Need help with test results

musicfreak wrote:@Chicagogranny Unfortunately I'm in Canada so I'm not able to use the link but thank you for looking.

You asked about Seattle, and there are a number of labs listed for Seattle.

musicfreak wrote:Does anybody know if there's a sleep lab in Seattle that tests for UARS?

Cheryl,

I would go to an academic sleep clinic for UARS. please search upper airway resistance syndrome within this paper and this was done at UW sleep center. So the UARS knowledge would be there.
http://apnea.cs.washington.edu/apneaapp.pdf

In general, I think any physician working at a good academic sleep center (medical school) should know UARS. RDI is usually calculated based on a PSG study with recording showing the brain arousals.

You are having constant FL with cardiovascular stressful events at probable REM period. Your body weight is normal. I am curious what is your craniofacial characteristics? Do you have a small lower jaw? how is your nasal breathing? any allergy or nasal congestions?

Pugsy wrote:I was just looking the column for normal values that is shown on your report.
where it says % FL normal is less than 60 and the other one is less than 40.
Just is odd at least to me but I don't know what their standards are.

I'm a newbie Pugsy so I find understanding some of the reports hard. What is odd to you about it?

Odd that it takes 60 of those things to be considered not normal.
I guess it would also depend on time frame involved...60 in one hour might be a lot but 60 in 8 hours wouldn't be so bad.
Again..I am not familiar at all with the parameters of this type of home sleep study so I don't know anymore than what it says in front of me.

Pretty much all tests have certain parameters that are established for whatever and however reason that gives these values to base evaluation on.
I have no idea where they came up with 60 as being the cut off line.
As it is you are well below that cut off line so your values are to be considered within acceptable normal variations I guess.

Guest wrote:

musicfreak wrote: What is the difference between RI and RDI?

Calculation of risk indicator (RI)
The risk indicator (RI) is calculated as follows:
RI = point score as a sum of AHI + score of FL/FS
Points calculated from AHI:
AHI x 1 h = number of points (eg, AHI = 5/h x 1 h= 5 points)
where h is the evaluation period
FL/FS point score:
Number of points = 10 x (0.8 x FL + 1.2 x FS) / If
where:
• AHI = apnea-hypopnea index
• FL = number of flow-limited breaths without snoring
• FS = number of flow-limited breaths with snoring
• If = total number of breaths

Thank you Guest. This is a bit hard to understand as I'm a newbie. I tried to look online before and didn't find much about RI but today I found:

RI = number of respiratory arousals /hr
RDI = number of apneas/hypopneas per hour (same as AHI).

Correct me if I'm wrong.

ChicagoGranny wrote:

musicfreak wrote:@Chicagogranny Unfortunately I'm in Canada so I'm not able to use the link but thank you for looking.

You asked about Seattle, and there are a number of labs listed for Seattle.

musicfreak wrote:Does anybody know if there's a sleep lab in Seattle that tests for UARS?

You're correct. I guess I just hoped it would show some Canadian labs as I'd rather get tested in BC, possibly Alberta but most likely I'll have to go to the US. I saw later it's a site for AASM labs so Canadian labs wouldn't be listed anyway. So yes, I'm still interested in a lab in Seattle.

Thanks again.

musculus wrote:Cheryl,

I would go to an academic sleep clinic for UARS. please search upper airway resistance syndrome within this paper and this was done at UW sleep center. So the UARS knowledge would be there.
http://apnea.cs.washington.edu/apneaapp.pdf

In general, I think any physician working at a good academic sleep center (medical school) should know UARS. RDI is usually calculated based on a PSG study with recording showing the brain arousals.

You are having constant FL with cardiovascular stressful events at probable REM period. Your body weight is normal. I am curious what is your craniofacial characteristics? Do you have a small lower jaw? how is your nasal breathing? any allergy or nasal congestions?

Hi Musculus,

Thanks for the link. If it's mentioned there then it gives me confidence they test for it.

"You are having constant FL with cardiovascular stressful events at probable REM period." Thanks for your opinion on my test.

I don't know what people would say my craniofacial characteristics are. But I would say I have a small narrow jaw and I have a long skinny neck. I'm also thin and a woman which is pretty common in UARS. I don't know if my nasal breathing is good. I feel claustrophobic at times. I had a deviated septum on the left side but got it fixed 15 years ago. I do have a lot of post nasal drip (non allergic rhinitis) which is infected and I wouldn't be surprised if that affected my breathing. Have had this at least 20 years! I tried Nazovent to help open the nasal airway but it didn't help and I found it uncomfortable. I think I have post nasal drip because of my stomach acid coming up into the sinuses as talked about in articles by Dr. Steven Park. I also have a bit of reflux. I can't get rid of the post nasal drip no matter how hard I try. I've used the neti pot with everything imaginable. I don't think it will go away until I do CPAP.

