Is this sleep apnea?

[Paulsangel]

My boyfriend is 36 years old.  He has gained weight as the sleeping disorder has became worse.  He is currently around 20 pounds over weight.  His symptoms are morning head aches, light headness, depression, forgetfulness, mood and behavior changes, trouble concentrating, loss of energy(becomes physically weak), nervousness, wakes up and feels like he never slept, horrible anxiety, snores sometimes, coughing or gaging on something though he only remembers if I ask if he is alright, and occasional pounding heart.

He is currently on medication to help him get to sleep and one that is suppose to promote better quality of sleep.  

It has been getting increasing worse over the last year to year and half.

He had 3 sleep studies done over the past several years.  The first two came up in conclusive.  The last one he just had two weeks ago came back and his family doctor told him he thought he had Hypopnea and referred him to a specialist.  Now the specialist is telling him that he thinks he is having stroke like events.

The sleep study findings are (this is with him on his medications)
total sleep time: 367
Sleep Latency: 17
REM latency:80.5
Final wake latency:374
PLM index 5.1
average osat: 96.3%
number of epochs: 788
Sleep efficiency: 93.5%
Total awakenings:11 Index 1.8
AHI: 1.3
Minimum OSat: 86.0%
WASO: 7

EEG: seemed normal.  There were frequent arousals during the study that were associated with respiratory events and periodic limb movement.

EMG: unremarkable.

EKG: lowest heart rate was 50 no other arrhythmias

Respiration: oxygen saturation decreased as low as 86% during NREM sleep and 88.9% during REM sleep in assoication with respiratory events.

Other: snoring
Interpretation: periodic limb movements in sleep.

He spent 70.7% in stage 2
19% in REM
6.5% wake
and 3.9% in stage 1

respiratory events went as follows 1 obstructive apnea, 1 apnea, 7 hypopnea, 19 oxygen desaturation, 27 respiratory

Arousal summary
17 leg movements sponstaneous was 211

his heart rates   Min(bpm)               Average(bpm)               Max(bmp)
wake               55                                 75.9                         105
Stage 1            50                                64.6                           114
Stage 2            52                                 61.1                          85
stage 3 none
stage 4 none
NREM               50                                61.3                        114
REM                56                                   64.7                       97

I dont know what all of this means and so many of these symptoms qualify him for so many different things.  We did rule out some basic things so now we are on to actual sleeping disorders.  We are desperate to find an answer so he can live a full life.

[KatEyes]

Keep in mind I am not a medical professional, so anything I say is either out of my experience with sleep disorders or from my readings on the subject. I agree that he needs the help of a specialist to get to the bottom of things. Also think he may need to be persistent in expecting answers and solutions. Following are some things he could discuss with the specialist.

Oxygen levels below 90 are not acceptable and there needs to be resolution. My brain scans show multiple "lesions" that were interpreted to be microvascular ischemic areas, where the fragile tiny blood vessels at some point were compromised and those spots didn't get enough oxygen. Sleeping in a lab is not always representative of how we sleep in the comfort of our own home. It would not hurt for him to ask the doctor about using an overnight recording oxygen monitor to see if the results are consistent.

He had no Stage 3 sleep, which is important to sleep being restorative. It's the why that is not real clear. There is something called Upper Airway Resistance Syndrome (UARS) that is short of being apnea but can still disrupt sleep stages. Can't say if his results lean toward that or not.

Limb movements in a sleep study are generally either associated with respiratory efforts or independent of them, such as in Periodic Limb Movements Disorder (PLMD). Both respiratory efforts and PLMD can be a cause of arousals that disrupt sleep stages. When both are present, they may vie for expression, and the result can be an unclear picture of either issue. For instance, if there were no breathing issues, maybe he would sleep deeper and thus have more PLMD limb movements. Or if the movements were not present, maybe he would sleep more and thus have more respiratory issues. If he has PLMD, he probably shouldn't expect these sleep study results to be the end-all. It was my third one over a period of years before my OSA was apparent on a study, even though the symptoms were always present. Some of my studies at a glance seem too different to even be on the same patient.

Regarding PLMD - avoid caffiene in the evening. Also, one school of thought is that keeping the ferritin level above 60 can be beneficial to some.

About taking meds to sleep - I would be concerned that if there is sleep disordered breathing, some meds can exacerbate that, as when everything relaxes, it can include the tissues in the throat. Sometimes side sleeping and elevating the head of the bed can help a little. Maybe he could do that while waiting for answers.

Sorry I couldn't give you answers, just things to think through. I think you're on the right track to focus on sleep disorders. So many of his symptoms are prevalent in those with sleep disorders. Hope you post to let us know how things progress.

[Red931]

These results don't indicate that he stops breathing much while sleeping or (Sleep Apnea). His blood Oxygen Saturation is falling and staying below 90. That is most likely the cause of his headaches and some of the other symtoms.

I would stick with the Specialist and see if he can't find the exact cause of his problem.