Do I have sleep apnea?

[Illorum]

There are three respiratory disturbances in sleep apnea: Apneas, Hypopneas, and RERAs. The name is kind of confusing because "sleep apnea" seems to imply that its a disease that is only made up of apneas, but Hypopneas and RERAs are also considered part of sleep apnea. Someone who only has RERAs has "sleep apnea", someone with only hypopneas has "sleep apnea" etc. Just because one doesn't have "apneas" while asleep, does not mean that they don't have "sleep apnea." 

Are RERAs gonna kill you? For now, no. Most of their symptoms are neurological (insomnia, concentration problems, unrefreshing sleep). Left untreated and given the time to turn into apneas and hypopneas is when they become more and more dangerous. People who die in their sleep from sleep apnea usually have very severe advanced sleep apnea. You are probably in the mild stages for now (if you have RERAs). You had good oxygen desaturation so I wouldn't be worried about your heart for now.

[Maudlin]

There are three respiratory disturbances in sleep apnea: Apneas, Hypopneas, and RERAs. The name is kind of confusing because "sleep apnea" seems to imply that its a disease that is only made up of apneas, but Hypopneas and RERAs are also considered part of sleep apnea. Someone who only has RERAs has "sleep apnea", someone with only hypopneas has "sleep apnea" etc. Just because one doesn't have "apneas" while asleep, does not mean that they don't have "sleep apnea." 

Are RERAs gonna kill you? For now, no. Most of their symptoms are neurological (insomnia, concentration problems, unrefreshing sleep). Left untreated and given the time to turn into apneas and hypopneas is when they become more and more dangerous. People who die in their sleep from sleep apnea usually have very severe advanced sleep apnea. You are probably in the mild stages for now (if you have RERAs). You had good oxygen desaturation so I wouldn't be worried about your heart for now.

Thanks for your reply.

If it turns out I have RERAs, what in your opinion would be my best option? Since I have noticed my problems appear while sleeping on my back, does something regarding the sleeping position and its management seem suitable to be done? Pillows? Collars? Is CPAP always the best option or other alternatives should be tried before someone goes for CPAP?

[Illorum]

If you do have RERAs, the best options are surgery and BiPAP - most prefer the latter (though recently there have been some great advances in noninvasive surgeries). Sleeping on the side definitely helps, but most people find that hard to adhere to even with pillows and special devices. Humans naturally change positions while sleeping to prevent blood clots.

[mesenteria]

maudlin - "My main concern still stays the issue with the risk of dying while sleeping."

You don't have anything to worry about unless you have fairly advanced ischemic heart disease.  You are much more likely, in the near term of between 4-12 months, to develop another symptom of your general distress which will be yet another warning sign of something that needs attention.  For example, a surprising number of people who have gone for several years with unnoticed/undiagnosed apnea will suddenly experience atrial fibrillation.  If a cardiologist hasn't been called upon to deal with that, you can rest assured.  Other problems might be elevated cortisol, poor ratio of HDL/LDL and general hyperlipidemia, weight gain, adult onset of diabetes after a period with metabolic syndrome...that kind of thing.  Your BMI seems fine; I don't imagine recent blood tests have pegged you as at-risk for lipid problems or insulin resistance?

[Sleeprider]

We are hard-wired to arouse and breathe. It’s carbon dioxide that triggers respiratory drive, and no one has ever died of an obstructive apnea. The adrenaline and drive to breathe builds with carbon dioxide and you will breathe if air is available. Sleep apnea kills by long term damage to the heart by the stress of repeated shots of adrenaline, tachycardia and pressure in the chest. Put that fear behind you and focus on therapy that benefits your health by eliminating the stress of apnea, hypopnea, flow limits, RERA and other events.

[Maudlin]

If you do have RERAs, the best options are surgery and BiPAP - most prefer the latter (though recently there have been some great advances in noninvasive surgeries). Sleeping on the side definitely helps, but most people find that hard to adhere to even with pillows and special devices. Humans naturally change positions while sleeping to prevent blood clots.

Since I would abstain from using BiPAP or any similar advice at this point, could you recommend a special pillow or a collar that in your opinion has its benefits?

maudlin - "My main concern still stays the issue with the risk of dying while sleeping."

You don't have anything to worry about unless you have fairly advanced ischemic heart disease.  You are much more likely, in the near term of between 4-12 months, to develop another symptom of your general distress which will be yet another warning sign of something that needs attention.  For example, a surprising number of people who have gone for several years with unnoticed/undiagnosed apnea will suddenly experience atrial fibrillation.  If a cardiologist hasn't been called upon to deal with that, you can rest assured.  Other problems might be elevated cortisol, poor ratio of HDL/LDL and general hyperlipidemia, weight gain, adult onset of diabetes after a period with metabolic syndrome...that kind of thing.  Your BMI seems fine; I don't imagine recent blood tests have pegged you as at-risk for lipid problems or insulin resistance?

