Understanding sleep study results

[oyasumi]

Hi! I've been on this forum a few days and already have learned so much. I was just diagnosed with OSA and am trying to understand the results of my home sleep study. The doctor called after the test to tell me I have moderate OSA (AHI 19) and that my oxygen saturation is not good and dipped down to 78%. I had trouble falling asleep and woke up several times during the night, and when I awoke the monitor was off, but the doctor said that was ok and they had had enough data to make a diagnosis.

The doctor implied that my desaturations were very bad but he was hopeful that with CPAP my cognitive symptoms, paresthesias, vertigo, etc. should begin to improve. After looking at the forum, I'm wondering how bad the O2 levels really are. I also wonder what it means to have equal numbers of obstructive and central events and whether the number of flow limitations is something to be concerned about. I tried improving the resolution on the document but was unsuccessful, so it's very hard for me to even read this. I'm hoping someone more used to reading the graphs might be able to help.

I'm female, 49, have autoimmune problems, fibromyalgia, CDD, GERD (probable LPR), IBS, migraines, anxiety, etc. My rheumy suspects CNS lupus but I'm hoping, like the sleep doc, that CPAP will help. I'm in the process of getting a referral to a neuro.

I hope it's ok to just come on like this and upload my results. I really want to understand what's going on and make my CPAP therapy a success. Before reading this forum I thought I would just slap the mask on and my symptoms would magically disappear!

Thanks in advance!!
Cathy

[mossytreesprite]

Hi, I'm a newbie on here too, but I thought you might benefit from some of the stuff I've learned over the past several months. Firstly, no, 78% O2 is not good, anything below 88% means that pressure is insufficient to allow oxygen to enter red blood cells, so they aren't carrying the O2 around in your circulatory system (causing headaches, inflammation, you name it). It looks like you only had one serious desaturation event, but that seems like enough, in my humble opinion. The O2 desaturation is likely contributing significantly to your headaches. I've had terrible headaches for a long, long time (my take home sleep test O2 dipped to 62%). I also have chronic pain issues and the medication I've taken to control it has caused significant central sleep apnea. What the tech told me at my second sleep test (I've had 3 so far - one take-home and 2 in the lab) is that the take home test may significantly underestimate central apnea events. Are they scheduling you for an in-lab sleep test to titrate the cpap or bi-level? If they aren't, I would push for that rather than just starting cpap without the titration, especially if you may have complex sleep apnea. The last comment I'd like to share is that once you get your sleep apnea under control, you may find a lot of your other symptoms resolve, so lupus may not be something you need to worry about. Lack of adequate sleep along with significant O2 desaturation causes a whole litany of health problems. I've struggled thus far to get my CSA under control, but I have read numerous success stories, so I am truly optimistic.
Good luck!

[palerider]

it's perfectly fine to come on and upload your results, however, the images you posted are so tiny and blurry, I can't read anything useful out of them at all.
sorry.

[bwexler]

Maybe you could request a clear more legible copy of your sleep study, so you and all of us can actually see what it says.
Did you get any indication of what comes next? An in lab study, a visit to a DME or???

[oyasumi]

Mossytreesprite, thank you for your reply. I'm sorry to hear you've been struggling with health issues but your final comments are very encouraging!

My doctor did say that home studies can underestimate the severity of apnea, but he didn't mention central apnea at all. It wasn't until I got the report in my hands that I saw the CA number, but I wasn't sure how to interpret it. I have pretty serious cervical disc degeneration and I noticed in a few places online that cervical spine problems are associated with central sleep apnea. My most serious dizziness, numbness, articulation problems, etc. seem to me to pattern with the severity of my neck problems, but my PCP and rheumy have discounted that. I do have the neuro consult scheduled in about a month but he is not a sleep doctor.

My sleep doctor has not mentioned having any follow-up in lab testing. The DME is coming tomorrow to set up my equipment (a PR System One RemStar Auto 560). I hope they aren't coming with the wrong type of machine.... I have so much to learn!

Thanks again for your help! Hope you continue to have good success in sorting out your own treatment!

Cathy

[oyasumi]

I'm sorry, I didn't see the additional replies. Thanks so much!

I will call the doctor again to try for more legible results. I hoped it might just be my own blurry vision! If you can believe it, these results are more legible than the first ones they gave me, and it took me two emails, two phone calls and a trip to the office to get any help!

DME is coming tomorrow afternoon. I called them to make sure I was getting an APAP with data capability since I had no titration study.

I know my apnea isn't severe but I have a lot of health problems, and early coronary artery disease and stroke run on both sides of my family. It's really important for me to get this right.

You guys are wonderful! I have to go out now but I will call my doctor with these questions.

Thanks!!!
Cathy

[Pugsy]

Welcome to the forum.

At this point the number of centrals don't point to anything unusual. We all have a few of them as they are normal. They are only a problem should they become really numerous or disturb sleep or cause desats.
Cross that bridge if and when you need to.

I also cannot make out much on your reports but I see enough hyponeas and flow limitations/snores and OAs to know that you have enough events to be a problem. The PR S1 model 560 is a good machine and it should serve you well. It's a full efficacy data machine and software is free and easy to use. Check out the links in my signature line. Should centrals become too numerous and present a problem...that machine will flag them and they are easy to spot. Just remember..and occasional central is normal and not a big deal.

