I am 79kgs and 6ft tall, was a heavy smoker and loud snorer. A few months ago, I went through a sleep test as I was choking in my sleep. According to the test, I snored verrry loudly and I did stop breathing several times during the night, but not enough times for the test to diagnose me as CLEARLY having sleep apnea. The sleep specialist said that my symptoms were standard:
1. Choking and gasping for breath while I was asleep, 2. My neck size was 17, 3. I snored very loudly, 4. Tiredness during the day,
5. A quick nap in the afternoon (at work) was required - just 5-10 minutes
6. After diagnosis, I was depressed and sad most of the times (don't know if it was related to sleep apnea or the diagnosis itself

We verified if there were any problems in my ENT, but that was ok. The specialist suggested that I go for CPAP, but I was reluctant. I made a few changes:
1. Slept on my chest - my snoring has stopped according to my wife (she says I rarely snore)
2. Cut down on sweets, reducing my weight
3. Quit smoking (almost 9 months now)
Now I sleep longer so that I get enough sleep (10 hours so that I feel rested .. meaning I go late to work, but stay back late too). Even now, there are times when I sense that I have stopped breathing, this is just before I am totally asleep. I havent had the choking problem in the last few months though.

I am up for a very important assignment in Europe, and it is very important that I do my best. I have been trying to manage this problem for a while now. Need some direction from those who have experience.

Was the sleep lab unable to collect enough data to make a diagnosis or are they simply unable to interpet your results?  What did they test for?  A well run sleep study has you hooked up to around 22 leads measuring EKG, EEG, snore, breath, chest movement, leg movement, pulse oximetry (pulse and O2 levels).  I think you need to find out why they could not make a definitive diagnosis with the data and have it repeated with a good sleep lab if necessary.

Why are you reluctant to use a CPAP?

Vicki

Thanks for the response vicki. Why am I reluctant to go CPAP? Well, the thought of depending on a device for the rest of my life puts me off. And if I can live without smoking (which was my favourite habit), I can live without anything Jokes apart, I dug out my sleep study report. This is what it says:
Index based on: 5h 39m sleep
SpO2 < 90% = 0%
AI: 0.4
AHI: 4.1
ODI: 0.5
Deepest Saturation: 93
% in supine: 66
Apneas with desat: 2

O.Apnea        Total (02)    Min (14)   Average (14)    Max (15)    Index(0.4)
C.Apnea        Total (00)    Min (00)   Average (00)    Max (00)    Index(0.0)
M.Apnea        Total (00)    Min (00)   Average (00)    Max (00)    Index(0.0)
Hypopnea      Total (21)                                          Max (18)    Index(3.7)
Desaturation  Total (3)                                           Max (29)    Index(0.5)

As per the sleep specialist, Sleep Study report is normal but in view of the symptoms and daytime effectgs, a CAPAP trial may be given for Upper Airway Resistance Syndrome. Also says: Choking sensation in sleep, Twitching in sleep, HEavy Snoring
[/b]

Anonymous wrote:

Thanks for the response vicki. Why am I reluctant to go CPAP? Well, the thought of depending on a device for the rest of my life puts me off. And if I can live without smoking (which was my favourite habit), I can live without anything :-) Jokes apart, I dug out my sleep study report. This is what it says:
Index based on: 5h 39m sleep
SpO2 < 90% = 0%
AI: 0.4
AHI: 4.1
ODI: 0.5
Deepest Saturation: 93
% in supine: 66
Apneas with desat: 2

O.Apnea        Total (02)    Min (14)   Average (14)    Max (15)    Index(0.4)
C.Apnea        Total (00)    Min (00)   Average (00)    Max (00)    Index(0.0)
M.Apnea        Total (00)    Min (00)   Average (00)    Max (00)    Index(0.0)
Hypopnea      Total (21)                                          Max (18)    Index(3.7)
Desaturation  Total (3)                                           Max (29)    Index(0.5)

As per the sleep specialist, Sleep Study report is normal but in view of the symptoms and daytime effectgs, a CAPAP trial may be given for Upper Airway Resistance Syndrome. Also says: Choking sensation in sleep, Twitching in sleep, HEavy Snoring
[/b]

Hi,

From my limited knowledge your sleep test looks OK.

Your doctor suggested a trial with cpap, as your symptoms might lead towards UARS. Did you try cpap at all ?
If not, you might never find out exactly what is wrong. I appreciate that you don't want to be dependant on a mechanical device, but outside your health you do depend on various devices, why not one to help your health ?

I think its important to go back to your doctor, take the trial, see if it works. If not you and your doctor can start looking at other areas, possibly thyroid or similar, but until such time as you eliminate the possibles you will never get to the root of the problem. This is particularly important if you are expecting to 'bat with us Europeans' as you will want to be on top of your game  :lol:

Daniel


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Hi-

     Well your test result looks like a lot better then mine, however if C-pap was suggested you should try it.  The idea as many here will tell you is to improve your overall health and life.  I have been having alot of trouble adjusting to my C-pap.  
I first considered an inconvenience - but I now pray that I can get used to it so it will help me and prolong and save my life.   Good Luck to you.  - John

Daniel wrote:

Hi,

From my limited knowledge your sleep test looks OK.

