When you’re tired and your sleep apnea is mild

A common misconception is that mild sleep apnea means mildly sleepy, moderate sleep apnea means moderately sleepy, and severe sleep apnea means severely sleepy.  Although this would be intuitive, it just isn’t the case.  There are people with very mild sleep apnea (by the AHI) who feel terrible and improve significantly when they get treated.  

In fact, the relationship between the severity of sleep apnea and the daytime symptoms a person experiences is very loose.  Not reliable at all.  No doubt there is a component (or several) of sleep that we aren’t measuring or understanding well.  In fact, the way we measure sleep apnea is rather limited- the AHI (apnea hypopnea index) is used to describe severity but it is only one dimension.  In my mind, we would do better to describe sleep apnea with multiple data points to paint a better picture.  But I digress. . .   

You’re a person, not an AHI number.  I’m a physician, not a robot.  So I treat the person, not the number.  

I remember one woman who came to see me because she was so debilitated with sleepiness.  Her husband had to drive her to work in the morning because she didn’t trust herself to stay awake.  And her sleepiness was affecting her performance in her air force job.  Her sleep study showed she had an AHI of 5, barely qualifying for CPAP treatment.  I wasn’t sure if CPAP would work for her.  We talked about other things that may have been causing her sleepiness, but she was savvy and was doing all the right things to boost her sleep quality and wakefulness.  There didn’t seem to be anything else left to address, so she decided to move forward with a trial of CPAP.  

I saw her a couple of months later.  She was using CPAP every night and throughout the night.  She described feeling better than she had in years.  She was driving herself all around and doing well in her job.  She was so excited to tell me how much using CPAP helped her, and her sleepiness was totally resolved.  

That really made an impression on me.  It was a good lesson because I really had reservations that CPAP would work for her.  The truth is, I had put myself in her shoes and I thought that I would not want to go through the inconvenience with the amount of doubt I had.  I certainly didn’t talk it up, so her expectations were probably low too.  But she wanted to try it, and she tried it with curiosity and consistency.  And we both benefitted.