Not really diagnosed; does this ResMed data help?

Hi all,

I have the daytime sleepiness symptoms of sleep apnea, including stumbling around exhausted and without functioning memory, but my sleep study results showed only a mild apnea and no other issues besides "non-restorative sleep" (too much time in REM, too little in deep sleep) and delayed sleep phase syndrome. The sleep specialist loaned me a CPAP (auto-pap) to see what would come of it; he did not enter a diagnosis of sleep apnea into my record. I have data from last night. Can anyone give me their impressions -- does this look like sleep apnea? The number of incidents seem few, but significant nonetheless. I don't really know, though.

Thank you!

CPAP Usage
Average Hours per Night 05:01
Compliance 100%

Therapy Efficiacy
AHI 1.59
Obstructive Index 1.20
Hypopnea Index 0.20
Clear Airway Index 0.20

Leak Statistics
Average Leak Rate 1.14
90% Leak Rate 2.40
% of time above Leak Rate threshold 0.00%

Pressure Statistics
Average Pressure 7.80
Min Pressure 5.00
Max Pressure 10.56
90% Pressure 9.64
Average EPAP 5.94
Min EPAP 4.00
Max EPAP 8.56

Date 9/30/15
Sleep Wake Hours
21:36:01 02:37:02 05:01:01
Large Leak 0.00%
Clear Airway 0.20
Unclassified Apnea 0.00
Obstructive 1.20
Hypopnea 0.20

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 7.80 5.00 8.04 9.94 10.56
EPAPExpiratory Pressure (cmH2O)
W-Avg: 5.94 4.00 6.04 7.94 8.56
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 4.18 0.62 4.00 5.62 16.00
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 16.15 2.00 15.80 19.80 42.40
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.01 0.00 0.00 0.07 0.40
Leak RateRate of detected mask leakage (L/min)
W-Avg: 1.14 0.00 1.20 3.60 9.60
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.02 0.12
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.65 0.50 1.60 2.20 15.58
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.11 0.10 2.14 2.52 3.60
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 251.50 120.00 240.00 320.00 1140.00

Total time in apnea 00:02:39
Time over leak redline 0.000%
Machine Settings

ModeCPAP Mode APAP
Pressure MinMinimum Therapy Pressure 5 cmH2O
Pressure MaxMaximum Therapy Pressure 12 cmH2O
EPRResMed Exhale Pressure Relief Full Time
EPR LevelExhale Pressure Relief Level 2cmH2O

Session Information
CPAP Sessions
On 21:36:01
End 02:37:02
Duration 05h 01m 01s

Here are my event stats:
http://imgur.com/0yPdUAq

BabyApnea wrote:Hi all,

I have the daytime sleepiness symptoms of sleep apnea, including stumbling around exhausted and without functioning memory, but my sleep study results showed only a mild apnea and no other issues besides "non-restorative sleep" (too much time in REM, too little in deep sleep) and delayed sleep phase syndrome. The sleep specialist loaned me a CPAP (auto-pap) to see what would come of it; he did not enter a diagnosis of sleep apnea into my record. I have data from last night. Can anyone give me their impressions -- does this look like sleep apnea? The number of incidents seem few, but significant nonetheless. I don't really know, though.

Thank you!

CPAP Usage
Average Hours per Night 05:01
Compliance 100%

Therapy Efficiacy
AHI 1.59
Obstructive Index 1.20
Hypopnea Index 0.20
Clear Airway Index 0.20

Leak Statistics
Average Leak Rate 1.14
90% Leak Rate 2.40
% of time above Leak Rate threshold 0.00%

Pressure Statistics
Average Pressure 7.80
Min Pressure 5.00
Max Pressure 10.56
90% Pressure 9.64
Average EPAP 5.94
Min EPAP 4.00
Max EPAP 8.56

Date 9/30/15
Sleep Wake Hours
21:36:01 02:37:02 05:01:01
Large Leak 0.00%
Clear Airway 0.20
Unclassified Apnea 0.00
Obstructive 1.20
Hypopnea 0.20