Your doctor suggested a trial with cpap, as your symptoms might lead towards UARS. Did you try cpap at all ?
If not, you might never find out exactly what is wrong. I appreciate that you don't want to be dependant on a mechanical device, but outside your health you do depend on various devices, why not one to help your health ?

I think its important to go back to your doctor, take the trial, see if it works. If not you and your doctor can start looking at other areas, possibly thyroid or similar, but until such time as you eliminate the possibles you will never get to the root of the problem. This is particularly important if you are expecting to 'bat with us Europeans' as you will want to be on top of your game  

Daniel

Hi..Signed up after putting in a couple of posts as anonymous. Thyroid I guess is ruled out because I went to an ENT specialist and he said that my ENT was fine. Some encouraging signs in the last few months have been little to no snoring, daytime drowsiness (the 5 minute nap i ALWAYS needed) is gone. I can't believe this could be because I stopped oops..quit smoking. Makes me doubt if I really have the problem, compared to the test results of some people here, mine seem negligible, but will see the doctor anyway. I am meeting the doctor tomorrow to take up his advice on the CPAP trial. I hope I get used to it, not that I have too much of a choice.

Hi TVinIndia!
Smoking can make SA worse, so there definitely could have been some improvement in the SA as well as overall improvement in sleep architecture as the effects of nicotine and other toxins are no longer present.
The diagnosis of UARS (Upper Airway Resistance Syndrome) needs to know the number of arousals to make that diagnosis.  That's the AI, and, like the AHI, needs to be in the neighborhood of <5.0.  As you can see, it's way low.  Double check the number of arousals to be sure.  But the question you should ask is, "why should I be treated for UARS, when I have no 'A'?"  Write back.
sleepydave

Hi sleepydave,
The question I should ask seems to be valid, but isn't this a doctor thing? I mean, if he says that I need to be treated for UARS...what can i possibly do? I got a second opinion, and this doctor tried to investigate the possibility of Acid reflux leading to choking. I did as he asked to, but I havent seen any major differences except in a reduction in acidity problems (which again could be helped due to quitting smoking). He was of the opinion that since I wasn't overweight, chances of having SA was very less. At the same time, choking .. waking up in the middle of the night gasping for breath .. sensing that I wasnt breathing ... are not imaginary either.
I know there is a problem, there is something definitely wrong. I am not sure if it is physical or pyschological or both. I am more impatient than I was, more prone to feeling down....angrier but also less sleepier, much healthier and only the odd instance of choking (all this because of changing my sleeping posture and quittign smoking? find it hard to believe). That's where the confusion stems from. My report does show some very low values and the doctor is treating me on symptoms than on the report results. I trust the doctor's opinion, his intelligence...but...
TV

Hi TVfromIndia:

Quote:

choking .. waking up in the middle of the night gasping for breath .. sensing that I wasnt breathing ... are not imaginary either

No, they're not imaginary, you're doing this 4.1 times per hour, as a matter of fact, and you're probably only aware of a couple.  However, this AHI is considered within normal range by ALL medical groups.  And as long as you aren't having major oxygen desaturations (which you aren't) or have sleepiness during the day (and that sleepiness would have to be a direct result of the respiratory events, which you aren't, anyway) CPAP is not indicated here.

Quote:

what can i possibly do?

Quote:

Double check the number of arousals to be sure. But the question you should ask is, "why should I be treated for UARS, when I have no 'A'?"

That's what you do.  And see where your all of your respiratory events are?  Hypopneas.  And a hypopnea needs a desaturation or an arousal to be scored a hypopnea.  And if the number of desats and arousals you posted is correct, you've got 5 events MAX that can be used to qualify hypopneas.  So right now, you are even BETTER than the numbers say.

The diagnosis of UARS is based on objective criteria.  And you don't have that criteria.

CPAP is a lifesaving measure for many people.  It's also a lifetime commitment.  If you need it, you have to do it.  If you don't, why go through all that trouble.

Quote:

isn't this a doctor thing?

Yes, and right now I'm some faceless guy on the internet.  In answer to your question, though, no, it's not a doctor thing.

It's a patient thing.

Good luck.
sleepydave

Thanks sleepydave. This is the first time I am seeing the word "arousal" in this context Another alternative is to go for another sleep test or atleast insist on one before I go on a CPAP. Good idea? My insurance doesn't cover anything related to sleep apnea or related equipment but it will be money well spent.

Anyway, was supposed to meet the doctor to see what he says. I wouldn't have, if it had not been for the overall impact this episode has had on me in the last few months (more mentally) and if I hadn't had this critical assignment coming up. Don't want a curable health problem stop me from getting the job done. Just thinking aloud here.

I was lucky to have found this forum. When I quit smoking, the first few days were all about visiting whyquit.com which says NTAP (Never take another puff). That helped a LOT and this seems like a good start. Keeping my fingers crossed and will update.

