Help me figure this out?

[Eerie]

Hey all,

I just started looking into CPAP and found this wonderful forum and I figured, perhaps they could give me a little insight. Let me give a really shortened version of my "story" as a precursor. I'm sorry in advanced for being so long winded.

Started about a decade ago, I went to a doctor because I couldn't sleep, insomnia, feeling horrible, she spent a whole 5 minutes with me, said I was "depressed" and put me on meds...I was young and stupid (just left home for college) and figured she knew what she was talking about. I spent years on meds, trying different kinds, and sleep meds, all trying to help me feel better... I still wasn't sleeping... when I did, I'd sleep and sleep a long time and feel horrible. Nothing ever helped me stop feeling exhausted. My emotions started going on over drive, I started gaining weight like crazy, getting hypoglycemic episodes, was diagnosed bipolar in a similar 5 min doctor visit...followed by more/different med cocktails which made me feel like a zombie, didn't help me sleep or feel better when I woke up. No amount of dieting or exercising seemed to work... I lose a bit at first and then just flat out stop losing and start gaining again.

Last year, I decided to try a ketogenic diet, my hypoglycemic episodes stopped, I lost 40 lbs, took myself OFF my depression and bipolar meds and I felt exactly the same, so I just stopped taking them and seeing my psychiatrist. What was the point. Exhausted, fatigued, extremely frustrated that all this weight that piled on wouldn't budge... So, I went to my doctor and demanded she start taking me seriously. I told her about my diet and being off my meds, she swore I needed to get back on them and thats why I felt so tired and to "keep on trying" to lose weight. I refused to take that for an answer, I felt exhausted with or without them. I had a serious talk about being sick of not being listened to and passed off as being over weight is my issue and how could I help myself if my body was fighting me 24/7. She finally said ok and ordered a series of blood tests, did a physical, etc. My hormones are out of whack, my fasting blood sugar was a bit high but not horrible, and my A1C was good, she said I have metabolic syndrome/insulin resistance and to keep up my diet (and I have). And finally, I got her to stop trying to put my sleeping problems/chronic exhaustion on the psychiatrist. I had explained to her so many times it wasn't helping me and finally she referred me to a sleep doctor.

At my consultation I gave him the longer version of the above and he was actually very upset that it took them so long to send me for a sleep study. So I was scheduled for one asap.

I always feel weak, off balance, clumsy, foggy/confused, super forgetful. I can nap anywhere. I've fallen asleep almost daily at work (graphic/web designer) and have a hard time just functioning. Sometimes I'm so tired I feel like I'm drugged and cannot keep my eyes open and have fallen asleep despite fighting it. Nothing has ever made me feel refreshed, I'm just always so tired. Without some sort of aid I don't sleep, I wake up a lot...when I have been able to sleep, I can sleep 12-16 hours and I still just always feel so exhausted I can barely keep my eyes open. I'm so sick of my body holding me back from living life. Could having mild sleep apnea have this much of an effect on me? Or perhaps I have other problems as well? I have no idea, but I have to start somewhere.

Edit: They did give me an ambien on the night of my study, forgot to mention that, though I only take ambien 2x a week as my doctor won't give me more than 15 pills/month so I only take it on the weekends.

I got my first sleep study done on 9/19/2014. I got a super fast low down of "you have mild sleep apnea" over the phone by the tech with no explanation and referred for a CPAP Titration study, which is tonight at 10pm. I requested my results in the mail of my initial study and I finally got them, but I have no clue what they mean.

Respiratory Analysis:
AASM AHI: 9.3
CMS AHI: 4.4
NREM AHI: 3.9
REM AHI: 26.1
Supine AHI: 9.7
Obstructive Sleep Apnea: 0.0
Central Apnea Index: 0.5
Hypopnea Index: 8.8
Cental Index (Central Apnea+Central Hypopneas): 0.5
Mean Sleep % SpO2: 94
Min % SpO2: 84
% Sleep Time with SpO2 <, 88%: 0.2
% Sleep Time with SpO2 <, 89%: 0.4

Total Apneas + Hypopneas: NREM 18, REM 39
Obstructive Apneas: 0
Mixed Apneas: 0
Central Apneas: 0
Hypopneas: NREM 18, REM 36
Snoring: soft, frequent

Total recording time: 6hrs 31 min
REM Latency 64.5 min
Stage Shifts: 42
Arousals: 31
Arousals/hour of sleep: 5.1

N1 Sleep: 5 min
N2 Sleep: 184 min
N3 Sleep: 89 min
R Sleep: 89.5

NREM/REM HR: 71-102

[Julie]

Do you sleep on your back?

