Hypopnea and alpha intrusions

[Dulce]

Hello all. I am new to this forum and have a question about my recent sleep study. My results showed no sleep apnea, but I had hypopnea and a large number of alpha delta sleep intrusions. Whomever read the study stated that the hypopnea did not require a CPAP machine. I have suffered from horrible, non restorative sleep with daytime brain fog for most of my adult life. I also wake up often feeling a heaviness in my chest. The rheumatologist who ordered the sleep study didn't think anything of the hypopnea and is just giving me a medication for sleep. Does anyone have any advice for me as to what might be the issue or what I should do?

[DeepBreathing]

Hi Dulce. Welcome to Apnea Board.

Hypopneas are a form of sleep disordered breathing in which the airflow is reduced substantially for a period of 10 seconds or more. Unlike apneas, they are not a complete cessation of breathing, but can still disturb your sleep. Whether they are significant depends on how many are occurring (the hypopnea index) and their duration. Do you have your sleep study report? If so, let us know the hypopnea index and any comments in the report. (If you don't have a copy should should get one for your records).

Alpha delta sleep is somewhat outside our remit here at Apnea Board - we're not doctors but apnea patients who help each other. From a little bit of reading I have done, I know that alpha delta is associated with other conditions including clinical depression, chronic fatigue syndrome and fibromyalgia. All of these are known to cause disrupted sleep and severe fatigue, such as you describe. I guess this isn't news to you, though.

As I said above, let us know what the sleep study said about your hypopneas. We have had members here with very borderline sleep apnea who none-the-less experienced significant improvement in symptoms by going onto CPAP therapy.

[Sleeprider]

Whether hypopnea is a problem depends on the numbers, duration, effect on oxygen saturation (SpO2) and arousals. Many individuals experience exclusively hypopnea events, and it is often associated with Upper Airway Resistance Syndrome (UARS). In general, a CPAP or BPAP can be effective in treating this problem, and should be prescribed when events are numerous, results in excessive arousal or low oxygen levels. UARS can also result in fatigue and related dysfunction, and pose risks in driving or just coping with your daily routine.

Get a full copy of your sleep test detailed results, in addition to the summary and recommendation. If you care to post some more specific information we can help you to decide if a second opinion might be in order. If you feel or know this problem may be affecting your health or how you live your life, insist on CPAP therapy or obtain a second opinion. Meanwhile do some research on UARS.

[Dulce]

Thank you! I will give some more details on my report when I get home tonight. Mainly I just have a gut instinct that something is causing my sleep disturbances and it might be related to my breathing.

[HalfAsleep]

My sleep study showed almost all hypopneas rather than apneas. I am diagnosed with moderate obstructive apnea (AHI of 18). So, yes, hypopneas are a very important factor in diagnosis.

A couple of thoughts..

Start documenting (if you haven’t already) the symptoms related to sleep. Perhaps orient your notes around the Medicare guidelines for treatment, since they are the industry-wide standard.

Take care to note that corollary conditions such as stroke history, diabetes etc. are important in diagnosis and qualification for treatment.

Also, take the little sleep symptoms test (it’s gotta be on here somewhere), so you’re really clear about what might be a sleep disordered symptom (e.g. falling asleep while driving) versus something that’s probably something else (e.g. an arthritic elbow) versus a symptom that’s too vague to be pinpointed as a sleep issue (e.g. general malaise).

These notes will let you home in on key factors in diagnosis and give a clear basis of discussion with docs.

Absolutely, post the sleep study summary here, so you can get clarity about the important (for now) numbers.

If you don’t qualify for treatment by the numbers, you can potentially get an APAP without physician intervention if you pay out of pocket.

PS Did you have a home sleep study or overnight at a facility? AFAIK Home sleep studies can’t test for key factors, such as whether you’re actually asleep and oxygen levels.

[trish6hundred]

Hi Dulce,
WELCOME! to the forum.!
I wish you good luck in figuring out what is going on with your sleep.
Hang in there for more responses to your post.

