Please help on polysomnogram results

[stilltired]

Brief history:  34-year old female, 5ft 4in, 115 pounds.  For 5 years have suffered excessive daytime sleepiness. Was previously very active, have a masters degree, now cannot stay awake for more than 4 hours without the aid of a prescription stimulant, cannot come up with appropriate words to use in conversation, fighting off sleep or excess fatigue all day but often takes longer than normal to fall asleep and sometimes can't stay asleep, wake up feeling exhausted.  I've had every test possible and I do see a psychiatrist who ruled out psychological cause and prescribes me Adderall (adderrall) for fatigue. (He's also prescribed me a few things to help me sleep, but sleep aids seem to cause me to wake up feeling even more exhausted).

I recently had a sleep study and the results didn't point to anything.  Based on a pre-study survey my Epworth sleepiness score was 15. The report showed total AHI of 5.2, which I realize is barely above the threshold.  The percentages of time for each sleep stage were close to normal, and no PLMs.  Sleep latency was 65 min, Stage R latency was above normal at 220 min, WASO 39 minutes. 76% sleep efficiency-not horrendous, but less than optimal.  Arousal index was 32/hour of sleep.

I'm confused how is it that the board certified sleep physician who reviewed my report signed off that it was a "normal sleep study" and indicated no further suggestions?  When my primary received the results she told me  my sleep is fine and gave me no suggestions for how to proceed.  Admittedly I don't know if the prolonged REM latency, etc, means anything at all, but I feel that considering my complaints, particularly the arousal index should have raised some alarms.

I don't know what to do now.  I can't continue to take Adderall (adderrall) all day to keep me just barely awake and just go through every day this way. I know there is something that is not normal here, but if even a board certified sleep medicine professional thinks my sleep is "normal," what else can I do?  

[Steven Y Park, MD]

Based on everything you relayed, it sounds like you may have upper airway resistance syndrome. I have a more detailed description about UARS in my articles section. Briefly, you are having multiple obstructions and arousals which don't qualify as official apneas. An apnea or hypopnea has to last longer than 10 seconds. If you stop breathing and wake up after 1-9 seconds, then it won't get counted. Most people with these findings get the diagnosis of "idiopathic hypersomnia."

If you normally can't sleep on your back, or have cold hands or feet, or have a parent that snores loudly, then you should still pursue a sleep-breathing diagnosis before considering other conditions such as hypothyroidism, adrenal fatigue syndrome, chronic fatigue syndrome, etc. Do you have a relatively small mouth/jaws?

[stilltired]

Dr. Park, thank you for your response.  Your article on UARS was very enlightening, as was your entire website.  Thank you for that.

I am petite and do have a relatively small mouth and jaw.  My primary is under the impression that my many sleep disturbances were spontaneous arousals, but to me that's not good enough because it gives no explanation.  The fact that I was sleeping in a strange environment could have disrupted my sleep a bit, but I don't know that it cause such fragmentation.  Something like UARS certainly seems a more likely cause.  Unfortunately because I'm the patient and my doctor doesn't share my opinion I've got some research to do now to find another doctor to review my report.  

To your knowledge are there any conditions that would cause a high amount of spontaneous arousals (not breathing related)?