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What exactly is the Snore Index and how do I read my score based on it?

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singingkeys +0 points · 3 months ago Original Poster Sleep Commentator

I had a in-lab sleep study in early 2018. My results with private info removed:

https://i.ibb.co/4phNfxN/1.jpg https://i.ibb.co/mFrd0VR/2.jpg https://i.ibb.co/L93YK3z/3.jpg https://i.ibb.co/L64xw0C/4.jpg https://i.ibb.co/vcw5CfZ/5.jpg

4.7 AHI. 18.1 RDI. 40.3% sleep efficiency noted. 41 snoring episodes and 14.86/hour snoring index. I only slept about 2.75 hours and they kind of botched everything by starting my study late (was one of the last people to get electrodes placed) and such. 6.5 total minutes of REM sleep during nearly 3 hours. Doc said the 0.3 below 5.0 AHI meant I didn't have sleep apnea. Told me to come back again for an in-lab study again in 6 months to "see if it was any worse" than that time. He joked around that it was "a good thing that I had an active job, because you'd be going to sleep at your desk if you had an office job." I do fall asleep and pop away with hypnogogic jerks a ridiculous amount of times at home, on the bus, while riding as a passenger in a car, etc.

Did a home sleep study on 4/6/2019.

PATIENT INFORMATION: This 36-year-old Male was referred for a type 3 portable sleep study. With sleep complaints of: Witnessed apnea, excessive daytime sleepiness, insomnia, gasping/choking. The patient is 68.0 in and weight was 157.0 lb, which represented a BMI of23.87. The patient has an Epworth score of 21/24 and a STOP BANG score of, STOP score of 2 and a BANG score of 1.

SLEEP TIME AND EFFICIENCY: The sleep study recording began at 02:08:53 AM and ended at 08:55:12 AM. Total recording time was 406.3 minutes. The total sleep time was 348.0 minutes. The sleep efficiency was 85.6 percent. The patient spent 232.9 minutes supine, and spent 115.1 minutes non-supine. The patient’s own estimate of sleep time was 6.50 hours.

RESPIRATORY DATA: The AHI in this report is indexed to sleep time based on actigraphy. The AASM defines this as REI. The AHI on this type 3 Home Sleep Study may understate the AHI determined on a type 1 or 2 study, since EEG is not monitored resulting in the inability to score non-desaturating hypopneas.

Based on 3% Calculation: The AHI3% calculation of 5.3 per hour of recording time was based on a total of 23 scored apneas and 2 scored hypopneas with 3% desaturations. Supine AHI3%:4.9 per hour. Non-supine AHI3%: 2.6 per hour.

Based on 4% Calculation: The AHI4% calculation of 5.3 per hour of recording time was based on a total of 23 scored apneas and 2 scored hypopneas with 4% desaturations. Supine AHI4%: 4.9 per hour. Non-supine AHI4%: 2.6 per hour.

Oxygen Summary: Patient's baseline O2 saturation was 98.1 %. The patient spent 0.0 minutes at an oxygen saturation less than 90%, and 0.0 minutes less than 85%. The desaturation index was 1.4 events per hour sleep time. The lowest saturation was 91.0 %. SNORING: The percent of the study time spent snoring was 88.5 %. The Snoring Count was 6931 . The Snoring Index was 1195.0 . PULSE RATE REVIEW: The mean heart rate was 65 beats per minute. The rate ranged from a low of 46 to a high of 95 beats per minute. DIAGNOSIS:

  1. Mild Obstructive Sleep Apnea G47.33 This is likely a significant underestimation of the severity of Obstructive Sleep Apnea, because of the limitations of the Home Sleep Study
  2. History suggests Severe Daytime Hypersomnia. This may be related to the Obstructive Sleep Apnea TREATMENT PLAN RECOMMENDATIONS: For accurate assessment of patient's sleep-disordered breathing, we recommend that they have an in-lab overnight SPLIT NIGHT STUDY. Recommend ENT evaluation if the Patient has symptons of nasal obstruction.

Longest Obstructive Apnea duration was 85 seconds. Mean Apnea duration was 34 seconds. Longest hypopnea was 29 seconds and mean was 23 seconds. My AHI seems to cut in half when I'm on my side and possibly my stomach. Sleep efficiency was listed as 85.6%.

SNORE SUMMARY SNORE Count: 6931
SNORE Index: 1195.0 SNORE Supine Count: 4602
SNORE Supine Index: 1185.6 SNORE Non-Supine Count: 2329
SNORE Non-Supine Index 1214.1 Percent of sleep time snoring: 88.5

PULSE RATE SUMMARY Mean Heart Rate 65(bpm) Minimum Heart Rate 46(bpm) Maximum Heart Rate 95(bpm)

My heart rate dropped to 46bpm and at one point I stopped breathing for 85 SECONDS?? Yikes.

Sleep doc from the first study is giving me the run-around. Wants me to come back to get CPAP prescription because I "haven't seen him in a long time." Prescription request for an APAP denied until a visit, which they can't do for months (backed up). Asked my PCP doctor if they could write a prescription and they won't. Next I'm going to ask my ENT that did the surgery. Yeah, I had the study last year in like March of 2018. Had turbinate reduction/deviated septum surgery in July 2018 and took a few months to heal all the way. My airways in my nose were too small. I breathe much better now, but it seems like when I lie down on a bed, I instantly feel like I don't breathe as well. My snore numbers look off the charts.