[Eerie]

I sleep mainly on my back and right side.

[Julie]

Because... when you sleep on your back you provoke many more apneas, and considering what a small number you registered on the study, I wonder if you made an effort to not back sleep (using pillows, wedges, whatever behind you) whether you'd then register any events beyond the normal couple that anyone would... it's called 'positional apnea' and in your case I might well try to find out if you have it (at best).

[chunkyfrog]

Good point, Julie. My DH's apnea is strongly positional,
so as long as his old bones allow side-sleeping, he can, but must "pap" if pain puts him on his back.

[Eerie]

Yeah, part of my problem with positioning is I kind of have to sleep on my back. I have chronic back/neck problems dating back to a high school injury and whiplash from a car accident. My neck is kind of curved forward (not visibily, but you can see it in an xray) and I've been getting chiropractic adjustments and traction for years but I'm basically maintaining it from getting worse. Over the past few months I've had some major/intense left shoulder pain (meaning I can't lay on my left side) and have gone to two different specialists who've given me cortisone shots and sent me home telling me I'm fine..except for the numbness/shooting pain/inability to lay on or use my left arm for much of anything. Now my primary care doctor wants to do a neck xray and thinks I have a pinched nerve in my neck or something and will probably have me do some physical therapy.

Laying on my back is usually the only way I can fall asleep and I seem to switch to my right side at some point usually in the night, but too long and my neck and back hurt.

I don't know if it's related but, I may have to see an ENT soon as well because I've been getting a chronic pain in the front of my neck/throat (above the clavicle, but not like a cold-type sore throat) for the last 5 months, it feels like someone is pushing on my throat, constant ache, starts to hurt more when I drink/talk and my voice sometimes cuts out on me. I'm placating my PC doc right now bc she wants me to try nasal spray... even though I know it's not allergies/post nasal drip (she tried this before a couple years ago, I developed a really bad chronic cough with no other symptoms that lasted 4 months, no meds we tried helped and I still have no idea what caused it) and the past two days using the spray have made it worse.

I feel like I'm falling apart Seems like a snowball of one thing after another.

[Julie]

If I were you I'd push for a CT or MRI of your neck (which I bet is causing your throat problems) and not fool around any more. There could be real problems (not to scare you!) which could be fixed if properly diagnosed and taken care of... stay away from chiros - they'll string you out as long as possible for money and not let you get better... and in case you're wondering I spent almost all my working life with neurologists/neurosurgeons in teaching hospitals and have some personal (related) issues myself. Your shoulder thing may well be neck related also.

[Eerie]

I've been seeing my chiro for 10 years now, and the funny thing is, he said the same thing about wanting me to get the CT/MRI...so he referred me to a specialist to get the MRI who blew me off completely (talked like he was on speed and spent a whole 10 min moving my arm around with me crying out in pain, and gave me a shot then did nothing at the 2 week followup, said I was fine and gave me a couple boxes of Celebrex samples). I didn't like his flippant attitude so I got a referral to another doctor elsewhere, he did the same thing, this time with shoulder xrays when I told him it was my neck. Gave me a shot in the shoulder and said I didn't need a follow up and left. :/ I'm hoping that having my PC doc actually look at my neck might get me some answers.

[Julie]

Good for you - don't give up. But I really wonder where you found those two prizes - sounds like they should be disbarred... or... you know what I mean! You NEED a neuro. person, not an orthopod.

[Janknitz]

While this article concerns PCOS primarily, the information on metabolic syndrome and sleep apnea is very universal: http://www.ncbi.nlm.nih.gov/pmc/article ... rt=classic You might want to share it with your doctor, who should be referring any patient who presents the way you did for a sleep study as a matter of course.

[Eerie]

Its time for my CPAP Titration, idk why but I'm nervous

Looks like I have to choose my DME now from a very short list. Not sure what my insurance covers or what's in the area.
I've been reading to avoid Lincare and Apria, heck my tech even said, yeaaa I wouldn't go with them, they get a lot of complaints. I might just go with the Hospitals DME.