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sleepsleepsleep
Unread post  Post subject: Worth pushing for sleep study based on oximeter result?  |  Posted: Tue Sep 10, 2019 8:21 am

Joined: Tue Sep 10, 2019 7:11 am
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I'll try to keep this short but provide enough info at the same time.

I'm 37, male, and live in Ireland. For two solid years I've had daily day-time drowsiness and it's gotten to the point where it's like a fog in my head every day and I can't focus or maintain concentration or memory at work and have had to take time off work.

Just prior to my drowsiness kicking in two years ago I started to get visual migraines followed by a severe migraine lasting an hour, though these only lasted about 2 months and have not occurred since. I was also getting brief flashes of a single blue dot in my vision at random times (not floaters) and in random places in my visual field - these continue to this day. I attended my family doctor at the time and he said he felt it was unlikely anything serious, unlikely to be a brain tumor or anything, and possibly just normal life stress related.

In terms of my sleep I have a FitBit that tracks my sleep and whether I sleep 5, 6, 7, 8, 9, 10 hours I never wake up refreshed - I'm told this could be non-restorative sleep. On average I get a little over 7 hours of sleep per night. I have no problem falling asleep and for the most part don't wake up during sleep - only recently have I had three moments of waking up on separate nights and feeling my throat closed and needing to move my head to take a breath but I can't say I was gasping for air for any of these three. I snore to the point my wife has to wear earplugs all night every night, so unfortunately she can't tell me if she hears my breathing stop to tell whether I have apnea/hypopnea events. I seem to breath through my mouth and not nose, so would have throat dryness. I wouldn't say I wake up with headaches but instead feel more like I'm hungover in my head. I used an app to record my snoring and it sounds like I snore both on the in breath and the out breath. I've never fallen asleep in the car.

My own completion of the Epworth sleepiness scale scores me at 11.

I returned to my family doctor and he again felt it was stress related - I am working and studying at the same time so there is stress there but the non-restorative sleep didn't start during a period of any high stress and instead I feel that the sleep has contributed to my stress as it began affected my ability to work and study, so it's hard to say which came first to be honest but personally I would say the sleep issues came first. He wasn't overly keen on sending me for a sleep study but I pushed it and got a referral but due to health service issues I won't bore you with that's been majorly delayed.

I paid privately for a consultation with a respiratory consultant who was suggesting a sleep study was needed until I showed him the result of an oximeter test I did myself over a year ago which showed the AHI was 4.6 - he said based on that he doesn't think I have sleep apea and said to try alternative medicines. The consultant said I don't fit the stereotypical physical profile of a someone with sleep apnea, he checked my airways and said I don't appear to have the typical throat of someone with sleep apea but due to a dental issue I have an underdeveloped upper jaw which has led to one nostril being blocked and he suggested rhinoplasty could help with this.

I've attached two images of that oximeter reading I did at home a year ago. Unfortunately I don't know the oximeter model I used and don't have access to it as it was a work colleague who loaned it to me and I no longer work there. That report was all I generated at the time so I can't provide any more info.

I have spent a significant amount of time reading about the AHI and how there are different types of AHI and have found posts with people saying theirs was below the 5 cutoff on average but was 13+ during REM sleep. The readings I got don't show that kind of breakdown. I've also read journal articles about how the AHI is actually a rudimentary number and doesn't take account of how long the desaturations or a/h events last, and the oximeter reading I took said mine lasted on average 33.8 seconds, which again I've read seems not outlandish but are long enough. I can't find the links to the articles I found and the odd video I found where a specialist in the area talks about people with 5+ AHI's who don't have sleep apnea and people below 5 still can have it - I'll see if I can find them all again (ended up with lots of open tabs). I do though understand from my readings on that one night that my lowest O2 was 91% which isn't below the 89% zone that seems to definitely indicate sleep apnea, and my basal was 96% which seems good.

I guess I'm feeling a bit disheartened and that I'm being met by medical professionals who are saying it's basically life stress and you should try alternative therapies. I'm also surprised at a single basic 'homemade' oximeter reading being used to rule out a sleep study when initially based on my reports he said one should be done.