APAP? Seek some kind of ablation surgery? How do I figure out which makes me snore? I wake up with teeth marks on my tongue that are very deep, sometimes deep enough to turn into canker sores. My tongue looks swollen some mornings. My lips tend to be bright red (not chapped, more like blood pressure related) and yet I don't have high blood pressure in general when I check it during those times. Face looks flush red during the day. Blood pressure usually shows a little low like 110/70 when it feels like it is high in my hands and face and those areas will feel hot.

Was going to try ResMed Air Sense 10 Auto probably with P20 mask and upgraded supports for the mask (people said it is flimsy). Why would I snore that much? Should I seek another solution?

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Sierra +0 points · 3 months ago Sleep Innovater

The snoring index seems extremely high in the home study. It makes you wonder how they measured it. The snore in the lab study seems more reasonable. In general CPAP pressure does reduce snoring.

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Rydog22 +0 points · 3 months ago

Hi there,

My numbers in my home sleep study gave me very similar numbers for my snore index (I am only 23!)

I knew I am capable of quite loud snoring (especially after a drink)...but I didn't think my snoring was record breaking (which apparently it is according to the home sleep study).

HOWEVER, the lady who conducted my sleep study told me that measuring snoring from home studies are largely inaccurate. They are accurate for AHI and breathing events, but for snoring not so much. To accurately gauge how loud your snoring is, an audio recorder would be needed.

I hope this helps!

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bonjour +0 points · 3 months ago Sleep Commentator

In your lab study your most significant issue was RERAs, Respiratory Effort Related Arousals, these are a series of Flow Limitations ending with arousal. Yours were such that you would have an arousal every 4-5 minutes. How restful do you think that was? Your surgery should have reduced or eliminated these.

You say "I wake up with teeth marks on my tongue that are very deep, sometimes deep enough to turn into canker sores. My tongue looks swollen some mornings. My lips tend to be bright red " something is likely going on and I suspect your ENT may be the one to ask. Your Home study said nothing about RERAs which we dominate prior to surgery. The Snores do indicate a respiratory restriction so you may still have RERAs but cannot tell from your current information. Your swollen tongue MAY indicate a similar issue, thus the consult with your ENT. The Split study make sense because the surgery would mean that you should have a new baseline.

How disruptive do you find the snoring?

Your AHI is up to 5.3 from the 4.7 in the lab study.

Because of the RERAs in your lab study the only brand CPAP you want is ResMed because of the way they implemented EPR and that can help with treating RERAs. A BiLevel with greater pressure support may be better for you but it is unlikely the system will let you get one.

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Sierra +0 points · 3 months ago Sleep Innovater

I had a look at my sleep report which was based on an at home Phillips Alice NightOne system. They reported a % of the time that I was snoring. It was high at nearly 40%. The % of time snoring may be a better indicator of snoring severity than an index. If your snoring incidents were short but frequent, it could give you a very high index number.

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singingkeys +0 points · 3 months ago Original Poster Sleep Commentator

My big concern is the events where I stop breathing completely. One of them was 85 seconds, which is a pretty long apnea. I remember a couple of weeks ago before I did the sleep study, I woke up and did a big gasp for air. My entire body from head to toe was tingling all over and I figured it was from lack of oxygen. No idea how long it was. This very morning, I woke up 2 minutes before my alarm clock was going to go off. I was laying for sure on my stomach with my head turned to the side. I gasped awake, so this apparently happens when I'm also on my stomach and possibly on my side. Home study results seemed to indicate that I had less issues on my side and stomach than on my back, which seems normal for obstructive apnea. Seems quite abnormal for me to gasp awake like that while on my stomach, however. That can't be my tongue falling back. Could be the soft palate/adenoids. Doesn't seem likely at all that it is anything in my sinuses since surgery took care of that.

I do feel like when I lay down, my airway seems a little more constricted than normal for some reason. I do know that my sinus cavities were clear when the ENT doc had me do a CT scan. The swollen turbinates were corrected and so was the deviated septum, so those aren't an issue and I still notice that I breathe much more easily than before the surgery. So I suspect either my tongue falling back, the tissue/soft palate/adenoids.

My tongue looks "larger" sometimes because I think it swells up some when it is pressed into the teeth and irritated all night. Other times during the day, no teeth marks and it looks smaller and more normal to me.

My primary care doc office refused a CPAP prescription, but I have read that primary care docs can write prescriptions for CPAP. They claimed they don't treat sleep apnea. The sleep doctor that I went to before seemed quite incompetent. What are my chances for my ENT doc to write me a prescription for a ResMed Air Sense Auto?

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Sierra +0 points · 3 months ago Sleep Innovater

The way it works here in Canada is that the sleep clinic produces the report like you have and then the GP signs a cover sheet to make it a prescription.

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singingkeys +0 points · 3 months ago Original Poster Sleep Commentator

GP says they don't treat sleep apnea.

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