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Help Needed - Shallow Breathing

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  • Help Needed - Shallow Breathing

    Hello forum,

    I need some advice if possible. I'll be discussing my situation with my GP in a few days' time but would be interested to hear others' opinions too.

    I suffer from poor health. I am very very tired most of the time & my levels of physical activity are correspondingly low. There's a familiar pattern to this, which is that most mornings when I wake up I feel dizzy, weak and a bit sick. It's the same feeling you get when you have to crawl out of bed at 3am (eg to catch an early flight), but I get it almost every day, and no matter how long I sleep, it doesn't help. I tend to very slowly improve as the day goes on, so that by the evening I usually feel reasonable-ish.

    Something isn't right with my sleep - I'm sure of that. I might wake up once or twice during the night, which isn't such a big deal, and I tend to be able to get back to sleep fairly quickly. But when I'm half-asleep & dozing, I notice that my breathing seems to be very shallow & often I find myself being shaken awake by slight dizziness & having to take a few deep breaths. It's much worse when I sleep on my back so I invariably sleep on my side.

    I've long suspected that there's some sleep apnoea going on, but about 18 months ago I had a test for apneoa which came back negative. Results said 'moderate snoring', blood oxygenation ok, etc. But it wasn't a full-blown test in one of the sleep study centres, it was done using a little machine which I borrowed from the hospital & took home with me - measured pulse & blood oxygen (thingy on end of finger), microphone to listen to breathing, motion sensor, etc. Are those things very reliable?

    I desperately need to find out what's going on. I've only been well enough to work for about 1 year in the last 4, and I spend most of my time looking & feeling like a zombie - very tired, very depressed and very anxious, and virtually no physical or mental energy at all. I suffer from poor memory & concentration too. Most of my days are spent in bed. Even when I do have the strength to exercise, I am usually exhausted afterwards & can find myself spending 24-48 hours in bed, sleeping fitfully & feeling absolutely terrible.

    Grateful for any thoughts, advice, suggestions, etc.

    Many thanks,

  • #2
    Hi Al

    You describe in detail exactly how it is to suffer untreated OSA. That isn't to say your symptoms may not have another cause but they match OSA perfectly.

    The oxymetry test you did a while back is very reliable and showed that on one night a while back you didn't suffer from sleep apnoea. However, that certainly doesn't mean you don't suffer OSA now.

    If it is OSA, well and good - a pain in the anus to have it but at least you know and the cure is simple and very effective. CPAP/APAP or whatever you might need gives you your life back (a very few folk don't take to it).

    Good luck with your GP and let's hope you get a sleep study asap. If it takes too long for you, Intus can fix you up privately with a home sleep study in a trice.

    Some reading while you are waiting - research DVLA and OSA and see if you can avaoid losing your license even for a day.

    Respironics REMstar 'M' Series APAP.
    Resmed Mirage 'Quattro FX' Full Face Mask with a 'Quattro' headgear.


    • #3
      Many thanks. Agreed: my symtoms could easily be explained by OSA. The exhaustion, anxiety, depression etc. have been so bad that at one point I was admitted to a psychiatric hospital. I've taken several different antidepressant meds over the last few years but none of them really made much difference. Could it all have been a red herring?

      I was genuinely surprised that the test came back negative last time but, from memory, I felt a lot less bad *on that particular day* than I have done recently. Hopefully I can persuade my GP to arrange a repeat test, and quickly.

      Thinking ahead slightly re: ordering a home sleep study privately if there are waiting lists at my local NHS sleep clinic - I found the Intus website and it all looks straightforward, but if they confirm the presence of OSA don't I still need a doctor's prescription to get hold of a CPAP machine & have it calibrated for my needs? How do I get hold of the magic bit of paper?


      • #4
        James!!!!!! Tom!!!!!!!!

        Hi Al

        Give Intus a bell on Monday and they can answer your questions definitively.

        For today - I think they have qualified staff to take care of a prescription. I know they do the whole deal in a matter of days.

        Are you aware that Intus run this forum? They come highly recommended by me and many others - even the few begrudgers (who have posted here) have come round once Intus have had time to respond to an issue. Their after-sales is as good as their pre-sales. An added benfit is that they can have you sorted so fast you need not have driving license hassle.

        Respironics REMstar 'M' Series APAP.
        Resmed Mirage 'Quattro FX' Full Face Mask with a 'Quattro' headgear.


