AHI of 10 but severe symptoms?
Hi all!
Is it possible to have severe symptoms despite mild OSA (AHI = 10). I've heard that the mild just refers to the AHI itself, but the actual severity of the symptoms.
Feel like my IQ has dropped 30 points, horrific memory, dissociation, and obviously major fatigue.
Would be reassuring and insightful to hear any of your experiences for those that have a AHI lower than 15!
Thank you!
RE: AHI of 10 but severe symptoms?
AHI by itself tells us very little. I had in my initial diagnosis an AHI of 5.8 and similar symptoms to you. The reason? I was only having event in REM, which accounts for 20-25% of sleep, so my REM AHI was 4-5 times higher, and focused all within the period of sleep required for the brain to recover.
There are also differing definitions. If I had taken one of the at-home tests where they define an event as a 3% desaturation of O2, I would have had an AHI of zero!
So, what's the rest of your story?
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
RE: AHI of 10 but severe symptoms?
What you are describing is typical for an incorrectly configured machine. We can help, but need data. Please post OSCAR charts for review.
Initially, the graphs we need to see are: Events, Pressure, Flow Rate, Flow Limitation and the Leak Rate Graph. Always include the entire left side bar, minus the calendar and pie graph.
Set your display to the Standard view.
(View > Reset Graphs > Standard)
Take a screenshot of your Daily screen.
* For Windows or Linux: Use the F12 key
* For a Mac: Use Fn+F12 or cmd-space-3
RE: AHI of 10 but severe symptoms?
Thank you to the both of you for your comments.
@Boxcar - very interesting details. Thanks for the color. My sleep study contains graphs that show sleep stage and events, but it isn't absolutely clear. My study used a 4% desaturation rule, meaning I'd probably have a higher AHI if the 3% rule was used.
I think I should mention that I have severe periodic limb movement disorder (63 plms/hour)as well. I am working on that right now and am weaning off medication that causes it.
@Boxcar and @PeaceLove - I actually have not been able to use my CPAP for about a month as I got severe anxiety on it. It has nothing to do with me actually tolerating the machine. I am able to sleep the full night with it on - I just feel absolutely terrible and could not function through the day because of the anxiety. This was despite my AHI getting down to around 2. Once I stopped using it, the anxiety went away. That being said, the possibility of the CPAP being incorrectly configured as a cause of this makes total sense.
I will post my most recent graphs. Thank you very much for offering to take a look.
RE: AHI of 10 but severe symptoms?
One glance at your chart bears out the story: you are not getting restful sleep. There are many spikes representing singular extra-deep breaths, these are often the result of an arousal from sleep, either to a lighter stage of sleep or an awakening too brief for you to remember it in the morning. This likely goes hand-in-hand with your PLMs, so that's the area I would focus on for now. If your O2 levels are good and CPAP does not help you progress smoothly through all the proper phases of sleep, then it is not the best tool for your treatment. That said, it can be hard to track what's working and what's not without some kind of data logging, which we can do a really good job of with OSCAR.
Best of luck, and don't give up!
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
RE: AHI of 10 but severe symptoms?
Thank you again for looking, really appreciate it. Yeah, I never knew why I felt so awful, and some of the symptoms would come and go, but fatigue would always stay. That's why I got the sleep study. I have to focus on that.
That being said, my sleep doctor glossed over my O2 numbers. Actually, not even sure if he even mentioned them (this was 5 months ago or so). However, after doing some digging, I felt that they were possibly troubling. I gave up on him as a doctor and am currently looking for a new one.
O2 nadir was 85%, which I know doesn't mean much. I was at 88% or below for 4.7 minutes of the night - I know the supplemental oxygen threshold is 5 minutes. However, I only slept about 4.5 hours that night in the sleep study. One would imagine that time below 88% would be well above the 5 minute mark if they were to extrapolate based off an average 8 hour sleep time.
That is one reason why I am still wanting to tolerate CPAP (or possibly a mandibular advancement device).
Any thoughts?
RE: AHI of 10 but severe symptoms?
I still think the arousals are your biggest problem, but those O2 numbers are not in "OK to completely ignore" territory either. I'm not a huge fan of MADs, having used one for a year it never really fixed my problems and caused plenty more of its own. I would not pursue that route unless you are clearly indicated for one, confirmed via endoscopy, and didn't tolerate any other options.
Look, I'm an engineer, not a doctor! Please don't take my opinion as a substitute for medical advice.
RE: AHI of 10 but severe symptoms?
It looks like it was a rather tough night for quality sleep with the apnoea’s, flow rate disturbances, respiration rate spikes, and arousals that are in the chart posted.
Your flow limitations seem fine at that pressure, but I think it is worth increasing pressure a bit to see it if improves overall sleep quality. Two ways to go about it are slowly increasing your pressure by 0.2 per night or increasing it by 1 per night. When things go wonky, it is too high.
For some they can have an excellent AHI, low flow limitations, but still have a poor nights rest. In many cases it is simply needing more pressure, for others a bilevel is needed, and still others need an ASV. The path to determine that for now is using more pressure to try and smooth out the arousals.
If you are willing, give that a go for a few nights and let us know how it works out for you. You may need a bilevel to get more fine-grained control over the trigger settings and we will know more as the experimentation progresses.
RE: AHI of 10 but severe symptoms?
Sleep position can have an effect on how well you do with the machine. it is possible to sleep in any position but side sleeping is much better than any other for me. I have a FFM because of the mouth and nose breathing so it gets in the way of stomoch sleeping without turning the neck enough to cause obstructive issues for me. If you are a back sleeper you can try a foam wedge behind you to get you to at least a 45 degree angle or keep you off your back.
Seems like I have read sleeping on the left side is better than sleeping on the right, but I may have it backwards. I sleep on either side without trouble so I never dug into it well.
Anyways, stick with the machine and you can get better. Might not be the correct machine, but only time can tall. It took me perhaps 6 months to loose the brain fog and daytime sleepyness entierly. And recently I am having all my AHI below 0.5 or 50% of the time the are 0.0 ... that is down from 55 during the sleep study.
Look at the link in most of our signatures to organize your oscar charts.
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