04-08-2021, 07:15 PM
Home Sleep Study - Low AHI but significant desat
Hello. I’ve been reading through the archives on this forum and am amazed at how knowledgeable and helpful everyone is! I’ve found some questions similar to mine in the archives, but not quite the same, so I figured I would just start a post and ask for some thoughts.
TL;DR: I have a history of signs and symptoms of sleep apnea. At-home sleep study shows AHI 3.8 with significant oxygen desat to 67% with 107 minutes under 88%. I’m assuming that insurance won’t cover a machine with the low AHI. Looking for advice – should I wait for an in-lab sleep study to rule out other sleep-related issues or assume I’ll eventually end up with a PAP anyway and try to convince my primary care doc to write a prescription and self-titrate.
Here’s the longer version:
I’m a 48yo woman. I’m overweight but not obese. I’m active with hiking and archery, although I’m not as fit as I was in college, for sure.
I’ve snored since I was a kid – enough that I was often the but of jokes at sleepovers, and all of my college roommates complained about my snoring more than once. My husband knows better than to complain
but he definitely “hints strongly” that I snore. My teenagers aren’t so polite about it – they complain openly that I snore a lot.
For most of my adult life I’ve woken up with headaches that fade after about an hour. I don’t drink often and I don’t do any drugs or take any crazy prescription medicine, so it’s not caused by an external factor that I know of. Lately, I’ve even been waking up with headaches in the middle of the night and fighting to go back to sleep. I’m tired and fuzzy-headed all day long and it’s impacting my job. It’s high time to fix this issue.
So, I finally gave in and asked my doctor to schedule a sleep study. It was a home study since she figured it would be the fastest way to get some answers during the COVID backlog. The study came back with a low AHI but significant hypoxemia. Being an inquisitive engineer, I spent hours searching for causes and cures for hypoxemia, I bought a Wellue ring to see what was going on, and now I have more questions than I had before…
Results of the sleep study (summary only – I’m still fighting with them to get a detailed report):
Diagnosis: Nocturnal Hypoxemia.
Impressions:
- No significant OSA with an overall AHI of 3.8 events per hour and lowest oxygen saturation of 67%.
- No significant central sleep apnea
- No snoring was audible during the study. (side note: my kids told me I clearly did the test wrong because I always snore, and it should have been obvious to the sensors.)
Respiratory Parameters:
- 1 apnea (obstructive)
- 28 hypopneas
- AHI 3.8
- Oxygen desat to 67%
- Mean oxygen saturation 89%
- Cumulative time spent under 88%: 107.2 minutes
- Mean heart rate 59.6 bpm
The O2 desats kind of concerned me, so I sprung for the Wellue ring and have been wearing it at night. I’ve attached a couple of sample nights. My O2 doesn’t go down to 67% on any of these charts (thankfully), but it does consistently drop through the night. Even considering that I live at an altitude of 7300 ft, it seems like it’s too low. I’ve checked my daytime O2 and I stay in the 94-97% range, so there’s plenty of oxygen here for me to breathe.
I don’t have any significant health issues that would cause this. I do have some autoimmune history that’s well treated with Synthroid. I have mitral valve prolapse, but I’ve passed every heart function test with flying colors, so I don’t think that’s the cause. I’ve had two shoulder surgeries and do end up sleeping on my back more than I would like since side-sleeping too long gets painful. I suspect that’s part of the issue, but not something that I can fix at this point since it will take a shoulder replacement to repair the rest of the damage there.
Whew! Thank you to anyone with the fortitude to read through this mini-novel and get to my questions. Here they are:
1) I can’t find any examples of “normal” SpO2 charts at a similar altitude, so I’m not even certain that mine is bad. Does anyone have insight to whether these charts are abnormal, or if I’m just over-reacting?
2) If the charts are abnormal, do they indicate RERAs? That’s how I see it, anyway. My O2 drops, I respond with increased heartrate and/or moving around, and then go back to sleep, only to have it happen again. Most of the time I don’t remember waking up, but if I do fully awaken, it’s usually based on someone or something in my dream telling me I “must” wake up, and I’m panting and sweating with effort. That seems like RERA to me, but I’m still trying to understand.
3) If this does look like an apnea type of thing, do you recommend that I go back and get an in-lab study to see if my AHI goes up enough for insurance coverage, or just accept that it’s not full-blown OSA and that I’ll be on my own for treatment?
4) I have an appointment with my primary care doc in two weeks to go over the sleep study results. I anticipate that she will agree to ordering an in-person study, but I’ve been warned that it will take months to get in due to the COVID backlog. Should I just ask her to write a prescription for equipment? I’m willing to buy my own equipment if the standard S10 Autoset is likely to work. But if this is a UARS thing where I might end up on the VAuto after already spending a bunch on the Autoset, I’m a bit leery of jumping into a purchase without knowing more.
