Apnoeas, me? My Baseline AHI

I'm going to be exploring some of the sensible and not so sensible suggestions in order to bring down my AHI (see my post "What is an Apnoea?" for an explanation).

To do that I needed reliable data, so I decided on a 5 day mean with a few basic rules:

• No coffee after 3pm
• Monday - Friday monitoring only (to ensure routine sleep and wake times)
• No alcohol
• No other supplements known to affect sleep
• Begin sleep on my back (supine)
• Motion detection IR camera (for verification of events if needed)
• The same apnoea / hypopnea scoring criteria will be used throughout

I could use the IR camera to detect sleep position, but that would take a lot more time, so until I have a system that can detect that reliably then I won't include that data, and I may re-evaluate some weeks using that ability.

I did initially check the camera to see if I attempted to breathe when the system was detecting apnoeas. I did make some respiratory effort, so I will make the presumption (for now) that my apnoeas are obstructive in nature.

I also noticed that when the oxygen desaturations due to apnoeas were compared to the Zeo hypnogram, that like my son's, they were clustered around REM sleep.  

The top line is my oxygen level.

It does look like I'm awake for those periods, but the black line is a more detailed Zeo hypnogram (data calculated on a 30 second basis). Zeo has a scoring system and shows the highest scoring sleep stage as being the dominant one. "Wake" scores the highest; this makes sense, as being awake is probably the most important thing to show when you are supposed to be sleeping.

The 30 second graph shows why the main Zeo graph shows a lot of wakefulness during the night... I have oxygen desaturations which in turn wake me up, hence Zeo shows "wakefulness for the whole 5 minute epoch. However, when you see Zeo's calculations of time spent in each sleep stage, these are based on the more detailed 30 second data.

Sleep apnoea can run in families. Whether that is a factor or not, my diagnosis (albeit a self-diagnosis) doesn't surprise me. I sometimes snore, I wake up with headache a lot, and I could do with losing a bit of weight.

I have long suffered with sleep paralysis, and I suspect that being disturbed in REM sleep is a major factor in that, if not the sole cause.

So, how is this a problem?

My average AHI (number of apnoeas and hypopneas per hour) is 7, hence I am classified as having "Mild Obstructive Sleep Apnoea".

The classification ranges are:  

<5      -    Normal (unless symptomatic)
5-15   -    Mild
15-30 -    Moderate 
30+    -    Severe 

The REM element brings the name to "Mild REM-Related Obstructive Sleep Apnoea"

I will say that this "diagnosis" is an amateur one, it may not correlate with a professional one in a sleep lab, but if I use the same equipment throughout this experiment the results will still be valid, just relative to my original numbers.

So, what if I don't want to have that diagnosis, what if I want to be "normal" (says the man who sleeps with electrodes on his head, prongs up his nose and a camera watching him)?

Standard advice:

• Lose weight if you are overweight (even a small amount can make a difference)

That's all very well, and something that I will do, but that won't help me fix my sleep tonight will it?

Other advice includes:

• Prop the head of your bed up by 4-6 of inches (takes the weight off your neck)
• Cut down on alcohol (see this blog entry on alcohol)
• Quit smoking
• Use a mandibular advancement device (pushes the bottom jaw forward to hold the airway open)
• Use a CPAP device (see this blog entry on NIV)
• Avoid caffeine and heavy meals within two hours of bed
• Use a nasal dilator (keeps the nostrils open)
• Try a nasal saline spray
• Throat exercises
• Surgery

I'll evaluate some of these (plus a few more ideas that I have) and back up the findings with a 5 day mean AHI and sleep graphs.

Let's face it, we're all looking for quick-fix solutions, and I'm not trying to cut corners, but I am trying to help myself whilst on the journey to losing a bit of weight.

So that I don't confuse the issue I will not intentionally lose weight until I have tried some of the other methods.

So, in essence I am looking for some way of bringing my AHI down, along with the time that I spend awake at night.

...but before I do that, how about trying to INCREASE my AHI? Next blog post.

Comments

[James R. Skinner]

If you think you will have trouble coping with CPAP I recommend that you try a mandibular advancement device first. Also make sure that your nose is working well as that will affect the probability of having apneas

[Hypnagogia]

Thanks very much James.

The mandibular advancement device is something that I plan to test.

I'm going with the Somnofit brand and have moulded it ready.
To be honest, I think I'm going to prefer CPAP, but time will tell :)

Thanks again for reading and making a comment, I really appreciate it.

[James @ Intus / Zeo UK]

We have a chap in the CPAP forums by the name of Tigers Fan who tested our SinuPulse Elite against his Auto-CPAP usage. His residual AHI dropped (was low already, in fairness) and his average pressure dropped too. Nasal breathing is very important full stop, and especially for CPAP and MRA/MAD users. Some poeple can abolish their snoring and very mild OSA entirely with sinus irrigation, if of course that is the problem for them.

In your list of avoiding apnoeas you can add "Stay off your back". We use the Rematee for that. If yours is not supine-related but REM related, you can perhaps try and work out a way to remove REM (not a great long-term solution, but someone like you may find it an interesting experiment). I know that serotonin boosting anti-depressants can completely wipe REM sleep. And with it, your apnoeas (if REM-related indeed). But again, that's a crazy idea.

For throat exercises there is "Singing for SNorers" and playing the Didgeridoo.

You can also torture yourself with hypoglossal nerve stimlation, or tong retaining devices. And we've also seen people's AHI drop when using blood vessel dilating sprays, eye-sprays even. You can get those as nasal sprays, though we prefer the all natural salt ones with the active dilator components (which aren't suitable for long-term use).

[Hypnagogia]

Hi,

That's interesting about the SinuPulse. That's something else I could try.

I very nearly ordered the Rematee today in my order from you, so I guess that'll be on my next order. I could validate that by checking my sleep position against the video, but an automated way would be great. I like the idea of the Rematee a lot more than the "tennis ball in the back of pyjamas" :-)

Re the blood vessel dilation, would that be something like Nifadapine or GTN spray? We have that around, but not sure I want the drop in blood pressure, if we are talking about the same things.

In the early stages of my son's issues with REM related apnoea, we did think about decreasing REM with meds, but as you say that's not really an option. I like to think that REM has spiritual benefits as well as physical ones.

I'm hoping that 5-HTP will cause a drop in AHI, without a drop in REM.

[James R. Skinner]

I would recommend against using drugs to reduce REM as a way of decreasing AHI. REM is important for memory consolidation, learning, and emotional processing. Reduce REM and you will create other problems.

[Hypnagogia Blog]

I agree.

It's interesting that what may work in theory, may not be desirable for other reasons.

I have used 5-HTP before while monitoring myself with the Zeo, and although I wasn't checking my AHI at the time, I didn't see it having a noticeable effect on my REM, but that was only for the odd night, not consecutive days.

I have to say that I like my REM, and in a strange way I also like the REM disturbances because they mean that I remember a lot of dreams, and may even cause me to have lucid dreams. I'm actually hoping that during this long period of monitoring my AHI that I will "catch" a lucid dream or an episode of sleep paralysis on the EEG and be able to correlate that to an arousal from an apnoea.

[James R. Skinner]

What tool are you using to generate the 30 second charts from Zeo? I assume you are downloading this data via the CSV?

[Hypnagogia Blog]

Hi, yes I'm using the CSV data then processing it in Excel.
Once I had the graph formatted as I wanted I was able to save it as a template to speed things up next time.