I don't smoke. I do drink but virtually don't for the tiny amount I do drink. All meals are home cooked with fresh food and balanced with meet/veg/etc. My BMI puts me in the overweight category but I'm athletically built so have been told the standard BMI categories aren't necessary 'fair' for my build. I do an average amount of exercise - I could do more - but even during periods of increased exercise for sustained periods there is no improvement in my sleep. I have the tiredness on holidays and during previous long breaks from work - I had a 5 week long break (not due to the sleepiness) and throughout that time I was till tired all day long.

I feel like I'm at a point where I either need to 'take charge' and politely start telling the medical professionals I meet what I want done rather than going along with what they tell me, or just giving up on the idea that it could be sleep apnea and look elsewhere - but I'm unsure where else to look bar some potential immune system issues that seem to potentially explain what I have... I can't tell if I'm experiencing what others seem to have experienced whereby medics don't take it seriously enough and need 'pushing', or whether they're correct and I need to search elsewhere for a solution...


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Sleepyhead 1 - Copy.jpg
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Pugsy
Unread post  Post subject: Re: Worth pushing for sleep study based on oximeter result?  |  Posted: Tue Sep 10, 2019 10:32 am
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Not everyone who has OSA or snores will have significant desats.
Unfortunately this is one of the limitations of using an overnight recording pulse oximeter alone to rule in or out whether a person has OSA or not.
It can tell you whether you likely have OSA but it really can't tell you that you don't have OSA. All it tells you is that you don't have significant desats.

I have a friend who has severe OSA....AHI of 60 something done in a lab setting with tech in attendance. Her oxygen levels never really dropped below 93% from a baseline of 96%.

Push for a real sleep study.


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sleepsleepsleep
Unread post  Post subject: Re: Worth pushing for sleep study based on oximeter result?  |  Posted: Wed Sep 11, 2019 5:35 am

Joined: Tue Sep 10, 2019 7:11 am
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Thanks for your reply Pugsy. I've seen you post here and on other forums, and that you're highly knowledgeable about this whole area - I was wondering if you could clarify a couple of things from your knowledge just so I feel 'in the know' for when I push for as assessment?

> There is an option to get a home sleep study done much sooner than the full polysomnography, but I've read that the home sleep studies are also limited and cannot identify a range of sleep disorders as they, for example, don't include brain wave scans, so really I need to get a lab-based polysomnography test to be 100% sure?

> Are the length of my events (33.8 seconds) within the 'typical' range? I've had trouble finding anything concrete on what is defined as mild/moderate/severe length of average events. I'm thinking that this being an average that would mean I had longer ones...

> Is the Basal reading basically my overall average throughout the night's sleep?

> How is the Avg. Low Sp02(%) worked out?

> Would the scanner and/or software know when I was awake and adjust for this? It's a long time ago since I did this but I remember being awake for a while initially so imagine the first 30 minutes at least was not me being asleep.

> This is a bit of a throwaway question as I'm sure there's no real answer, but I'm wondering is there something I can ask prior to choosing a hospital/consultant to go with to know they are knowledgeable enough not to rely solely on the AHI value like the consultant I've seen already?

Hope that's not too many questions :shock:


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Pugsy
Unread post  Post subject: Re: Worth pushing for sleep study based on oximeter result?  |  Posted: Wed Sep 11, 2019 7:52 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1327
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Basal O2 reading is essentially your normal while awake average.

I have no idea how avg low O2 is figured.

The pulse ox has no way to know if you are awake or asleep at all so no adjustments for awake vs asleep can be made.

I don't know how the average duration of O2 events (desats) might translate into any OSA related terminology.
And as of yet there really isn't any documentation as to duration factoring into whether OSA is mild, moderate or severe.
So your 33 second average duration of an O2 event doesn't really give us anything to compare to.
Just use common sense....the longer anything goes on that impacts us...the worse it is.

People tend to get hung up on numbers to qualify something and sometimes numbers simply don't tell the whole story.

Sleep studies...home studies to be more specific..there are different levels of comprehensiveness....there are home studies that do use EEG leads to verify sleep status just like in the lab.
Whether or not they are readily available in your neck of the woods...I don't know.
See here for explanation of the various levels of data collected.
Obviously the more data that is collected the more expensive the cost.

http://freecpapadvice.com/home-sleep-tests


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