JNK’s sleep studies. Any thoughts?

[jnk]

Greetings, forum!

I just got the results of my two sleep studies from May.

My diagnostic PSG results showed that my sleep was severely disturbed and that my architecture was abnormal. (Not the first time I’ve been described as disturbed or abnormal, I guess. )

My sleep efficiency was 74.5%. (Stage 1, 29.8%; Stage 2, 58.8%; Stage 3, 0%; Stage 4, 0%. REM, 11.4%.) AHI was 114.7; 96 obstructive apneas, 498 mixed apneas, 39 central apneas, and 19 hypopneas. Mean apnea duration was 18.6 seconds; longest was 33.6. Apneas in REM, 69; in NREM, 564. I had 12 spontaneous arousals in NREM but no limb arousals or UARS, though I did have 376 limb movements without arousals. No PLMs.

Awake SaO2 was 95%. Lowest SaO2 was 71%. Out of 7:42:00, my time below 95% was 4:21:00, time below 90% was 2:00:00, and time below 85% was 0:39:15. Heart rate varied between 21 and 166 bpm. Arrhythmias observed.

Then . . .

On my titration night, 16/14cm eliminated most events and all snoring and got my AHI down to 17.9 for the two hours I was at those pressures. My sleep efficiency that night was 67%. (Stage 1, 23.6%; Stage 2, 54.2%; Stage 3, 6.4%; Stage 4, 0%; REM, 15.8%.) [I guess now I can’t rename myself –SWS Jr., huh? ] The tech had trouble defining central and mixed apneas due to poor-to-no respiratory effort signal. This time I had 22 PLMs without arousals. Heart rate still varied between 31 and 160 bpm and I still had arrhythmias. My lowest SaO2 was 81%, but my time below 90% was 0:19:15 and time below 85% was 0:01:19.

Now . . .

For treatment I am using a ResMed VPAP Auto autobilevel set to minimum 10cm, maximum 18cm, with a locked-in 5cm differential. (Only giving it 3cm wiggle room.) The pressure usually sits solid all night right at 15/10, only jumping one cm or less occasionally. My median leak with my nose pillows is 0.0. Median tidal volume is 540. Median minute ventilation is 7.6. Median resp. rate is 14. My AHI for the last few months is 7.4 and my AI is 0.4. My average daily use is 7:11:00. Most of my apneas are only 10 or 11 seconds. The longest I’ve seen is 16.

I welcome any observations, warnings, pats on the back, or thoughts.

Thanks!

[rested gal]

Sounds like your treatment is going extremely well and that you really, really, REALLY needed it.

You definitely deserve a pat on the back for many things...not the least of which is the way you are helping others with your excellent posts on this message board.

[carbonman]

I welcome any observations, warnings, pats on the back, or thoughts.
Thanks!

Big PAT on the back!

We are on the same time line.
We immediately accepted our reality,
made the decision to deal w/it,
acted on that decision,
and now have the numbers and
recovering health to show for those actions.

CONGRATS!!!

All the best to you.....I hope it just keeps getting better and better.

[dsm]

JNK

Fantastic - when I 1st read the study info I thought "heres trouble" but to see the results the resulting therapy is extraordinary.
That was one big mess you started with. The HI numbers are certainly acceptable & I doubt if upping your ipap setting is going to change them much.

Congratulations

DSm

[ozij]

Congratulation, JNK.

PSG
time below 90% was 2:00:00, and time below 85% was 0:39:15

Titration
my time below 90% was 0:19:15 and time below 85% was 0:01:19

That's just wonderful!

O.

[jnk]

@rested gal- Yep. I had no idea how bad off I was until I got my hands on those studies yesterday! Thank you for your kind words about my posts. They are only based on the info and approach I've tried to learn from you and all the other helpful people here.

@carbonman- You've been a big inspiration to me and many others, friend. Also, since I'm stuck here in the big city, I appreciate the bike-ride shots from you, our resident biker-philosopher!