I am thinking of getting another Sleep Apnea Level 3 test done at this place http://www.clinicalsleep.com/sleep-apnea-treatment.cfm

It seems to offer more info than my other Sleep Apnea Level 3 test which was an ApneaLink Plus machine by Resmed. I don't think it had Sleep Wake cycle on it or REM/NON REM Sleep Stages. The Resmed which used a finger probe and cannula. This one is an ARES Unicorder where you wear a forehead sensor and a cannula. I would be interested to know what my sleep cycle and REM stages say.

http://watermarkmedical.com/about_ares.php
http://watermarkmedical.com/patient_ins ... corder.pdf

Glad to know I'm not crazy and there is really something wrong with me! Today I feel like I've been run over by a semi truck. So exhausted as I've busy the last few days even though I sleep long hours and cat nap!

Pugsy wrote:Odd that it takes 60 of those things to be considered not normal.
I guess it would also depend on time frame involved...60 in one hour might be a lot but 60 in 8 hours wouldn't be so bad.
Again..I am not familiar at all with the parameters of this type of home sleep study so I don't know anymore than what it says in front of me.

Pretty much all tests have certain parameters that are established for whatever and however reason that gives these values to base evaluation on.
I have no idea where they came up with 60 as being the cut off line.
As it is you are well below that cut off line so your values are to be considered within acceptable normal variations I guess.

Yes, my results showing the percentage of FL and FS seem normal but the results on the other side for FL seem high but I guess I'm wrong. I agree it's hard to know where they get there parameters from.

I need to get a PSG done so I compare those results with you guys but where I am they don't test RERA's. So my respiratory therapists says. He should know but maybe I should call the lab to be sure.

@Musculus
@Pugsy

I have included my respiratory assessment from 2009 at https://sleeptestresults.wordpress.com/ if you want to look at it. It says I have grade 3 hypopharynx and marked descent of larynx.

I weigh 130 lbs now and my BMI 18.2.

I recently did a another oximetry test but the finger probe fell off for a couple hours. The 2009 one shows the heart rate better.

musicfreak wrote:@Musculus
@Pugsy

I have included my respiratory assessment from 2009 at https://sleeptestresults.wordpress.com/ if you want to look at it. It says I have grade 3 hypopharynx and marked descent of larynx.

I weigh 130 lbs now and my BMI 18.2.

I recently did a another oximetry test but the finger probe fell off for a couple hours. The 2009 one shows the heart rate better.

It's a very good quality report! I think I know what is wrong: your airway obstruction/flow limitation site is most likely epiglottis.

Check out this publication and presentation by the first author.

http://www.ncbi.nlm.nih.gov/pubmed/26371602

https://www.youtube.com/watch?v=SK6cfAnCvoY

It's easy to verify. Since your pulse rate increase correlates very well with the snoring pattern. Let your ENT do the laryngoscopy while you try to simulate snoring with Muller's maneuver.
Whichever structure causes the airway collapse or vibration is the site of obstruction in sleep.

Did you ever have a cephalometry done?

Try sleep with prone position as much as possible. xPAP most like won't help in such case.

musculus wrote:

musicfreak wrote:@Musculus
@Pugsy

I have included my respiratory assessment from 2009 at https://sleeptestresults.wordpress.com/ if you want to look at it. It says I have grade 3 hypopharynx and marked descent of larynx.

I weigh 130 lbs now and my BMI 18.2.

I recently did a another oximetry test but the finger probe fell off for a couple hours. The 2009 one shows the heart rate better.

It's a very good quality report! I think I know what is wrong: your airway obstruction/flow limitation site is most likely epiglottis.

Check out this publication and presentation by the first author.

http://www.ncbi.nlm.nih.gov/pubmed/26371602

https://www.youtube.com/watch?v=SK6cfAnCvoY

It's easy to verify. Since your pulse rate increase correlates very well with the snoring pattern. Let your ENT do the laryngoscopy while you try to simulate snoring with Muller's maneuver.
Whichever structure causes the airway collapse or vibration is the site of obstruction in sleep.

Did you ever have a cephalometry done?

Try sleep with prone position as much as possible. xPAP most like won't help in such case.

Thanks for the info. It sounds interesting. I wonder why my respiratory therapist never picked up on it though? I haven't seen an ENT for sleep problems. I will get a referral. I saw one for Post nasal drip which he said was non allergic rhinitis and wanted me to use a neti pot and steriod sprays which I know isn't the answer. I didn't think to mention UARS because it wasn't on my mind because I thought maybe I didn't have it because I didn't respond to CPAP. But then I still couldn't get myself well and found out it was common for people with UARS to have a hard time adjusting to the mask/machine so thought I needed to try it again. When I talked to my respiratory therapist again he said my last oximetry test on the machine was worse than room air so I thought it was the case and he prescribed me Autopap which I haven't tried yet. I originally tried CPAP but I felt like it was choking me and did better on CPAP EPR to make it better for exhaling. That was a lot more comfortable but I didn't feel better.

