Do you agree with this diagnosis?

[amyK]

Hello everyone, this is my first post to this forum, glad to have found you all. I am newly diagnosed with severe sleep apnea, though I think it's possible there's a different issue at play. 

I'm attaching my sleep study for your thoughts, as I wonder if it was misinterpreted. I was very restless the night I did the test. (I'd just recovered from a stomach bug that had me sleeping away most of the previous 2 days.) Though I started the study at about 11:30 pm, I only truly slept for about 4 hours that night, about 4:30—8:30 am. For the first 5 hours, I worried about the test, struggled to breathe past the nose cannula, and also cried several times, talked to my husband, got up to use the bathroom again and again, switched beds (to stop disturbing him), and mostly lay on my back doing puzzles on my phone trying to calm down. Every time I started to feel like I could nod off, I'd put down the phone and turn on my side, but then I'd be wide awake again and back to worrying, etc. 

The test says I snored for more than 7 hours— even if I was a snorer, I was definitely not even asleep that long. (My husband says I don't snore, but do make some light clicking sounds sometimes.) When I spoke to the doctor who interpreted my study, he admitted he assumed that the first half of the night, when I was awake, was the part where I was sleeping, though this did not change his diagnosis.

In looking at the test results, it seems to me that when I was actually asleep, I did much better. I wonder now if I just put away my phone and stayed on my side, if most of the problem would disappear. I also wonder if it's worth doing a repeat study. (Insurance won't cover another).

A bit more about me, in case it helps: I'm 53 years old, athletic, though I could stand to lose 15-20 pounds. I've slowed down a bit in the last several years, but I still run, swim, or bike nearly every day. My BP is low/good. 

I noticed difficulty with sleep after pneumonia in 2019—I would struggle to fall and stay asleep, and wake with headaches, I thought due to emotional stress. After having mild COVID in 2020, I started noticing shortness of breath during the day, especially when at rest. (A few weeks after COVID, I was mostly back to normal exercise, so I assumed the sensation of SOB was also due to emotional stress.)

I got a smartwatch recently and was surprised to discover it tracks blood oxygen levels and that I have low readings night and day, occasionally as low as 81% at night, 87 while relaxing on the couch (it doesn't capture readings while in motion). Two tests with doctors while walking around their office for a few minutes yielded low readings—83, and 91. I did not feel winded. As soon as I sat down, the level quickly returned to normal range. (98%) After I changed my response to shortness of breath—instead of trying to relax when I feel "anxiety" I now breathe deeply. My spO2, in general, has improved, and I feel SOB less often. I now hit 100% spO2 most days, average around 95%, but at night I still go below 90% at times. I'm yet to have a lung function test, though I have one scheduled in May.

Looking forward to your thoughts. Thanks for reading this long post, and for taking a look at my sleep study results.

[cmpman1974]

Was this a real sleep study done in a lab setting with a tech watching all night?

You showed hardly any extremely low O2 levels during sleep.  Very odd for someone who says they desaturate in the daytime.  Usually O2 levels go down at night a bit relative to daytime.  It is possible extra effort on the heart / lungs may cause that in the daytime though.  Those are some big AHI numbers so I'd say no doubt you have sleep apnea.  It seems indisputable. You don't hear someone having an AHI of 33 but no sleep apnea.

Don't trust Smartwatch O2 stats - most are garbage in that respect. They try to be everything and can't be. The newest fad is Smartwatch tracking glucose - yeah sure. Buy yourself a good medical grade pulse-ox for spot reading. I use a Checkme Max O2 wrist monitor at night. It's recommended by some here. I am not 100% convinced concerning accuracy especially at sub-90% SPO2, but it's a decent baseline. It's one of the better consumer options for continuous night-time reading of SPO2. It's kind of odd to have so many apneas with so little desaturation though. That stumps me some. I assume you are in better physical shape than many here so your desaturations don't lead to very low O2 levels as much as a more overweight individual. 98% to 94% is a desaturation, but not a low low level overall.

Sleep is measured in the lab by EEG waves. If they say you're in a sleep stage regardless of your perception, most likely you were. The stages of sleep are said to be quite distinguishable based on appearance.

It sounds like you need a pulmonary and cardiac work-up to rule-out stuff. You need verifiable data concerning low SPO2 and other stuff. Best of luck!

[mesenteria]

Everybody has desats during any part of a 24 hour cycle.  We can desat watching TV. The important factor is their frequency, yes, but also their duration. We can desat pondering something, but we'll rebound within 10 seconds or so.  If we are in deep sleep, and obstructed, that range might run out to 30-45 seconds, and if you snort to get your breath, which would be likely, that will be a snore.  Not a snort. 

For whatever you want it to be, the evidence I see from your sleep report says you have severe sleep apnea. Believe me, I was as shocked and dismayed as you when I learned that I, a runner and cyclist, and well under BMI 26 at 65 years of age, have severe apnea.  But whatteryagonna do?  Me, I got on board and treated it for the deadly disorder that it is, and that it remains for me. 

I know this isn't cricket, but count yourself lucky that you didn't find this out AFTER developing atrial fibrillation.  That was my first clue, except I didn't know it.  It took a visit to a cardiologist, who referred me to the sleep lab after all other diagnostics showed nothing untoward.  When we learned of the results of the polysomnography, he said, "Well, I guess we know why you have AF!"

As much as it pains anybody to have to accept it, this is now a chapter in your life's book.  Best read it and move on.

[amyK]

Thanks for sharing your thoughts, cmpman1974. I wasn't in a lab, I was at home, as I described in my (overly long—sorry) post. I'll look into that oximeter you mentioned, thanks for the tip. I have an apple watch, which I read is relatively accurate, though it only takes readings when the watch face is turned upwards...

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Thanks mesenteria, I didn't know that about desats. Interesting.

[Sleeprider]

The biggest problem with the home tests is they "interpret" sleep, but can't actually measure sleep stage or real sleep. They sometimes tend to over-count AHI and RERA if the subject is awake or in light sleep stages. I think you're on to the next step which will be therapy. Hopefully you get a Resmed Airsense Autoset machine, and an order for self-titration. That will save you another night in a sleep clinic, and a chance to really optimize effective therapy using a self-help software OSCAR and this forum. I don't see oximetry as a major issue for you. Your average SpO2 (oxygen saturation) was very good, and you were under 90% for only 2.5 minutes. That is not an oxygen concern, especially considering it will improve with CPAP. All of your events were during the first-half of the test, and the second half was nea8rly clear of events. From 4:30 to 9:00 there was basically nothing. If this is more typical of your sleep, you have fairly mild sleep apnea. You may have been more nervous had had problems sleeping until that time, but the difference is pretty remarkable.

Push to get a Resmed Autoset machine rather than Philips or one of the Chinese imports that are common now. It's the highest quality CPAP and provides full data to help you optimize therapy. If you come here with a Resvent or BMC, and no data, there will be very little we can do to help. Insist on it and you can get it. The supplier will complain they are not available, but the truth is, they make less money on Resmed.