I've suspected I have sleep apnea for a few years based on daytime fatigue and need for a nap in the afternoon, my grandfather has it, and I snore like a chainsaw (I audio recorded myself over night to check).

So my doctor finally agreed to an  at home sleep screening, as he didn't think the real study was prudent. I am 26 so I am a bit young for this, but I feel it's very possible I have it given that even when I breathe in the day I can feel loose flaps of skin in my throat.

The at home test was simply a pulse oximeter connected to a recorder. The technician that brought it out for me I think was just a salesman for an oxygen company, but the device seemed pretty foolproof even without instructions.

So three weeks later (and after  three hours in the waiting room) just to get these results, I see the doctor who is reading the results--I had to help him figure out how to interpret them. he had obviously never had to read results like this before. The only info I remember was that my average low was 92% oxygen, but I had an event each night I tested (tested two nights). During one event from one night my 02 was down to 77. And one  night down to 82. And according to the sheet an event means it is at least at that level for 10 seconds. The thing is I could not figure out how long the event lasted. There was a graph but the quality was so bad, it was hard to make out. The doctor told me not to worry but acquiesced in prescribing a sleep study.

Unfortunately his office insists on setting up the appointments instead of giving me the script, and it will take them at least a week just to make the phone call, and then the appointment is only for a consult at a sleep lab.

I am wondering with these results if I shouldn't be checked out much sooner or get a CPAP until I can be tested to be safe?

I have always had problems with anxiety, depression, and fatigue. I am also on bad medications for anxiety that a doctor put me on when I was 14. I have taken the same dose since then but been unable to get off of it, and it's really bad stuff, I know all my medications depress your CNS, but I have tried to get help getting off of them and the doctors I have seen seem incredulous at the idea that I would ever want to get off the meds. I feel like I need rehab and they on the other hand seem to want to up the doses every time I go in! It's horrible stuff. Anyhow, I just wrote that because I wonder if either the anxiety and depression have been caused by brain damage from apnea or if my medications are causing the apnea.

I know my grandfather had apnea, although he lives in Sweden and I never really talk to him, but I think he had some sort of surgery on his throat that cured the problem.

Do any of you have any insight on the events I had each night of the two nights of my at home screening?

Thank you!

The desats + your snoring could indicate you have sleep apnea but only a proper sleep study can diagnose it.

There's nothing wrong with proactively calling your office to lean on them a little to get the consult at the sleep center done sooner.  Also, I'm not sure how your Dr. or sleep lab does things, but my first sleep study I managed to bypass the initial consult with the sleep Dr. and went straight in for a study.  You may want to check in with the sleep center to see if you can do this and then follow up with the Dr after you get your prescribed pressure titrated.

Also, you should find out if they will plan on doing a split study + titration in a single night or if it will require 2 nights  of study.  If 2 nights are required, see if they can schedule you ahead of time for the titration (2nd) study so that you don't have to wait very long between nights.

I don't know if you should get a XPAP before you get diagnosed/titrated or not.  I personally wouldn't because there's a lot of different kinds plus you wouldn't get the opportunity to try different masks at the sleep center.  There's the potential of a negative experience before you have a chance to work with professionals.  this is just my opinion and there are other more experienced people here that may disagree for different reasons.

With that said, you should try to sleep on your side and/or reclined a bit to reduce any possible apneas.  I would also take great care with driving and try to reduce the amount of driving you do on days where you feel fatigued.

Welcome to the forums and good luck with your studies!

Thanks for the reply. I just got a call and my doctor schedule my consult for the 25th. I am going to try to call the sleep lab directly and see if I can move things along. In my experience with doctors they will insist on a consult first, but I'll give it a go.

A consult is a good idea first, especially given your situation.  Though it could be sleep apnea, you are also quite young, and you could have a disorder of primary hypersomnolence.  In order to make sure the appropriate test is ordered a consult is recommended.  Your doctor may decide based on your history that a PSG +/-  MSLT would be a good idea.  If you did not have the consult first, you'd have a PSG alone.  If this was negative, then you'd have to go back again for a repeat PSG + MSLT... This results in not only a delay in diagnosis but also increased cost...