No I've never had a cephalometry done.

Almost every night I would sleep on my stomach for a period of time (with one leg raised up) but I stopped doing it because I was developing wrinkles on one side of my face! I don't think I could sleep like that most of the night. A lot of times it hurt my back. If the epiglottis is causing the airway problem would that still be the cause of post nasal drip?

I'm busy all day tomorrow so I will look at the info tomorrow night and get back to you then or on Fri.

Thanks again.

musicfreak wrote:

musculus wrote:

musicfreak wrote:@Musculus
@Pugsy

I have included my respiratory assessment from 2009 at https://sleeptestresults.wordpress.com/ if you want to look at it. It says I have grade 3 hypopharynx and marked descent of larynx.

I weigh 130 lbs now and my BMI 18.2.

I recently did a another oximetry test but the finger probe fell off for a couple hours. The 2009 one shows the heart rate better.

It's a very good quality report! I think I know what is wrong: your airway obstruction/flow limitation site is most likely epiglottis.

Check out this publication and presentation by the first author.

http://www.ncbi.nlm.nih.gov/pubmed/26371602

https://www.youtube.com/watch?v=SK6cfAnCvoY

It's easy to verify. Since your pulse rate increase correlates very well with the snoring pattern. Let your ENT do the laryngoscopy while you try to simulate snoring with Muller's maneuver.
Whichever structure causes the airway collapse or vibration is the site of obstruction in sleep.

Did you ever have a cephalometry done?

Try sleep with prone position as much as possible. xPAP most like won't help in such case.

Thanks for the info. It sounds interesting. I wonder why my respiratory therapist never picked up on it though? I haven't seen an ENT for sleep problems. I will get a referral. I saw one for Post nasal drip which he said was non allergic rhinitis and wanted me to use a neti pot and steriod sprays which I know isn't the answer. I didn't think to mention UARS because it wasn't on my mind because I thought maybe I didn't have it because I didn't respond to CPAP. But then I still couldn't get myself well and found out it was common for people with UARS to have a hard time adjusting to the mask/machine so thought I needed to try it again. When I talked to my respiratory therapist again he said my last oximetry test on the machine was worse than room air so I thought it was the case and he prescribed me Autopap which I haven't tried yet. I originally tried CPAP but I felt like it was choking me and did better on CPAP EPR to make it better for exhaling. That was a lot more comfortable but I didn't feel better.

No I've never had a cephalometry done.

Almost every night I would sleep on my stomach for a period of time (with one leg raised up) but I stopped doing it because I was developing wrinkles on one side of my face! I don't think I could sleep like that most of the night. A lot of times it hurt my back. If the epiglottis is causing the airway problem would that still be the cause of post nasal drip?

I'm busy all day tomorrow so I will look at the info tomorrow night and get back to you then or on Fri.

Thanks again.

1. epiglottis is rarely on any sleep ENT physician's radar until very recently. It also depends on the floppiness of epiglottis of the individual. see the following video for the obstruction in action.

https://www.youtube.com/watch?v=G0V9nNobr-I

2. it's not the cause of post nasal drip but it probably causes acid reflux by creating negative pressure down the throat when it collapses.

3. http://www.amazon.com/Amazing-Core-Prod ... R160%2C160_

or

http://www.amazon.com/Pron-Pillo-Prone- ... ad+support

might help with the prone sleep. Yes, you have to make the spine in the natural position otherwise you will soon roll over to other positions...

Hi Musculus

I'm not sure I have epiglottis or not. I'm going to make an appt. to see my Respiratory therapist about my last sleep test (though I know he won't say much about it) and I will ask him about the epiglottis. I don't think he'll say anything about it either. The Glottis on my assessment was fine. I think I will see my family doctor and ask for a referral to an ENT to check the epiglottis.

Do all ENT's do the sleep endoscopy? Otherwise I can suggest laryngoscopy while simulating snoring with Muller's maneuver but that seems hard to do.

I'm not feeling optimistic because when I google ENT's they mostly do sinus or ear surgery and not many deal with Sleep Apnea. I'm going to email the ENT I want to see and tell him I have UARS and see if he will look at the epiglottis and if he does surgery. And if I google sleep doctors I get clinics that just want to sell you CPAP machines or dental appliances. I really want to see Dr. Steven Park in NY or go to Standford. I don't know if they accept Canadians though. I just feel no one here understands my problems. I don't have the money to go anyway but I'm going to start saving.

Thanks for the links for the pillows. I don't think I can sleep on my stomach for long periods of time though.