I’ll take any and all input on this. I’m hoping to have a coherent plan of action when I go to my appointment. And after reading through years of posts on this board, I’m convinced that I’ll get good advice here.
Thank you!
TL;DR: I have a history of signs and symptoms of sleep apnea. At-home sleep study shows AHI 3.8 with significant oxygen desat to 67% with 107 minutes under 88%. I’m assuming that insurance won’t cover a machine with the low AHI. Looking for advice – should I wait for an in-lab sleep study to rule out other sleep-related issues or assume I’ll eventually end up with a PAP anyway and try to convince my primary care doc to write a prescription and self-titrate.
Here’s the longer version:
I’m a 48yo woman. I’m overweight but not obese. I’m active with hiking and archery, although I’m not as fit as I was in college, for sure.
I’ve snored since I was a kid – enough that I was often the but of jokes at sleepovers, and all of my college roommates complained about my snoring more than once. My husband knows better than to complain
but he definitely “hints strongly” that I snore. My teenagers aren’t so polite about it – they complain openly that I snore a lot. For most of my adult life I’ve woken up with headaches that fade after about an hour. I don’t drink often and I don’t do any drugs or take any crazy prescription medicine, so it’s not caused by an external factor that I know of. Lately, I’ve even been waking up with headaches in the middle of the night and fighting to go back to sleep. I’m tired and fuzzy-headed all day long and it’s impacting my job. It’s high time to fix this issue.
So, I finally gave in and asked my doctor to schedule a sleep study. It was a home study since she figured it would be the fastest way to get some answers during the COVID backlog. The study came back with a low AHI but significant hypoxemia. Being an inquisitive engineer, I spent hours searching for causes and cures for hypoxemia, I bought a Wellue ring to see what was going on, and now I have more questions than I had before…
Results of the sleep study (summary only – I’m still fighting with them to get a detailed report):
Diagnosis: Nocturnal Hypoxemia.
Impressions:
- No significant OSA with an overall AHI of 3.8 events per hour and lowest oxygen saturation of 67%.
- No significant central sleep apnea
- No snoring was audible during the study. (side note: my kids told me I clearly did the test wrong because I always snore, and it should have been obvious to the sensors.)
Respiratory Parameters:
- 1 apnea (obstructive)
- 28 hypopneas
- AHI 3.8
- Oxygen desat to 67%
- Mean oxygen saturation 89%
- Cumulative time spent under 88%: 107.2 minutes
- Mean heart rate 59.6 bpm
The O2 desats kind of concerned me, so I sprung for the Wellue ring and have been wearing it at night. I’ve attached a couple of sample nights. My O2 doesn’t go down to 67% on any of these charts (thankfully), but it does consistently drop through the night. Even considering that I live at an altitude of 7300 ft, it seems like it’s too low. I’ve checked my daytime O2 and I stay in the 94-97% range, so there’s plenty of oxygen here for me to breathe.
I don’t have any significant health issues that would cause this. I do have some autoimmune history that’s well treated with Synthroid. I have mitral valve prolapse, but I’ve passed every heart function test with flying colors, so I don’t think that’s the cause. I’ve had two shoulder surgeries and do end up sleeping on my back more than I would like since side-sleeping too long gets painful. I suspect that’s part of the issue, but not something that I can fix at this point since it will take a shoulder replacement to repair the rest of the damage there.
Whew! Thank you to anyone with the fortitude to read through this mini-novel and get to my questions. Here they are:
1) I can’t find any examples of “normal” SpO2 charts at a similar altitude, so I’m not even certain that mine is bad. Does anyone have insight to whether these charts are abnormal, or if I’m just over-reacting?
2) If the charts are abnormal, do they indicate RERAs? That’s how I see it, anyway. My O2 drops, I respond with increased heartrate and/or moving around, and then go back to sleep, only to have it happen again. Most of the time I don’t remember waking up, but if I do fully awaken, it’s usually based on someone or something in my dream telling me I “must” wake up, and I’m panting and sweating with effort. That seems like RERA to me, but I’m still trying to understand.
3) If this does look like an apnea type of thing, do you recommend that I go back and get an in-lab study to see if my AHI goes up enough for insurance coverage, or just accept that it’s not full-blown OSA and that I’ll be on my own for treatment?
4) I have an appointment with my primary care doc in two weeks to go over the sleep study results. I anticipate that she will agree to ordering an in-person study, but I’ve been warned that it will take months to get in due to the COVID backlog. Should I just ask her to write a prescription for equipment? I’m willing to buy my own equipment if the standard S10 Autoset is likely to work. But if this is a UARS thing where I might end up on the VAuto after already spending a bunch on the Autoset, I’m a bit leery of jumping into a purchase without knowing more.
I’ll take any and all input on this. I’m hoping to have a coherent plan of action when I go to my appointment. And after reading through years of posts on this board, I’m convinced that I’ll get good advice here.
Thank you!
