Struggling w/treatment-will you please review my sleep test?

Those of you who are good at reading sleep tests, would you be so kind as to look at mine? It's from a few years ago but my condition remains the same.

I am struggling with treatment and often tired and it's taking its toll on my life. I have been to several doctors but they haven't been all too helpful... I am trying to gain as much insight as I can here. I'm hoping some of you who have struggled with OSA can help. Also doctors have not recommended treatment for PLM however I'm wondering what you think about those numbers as well.

I use a MAD and Autopap. Neither seems to help much. The first few weeks wearing the MAD I felt a lot better and my Resmed S9 indicated near 0 AHI, but a few weeks later and my numbers are back up and I'm very tired. Autopap is a little helpful but not enough. I only am able to tolerate autopap on my back.

Below is a pdf viewable on your browser (you don't have to download it to read it.)

https://www.dropbox.com/s/qjng9iifb687e ... m.pdf?dl=0

EDIT: Here's a Sleepyhead report as well:
https://www.dropbox.com/s/4z0evypw52ece ... y.pdf?dl=0

Here's the summary part of the document. Any comments would be very appreciated:

IMPRESSION: Nocturnal polysomnography (NPSG) was performed by standard laboratory protocol. The sleep latency occurred within 23.0 minutes of the initiation of the recording. The patient experienced 94 arousals, 39 of which were respiratory-related, resulting in a sleep efficiency of 85.0%. This value is below the normal
range and indicates an increased percentage of wakefulness during the recording period. The sleep architecture was normal with a high percentage of stage N1 sleep at 18.6%, a low percentage of stage N2 sleep at 32.0%, and a 27.7% of stage N3 sleep. Rapid-eye-movement (REM) sleep was low at 10.1%. The REM sleep latency was prolonged at 253.0 minutes.

There were 16 apneas and 51 hypopneas, resulting in an apnea/hypopnea index (AHI) of 8.6 events per hour of sleep, which is above the normal range. In addition, there were 14 RERAs, resulting in a respiratory disturbance index (RDI) of 10.8. These data points are consistent with evidence of mild obstructive sleep
apnea. The maximum duration of apneas was 21.7 seconds and the mean duration was 16.3 seconds. Most, if not all, respiratory events terminated in arousal. The baseline SaO2 was 98.0%. The mean saturation across the entire recording period was 96.8% and was 95.2% during respiratory events. The lowest observed saturation was 93.0%. This is consistent with mild hypoxemia during sleep. Snoring was noted to be mild. The majority of the episodes were related to supine position.
There were 63 total limb movements during sleep, 37 of which were periodic limb movements (PLM), resulting in a PLM index of 6.0 per hour of sleep. Of these, 18.9% contributed to arousal. The EKG revealed the presence of normal sinus rhythm.

You apparently have SleepyHead, why not post pix of those results so we can see what's going on now, every night? Do you not use it?

Can you post a copy of the titration study results? I am curious how your limb movements responded to the cpap. Once your cpap treatment is verified to be therapeutic, if your symptoms remain, I'd consider if the limb movements are the issue. It is not unusual for limb movements to worsen once cpap treatment is working well. (The flip side of that is also true.) I wouldn't go down that path until you know your sleep apnea is not the culprit of your symptoms. Not sure if retesting is an option for you. If that does end up happening, I hope your doctor thinks out of the box and does any retesting with a night using your cpap at an already known to be effective pressure. Neither another diagnostic study nor a titration can answer what your legs are doing on a usual night. Hopefully you'll be able to tweak your cpap treatment and things will resolve. If not, we can talk later.

tiredman, welcome to the forum. On the nights when your numbers are higher what is the breakdown of the AHI (obstructive, hypopnea, clear airway/central)? If you don't know how to get this information from your machine, the brief tutorial I have linked to at the bottom of my post will help.