Do you have to have all these symptoms? http://www.sleepreviewmag.com/2004/05/t ... eep-apnea/
The only one I have is apneas which I had only 2 times on this test and no hypopneas. (My last apnealink test showed 2 apneas and 3 hypopneas). I don't have any of the other symptoms.

I'm frustrated with my family doctor cause I've asked twice for a referral to the sleep lab and she said it takes too long to go through her so she sends me to the respiratory therapist and he won't send me either cause they won't check for UARS. I think I should go anyway just to see if they see something else. Do sleep labs check the epiglottis? I know they check your sleep but I don't know if they examine you inside.

If the epiglottis causes negative pressure which causes reflux then I feel it can cause PND. Dr. Park said in UARS the negative pressure causes the stomach acid to go up which causes reflux and it can cause PND cause the acid can even reach the sinuses cause they've found H Pylori there. But I'm just a newbie so I may be wrong.

I feel down right now cause if my problem is the epiglottis then I'm screwed if I can't find a doctor to help me. At least if I didn't have that problem I could eventually save for a CPAP machine and try and treat UARS myself (if I don't get approved for a trial).

I don't understand why it's taking Sleep Medicine so long to understand/recognize other problems besides Sleep Apnea. I've been sick 31 years! I need a break! I truly would rather have sleep apnea than go through all this crap and I would have been diagnosed and treated YEARS ago!

I just slept 9.5 hrs and I'm exhausted. Argh!

Musicfreak,

1. laryngoscopy while simulating snoring with Muller's maneuver is not hard to do. Can you simulate snoring? you can relax your throat and jaw muscle and breath in.
I think it will be very helpful since your sleep test clearly showed that your snoring and heart rate increase/arousal were related.

2. epiglottis could be the obstruction site. However, nasal congestion can create the negative pressure in the airway that propel the epiglottis to close.
I highly recommend you to try the Afrin test, which is to use Afrin (use nasal rinse before Afrin, wait 10 min and spray Afrin again to make sure Afrin reach as deep as possible) just before sleep to make sure your nasal airway stays open through the night. If that improve your sleep, that means nasal congestion is a factor as well. Nasal airway is the most narrow passage in the upper airway and it is well known that during REM sleep the nasal turbinate will be more congested due to increased blood flow to the brain (see the following paper).

http://www.ncbi.nlm.nih.gov/pubmed/18984253

3. Here is a sleep ENT expert on epiglottis and sleep apnea.

http://www.sleep-doctor.com/blog/the-ep ... eep-apnea/

musculus wrote:Musicfreak,

1. laryngoscopy while simulating snoring with Muller's maneuver is not hard to do. Can you simulate snoring? you can relax your throat and jaw muscle and breath in.
I think it will be very helpful since your sleep test clearly showed that your snoring and heart rate increase/arousal were related.

2. epiglottis could be the obstruction site. However, nasal congestion can create the negative pressure in the airway that propel the epiglottis to close.
I highly recommend you to try the Afrin test, which is to use Afrin (use nasal rinse before Afrin, wait 10 min and spray Afrin again to make sure Afrin reach as deep as possible) just before sleep to make sure your nasal airway stays open through the night. If that improve your sleep, that means nasal congestion is a factor as well. Nasal airway is the most narrow passage in the upper airway and it is well known that during REM sleep the nasal turbinate will be more congested due to increased blood flow to the brain (see the following paper).

http://www.ncbi.nlm.nih.gov/pubmed/18984253

3. Here is a sleep ENT expert on epiglottis and sleep apnea.

http://www.sleep-doctor.com/blog/the-ep ... eep-apnea/

No the laryngoscopy while simulating snoring isn't hard to do, just odd. Despite my tests I really don't think I'm much of a snorer so I think simulating it is odd but that's besides the point!

I will try the spray though we don't have Afin in Canada but I'll see if we have another brand with the same ingredient. I don't think nasal congestion is causing it if you're thinking PND as I first got sick in 1988 with fatigue/pain and I didn't have PND until somewhere between 92-94. I think it's the result of UARS and not caused by something else. I had my deviated septum operated on thinking it was causing PND/congestion but it didn't make a difference. I remember trying nasal sprays many years ago because I always felt stuffed up and probably for the PND but eventually stopped using them because they didn't work and I felt I was using them too much. But I will try this test you suggest.

I was healthy until about age 15 so I feel like as I started to mature into an adult is when UARS started.

I've found a young ENT that was trained in the US and has moved back here. He did his Residency at Stanford University so I'm hoping he knows a lot about UARS? One of his interests is Sleep Apnea. One site says he "is trained to treat various disorders concerning speech, swallowing, upper-airway breathing, balance and hearing, among other functions."

He has written 8 publications. Do you know how I could find them? I googled his name but I can't find anything.

Thanks.