Statistics
Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 7.80 5.00 8.04 9.94 10.56
EPAPExpiratory Pressure (cmH2O)
W-Avg: 5.94 4.00 6.04 7.94 8.56
Minute Vent.Amount of air displaced per minute (L/min)
W-Avg: 4.18 0.62 4.00 5.62 16.00
Resp. RateRate of breaths per minute (Breaths/min)
W-Avg: 16.15 2.00 15.80 19.80 42.40
Flow Limit.Graph showing severity of flow limitations (Severity (0-1))
W-Avg: 0.01 0.00 0.00 0.07 0.40
Leak RateRate of detected mask leakage (L/min)
W-Avg: 1.14 0.00 1.20 3.60 9.60
SnoreGraph displaying snore volume (?)
W-Avg: 0.00 0.00 0.00 0.02 0.12
Insp. TimeTime taken to breathe in (Seconds)
W-Avg: 1.65 0.50 1.60 2.20 15.58
Exp. TimeTime taken to breathe out (Seconds)
W-Avg: 2.11 0.10 2.14 2.52 3.60
Tidal VolumeAmount of air displaced per breath (ml)
W-Avg: 251.50 120.00 240.00 320.00 1140.00

Total time in apnea 00:02:39
Time over leak redline 0.000%
Machine Settings

ModeCPAP Mode APAP
Pressure MinMinimum Therapy Pressure 5 cmH2O
Pressure MaxMaximum Therapy Pressure 12 cmH2O
EPRResMed Exhale Pressure Relief Full Time
EPR LevelExhale Pressure Relief Level 2cmH2O

Session Information
CPAP Sessions
On 21:36:01
End 02:37:02
Duration 05h 01m 01s

Here are my event stats:
http://imgur.com/0yPdUAq

If the sleep study showed mild apnea, that means your untreated events were between 5 and 15 per hour. With the CPAP your events have droped to 1.5 per hour. Basically, you have sleep apnea. All the figures you are showing here are "treated with CPAP".

LSAT wrote: If the sleep study showed mild apnea, that means your untreated events were between 5 and 15 per hour. With the CPAP your events have droped to 1.5 per hour. Basically, you have sleep apnea. All the figures you are showing here are "treated with CPAP".

Okay, thank you. The first sleep specialist I had an appointment with was a sleep psychologist, not a doctor, so he didn't even see the polysomnography results as pointing to mild apnea. I thought his focus on sleep hygiene was bull, so I looked up numbers and terms myself and then went to a physician with a sleep disorder specialty to review with him. Yet because I am thin and do not snore, he was reluctant to diagnose me, despite the fact that I'd wake up literally jumping out of bed choking. My argument that I have Ehlers Danlos Syndrome, which would account for lax throat muscles, was what finally convinced him to loan me the CPAP.

So my question now is: given this is only mild, why am I so dang tired and nonfunctional most days? Could it be that I have this combined with sleep phase disorder and also other parasomnias, like somniloquy? Do you think that might be the case? My exhaustion just seems out of proportion to the actual data.

BabyApnea wrote:my sleep study results showed only a mild apnea

Only a mild apnea?

By definition of the medical field, the lower limit of "mild" is an average (AHI) of five breathing events per hour.

Think about sleeping 7 hours nightly and having five events per hour. This is 35 times per night that you struggle with breathing, are awakened and then fall back to sleep. What if someone choked you and woke you 35 times each night? Does that sound "mild"? Under those conditions, do you think you could lead a healthy and energetic life?

BabyApnea wrote:Yet because I am thin

Don't fall for the old myth that obesity is the cause of sleep apnea. This forum is loaded with thin people who have sleep apnea. "It's not the size of the neck on the outside, it's the size of the airway in the neck." - Dr. Mack Jones

Shame on your psychologist for thinking thin people don't have obstructive sleep apnea.

Go to the mirror, count your teeth and let me know how many you have. Are they straight? Are they crooked? Are they overcrowded? Have you every had braces? Have you had any permanent teeth removed?

