Do I really not have sleep apnea?

[apnea-rabbit]

Hi guys, I have been following this interesting community for a while and this is my first post. I am quite confused, and would appreciate some comments and thoughts.

I have a suspicion that I have sleep apnea, but after one nights sleep study the sleep specialist doctor was very certain in his conclusion that I do not have sleep apnea (he is not ruling out other sleep disorders).

I feel something might not be right here, and would like a second opinion from you guys - whether I should spend more time on a sleep apnea diagnosis or find another specialist who can try to diagnose if I have some another sleep disorder.


RESULTS OF THE SLEEP STUDY (using Philips Alice PDx Diagnostic System)
- Length of sleep: 6 hours
- AHI: 4.7 (total events: 28)
* Central apneas: 8
* Hypopneas: 18
* Obstructive apneas: 2


MY SYMPTOMS
- I usually have a very stable sleeping schedule. No problems falling asleep
- About 3-4 days a week I am rather tired during the day and I feel sleep deprived. This is also the days where I did sleep enough and wake up without alarm clock.
- When this happens, I already feel it in the morning. It feels like I have had a bad night of sleep. During these days I am not that social, and I just want to avoid people. Also I eat a lot more than usual. Basically, I just want to sleep and eat.
- I do snore a lot, but not every night.
- My girlfriend has very occasionally noticed that I can stop breathing for a short period of time and then suddenly cough or move and continue breathing. However, she has only noticed this a couple of times in the last year, so it is very rare.

I am wondering if the doctor can make such a conclusion after only one nights sleep study of 6 hours. I did challenge him, but he was very certain and confident and said "you certainly don't have sleep apnea as your AHI is so low", and he also said that his own AHI number is 5-6 and that he does not have sleep apnea.

What do you guys think, based on the study results and my symptoms. How likely is it that I have sleep apnea? Or is it more likely that I might have some other sleep disorder?

[DocWils]

Well, from the numbers, you do not fall under the clinical definition of SA (just under - 5 AHI is the borderline), but since you did not include your sO2desats, it is hard to be certain how much of your problem is related to anoxia and how much is related to some other problem. Since you mention that you do not have this problem regularly, you are also posed with the classic medical dilemma - not all symptoms show up when we test for them - I have had more than a few heart patients where the problem never showed up when we tested, nor when we got them to wear a 24 hour Holter (a rig that records your heart for 24 hours and hangs around your neck like a halter). Only when I gave them a portable Single lead EKG device and told them to take the reading when they felt off, could I get something.

Unfortunately, testing you, even with home tests, for a week would be difficult and prohibitively expensive, and may well not turn up anything useful, since if you had sub clinical level in your testing, and it is likely that if you had only apnoea on certain days, it would have been due to another environmental trigger, whether diet, drug or some outside force I cannot determine.

Getting a home test, so that you are doing it in your own environment would be a good first start if you are uncertain that the test you did was any use, but before you do that, make a diary of your environment and food, drug (including booze and booze type), whatever, intake each day and night, and any other conditions you might encounter as variables, and note the next day how you slept that last night - see if anything from that is influencing your sleep. Then try the home test, if needed, on a night when you can replicate the circumstances around which you have a bad night, and see if you get higher readings. Make sure the home test includes an oxymeter to measure sO2sats.

I suspect, however, that once you examine your diary that you will see that you are responding to specific triggers that cause you to have a lousy night. Whether these triggers are environmental or psychological is something you will then be able to determine. Borrowing or buying a recording pulseoxymeter and using it for a few nights is not the worst idea (look elsewhere in the forum for discussions on how to best use them). Even without a home testing system, you can track your sO2sats overnight and see if there is a pattern of clusters of desats to focus on.

One thing is certain - SA is not a haphazard, show up every here and there, type of problem - it is generally a constant each night. If it remains haphazard and you cannot find a clear cause or pattern, then you might be experiencing other health issues that need to be examined. While you could have positional apnoea (sleeping on your back can cause that), it is more likely that you may have something else going on.

[trish6hundred]

Hi apnea-rabbit,
WELCOME! to the forum.!
Hang in there for more responses to your post and best of luck to you.

[PaulaO2]

Yep, a sleep diary would be the best first step for you. Like DocWils said, sleep apnea is an every night thing. But there are so many things that go into what constitutes a good or bad night's sleep. Stresses, food, drink, attitude, environment, weather, etc.

One thing of note, though, is you are right on the cusp of the diagnosis. An AHI of 5 would still be very low and a CPAP would not be the first step there but what you could be doing now is working to prevent ever having a CPAP in your life. If you are over weight, lose it. And keep it off. Have regular checkups by your physician to make sure your heart is in good shape.

[RonWessels]

Is it possible that on most nights you are sleeping on your side, but on problematic nights you end up sleeping on your back? Most people (myself included) report that their obstructive sleep apnea is significantly worse when they sleep on their backs. That could mean that you are marginal when sleeping on your side (as you did in the sleep study), but have significant OSA when sleeping on your back.

If this is the case, you could try the standard tricks like sewing a pocket onto your pajama top in the middle of your back and putting a tennis ball in there to discourage yourself from rolling onto your back in the middle of the night.

[PsychoMike]

From personal experience, it could also be something like UARS...upper airway resistive syndrome. It's not full on sleep apnea, but your airway partially closes, restricting airflow and disrupting your sleep. May not have full apneas that would count, but your RDI (a sleep disruption measure) would still be high and mean you're not getting the quality sleep you need.

[apnea-rabbit]

Hi everyone

Thanks all for your input and ideas. That is certainly helpful and I will definitely try to see if this only happens when I am sleeping on my back.

@DocWils
You asked for some oxygen stats. I have now finally received these from my last test and have attached them here. What do you think?

[DocWils]

This would not indicate a major desaturation problem, although you do desat a bit, but well within normal parameters.

[archangle]

Were there EEG leads during your sleep test? i.e. did they glue leads to your scalp and leave you with goo in your hair the next morning. Without EEG leads, a sleep test may miss some hypopneas.

You were 4.7 AHI and the diagnostic criterion is 5. You are sort of borderline and might fall into the range if you took the test again on another night, or in your own bed without the stress and sleep disturbance of being in a sleep lab.