DanM

Welcome, @OmaLaura! We're happy to have you as a MyApnea.Org member, and we invite you to complete the surveys and continue to share your experiences here on the forum. Congratulations on taking the first steps toward better sleep and better health! Keep us posted on how things progress if you like, and we welcome any questions or feedback you have!

All the best- Dan

Hi @AffableCobaltBlueJellyfish7400. Is the mouth piece you mention something you purchased over the counter without a prescription? Or have you seen a dentist who specializes in sleep medicine? There are oral appliances that can be adjusted that are designed specifically for patient who have sleep apnea, but they must be prescribed by a dentist and properly fitted and adjusted. Those types of oral appliances are generally most effective for patients with sleep apnea, depending on severity. There is CPAP technology available that senses wake and lowers the pressure until you return to sleep. If you Google "awake sensing cpap" there should be some results that talk about this. Some APAP machines will lower the pressure when they sense coughing, talking, etc. If you are willing to try CPAP or APAP again, this might be something worth mentioning to your home care provider or sleep physician. Good luck, and I hope you are able to get some rest and feel less tired!

Hi @Que,

The index is lower because it is an average. Calculating an index in a sleep study involves counting all of the events, hypopneas are one example, and then dividing the number of events by a length of time. For example, an apnea-hypopnea index (AHI) is calculated by counting the total number of apneas plus the total number of hypopneas, and then dividing that total number by the total amount of time you slept during the study. To further calculate your NREM Supine Index, only events that occur while you are on your back and in NREM sleep are counted. That total number of events is then divided by the amount of time you spent in NREM sleep during your study. Until the advent of computerized systems, a technologist did all of this manually--literally counting the number of different types of events, the number of minutes in each stage of sleep, the number of minutes spent in various body positions, etc.--and calculated all of these indices. Modern systems used to collect, score and generate sleep study data do these calculations automatically.

For your second question, all of the hypopnea events would normally contribute to your overall index. The difference is that some are associated with decreases in blood oxygenation levels and some are associated with arousals. The best case would be that a patient have as few arousals or decreases in blood oxygen levels related to respiratory events as possible. It is normal, as I've said in an earlier post, to have some arousals (ambient noise, general discomfort). But excessive arousals cause fragmented sleep which can contribute to fatigue. I encourage you to talk to your sleep physician about your concerns. Hopefully, the exchanges on the forum have helped you to understand more about your sleep study results. And all the best to you as well!

Thanks, Dan

Hi Anthony. Welcome to MyApnea.Org! Feel free to share your story, ask questions of our members and complete the surveys. There is a lot of information to explore, so let us know if we can help! -Dan

Hi @AmicableOcherGoose9739. I'm sorry to hear you have had such a terrible time with your sinuses since starting treatment. As a technologist, I have worked with many patients who suffer from sinusitis and allergy issues and have shared experiences with me that sound similar to yours. Maybe some members will share their stories here. I have terrible sinus and allergy problems and use medication (including a steroid spray) to manage my symptoms, and I have developed infections in the past. In my case, the infections were unrelated to my CPAP treatment, but CPAP can be very uncomfortable while trying to manage these problems. There have been nights--thankfully very few--that I was not able to use my treatment due to severe congestion or discomfort, and I had to wait until the medications resolved the worst of it. Is it possible that the timing of treatment happened to coincide with the development of an infection and that the two are not related? In my case, there was light at the end of the tunnel, and I rarely have issues wearing my CPAP. I try to keep my sinuses clean by using saline rinse, especially during allergy season, along with my medication. This seems to reduce my symptoms. It is important to follow the manufacturer's instructions for keeping your mask(s), humidifier and CPAP tubing clean to help reduce the risk of irritation or infection as well. Hopefully, your sinus issues continue to improve and treatment gets easier for you. Please keep us posted, and thanks for posting on the forum!

Hello @Que,

You're most welcome. To answer your questions:

There are a couple of "official" definitions used when assessing a sleep study, but a hypopnea is generally a reduction in airflow (breathing usually measured through a nasal cannula or by an alternate sensor) that results in a blood oxygen desaturation of at least 4% or that causes an arousal from sleep that lasts at least 3 seconds.

Regarding increased risk of mortality and the other issues you list, this data has been obtained through years of research showing the associations between sleep apnea and other conditions. The specific disorders, conditions or illnesses can be related to different things associated with sleep apnea. There is no single score or measurement associated with all of the conditions. Some risks may be related to decreased blood oxygen levels associated with respiratory events while others may be related to hypertension that is often worsened by sleep apnea. The important thing to understand is that research has shown us that sleep apnea can contribute to development of, or exacerbation of, many health conditions. There is also research that has shown that treating sleep apnea may lower the risk of developing some conditions and may even help improve other conditions. I wish it was as easy as assigning a score, but I hope this helps!

Hi @Que,

I will provide some general information, but your sleep physician should provide more guidance based on your entire clinical picture--medical history, sleep study results, medication history, etc. You should also discuss how you generally feel on a day-to-day basis. Are you frequently fatigued? Do you have a tendency to want to fall asleep or nap? Do you feel rested in the mornings after a full night in bed? All of these things are important to consider when discussing treatment options. In general, your hypopnea event indices are considered mild. However, some patients with mild sleep apnea report feeling very fatigued or drowsy during the day. This can sometimes be caused by frequent arousals that cause fragmented sleep. The American Academy of Sleep Medicine defines sleep apnea severity using the following AHI criteria: 5-15 is mild, 15-30 is moderate, more than 30 is severe. I hope this is helpful, and good luck as you continue to seek answers!

Thanks, @CharmingTanSparrow4349. We certainly appreciate your contributions to MyApnea.Org, and glad to hear you are working on few proposals! Feel free to post on the forum with any information or suggestions you think might be helpful.

Hi @Que. It is not uncommon for patients to have sleep apnea symptoms that are worse in both REM and in the supine position. In REM, the muscles relax. This is often referred to as REM sleep atonia. When the muscles associated with breathing and the airway relax during REM sleep, the respiratory event index tends to rise as breathing worsens. When in the supine position, the tongue has a tendency to fall toward the back of the mouth. Other tissue in the throat and upper airway can also contribute to airway obstruction. The respiratory event index, referred to as the AHI or sometimes the RDI, is the number of respiratory events per hour of sleep. This is usually provided for the entire night, for REM sleep and for non-REM sleep. Arousals are also reported as an index per hour of sleep and can be reported for the entire night, for REM sleep and for non-REM sleep. The respiratory event index and the arousal index are reported separately because not all respiratory events are associated with an arousal. Arousals can occur for many reasons--ambient noise, general discomfort and the need to change body position, coughing, etc. As for restful sleep, stages 3 and 4 (more commonly now called stage 3 or slow wave sleep) is usually the deepest and most restorative sleep. However, REM is very important because it also helps provide energy and supports some of the body's daytime functions. The National Sleep Foundation has a page that gives an overview of sleep stages that you might find interesting: http://sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep. Treatment for sleep apnea can help restore normal sleep architecture by helping to prevent respiratory events and associated arousals. I hope this information helps answer your questions. How is the didgeridoo playing coming along?

Hi Que. I cannot think of a good reason not to at least discuss the options with your sleep physician. There are surgeries available, but each patient must be properly evaluated to see if there are options for his or her specific needs. Risks vary by patient and surgery performed, so the risks and benefits should also be discussed with the specialist who would likely perform a given surgery. For example, the risks or side effects of removing tonsils and adenoids are likely different from the risks associated with implanting a stimulation device. Good luck as your explore the options, and keep us posted on your progress if you like!