@dsm- I believe that some may think 'here's trouble' every time I post. (I wonder if Snoredog will ever take me off his enemies list? ) I do hope I'm digging out of the mess. You may enjoy this story: I spoke to my primary care doc yesterday, which is when I asked for the paperwork on the studies and gave him a copy of my ResScan report. He said he 'doesn't believe so much in the AHI stuff.' He said what matters to him is how I feel and that my blood pressure, sugar, cholesterol, weight, etc. all normalize. He said that 'only the techs understand the machine info,' then he cautioned me about not getting too 'caught up in the gadgetry.' I immediately thought of you! It's too late. I love this stuff. And the doc will learn. I consider it my job to teach him. He'll get a report every few months whether he wants it or not. Thanks especially for the observation on ipap. That means a lot to me from you. I recently raised the differential one cm from 4 to 5 to get me from 14/10 to 15/10. It brought my HI down a bit. Now occasionally on some nights I get below 5 AHI! On a ResMed! So, yeah, I think I'll leave my settings where they are for now.

@ozij- I just hope my organs appreciate all the O2 they are getting these days! I wonder how much damage has been done, though. I don't worry about the brain damage so much--I have smart friends (like you and many other savvy message-boarders) and a fantastic wife who can do some of my thinking for me. But nobody can pump blood for me, so I am a little worried about the statements in the study mentioning arrhythmia. I'm only 44, so I hope the ticker keeps doing its thing for a while.

Thanks, everyone, on the congrats and observations. The success part of the story is all due to this amazing forum. I owe you folks a lot. So here's a big thanks from a guy who may live a few more years in spite of himself!

Keep up the good work.

jeff

[-SWS]

Congrats, Jeff! That's quite a well-deserved improvement.

I would also comment that as severe as your apnea was before treatment, it can take quite some time for the body to recover and heal from that big mess. I also enjoy your helpful and humorous posts. You can pull information together on-the-fly with the best of them!

[echo]

jnk - WOW! I mean WOW, No really , WOW!! Your pre-xPAP days must have been horrid, those stats are something I wouldn't wish on my worst enemy. But even more fantastic are your results after treatment. Way to go!
You have been a wonderful addition to the family here -- I love reading your posts .. and you have much more intelligent posts than me so that's always a good thing

Are you on any meds for the arrhythmia? Do you have it during the day as well? That sounds pretty scary - I do hope that you will be able to recover from that. The human body is amazing, and with all this extra O2 you're supplying it, I'm sure you'll do great!

As for the geekery -- I vaguely remember a post from a while ago - I thought it was from you when you first got your equipment - about how your sleep doc also said something about "not getting too 'caught up in the gadgetry.' " Isn't that half the fun??!!

carbonman - nice avatar

[OutaSync]

Now that is a success story, for sure. Very impressive. And I'm glad that you are "getting caught up in the gadgetry". If we don't look out for ourselves, who will?

Bev

[kteague]

Jeff,
Wow, those results are sobering, I'm sure. Glad you've seen so much improvement. Has anything been done to follow up on that arrythmia and times of very low pulse rate, like wearing a holter monitor or getting a cardiac workup? If not, while you're getting better, might as well go all the way with it. Congrats on such celebratory progress.
Kathy

[jnk]

@ -SWS--Thanks. Yeah, I sure got me some healin' to do. I've slowed down the parts of my life that I can and stepped up the exercise gradually.

@ echo--There you are! I've missed you, echo! No I'm not on any meds at all. As for the arrhythmia, to my way of thinking, it would be strange for the heart not to be throwing fits while dealing with those stats. I haven't had any heart-disease symptoms and have no family history, so it may be that the arrhythmia stuff isn't that big of a deal. I am a relatively emotional person and have skipped a beat or two now and then during daylight hours when dealing with emotionally stressful situations. But I think thats fairly common. Thanks for the 'WOWs"!

@ Bev--I have a feeling your looking out for yourself is gonna pay off for you in a really big way once your super-machine arrives.