Without seeing the trends in the nocturnal o2 it's difficult to say what it is.  it's also important to look at the pattern that is displayed, as one can have cyclical desats (which suggest sleep disordered breathing) yet have a relatively normal mean o2 sat.... this is not infrequently seen.

best of luck!

Thanks MOS. I just googled MSLT to read up on that as well. I'm looking forward to getting this done! If I actually do have this it would in some ways be good news in that there is an answer to this medical problem as opposed to many other types.


I thought of another question in the mean time though--with sleep apnea I have heard people can stop breathing hundreds of times a night--with my at home screening showing I had one episode each night, would that more likely indicate what I have is not apnea? Would it be considered normal even to stop breathing once in a while at night?

On the other hand it could also be possible that I stopped breathing more than once but that was the only one that stood out enough to lower my oxygen so much. Because I would also assume that if you stopped breathing for only 10 seconds your oxygen would probably not go down to 77. So my oxygen going down that low probably means I stopped breathing for quite a while. And I know adrenalin is supposed to kick in and wake you up to start your breathing again, but I have a lot of anxiety which means I probably get depleted of a lot of adrenalin by the time I go to bed (I think there's a bit of a refractory period for it to build back up) and also with my medications blocking CNS activity, I wonder if my body is less able to rev itself up overnight to breathe. I get quite worried wondering exactly how long I could have been not breathing to drop to 77. And those days of the test I felt pretty normal. Like today I have been exhausted, so who knows how low my 02 was last night. Ay ay ay.

I want testing yesterday!

[quote="swingerofbirches"]Thanks MOS. I just googled MSLT to read up on that as well. I'm looking forward to getting this done! If I actually do have this it would in some ways be good news in that there is an answer to this medical problem as opposed to many other types.


I thought of another question in the mean time though--with sleep apnea I have heard people can stop breathing hundreds of times a night--with my at home screening showing I had one episode each night, would that more likely indicate what I have is not apnea? Would it be considered normal even to stop breathing once in a while at night?

On the other hand it could also be possible that I stopped breathing more than once but that was the only one that stood out enough to lower my oxygen so much. Because I would also assume that if you stopped breathing for only 10 seconds your oxygen would probably not go down to 77. So my oxygen going down that low probably means I stopped breathing for quite a while. And I know adrenalin is supposed to kick in and wake you up to start your breathing again, but I have a lot of anxiety which means I probably get depleted of a lot of adrenalin by the time I go to bed (I think there's a bit of a refractory period for it to build back up) and also with my medications blocking CNS activity, I wonder if my body is less able to rev itself up overnight to breathe. I get quite worried wondering exactly how long I could have been not breathing to drop to 77. And those days of the test I felt pretty normal. Like today I have been exhausted, so who knows how low my 02 was last night. Ay ay ay.

I want testing yesterday![/quote]

What is hard here is to know the particulars of the pulse/oximetry test.  What do they define as an event?  Would they call a period of time where the average O2 level was less an event even though fifty desaturations occurred during that time?

Only the sleep study results will give you a clearer picture.

The issues of CNS and sleep apnea kind of hit a button with me.  I own a wrist worn pulse/oximetry testing device ($250 from the internet - made in China  - found a community appreciated distributor).  You wear it like a watch and simply place the little rubber boot over one of your finger tips.  It will take in data for over 48 hours at a time if you wish and seems to stay on pretty well at night.  When you have the data you can turn the watch off and USB download the data at any later time.  The included SW actually makes some pretty nice graphs and such for you, and one of the output options could be used in a spread sheet to graph there as well.  Anyway I lent the device to a friend who I suspected had OSA.  He did not have the usual body type but lots of daytime sleepiness and executive functioning issues.  His desats are worse than mine when measured with the device not using my CPAP (not a test I have done often)!  My OSA is severe and desats extreme!  It is worse during his first hour just after he has taken his nightly medication one of which is to put him to sleep!

So the doctor will not give him a sleep study because he believes he does not snore?!?!?!  Sometimes I wonder if somet of this stuff is not done simply to cover the previous and very wrong and irresponsible position of most doctors to not screen for Obstructive Sleep Apnea before they proscribe medications which are known to suppress the breathing systems.

Well I am preparing to write some letters to my congressmen, some medical professional organizations, and some doctors and hospitals in my area.  I guess you have reminded me of a few things that should be mentioned.

Thanks!

Todzo

I need to correct some misconceptions:

1.  Not all OSA patients snore.  In fact, in one study of 405 OSA patients, including both men and women, around 30% did not snore.

2.  It is not unusual to see people who are less than 40 with OSA.  We see it all the time.  In fact, we even have a pediatric forum.  Not only is age not a good indicator of the likelihood of OSA, neither is weight, gender or fitness level.

3.  A pulse-ox. is not a good way to screen for OSA.  There are several variables which determine if and how much a patient will desaturate and not all OSA patients desat.  So swingerofbirches you really have no idea how many events you are having.   Thankfully you desaturated once, otherwise it sounds like your doctor would have completely blown off the possibility of OSA.

OSA is going untreated and patients misdiagnosed because they don't fit the erroneous stereotype of an OSA patient as a middle-aged, overweight male.  And/or a physician uses a pulse ox. rather than (at the very least) a trial with an APAP to look at AHI and if the person doesn't desaturate, then once again, the accurate diagnosis of OSA is discounted.

To answer some of your other questions swingerofbirches:
Each apneic event is a true suffocation and as such elicits the "Fight or Flight" adrenalin response.   Often people with untreated OSA have higher anxiety because of this.  It is impossible to know how much of your depression and anxiety is due to OSA until you are treated.  Sometimes, we are just that way too.

Likewise, any meds that increase the laxity of throat tissue will increase the severity of OSA.

Keep asking questions!!

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Thanks for the replies and information from everyone. I wish I had done this testing years ago rather than sitting here now anxiously waiting for it. I'm going to call tomorrow to find out if the office lets a relative stay overnight with you. I know I would have a much better chance of sleeping if someone were there with me, even if not in the same room. I can't remember the last time I spent the night alone somewhere.

When I did my sleep study I believe you could take any one person with you and they would have/put a recliner in the room for them. It might not have been just anyone but I remember that I could have taken my 12 year old with me if I hadn't had someone at home for her.
Good luck
-me

I finally have my consult tomorrow. I have my hopes up that he will be an OK doctor because he sent out a very thorough pre-appt questionnaire. I am pretty much 100% convinced that I have apnea at this point either from structural problems in my throat or from the CNS depressing drugs I take. I am a little neurotic and bought my own pulse oximeter with 24 hour recording function. I used it successfully for the first time last night (lots of tape) and saw I desaturated for about a minute to 86. I am not sure if it's an artifact because it happened very suddenly--like from 94 or so to a straight drop to 86. And then it seemed to go back up to a "regular" number in the 90s very quickly again. But I also audio taped myself over night with some rather exotic sounding snoring, but what was interesting is that I believe that drop is right around when I woke up with a night sweat last night. (I often have cold night sweats.) I woke up and was talking to myself quite a bit and recall none of it! I was saying the word "ragnor" which has no significance to me and then some time later I woke up and was complaining out loud about how cold and sweaty I was and then seconds after I talked I was loudly snoring! It's not like me to suddenly fall asleep like that, but like I said, I wasn't even aware this morning that I had been awake. And then a few minutes later it sounded like I rustled awake again but without talking that time.

Anyhow, I can't be sure of what any of it means with any certainty, but willl bring it to the doctor. I also noticed that my Sp02 is permanently low--in the daytime--with this new monitor. It's probably most often at 93, and I live at sea level. Sometimes it does go higher, but with my previous pulse oximeter, my oxygen was usually at least 96. I feel a little better having my own oximeter seeing that my Sp02 is at least in the 90s for almost all of the night except that minute, because with the doctor's report I couldn't zoom in and see how much time the event was.

I am anxious, because well I have an anxiety disorder for one thing, but also a lot of other stressors in my life at the moment including having to be home alone a lot with my family being back at work and at school, so please think positive thoughts for me! I am thinking if I get this diagnosed and treated it could be a really good thing for me but in the mean time I am a little on edge about knowing that I am possibly suffocating overnight and not doing anything about it right away.

Thanks everyone for your responses and this place to get out my thoughts, it helps.