[Dulce]

Ok, here are the results from my sleep study:

The impression was that I have mild obstructive sleep apnea and Alpha Delta Sleep intrusion. I slept for a total of about 5 hours (that was after taking 2 sleeping pills). In that time, my arousal index was 19/hr. There were a total of 42 disordered breathing events; 4 central apneas, 3 obstructive apneas, and 35 hypopneas. The AHI was 6 and the RDI was 13 and it stated this was in the mild range. My O2 sats  during wake were around 95 and during sleep it was 85 at the lowest. I had a total of 122 total arousals including the Alpha Delta intrusions, for an arousal index of 19.

I have been doing some research and I am thinking that many of the physical symptoms that I have struggled with for most of my adult life stem from a sleep issue and that this issue might come from a breathing problem. The issue is that my doctor does not think I need to be on a CPaP machine nor any other treatment besides sleeping pills. Sleeping pills do not solve the issue. I still wake up and feel like I have run a marathon. I am completely and utterly exhausted most of the time and it feels as though I have dementia. I cannot remember simple things that people told me earlier in the day. I push through because I am a hard worker but this is seriously affecting my life. 

Does anyone have any more useful advice after seeing my numbers above?

---

Thank you!

[Dulce]

Thank you so much! I posted my results above. I did have a sleep study at a hospital sleep lab. Are there any other stats that would be helpful to people on here? 

I have read that some people have hypopneas that are treatable with a dental mouthpiece. I thought I might start there and then if that doesn't work, I might try to purchase a machine myself. The only thing that worries me is setting the machine correctly. I am not sure how the titration would work. Do the companies who sell them help with that?

[HalfAsleep]

You can get help here with settings, but you’ll also want an auto PAP, so it can select whatever pressure you need in the moment.

Many people do in fact buy their own machines, since it can be cheaper that way than an insurance copay.

On your AHI number....I qualify for insurance coverage by barely meeting the guidelines...AHI of 5 with4% desat), but I had the co-conditions. That’s why I said to look up co-conditions. My AHI with 3% desat was 18, but that was irrelevant for insurance purposes.

I had to convince my doc to let me have xPAP treatment. I’m so glad, since although the numbers in my sleep study weren’t very dramatic, I evidently have a complicated sleep profile.

I was not excited by the dental advancement device. Recipe for major and potentially irreversible TMJ.

Personally, I would not be excited by sleeping pills because of the risk of addiction. They might be useful as a short term fix, but sleep disordered breathing is a long-term health issue.

[Sleeprider]

Dulce, your results include a moderately severe oxygen desaturation to 85, and if it is persistently below 92, can be a problem. We really don't know the range. Although your event rate suggests mild apnea with AHI at 6, it is also a mixed apnea including both central and obstructive events with unclassified hypopnea. Your 35+3+4 = 42 events in 5-hours of sleep is actually an AHI of 8.4 which qualifies for treatment. The mixed apnea types may or may not complicate the use of CPAP. Your 122 arousals in 5-hours of sleep suggest an arousal index of 24.4 per hour, which is high enough to account for your feelings of fatigue and lack of mental acuity.

Your doctor has concluded that a course of treatment involving sedatives or sleeping pills is preferable to treating the mild sleep disordered breathing indicated in your study. That conclusion ignores the relatively low SpO2 you incurred, and is silent on whether your sleep disordered breathing also includes significant flow limitation which I strongly suspect is a cause of your low SpO2 and high arousal rate. This "profile" is typical of Upper Airway Resistance Syndrome (UARS) which may be present. You can research that and see if it seems to relate to your experiences. Positive pressure therapy can significantly help with flow limitations and oxygenation as well as treat the actual obstructive apnea and hypopnea. It may or may not help with central apnea.

You have the option to use these results and your awareness of a sleep-related problem to pursue a second opinion. If the doctor making this opinion is your primary doctor, then you would need to see someone able to better analyze your sleep disorder or an ENT specialist that might also look into the possibility of UARS to get a second opinion. If the doctor presenting the current opinion is a sleep doctor, then I would start with my primary physician and make the case that the current prevailing opinion does not take into account your overall sense of fatigue and desperate need for better rest without medication, which has been ineffective. Let's talk more about these options, and other avenues available to you, so I'm not speculating.