Tiffany from ADVENT goes over the results of Erik's home sleep study and what those numbers mean for his sleep apnea treatment options.
*ADVENT no longer does virtual visits
Hi, everybody. Erik here, continuing my ADVENT sleep journey. Got the results back from my home sleep study and we're gonna go over them with Tiffany right now. Since last time I did a virtual visit*, they've actually changed up the whole platform, and now you don't have to download an app or anything, they text you a link, you just click on that link and you're good to go. Okay, that was pretty easy.
[Erik] Hey Tiffany.
[Tiffany] Can you hear me, okay?
[Erik] Yep, I can hear you just fine. Can you hear me?
[Tiffany] Yep, I can hear you and see you perfectly.
[Tiffany] All right, so, we're going over your sleep study today.
[Tiffany] How did it go with the night that you wore it?
[Erik] It went great. It was, it was pretty easy, pretty comfortable. I was able to sleep like normal. It was a lot more comfortable than the, the in-lab sleep study I did, so.
[Tiffany] Good, good, good. Okay, so now remind me, you said you've had a BiPAP before, right?
[Erik] That's correct, yes.
[Tiffany] Okay, all right. So going over your sleep study, so the main number that we focused on is something called the AHI so that's the apnea hypopnea index. That is basically the count of times per hour you actually paused your breathing. So you paused it enough for your oxygen level to drop more than 3%, and a significant amount of time to count in the AHI count.
[Tiffany] So your number was 66.4. So that's 66.4 times per hour, you actually pause your breathing. To give you a reference range, anything less than five is really not considered sleep apnea. Anything that's like five to the mid teens is mild sleep apnea, anything that's like the mid teens to mid twenties is like moderate sleep apnea, and then anything above that is severe.
[Tiffany] So you are in the severe category, but I mean, we see 'em in the hundreds, so it can only be worse. This is based off of like a 3% oxygen drop.
[Tiffany] So like your, your pulse ox, you know, so if we're checking your oxygen level when you're up and awake with the pulse ox machine, it should be like 98, 99, 100 if you have no, like underlying lung disease. So yours at, throughout the night was mostly about 96%, BUT the lowest that it did drop was 80%. So that's really low. So they also looked at your positions. So when you were on your back, the average amount of times per hour that you'd pause is about 68. And then when you were on your side, it was about 62. So it wasn't really position related.
[Tiffany] You know, for some people like, they will, when they're sleeping on their side, maybe their number is like 30, and then when they're on their back, it's like 60, due to the way that gravity can kind of pull and like the throat structures can collapse part. In your case, it didn't really matter what position you were in, it was happening equally throughout. But I mean, we have seen people with AHIs in the sixties that have done well with an oral appliance and they haven't even needed CPAP.
[Erik] Oh really? Okay.
[Tiffany] So it's not completely out of the question for you. The oral appliance, is called a mandibular advancement appliance. So it basically holds the bottom jaw in a slightly forward position while you're wearing it at night. So it gets the tongue often at the back of the airway so you have less collapse of those structures.
[Tiffany] Everybody's a little bit different. There are people that will get the oral appliance and they could have their number in the sixties and we could get it dropped down to like 10 or five. And then there's some people who could get the oral appliance and the best we're gonna get it is it dropped down to 30. So it really does kind of depend on the person how much they can tolerate and how much of their anatomy is a tongue problem versus a pallet problem.
[Tiffany] Regardless of if you go with CPAP or BiPAP, or the oral appliance, if you have issues breathing through your nose then none of those will be very comfortable for you, which I think you kind of had the problem with your BiPAP being that issue.
[Erik] Yes, very much so.
[Tiffany] And a lot of times sometimes if your nose is blocked, the pressure does have to be higher on those machines so it can work appropriately.
[Erik] Oh okay.
[Tiffany] So, I mean, it's important to work up, you know, the reasons why you're not bringing well to your nose first, so we can figure that out, even though that does not have really anything to do with sleep apnea, per se, if we would just slap you with a CPAP like you had before or BiPAP or a mouth guard, and you can't breathe through your nose, it's not gonna work, you're gonna open your mouth at night, the mouth guard's gonna fall out and it's not gonna do what it needs to do.
[Erik] If we do move forward with a nasal procedure, and we go back to CPAP, I'm guessing I would most likely want a new machine.
[Tiffany] Yeah. Yes you would.
[Tiffany] Yeah, so think about it, I mean, you're not, you know, married to CPAP necessarily, but you could always try it again and if it doesn't work out again, you wanna do the oral appliance afterwards, you can do that, and we'll kinda see what shows up, you know, with your, sinus work up and then you can kind of go from there.
[Tiffany] Sound good?
[Erik] Yeah, it sounds great. So yeah, I'll just see what comes back in the CT scan and we'll formulate a plan from there.
[Tiffany] All right, sounds good. Well have a good day.
[Erik] All right, thank you so much, Tiffany. Appreciate it.
[Tiffany] You're welcome, bye bye.
[Erik] All right, bye.
All right. Just had my sleep study follow up. I guess that number is a little lower than I was expecting. I was originally told it was, you know, very severe, like I was, you know, not long for this world severe, at least that's the impression I got. But yeah, this, this is interesting, 'cause this means that, maybe an oral appliance would suffice. Maybe I don't need to do CPAP. A lot of that will depend on what comes back with the CT scan so, yeah, join me next week, we'll, we'll see the CT scan, we'll see what's going on up there and, and we'll get a plan moving forward so, thanks again for joining me and we'll talk to you again soon.