Not overweight, no known health issues, fit body, not a large neck size, not a typical candidate for sleep apnea.
In-lab study in March 2018 showed 4.7 AHI and 18.1 RDI. Sleep doc was an idiot and said I didn't sleep apnea because I was 0.3 AHI away from the required 5.0 to diagnose it. Regarding the 18 RDI, he joked, "Good thing you have an active job or you'd be asleep in your chair if you had a desk job!" It wasn't funny. Yes, when I get off from work and take the bus home, I pop awake with hynogogic jerks like every minute because I'm dead tired. I also fall asleep in my computer chair at home and even in the car as a passenger. Yet my oxygen levels never drop below the lower 90's around 93 or so.
I requested my own mail-order home sleep study. 5.2AHI. Mild to moderate sleep apnea with a warning that it could be even worse than that because their study isn't as accurate as in-lab. Longest apnea was 85 seconds. Hypopneas and apneas averaged about 20-30 seconds. Pulse rate shoots up to 90+ and drops down to lower 40's.
I came across my in-lab study details today. Buried in the back of the paperwork are my arousal indexes that nobody talked to me about. I slept for 2.75 hours that night.
REM: 2 total spontaneous. Arousal index of 18.5.
NREM: 44 respiratory, 10 snore and 77 spontaneous for a total of 131. Arousal index of 49.4.
Arousals: 45 Respiratory, 11 snore, 80 spontaneous for a total of 136. Arousal index: 49.3.
Awakenings: 2 snore, 2 spontaneous for a total of 30. Arousal index: 10.9.
Ar + Aw: 45 Respiratory, 13 snore and 108 spontaneous for a total of 166 arousals and awakenings combined over 2.75 hours. Arousal index: 60.2. No leg movements. No PLMS. No PLMS arousals.
Could I have something wrong with my brain causing all of this? I can't tell if I have UARS or what's going on. I'm popping awake a lot throughout the night even with my APAP (Air Sense 10) machine with near-perfect numbers (some nights 0 AHI and usually 1 or less) and leak rates ranging from 0 to 4L/min using a nasal mask. I am a mouth breather, but I tape and it works. Full face mask wasn't comfortable at all. I use a home security camera with night vision to hook to the main security system and keep it trained on my bed. I jolt awake throughout the night as if wondering where I'm at and then I look relieved that I'm in my bed and go back to sleep. No idea what is causing it. I have been a very "jumpy" person since I was a kid and 37. Didn't get sleep study until the age of 36. High school was a big struggle. To this day, I still can't focus enough to drive a vehicle (scared I'll have a wreck - I feel that tired and unfocused even after a full night of sleep with the machine). Should I go and talk to another sleep doc or what? In-lab study and home study both said I don't have central sleep apnea. No odd limb movements noted on the in-lab study. Central apneas do show up on my sleep numbers in Oscar sometimes if I have a bad/unrestful night while using the machine. Even then, they're like 0.5 and happen only when I'm extremely tired from days before when I didn't rest well. When fully rested, I don't get them. They also seem to kick in when my machine kicks up the pressure, so I'm not convinced that I have central sleep apnea. There are no centrals when I'm rested decently from days before.
I've noticed from my APAP results in the Oscar sleep software that my hypopneas/apneas happen after usually an hour or two of sleeping and start the most when I'm in deeper sleep after 2-3 hours. Since I only slept 2.75 hours, they didn't see what may have been a bulk of them for the later half of the night in deeper sleep.
Among that time for the in-lab study, I got 44 minutes of N1 sleep, 86.5 minutes of N2 sleep, 28.5 minutes of N3 and 6.5 minutes of REM sleep.
Latency results from in-lab study:
N1: 4.1 minutes. N2: 20.1 minutes. N3: 116.6 minutes. REM: 228.6 minutes.