Saw the doctor last evening and he says that my condition has improved over the last few months because of me quitting smoking and also losing weight, and that I am sleeping prone. My wife says I sleep in all positions and still dont snore - SNORE is her benchmark for my condition
My weight before: 80kgs
Weight yesterday: 75kgs
Neck size before: 16"
Neck size yesterday: 15"
(I think i lost weight because of the tension I have gone through hehe)
He still does suggest that I should go in for another sleep test, which might be sometime next week. I think I'll do it. His main concern is that I try to sleep longer than before (about 9-10 hours sometimes) just to make sure I am rested. His other concern is that I am sleeping prone and not supine, and he wants to test me under those conditions. Does that make sense?

Hi TVinIndia!
Sounds great, let us know how you make out.  OSA is almost always worse in the supine position, that's why the focus is on studying while supine, and yes, that's good information to know.  Still, by my calculations your RDI is more like 1.3, and positional therapy is a perfectly valid treatment in position-dependent OSA, but all's well that ends well.  Stay in touch.
sleepydave

The sleep stage summary says

Stage-- ------Latency-----Duration
WASO-- ------26.5---------2.5
Stage 1-------2.5---------39
Stage 2-------5.0---------49
Stage 3-------9.0---------77
Stage 4------51.5---------47.5
Stage 3/4-----9.0--------124.5
Total NREM---------------212.5
REM----------90.5---------39.5

# of Obstructive/Mixed/Central Apneas = 0
# of Hypopneas = 6
Hypopnea in REM: 1 - MAx 15.1 seconds
Hypopnea in NREM: 5 - Max 12.9 seconds/Mean 11.5 seconds

Average Saturation - 97.10%
Minimum - 91.0%

Arousal Summary

Source-------------------- Total
Spontaneous-----------------  8
Apneas-------------------------2
Hypopneas---------------------0
Snoring-------------------------9
Desaturation-------------------0
Periodic Limb Movement-----15
Total Arousals-----------------34

Study results
The overnight sleep study consisted of left and right EOG, submental EMG, left and right anterior tibialis EMG, central and occipital EEG, continuous ECG waveform, continuous airflow assessment and monitoring of respiratory effort, snore sensor, continuous overnight oximetry sampled at 10 Hz

The patient's sleep latency was 2.5 minutes with 2.5 minutes of wake time recorded after sleep onste. Total wake time during the night was 5.0 minutes. The sleep stages as a percentage of total sleep are as follows:
Stage 1 = 14%, Stage 2 = 17.6%, Stage 3 = 27.6%, Stage 4 = 17.0% and Stage REM = 14.2%

Total obstructive/mixed/central apneas were 0 and hypopneas were 6. 1 event occurred in stage REM and 5 events wre noted in nonREM with a respiratory disturbance index of 1.30 (RDI) events per hour of sleep. .

The respiratory disturbance arousal index was 2.39 per hour.
There were 34 total myoclonic events which calculates to 7.38 events per hour of sleep. The myoclonic arousal index was 3.25 events per hour. 8 spontaneous arousals were noted with an index of 1.90.

How normal or abnormal does this report look?

TV, Dave is "the best" at figuring out what the study data is saying.  Those arousals are getting to you, maybe.

As for "AHI", here are two interesting takes on that.  I'd opt for Dr. Sullivan's approach:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

Hi Guys!
You know, one of these days I gotta try to find the transcript of that debate between Drs. Rappaport and Sullivan.  I only ever see those excerpts, and sometimes I fear they can be taken out of context.  As I see it right now, I don't think Dr. Sullivan necessarily means throw out the AHI, let's use blood pressure as the primary indicator for OSA, and have a low tolerance for placing people on CPAP.
Dr. Sullivan et al did a great study on women with pre-eclampsia.  Both the pre- and post-CPAP studies showed essentially no change in sleep architecture, REM sleep or, interestingly, arousals, and AHI was less than 10.
What they measured was beat-to-beat BP changes, all night long, and the effect CPAP had.  So this was not daytime measurements of BP, which can be somewhat misleading if you're thinking that.  These observed BP elevations occurred at night.  Similarly, the response to CPAP was measured continually.
And what they found was thus:



Now THAT'S impressive.

Obviously, with the success that CPAP enjoyed in this patient group, something had to have changed.  They were particularly concerned with flow limitation.  The same flow limitations that you need a pressure transducer to pick up in PSG.  OK, fine, these pressure transducers also exist in AutoCPAPs.

But the point here is, I think Dr. Sullivan would still want us to use some scientific method to monitor CPAP application.

And you can include, you HAVE to include, measurements of EDS in there, be it either objective or subjective.  I mean all this tech stuff is slick, but if you do "feel better" using CPAP, that could, in many cases, be enough justification.
sleepydave

Reference
Am. J. Respir. Crit. Care Med., Volume 162, Number 1, July 2000, 252-257
Nasal Continuous Positive Airway Pressure Reduces Sleep-induced Blood Pressure Increments In Preeclampsia
N. EDWARDS, D. M. BLYTON, T. KIRJAVAINEN, G. J. KESBY, and C. E. SULLIVAN



Last edited by sleepydave on Sun Sep 25, 2005 11:00 am; edited 2 times in total