Let us know what your current pressure settings are and if you don't yet have SleepyHead software it would be a good idea to download it and start looking at what's going on during the night. You'll also be able to post some screenshots of your Sleepyhead data for us to look at here which can help us to help you.

Where to download SleepyHead: http://sleepfiles.com/SH/index.html?TestingVersions

I see kteague has spotted your post, that's good.

Julie wrote:You apparently have SleepyHead, why not post pix of those results so we can see what's going on now, every night? Do you not use it?

Thanks for your replies this forum is awesome.

Here's a sleepyhead report. Its from a few months ago because I haven't been using consistently since then, as I thought I had some success with a MAD, although that is now not working for me.

(viewable in browser, download not necessary)
https://www.dropbox.com/s/4z0evypw52ece ... y.pdf?dl=0

kteague wrote:Can you post a copy of the titration study results? I am curious how your limb movements responded to the cpap. Once your cpap treatment is verified to be therapeutic, if your symptoms remain, I'd consider if the limb movements are the issue. It is not unusual for limb movements to worsen once cpap treatment is working well. (The flip side of that is also true.) I wouldn't go down that path until you know your sleep apnea is not the culprit of your symptoms. Not sure if retesting is an option for you. If that does end up happening, I hope your doctor thinks out of the box and does any retesting with a night using your cpap at an already known to be effective pressure. Neither another diagnostic study nor a titration can answer what your legs are doing on a usual night. Hopefully you'll be able to tweak your cpap treatment and things will resolve. If not, we can talk later.

I have not had a titration study. Would it helpful for me to have one even though I am using an autopap?

"The majority of the episodes were related to supine position."

Have you done anything about that, like using something behind you so you don't back sleep? It can make such a difference and for some people, all the difference.

You have an Apap and can self titrate, but need to be a bit scientific about it, like trying a certain set of pressures and sticking to them for a few days at least to see what happens, then try another set, and another, etc. And then see just what occurs.

Julie wrote:"The majority of the episodes were related to supine position."

Have you done anything about that, like using something behind you so you don't back sleep? It can make such a difference and for some people, all the difference.

Without auto pap, I sleep on my left side and don't move around much, but I am still tired in that position. With auto pap, I only sleep on my back as I get aerophagia soon after I put on the mask, even before I fall asleep. I would like to be able to sleep on my side with auto pap to see if that helps but I am very fearful of aerophagia as it was so excruciating last time it happened.

Julie wrote:"The majority of the episodes were related to supine position."

You have an Apap and can self titrate, but need to be a bit scientific about it, like trying a certain set of pressures and sticking to them for a few days at least to see what happens, then try another set, and another, etc. And then see just what occurs.

I have tried different pressures as you mentioned but perhaps I should try again, taking a more scientific approach, keeping a log of how I'm feeling. Also, when I did that last time I did not have the Sleepyhead software so now it might come in handy, being able to look at the data.

Your EPAP pressure is very low. Just for kicks, turn off EPR or set it to 1, and turn off ramp tonight and lets see where you are in the morning. Your max pressure is 10, so this should be easily tolerable. Seriously, give it a shot.

Do you only sleep on one side, because e.g. the left can be very hard for some people, while the right is not... sounds like straws, but it's real for many people.

Sleeprider wrote:Your EPAP pressure is very low. Just for kicks, turn off EPR or set it to 1, and turn off ramp tonight and lets see where you are in the morning. Your max pressure is 10, so this should be easily tolerable. Seriously, give it a shot.

I will try this tonight and report back. Thanks!

Julie wrote:Do you only sleep on one side, because e.g. the left can be very hard for some people, while the right is not... sounds like straws, but it's real for many people.

I have tried my right side with the auto pap and still had the aerophagia.

I hardly ever sleep on my right side otherwise, but I will try it out without the autopap and see how it goes.

I would experiment with a higher minimum pressure as a first step.

There's a youtube video about something to try for aerophagia in my useful links below.

I notice you have a very old version of SleepyHead. You might get the latest testing version, also in my signature line.