On my Air Sense 10, my obstructive apneas and hypopneas seem to be treated beautifully. 1 AHI or below every single night, very low leak rate typically 4L/Min to 0L/Min with my Dreamwear mask. However, I feel that I am still exhausted because it isn't treating the RERA's. Should I be adjusting pressure UP to treat those? Current minimum settings are 6.2 starting and minimum (for consistency) and max pressure set at 9.0 because my auto settings always go up to 8.9, so I simply set it for 9 as the bar to reach. If I let it go over that, I start getting central apneas, which I think may be RERA-related because no central apneas were found on my in-lab study or home sleep study. I believe the machine is misidentifying them as centrals when they may in fact be RERA's. I've only seen the machine show RERA's one or two times specifically in Oscar.
Should I up my max pressure to a higher setting? I'm starting to think that the central apneas that show up do not matter and that's UARS after my obstructives are taken care of.
I am a dentist working in dental sleep medicine. From what you relate, it is very possible that you have UARS. The problem medically is that physicians are generally not very focused on UARS. If you pass the sleep test with a low enough AHI, they tend to wash their hands of you because, theoretically, you are O.K. and insurance won't pay for treatment of UARS anyway so they just kind of throw you out. Unfortunately, people with UARS are often just as symptomatic as people with OSA, if not MORE SO. Sleep dentists tend to get a lot of people with UARS after the physicians cut them loose. People with UARS tend to have low blood pressure, be jumpy and a bit high strung, possibly have fibromyalgia or a lot of somatic pains, G.I. problems, and be VERY light sleepers. Because they are such light sleepers, CPAP may tend to disturb their sleep because it is just too intense an experience. Oral sleep apnea appliances are often ideal for UARS patients because it is a gentle, quiet, no air pressure experience and the minimal AHI is easy for the appliance to control. It might make sense to consult with an ENT doctor also, because one major contributor to UARS is nasal obstruction. I hope that this helps you. Arthur B. Luisi. Jr., D.M.D.. The Naples Center For Dental Sleep Medicine.
I had an MRI of the brain last year. It was fine. I had a CT scan of my sinuses last year and also my ENT doc did turbinate reduction surgery and fixed my deviated septum. For most of my life, my breaths took longer to inhale (about 2-3 seconds longer than most people) and afterwards I breathe quickly, but it hasn't fixed the sleep issues. I just breathe better through my nose in general. I have a couple of fixed bridges and some previous Invisalign work (2 years) that was done before those fixed bridges could be placed. I also have a couple of front bottom center teeth that are, oddly enough, still baby teeth. They're a little wiggly because they're much smaller than the others and the adult teeth never existed. My upper lateral incisors never existed, either...hence the bridges and Invisalign work to make the gaps to do fixed bridges for a pontic in their place. So I'm a little iffy on the mouth appliance because I'm scared it will mess up my bite like so many horror stories. I avoid the boil-and-bite ones for the same reason, so I have to mouth tape with paper tape, instead. Otherwise I puff air out of the corner of my lips like I'm blowing a kazoo or something. Sometimes the pressure also activates my voice box and makes my throat make a little hum here and there or something.
You really do have a complex and vexing situation. In terms of nasal patency, you already have that covered and have already done every procedure that a person would reasonably want to have done. So the question remains, if you possibly have UARS, what is causing the increased breathing resistance, if not your nose? A possibility is that you just have an unusually small diameter trachea and other breathing tubes leading into the lungs. An ENT could determine that, but I am not sure that I would want to get into that because I think that those endoscopic procedures could be problematic. You might get a consult just to discuss the issue. I would not recommend boil and bite oral appliances to anyone, mostly because they do not work well and do tend to do some damage to your teeth and mouth. The horror stories as to OAs messing up the bite are definitely over-rated. In my practice, it has not been that much of an issue if you use a morning realigner and a good quality appliance properly fitted. In life, lots of things are trade-offs. Which would you hate more, to go through life always feeling lousy and tired, or getting a little tooth movement. Your life-- your choice. I would focus your attention on one appliance in particular, the Luco Hybrid appliance. It is not very well known, but excellent for comfort, low potential for tooth movement, and restoring EXCELLENT levels of oxygenation. It is really good for UARS. See: www.lucohybridosa.com. Dr. Luisi