A little bit more details to that to make the picture clearer: I have an increased LDL cholesterol level but this is a genetic thing (my mother has it too). My LDL is about 4.8 mmol/l according to the European standard (I believe it is around 185 mg/dl in US standard) and 6.5 mmol/, 250 mg/dl US - total cholesterol. Blood pressure always about 110-120/70. Blood sugar in normal range, I have recently had a glucose test. BMI is just under 25. I used to have heart palpitations, went to Doc and everything showed it was fine. She was surprised to see, however that while sleeping the heart jumped from low 40s to 113 bpm and then back to normal again. I have always had a low heart beat, right now it is 44 bpm. I don't know if atrial fibrilation could be a combination of a slow heart beat and sometimes irregular heart beat. I mean if I try to "listen" carefully to my heart when measuring my pulse the rhytum is regular but from time to time the heart just slows for a single beat and then returns to normal. Like if the regular beat interval is 1.2 seconds it would be like that for quite some time, then it becomes 1.3 seconds for a single beat and then back to 1.2 again. But it has always been like that, since my teen years.

We are hard-wired to arouse and breathe. It’s carbon dioxide that triggers respiratory drive, and no one has ever died of an obstructive apnea. The adrenaline and drive to breathe builds with carbon dioxide and you will breathe if air is available. Sleep apnea kills by long term damage to the heart by the stress of repeated shots of adrenaline, tachycardia and pressure in the chest. Put that fear behind you and focus on therapy that benefits your health by eliminating the stress of apnea, hypopnea, flow limits, RERA and other events.

We all will die one day but at least we hope not now or not soon. I guess I should go to a clinic that specializes in sleep disorders for more detailed tests. Just to see the situation deeply. Until that happens, is there anything simple I could do as a prevention?

[Maudlin]

Anybody?!

[Illorum]

There aren’t any pillows or collars that can effectively treat sleep apnea. I recommend you get a study, and if you have it try PAP therapy.

[Palmtrees]

I also am not overweight, I exercise, and have an active lifestyle. Yet, my husband kept telling me I snored horribly and I would wake up in the mornings feeling like I had been in a wrestling match all night. My dad had sleep apnea and was a champion snorer. I could never sleep on my back because I felt like I was choking after a few minutes of falling asleep. For several years, I ignored this until... I started falling asleep sitting up when reading, watching TV, and even once...while driving (yikes! by the grace of God, nobody got hurt.) Also, by happy accident, I found out that my blood pressure first thing when I got up was HIGH. It would quickly come down to normal as the day went on. But, on first waking up....it was higher than is normal. I started thinking about things like ....heart attack in the early morning hours (very common) and killing someone after falling asleep at the wheel. So, I went to an ENT specialist who set me up for a sleep study in a sleep lab. Guess what... surprise! I have mild to moderate sleep apnea. Due, my doc says to "the anatomy." Oh. I didn't want to believe it. I kept saying,no,no,no.... this can't be right. Well.... I got the machine and over the last year and a half, I have tried masks, pillows, straps, you name it. There have been some bumps along the road, but.... I sleep. I wake up refreshed. My husband is happy because I do not snore. And...no falling asleep until it is time for bed. My blood pressure is within normal limits w/o medication. My only problem after finding the nasal mask or pillows that work best for me is... dry mouth, but I seem to have that doing better. The people on this board have been a MAJOR help. If I was you....even though nobody wants to do this....I would insist on a lab sleep study. It is a bit uncomfortable...they hook you up to all sorts of gadgets and you are on camera in a strange place....but it is more accurate and gives you a better picture of what is going on. they can even test you on a cpap machine if you qualify in a "split study." You go there about 7pm, sign in, they put you to bed and then get you up about 5:30 - 6:00 am. Results go to your doc and you can get a copy of the data. It is worth it. Why sit there and worry? If the study is normal and you don't have sleep apnea, then you can pursue finding out what is really causing the problem.

[tiredofbeingtired]

The amount of apnea you have can very from night to night and tests do vary in sensitivity depending on the kind of monitoring hardware they use. Maybe some nights your AHI is 5 instead of 2.5 which would allow you to be diagnosed with sleep apnea. As this study notes one negative sleep study cannot exclude sleep apnea: https://pubmed.ncbi.nlm.nih.gov/8449064/

If you are waking up with a racing heart that usually means your apnea is occurring during the REM sleep stage. People tend to have a more pronounced physiological response to interruptions in REM sleep. This is also more common in younger people which it sounds like you are. A test in a lab that reads your brain waves might provide you a little bit more insight about your apnea. I say do another more comprehensive sleep study if you can.