        • #5
          Why wait for Monday

          There are three levels of sleep apnoea diagnostics. Finger pulse oximetry, multi-channel respiratory and then full PSG. They each record respectively about 2 channels, 6-ish and then 12 or so.

          The finger pulse oximetry is great for confirming OSA in people where the suspicion really is 'just' OSA ie. little chance of it being anything else. However, finger pulse oximetry can not be relied upon to rule out OSA. So what they should have done after your first test, is to keep an open verdict and move you up one level, recording more data. But they didn't, even though your symptoms are very close indeed.

          Had you then been given the multi-channel respiratory study, which also records airflow etc. then they (an experienced sleep technician/physician) could have much more reliably ruled it in or out. If still inconclusive or not sure, you then move up to PSG.

          But for most, indeed finger pulse is just fine and confirms what they already thought they were suffering from.

          If the suspected sufferer is not overweight (as can be the case when he or she has an abnormal lower jaw shape for example) then finger pulse oximetry can be less accurate. This is to do with how fast blood pumps around apparently. This category should just do a multi-channel respiratory study right away.

          If the suspected sufferer is very obese, say BMI over 40, they should also skip the finger pulse oximetry test and go one level up right away. This is because a finger pulse oximetry test is really just good to detect OSA. It's difficult if not impossible to differentiate a desaturation due to an obstructive event from a central event for example. It's also difficult to detect obesity hypoventilation, something which could perhaps contraindicate the usual CPAP therapy. This is where you have such a heavy chest, due to so much weight, that it pretty much crushes your lungs all the time, affecting oxygen/CO levels to such an extent, treatment needs to be carefully considered. A multi-channel test can also differentiate hypopnoea's from apnoea's and work out whether you get them when on your back, side or both..

          So as explained on our Sleep Study site, if you are between BMI 25 and 40, have a few of the classic OSA symptoms and then don't have a history of heart problems, stroke etc. that's what you'd call your primary OSA candidate and they can simply do a an in-home finger pulse oximetry sleep study with 9 out of 10 times, the confirmation coming through immediately and then you have all you need to start Auto-CPAP.

          In the other 1 out of 10 case, we may suggest you move up to an in-home multi-channel respiratory sleep study or refer to your local NHS clinic for more specialised assistance.

          Hopefully that helps you understand the process. You can only move to Auto-CPAP as there is no titration involved (a measurement of which CPAP level of pressure provides accurate therapy for your level of OSA). An Auto-CPAP auto-titrates and works this out on the fly. If you want a (more affordable) fixed pressure CPAP, you'd take the sleep study results to your local clinic, show them the proof that they'll most likely recognise as factual, and then take it from there.

          Lastly, I'll briefly explain why a sleep study could come back negative. You say you mainly get it on your back. That night, you may have just slept on your side, making the recording borderline or 'healthy'. It could also be that you get the so-called micro-arousals (briefly waking up without you remembering much of it), but only desaturate (blood oxygen levels dropping) say 3.9%. If the sleep technician 'lazily' left the analysis software to count 4% dips, and you got 30-odd 3.9% dips, he or she could have counted none. Whilst a 4% dip is what they normally look for, that's not to say some people's sleep get interfered substantially (and feel miserable in the daytime because of it) when they desaturate 3.x%. A well trained sleep technician with sufficient experience will bear that in mind.

          It's good that you don't just take their word for it. That test was a snap-shot and may have not been representative or not been interpreted very well. If you do a one night test with us, it's 100. If you want to record two nights, it's currently 129. Most people do the latter, so they can get used to the equipment on night one and feel more comfortable on the second night, ensuring the wearing of the equipment doesn't affect their sleep in itself.

          If you fall outside the brackets described ideal for finger pulse oximetry, our multi-channel test would be better value, even though it's more money.

          Let me know if you have any questions, here or indeed tomorrow on the phone.


          • #6
            Thanks James.

            If it helps, the test I had before was done using a machine which looked almost identical to the one shown in the multi-channel respiratory sleep study link that you gave.

            My BMI is about 30 I think. I do however have a slightly recessed lower jaw ie at rest my bottom teeth are positioned behind my top teeth. I've also had a history of ENT troubles - nothing major, but a tendency to get blocked up easily, sinusitis, hay fever, nose bleeds, etc.

            Have appointment with GP on Wednesday morning so will discuss with him then.


            • #7
              Some people's OSA and snoring can be to a large extent due to blocked sinuses. See this thread for some suggestions: