I agree with CarrerLady. This is the problem with UARS. It's how it's diagnosed on a formal sleep study. An apnea or hypopnea is any stoppage in breathing that's 10 seconds or longer, but if you stop breathing and wake up anywhere from 1-9 seconds, then it's not counted as an apnea or hypopnea. You have the expected high arousal index. Some of these will be RERAs (respiratory event related arousals) and others will be labeled as non-respiratory related. My feeling is that many of these non-RERAs are in fact, respiratory related. Inside your throat you have pressure sensors that can detect when you're about to obstruct. It sends a signal to your brainstem and then an automatic feedback signal is sent to the deep brain sleep centers to tell it wake up to reverse the relaxation that occurs in deep sleep, which causes an arousal, without the signals even reaching your outer brain (which is what the EEG leads tell you).
Interestingly, your AHI of 5.2 gives you the diagnosis of obstructive sleep apnea, as long as you have daytime fatigue (using Medicare's criteria). You should qualify for a trial of CPAP, which I do recommend, even though in general, most people with UARS can't tolerate. But there are some that do benefit. Your best bet is to find a dentist that specializes in dental devices for OSA and UARS. By pulling your lower jaw forward, you pull your tongue forward, opening up your airway. Jaw surgery is an option if you have very small jaws, and soft tissue surgery to shrink your tongue is an option, but one of very last resort. Take a look at my article on UARS.
I agree with you, this is not a "normal" sleep situation. Both your excessive daytime sleepiness and your arousal index over 30 suggest that they are missing something in the lab. Either their instruments are not set to measure it, or they are not looking for it. In my study, they called it "respiratory effort-related arousals" (RERAs) They could measure it, but when they were supposed to try to treat my symptoms, they focused on my 1 apnea, and ignored my 148 RERAs.
I don't think a split night study will help, either. You need to find someone who knows the difference between obstructive sleep apnea and UARS. I had to see three doctors. And since UARS doesn't respond as well to CPAP (the only treatment any of my doctors seems to authorize) I am not out of the woods yet.
Thank you! The article describes me to a t. I can't afford the split-night study my doctor wants me to have because of my insurance deductible, but would I benefit at all from just seeing an ENT specialist? Or is it really important that I try the CPAP?