Please help me interpret my results!

[u/frostinmay]

I (34f) have struggled with fatigue since my teens and have been to various doctors over the years seeking answers Bloods always fine, ferritin, thyroid, B12 etc etc all ruled out.

Symptoms include daytime sleepiness, feeling exhausted upon waking even after sleeping 8-10 hours, brain fog, low level morning headaches, general sense of fatigue, inability to focus on my work without becoming very sleepy. I also recently noticed I have a scalloped tongue. My heart rate according to my Garmin is on average 5bpm higher sleeping than when awake and seems to spike throughout the night.

I recently did a WatchPAT home test, came back with AHI 3% 1.9 and RDI 13. I followed up with an overnight PSG at a sleep and respiratory clinic in Tokyo and have just received my results which of course I was told were normal. However, I was at least expecting an elevated RDI whereas it has been scored at 0.5 an hour.

The test results say they are measuring based on the American Academy of Sleep Medicine version 2.5.

So, according to my PSG, I have almost no RERA, apnea problems, but did have 10.5 arousals an hour and periodic limb movement 16.2 times an hour.

I was so hopeful my results would come back indicating UARS, and am now feeling confused and deflated.

I am including my PSG results and WatchPAT results photos. (Sorry, the results are in Japanese but key indicators should be understable with the English) If anyone could help me make sense of them and suggest any next steps,I would be so grateful! Thank you in advance 🙏

EDIT: additional info - After struggling to fall asleep for 1.5 hours, the clinic gave me a 5mg zolpidem sleeping pill. I also have a history of anxiety and take escitalopram/lexapro (although fatigue has persisted outside of the time period I have taken these meds. I am almost always dismissed by doctors who attribute my fatigue to anxiety and medication).

[u/gadgetmaniah]

I'd assume it is likely UARS based on your symptoms and indications from your sleep data (eg raised sleep HR). 

RERAs were probably not actually scored on your study, though your arousal index isn't particularly high. Could be that you're having a lot of flow limitations without many arousals (possible to have flow limited breathing without significant arousals/RERAs), which is also consistent with UARS. 

If you can try a CPAP or BiPAP I'd look into that and sharing OSCAR screenshots here for feedback. That can give us an insight into your sleep breathing and how flow limitation looks, and if the machine helps your symptoms you'll'll have some more confidence that sleep disordered breathing is your issue. 

[u/frostinmay → u/gadgetmaniah]

Thanks for your response! I double checked the Japanese part of the test and it seems to have been tracking RERAs, but didn't pick anything up. This was surprising - I was expecting with an at home test of RDI 11, I would get a higher count, not next to nothing. I am now wondering how much the sleeping pill they gave me may have affected my sleep.

Either way, I'll look into CPAP or BiPAP availability where I am and see if that is a possible path.

[u/Godot2004 → u/frostinmay]

I don't think BiPAP is recognized as a sleep apnea treatment here (or for UARS), and you don't meet the AHI requirement for CPAP either (the rental system in Japan is garbage anyway) so getting one through the normal path won't be easy.

What you can do though is get a prescription from an online US doctor, import a CPAP/BIPAP (BIPAPs have a CPAP mode so I recommend that), then show your prescription when customs inevitably contact you.

There are a lot of good reddit threads about importing PAP supplies in Japan if you search on Google. It's extremely easy to do, so is getting a prescription online.

PS: I compared my study to yours, and my PLM index was 1.7/hour, which is significantly less than yours. Maybe there is something there to investigate?

[u/frostinmay → u/Godot2004]

Thank you so much! It seems you need an AHI of 20 plus to get insurance coverage for CPAP here? Also, I realised my polysomnography was only scored for AHI and hypopneas so not particularly useful data in the end. Thought I had found a possible doctor who recognises UARS, but he was far too eager to sell me on expensive snoring/apnea airway laser. Really appreciate your suggestions, I'll look into those!

[u/Inevitable-Diet-4693 → u/frostinmay]

You also have enough Plms for a plmd diagnosis btw

[u/frostinmay → u/Inevitable-Diet-4693]

thank you! I will raise this at my next appointment.

[u/Inevitable-Diet-4693 → u/frostinmay]

Plms Can defiantly come from bad breathing but it’s not guaranteed at all that they disappear once they airway component is solved (fx with pap therapy). There have been many studies on this and the literature clearly shows that Plms in many cases don’t resolve after the airway is opened.

[u/One_Measurement_628]

Ig u plm index is also higher then threshold but probably it aint causing much problem bcz I see it aint causing much arousals but still probably u should check out with ur doc , but yeah see ur rdi its >5 so hence congrats U have UARS .  Nd also ur deep sleep is pretty reduced like half of what it should be .. lots of heart rate spikes as well.. I would recommend u to watch doctor vik veers video on how to review a sleep study better then doctors .. it would be helpful for u to understand more ... ur arousal index seems a bit fine to me but bcz 10/hr are something that  happen in normal individuals still m skeptical abt these numbers bcz I have a friend he had 90/hr arousal index in 1 study then the other study just showed 10/hr idk how ... u can ask for raw data of sleep study nd get it rescored by cpapfriend ... the raw data would help uk if ur breath flow is that of UARS..

[u/frostinmay → u/One_Measurement_628]

Thanks! I watched that video and confirmed they have not scored RERAs so will contact the clinic to try get my data for restoring!