@ Kathy--Yes. Sobering. I have to laugh at myself today at how I reacted yesterday to seeing those sleep studies. I am glad I waited until I could document some good results and my life was fairly stress-free before I asked to see that paperwork. I am so suggestible of a person that I've had chest pains ever since reading the studies! But I know myself well enough to know its just my subconscious messing with me. (My subconcious has always been somewhat of a prankster.) When I spoke to my primary care doc, he said something vague about wanting to give a good listen to my heart. I have a regular appointment with him in a few weeks. Part of the chest-pain thing is that I get sympathy pains, and I visited a friend in the hospital earlier today who had a heart attack a few weeks ago that was truly right out of the blue. He was in great shape, no family history of heart trouble, regular exercise, ate right, and wham! his heart stopped. He was technically dead for several minutes. The paramedics got to him within 5 minutes, so he has a lot to be thankful for. But now he needs triple bypass. Odd. So yeah, I think you're right. I should pursue a workup for peace of mind. I assume the low pulse rate during sleep may have improved with PAP therapy. But my sleep doc wants me to have another sleep study in a few months, so that should tell me something if that happens. Personally, I would like to see if I'm making it into stage 4 at all now too.

[kteague]

Jeff, I know many report arrythmias that improve with cpap treatment, and it makes sense that the heart rate would increase with the stress of apneas, and the pulse slows down during sleep, but a low heart rate of 31 even on the machine just doesn't sound like something to wait and check out in a few weeks or months. I was going to leave it at just suggesting followup, but I would rather speak up and be wrong than be silently right. In my opinion, too much time has already lapsed since those studies indicated a cause for followup. Ok, I'll get out of your business now.
Kathy

[jnk]

Jeff, I know many report arrythmias that improve with cpap treatment, and it makes sense that the heart rate would increase with the stress of apneas, and the pulse slows down during sleep, but a low heart rate of 31 even on the machine just doesn't sound like something to wait and check out in a few weeks or months. I was going to leave it at just suggesting followup, but I would rather speak up and be wrong than be silently right. In my opinion, too much time has already lapsed since those studies indicated a cause for followup. Ok, I'll get out of your business now.
Kathy

You are welcome in my business any time, Kathy. After all, that's why I posted all that.

One thing to factor in is that my resting heart rate is normally around 50 when I'm awake. I am morbidly obese, but I am very active. I've always had a low-rate pulse. It runs in the family. One doctor told me years ago to wake up slowly and sit on the edge of the bed for a few seconds before getting up since my pulse is so slow. Guess he didn't want me passing out and hitting my head or something.

I am still trying to wrap my mind around everything, and I value your observation very much. It's hard to think things through when it involves me--'forest for the trees' and all that. I actually stopped by my primary care doc to pick up a pulse oximeter, but the one he was willing to loan me wasn't a recording one, so I didn't take it. I may order one on my own now. That doc has also made the offer for me to sleep overnight at his general clinic any night I want for one of his overnight nurses to check my pulse and O2 every 15 minutes. Your words are making me consider taking him up on that. Maybe in a few days.

Thanks for speaking up. I'm still trying to figure out what I should be concerned about and what I shouldn't. I would welcome any further thoughts, too.

jeff

[echo]

hi jeff - your doc sounds like a star! A follow-up definintely sounds like a good idea, and the overnight clinic idea sounds super, and definintely get the followup sleep study sooner rather than later.

As for sympathy pains... i wonder how many of us justify away our body's symptoms just because we've lived with them our whole lives and think it's normal? Maybe you think it's just psychological, but in fact when we get nervous or exciting the body can release adrenaline and cortisone - and that will overwork the heart. Same thing as when you have an apnea event. Sounds like your heart is a bit sensitive to begin with (awwww ) so I would look to getting a full cardiac work-up if I were you. A CT or MR angio can make sure that you don't have any blockages and that the heart is pumping efficiently.

glad to be back. I missed you guys too! I had my last exams in august, then some holidays, and then I started working full-time again. I've been pretty exhausted during the week so I haven't been online in a while!

[jnk]

Thank you, echo. I appreciate your comments very much.

Looking at a more detailed bpm chart from my titration put my mind at ease a little. I was only above 80 bpm for about 0.25% of the night and above 70 bpm for about 3.5%. I was below 40 bpm for only 0.01% and below 50 for about 2.5%. So I was between 50 and 70 bpm about 94% of the time. Another version of the heart rate analysis in the same paperwork put my average rate at 64, my slowest at 35, and my fastest at 93. I think I prefer that version of the numbers to the version attempting to give the range of variation.

Nevertheless, considering what it's been through at night for who-knows-how-long, I agree my heart deserves some extra attention.

Thanks again, everyone.