Hi,

I am new to these forums and apnea in general. I am 44, active, and with a variety of mental and physical disorders: major depression, chronic pain, ADHD (brain never stops) and now moderate apnea. After years of smoking pot to self medicate my ADHD, I have stopped. Now, it is clear that I never really slept well in the first place. My chronic pain, exhaustion, maybe fibromayalsia is now exacerbated during sleep. When I wake up it feels like I have been hit by a 500 lb truck and my whole body is in pain, sore and achy.

I was diagnosed with moderate apnea and a marked amount of sleep fragmentation. Supposably I am a good canditate for an oral device.

I am interested in learning more about sleep fragmentation, whether it is related to the apnea or can brought on by psychological issues. I am so tired and in pain, but my cannot get good sleep. I am currently on short term disability and cannot imagine being able to do any work let alone basic things to keep my life going.

Here are my findings. I are really overwhelmed and don't know what to do. any help is appreciated.  thanks lisa

Diagnostic findings.
Arousal Index:  41.7/hr
Apnea/Hypopnea Index (AHI) 13.7/hr
Respiratory Disturbance Index (RDI):  14/hr
Respiratory Disturbance Index (RDI)Supine: 27.8/hr

Sleep Efficiency:  78.%
Sleep Architecture
Stage 1 sleep 17.1%
Stage 2 sleep 70.5%
Stages 3 & 4 sleep (Delta) 7.7%
REM sleep 4.8%
Sleep Latency (time it takes to fall asleep from Lights Out) 2 min
REM Latency (time it takes to obtain REM from sleep onset) 338 min

Quote:

I am new to these forums and apnea in general. I am 44, active, and with a variety of mental and physical disorders: major depression, chronic pain, ADHD (brain never stops) and now moderate apnea. After years of smoking pot to self medicate my ADHD, I have stopped. Now, it is clear that I never really slept well in the first place. My chronic pain, exhaustion, maybe fibromayalsia is now exacerbated during sleep. When I wake up it feels like I have been hit by a 500 lb truck and my whole body is in pain, sore and achy.

I was diagnosed with moderate apnea and a marked amount of sleep fragmentation. Supposably I am a good canditate for an oral device.

Technically you have mild apnoea.......bordering on moderate (AHI >5 <15 = mild)
What kind of meds are you taking ? They could have a bearing on the severity of your condition.

Quote:

I am interested in learning more about sleep fragmentation, whether it is related to the apnea or can brought on by psychological issues. I am so tired and in pain, but my cannot get good sleep. I am currently on short term disability and cannot imagine being able to do any work let alone basic things to keep my life going.

Sleep fragmentation, or disrupted sleep architecture is a vast area. Anything that causes an awakening can contribute to disrupting your sleep cycle/architecture. Pain obviously comes into the equation. Disrupted sleep architecture leads to excessive daytime sleepiness, irritability etc etc.

Quote:

Here are my findings. I are really overwhelmed and don't know what to do. any help is appreciated.  thanks lisa

Diagnostic findings.
Arousal Index:  41.7/hr
Apnea/Hypopnea Index (AHI) 13.7/hr
Respiratory Disturbance Index (RDI):  14/hr
Respiratory Disturbance Index (RDI)Supine: 27.8/hr

Your overall AHI determines the severity of your apnoea. The arousal index shows a substantial increase over AHI. Was this discussed with you ? Possible causes ? I can think of some, but it is best to have the exact causes explained to you rather than taking guesses. They do not appear to be respiratory based. This would contribute to your fragmented sleep.

Quote:

Sleep Efficiency:  78.%
Sleep Architecture
Stage 1 sleep 17.1%
Stage 2 sleep 70.5%
Stages 3 & 4 sleep (Delta) 7.7%
REM sleep 4.8%
Sleep Latency (time it takes to fall asleep from Lights Out) 2 min
REM Latency (time it takes to obtain REM from sleep onset) 338 min

Sleep efficiency at 78% is not good, but sleep efficiency is seldom good during a sleep study. At 78% it is worse than 'normal'.
Your sleep architecture

Stage 1 17% (perfect is 5%)
Stage 2 70% (perfect is 55%)
Stages 3 & 4 8% (This is now referred to as Stage N3) (perfect is 20%)
REM 5% (perfect is 20%)
Obviously there is room for a little manoevre on the 'perfect' figures quoted above...........age etc. You are very much 'out of kilter'.
With a reduced amount of Stage N3, usually contributes to excessive daytime sleepiness.

Sleep latency at 2 minutes is very quick. This can sometimes point towards Narcolepsy. You should ask about it.
REM latency is very extended at 338 minutes. Our first REM period of sleep usually occurs after about 90/110 minutes. The usual progression during our first cycle is Stage 1 (Non REM) to Stage 2 (Non REM) to Stage N3 (Non REM) to Stage 2 (Non REM) to REM Sleep.

The extended REM latency, coupled with longer than average Stage 2 Sleep (and little Stage N3 and REM Sleep) points towards disrupted sleep architecture. If you were to get a copy of your sleep graph and compare it to a 'normal' graph it would be very obvious.

If taking meds, they should be discussed with your sleep doctor before going down any treatment route.

IMHO, XPAP offers possibly the least invasive and quickest way to get your sleep patterns under control..........and this is the most important thing at present. I believe that a dental device is something to be looked at when things are under control and you can make a balanced decision...........say 6 months down the road....even 3, if you have things under control. Renting may be an option. It is hard to be objective at this stage, but I think you should see your sleep doctor in the first instance, discuss the report, get a copy of the report and listen to his recommendations.

Best of luck.

Daniel.


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

(Anon)

My sleep study results were kind of similar to yours (except I did not fall asleep that quickly). I also spent most of my night in Stage 2 sleep, and it also took me 300+ minutes to reach REM. You should talk to your doctor about what the sleep architecture might mean. Some medications (such as antidepressants) might make your first REM occur late in the night. If you usually sleep more than 8 hours a night, then you are likely getting more REM than the sleep study suggests.

You probably don't have narcolepsy since you don't go quickly into REM when you fall asleep. You would have to do the multiple sleep latency test to find out for sure about narcolepsy.

Hi,

Daniel thanks for you detailed response. Since my post, I have been having interesting experiences with doctors, insurance cmpys and medical device companies. My doctor is basically not really available anymore to see patients. Miss i knew this before I saw him. His collegues are no help cause they don't know my case. I questioned my arousal index when I go my results and he said that it was apnea. I know believe as I did before that it was anxiety and stress due to major changes in my lifestyle.

Since June, my insurance company has twice denied me treatment and now I am in appeals (I even have a PPO, its crazy), without any help from the doctor who is unavailable to write a more informed letter. I have rented a CPAP machine but have not become acclimated to it, got myself a better mattress and all.

Do you know about surgury to get rid of the tissue i the back of the throat that blocks that airway.

Also, what are your thoughts on the studies on didgeridoo. I actually play and am starting to investigate it more.

peace,

Lisa