver · Post by **DreamDiver** » Sat Aug 02, 2008 9:22 pm

I don't snore. I never have.
Technically, the snore index shows as 2.1 a week. (.3 avg per night)
But if you're clearing your nose, that shows as
a snore too.

That number hasn't changed since starting CPAP.

Snoreless sleeping delayed my OSA diagnosis because so many gp's think you have to snore to have OSA. I can tell you it's certainly not so.

split_city wrote:

I experience this same apnea pattern. Breathing volume decreases prior to the event and the hyperventilation afterward.

jskinner · Post by **jskinner** » Wed Aug 06, 2008 8:21 pm

Snoredog wrote:ZERO apnea, ZERO Snoring ALL Hypopnea??

The interesting thing is that my CPAP shows apnea's every night. (as well as hypopneas and often FLs)

rairy · Post by **rairy** » Fri Aug 08, 2008 12:42 pm

jskinner wrote: Does anyone else in the group other than me have OSA without much snoring?

I do. I did snore until my tonsilectomy. Now days I only snore if my allergies are bad. Otherwise my husband claims I'm a pretty quiet sleeper.

And as some recent serious health complications resulting from my non-compliance with my cpap have demonstrated - I do have OSA major enough to demand treatment.

skjansen · Post by **skjansen** » Fri Aug 08, 2008 1:12 pm

According to my husband and also my sleep study I do not snore a lot. That is one reason I went undiagnosed for so long. I think there is a misconception by the medical community that if you do not snore loudly and frequently then you probably do not have sleep apenea.

I would love for someone to do some research on how neck injuries might affect sleep apnea. When I was in my 20's I had an accident where I lifted up under a cabinet and hit my head to the point where the curve of my neck went from around 26 degrees, which I understand to be normal, down to a 5 degree curve. I am convinced that this lack of curve in my spine makes the internal structure in my neck, throat, and esophagus more likely to block my throat. Hope that makes sense. Last year I was also diagnosed with a calcified stylohyoid ligament that I can feel in the back of my throat. It again is my understanding that this calcification can occur from injury to the the throat/spine area. I have never had a doctor (beyond a chiroprator) that would even acknowledge that I may have really hurt myself when I banged my head so hard. They said if I did not pass out then it did not cause any problems. Never mind the sore neck, back and the curvature of the spine that it caused.

Okay, I am done whining about this. Just wonder if injuries can also bring on structural changes in the throat that could either cause OSA or make it worse.

jskinner · Post by **jskinner** » Fri Aug 08, 2008 9:39 pm

skjansen wrote:Just wonder if injuries can also bring on structural changes in the throat that could either cause OSA or make it worse.

Seems perfectly reasonable to think that this could be so.

Snoredog · Post by **Snoredog** » Fri Aug 08, 2008 9:52 pm

have they examined your epiglottis? Think you showed the vocal cords if not mistaken, they would have examined it during that time I would think.

with all hypopneas could explain why you did better on that old bi-level with the rotary dials, for those you could bump up IPAP and leave EPAP much lower.

another option would be if you could participate in that tongue "tether" study (aka tongue suspension procedure), if you could they would pay for everything, think it is located in Chicago, I'll look for the info, I got accepted for that trail but lived too far away. The company is located I believe in the Bay Area near San Francisco,

Thomas AJ, Chavoya M, Terris DJ.
Division of Otolaryngology-Head and Neck Surgery Stanford University Medical Center, Stanford, CA, USA.
OBJECTIVES: This study compares the efficacy of 2 tongue-base surgical procedures in the treatment of patients with moderate to severe sleep-disordered breathing. STUDY DESIGN AND SETTING: We conducted a prospective, randomized crossover surgical trial at a university hospital. METHODS: Seventeen patients with moderate to severe sleep-disordered breathing and Fujita type II upper airway collapse for whom conservative treatment failed were enrolled into an institutional review board-approved surgical protocol. They were randomly assigned to undergo palatopharyngoplasty combined with either tongue advancement (mandibular osteotomy) or tongue suspension. Parameters assessed included severity of sleep-disordered breathing (polysomnography), sleepiness (Epworth Sleepiness Scale), and anatomic changes (upper airway endoscopy), as well as demographic factors. Patients not achieving satisfactory improvement in their condition were offered nonsurgical management or additional surgical treatment that varied based on the postoperative assessment but included crossing over to the other tongue surgical procedure. RESULTS: Nine of the 17 patients were randomized to the tongue suspension group, and 8 to the tongue advancement group. In the 9 tongue suspension patients, Epworth Sleepiness Scale scores fell from 12.1 to 4.1 (P = 0.007). Airway collapse for all 9 patients measured on Müller maneuver improved, by a mean of 64% (P = 0.0006) at the palate and 83% (P = 0.0003) at the base of the tongue. In the 8 tongue advancement patients, Epworth Sleepiness Scale scores fell from a mean of 13.3 to 5.4 (P = 0.004). Airway collapse for 5 of 8 patients measured on Müller maneuver improved by a mean of 31% (P = 0.1) at the palate and 75% (P = 0.03) at the base of the tongue. CONCLUSION: Prospective, randomized trials of tongue-base surgery for sleep-disordered breathing are possible. Preliminary findings from the current protocol reveal a slight advantage of tongue suspension over tongue advancement.

http://www.ncbi.nlm.nih.gov/pubmed/14595277

Don't be proud man, email them Researchers with questions and for more information, you may just be surprised what you get back.

and if you are considering the Hyoid Suspension Procedure:
http://archotol.ama-assn.org/cgi/reprint/131/5/440.pdf

socknitster · Post by **socknitster** » Sat Aug 09, 2008 2:40 pm

James,

Good to hear from you! Yes--I do not snore and haven't ever done much snoring according to my husband. Right before I was diagnosed I did snore a little bit, but that was it. Mainly I snorted and gasped for breath, but my husband didn't even notice that until after I was diagnosed. I, too, was diagnosed with severe sleep apnea and am on bilevel because my initial pressure was so high it gave me central apnea without the relief a bilevel creates.

So, your Detroit doc is full of poo. You don't have to snore even if apnea is severe.

I suppose it depends on what is creating the apnea. It varies from person to person. In my case, my enlarged tonsils were a huge contributer. They grew so large during allergy season they touched, giving me a constant gagging feeling. Since they were taken out last summer I have seen my pressure needs decrease significantly on my bipap. I doubt if tonsils flap around enough to cause snoring. I suspect the rest of my problem is caused by damage and inflammation from some fairly severe silent reflux, occurring mainly at night when lying down. Since I started taking Zantac each night before bed I have been sleeping better than I have my entire adult life.

If I remember correctly, James, you have a significant narrowing of your lower airway--I really doubt that would flap around and cause snoring.

Keep looking for another doc.

Jen

Obstructive Sleep Apnea without snoring

Re: Obstructive Sleep Apnea without snoring