[mossytreesprite]

I defer to Pugsy in all things sleep apnea. From what I can tell from your report, it really doesn't look like you are having too many centrals. I haven't figured out how to paste a jpeg into a post yet (I guess I need to learn how to do that), but a report from my night is filled with central markers. I'm happy for you that you are able to get a cpap so quickly - it took 2 months for me to finally get a cpap and now it's going on another 2 months to move on to an ASV (the DME is a month out on appointments). I don't see any reason why a cpap won''t work for you, and I do think it will help resolve many of your health problems. I have severe cervical disc degeneration as well, so I know what a struggle that is to deal with. I'm sure that getting a REAL good night's rest will help us both!

[oyasumi]

I really appreciate everyone's comments. Pugsy, thank you for the explanation of the centrals and the thumbs up on the machine. I feel a little more confident that I'm in good hands with the doctor and DME after all, though of course I will continue to educate myself on here. I have to tell you, I've only been on this forum for a few days but I giggled like a teenager when I saw you'd replied, lol. I had a hard time explaining to my jealous husband exactly what THAT was all about.

Mossy, I feel for you. The neck pain makes it very hard to find a comfortable sleep position and in general seems to lead to all sorts of other problems. Did they say that the CDD has anything to do with your central apnea? I'm also sorry to hear that the DME is so slow to get you what you need. I hope that the new machine turns out to be the right one for you!

I've almost been afraid to go to sleep since the dx, so I'm looking forward to getting the machine tomorrow. Thanks again everyone for making me feel welcome! I hope someday to be able to help others as much as you've already helped me.

Cathy

[Pugsy]

I have the old bad DJD in my cervical spine also. I even have a metal plate holding it together. I have never seen anything relating DJD to centrals. Centrals are more of a brain thing for when it forgets or gets confused and doesn't tell the body to breathe. I doubt you will have anything to worry about.
There is a small percentage of people who do develop an excessive number of centrals as a result of some breathing instability as a response to cpap pressure but it's only 10 to 15 % depending on what you read so the likelihood is small but if that should happen in your case your machine will flag those centrals and appropriate steps can be taken to sort it all out.

Now with the cervical spine, finding a suitable bed pillow to accommodate both the C spine and the mask can be a challenge but pretty much any challenge you may have will have already been met by someone else and there are multiple options available to help figure out a solution.

I use a buckwheat bed pillow myself. It suits my needs which are low profile and good support to keep the C Spine in a nice straight line. I am not very big..small boned and all that with small shoulders so in my preferred side sleeping position a pillow that is too tall sort of puts my head/neck in a bind or out of straight line and it bothers my neck a lot and when my neck gets in a bind I end up with a neck headache....you probably know what I mean. If I was a really big guy with broad shoulders it might not be tall enough but for me it works great. I just move the hulls around a bit to get the perfect support and I move another little spot for the mask to rest and I am set for the night.
Send me a private message if it sounds interesting to you and I will fill you in more.

[Sludge]

If you look near the bottom of Page 1, there is a parameter entitled "Analysis status" with the comment "Analyzed automatically". This means that somebody simply pressed the autoscore button and did not see fit to make a single edit to the machine scoring (if they did it would say "Edited manually"), which is completely inappropriate (although quite expedient) because it looks like a lot of that stuff is SWJ and should have been excluded.

[cathyf]

Another reason I love my medical records lady! When I called her and asked for my results, we arranged that she would leave them in the clinic office in an envelope with my name on it. She called me back an hour later and said that what was in my chart was an illegible copy and that she was having them print out another original and she would call me when it was really there.

[oyasumi]

Sorry not to have been back on to post before now. I got my machine a few days ago and have been getting used to it, downloading SH, etc. I need to update my signature file but they gave me an AirSense 10 and AirFit P10 nasal pillows. I'll have to figure out how to read the SleepyHead data better but I'm not seeing a lot of centrals. Big gaps in the data that I can't figure out yet, though.

Pugsy, I'm sorry you have had such trouble with your neck and I do know what you mean about those headaches! My husband is Japanese and I've lived in Japan so I've also used the soba pillows. I'm glad you found one you like. I remember the first time I went to Japan in winter, sleeping in an unheated room on tatami mats, a thin cotton futon and a soba pillow. I wouldn't be able to walk for a week if I did that now! Recently I've been sleeping with one of those clay-filled heating pads under the back of my neck and it seems to be just big enough to create the right angle for my head (the non-electric kind so no worries about sleeping with it). I tend to want to sleep on my stomach with my head turned, which is the worst for neck problems, but the CPAP is fixing that quickly.

Thanks, Sludge, I didn't notice the report was autoscored. Kind of disappointing! I expected a PSG and a more in-depth explanation of the results, given what I have going on. I did find out that the neurologist I'll be seeing is also a sleep doctor so I suppose I can ask more questions there. I wish the staff at the sleep doc I have now were more on the ball like yours, Cathy! (I'm a Cathy too, by the way.)

Pugsy, I won't worry about centrals for now, as you said. I have seen the connection mentioned a few times though, including on the American Sleep Apnea Association site. It may just be a case of something rare being reported on one reputable site and then lots of other people copying it on their sites. There is a disorder called Chiari malformation which is associated with both obstructive and central apnea. Since I have most of the symptoms it keeps popping up in my searches and that was probably why I was quick to worry about the proportion of OAs and CAs in the initial report.

Anyway, thanks again for all the responses. You're a really great group of people!!