My sleep study showed an AHI > 80. If I have a treated AHI < 3, I get excited! I'll never understand the people that think they are dying with AHI < 1. If you think sleep hygiene is bull, you will never have a good night's sleep, and you will be tired. Good sleep hygiene kept me functional for decades before my sleep apnea finally caught up with me. If you are consuming caffeine at all hours, and not getting a full 8 hours every night, you will still be tired. If I stayed up after midnight every night and still woke up at 5 AM, I'd be tired and dragging my tail too. Reducing your AHI does not mean you can go with less sleep.

As my grandfather said, "The secret to a good life is three-fold: Eat good, sleep good, poop good."

If you ain't sleepin' good, your life is gonna suck. It's just like skipping oil changes in your car, do it enough times and you'll be in trouble. What ever time you get up every day, be in bed at least 8 hours before that, and stop the caffeine and alcohol 4 hours before bedtime. CPAP is useless without good sleep hygiene.

You said it, Chicago Granny. I am thin and I don't snore. I have some type of sleep apnea. My symptoms were misdiagnosed most of my life as hypochondria, allergy rhinitis, stomach trouble, gastric reflux, asthma, you name it. None of which proved to be the case. Doctors hated to see me coming because they could not figure what was wrong with me. I am so happy to finally have this figured out.

BabyApnea wrote:Hi all,

I have the daytime sleepiness symptoms of sleep apnea, including stumbling around exhausted and without functioning memory, but my sleep study results showed only a mild apnea and no other issues besides "non-restorative sleep" (too much time in REM, too little in deep sleep) and delayed sleep phase syndrome. The sleep specialist loaned me a CPAP (auto-pap) to see what would come of it; he did not enter a diagnosis of sleep apnea into my record. I have data from last night. Can anyone give me their impressions -- does this look like sleep apnea? The number of incidents seem few, but significant nonetheless. I don't really know, though.

Baby Apnea,

I am assuming this is a ResMed machine, which one is it?

I did not see Respiratory Effort Related Arousals (RERA) listed so maybe the machine does not measure them. They may be "just arousals" but that does not mean they do not disturb your sleep.



Did you do a detailed sleep study with (electrodes on head, heart strap leg electrodes, Oximeter on figure etc), or is this one night on the APAP your study? It sounds you are describing the sleep study.

Can you get the results of the sleep study with the graphs very helpful. Things to look for:

Are you going abruptly from one state to another and back again as in an arousal, waking up or maybe an apnea event.

How low did your Oxygen get.

To know if these results are an improvement, you need to know how you did without the machine on, this can be done by looking at the sleep study. Another way, which I am not advocating in any way is to use the machine at the lowest setting for the mask and see how many events are recorded with the machine. Not by switching to CPAP mode but by setting the high and low pressures to the same number.

With graph of the APAP results you can see how the pressure went up with the events.


The term Sleep apnea is general. Unfortunately many professionals including doctors only consider the Obstructive Sleep Apnea (OSA) which lowers saturated oxygen levers (SO2). Just because the OSA is mild does not mean you are not having other events that are disturbing your sleep. Then again there may be a combination of things not seen on the machine that can also add to the bad sleep.

Usually once you get the sleep study done, you then get titrated on an APAP machine for a week (hopefully.) This will show how much the different events were eliminated that were seen during the sleep study.

ChicagoGranny wrote:

BabyApnea wrote:Yet because I am thin

Don't fall for the old myth that obesity is the cause of sleep apnea. This forum is loaded with thin people who have sleep apnea. "It's not the size of the neck on the outside, it's the size of the airway in the neck." - Dr. Mack Jones

Shame on your psychologist for thinking thin people don't have obstructive sleep apnea.

Go to the mirror, count your teeth and let me know how many you have. Are they straight? Are they crooked? Are they overcrowded? Have you every had braces? Have you had any permanent teeth removed?

Thank you for this. That person wasn't my psychologist, just some guy that the sleep clinic calls a sleep specialist but has zero knowledge of medical sleep issues. His -- the psychologist's -- response characterizes my general experience with the medical field. I have all my teeth but the wisdom teeth; when I was young they were perfectly straight, no crowding, but shifted as I aged and are now crowded. This is inline with what happens to the mouth with Ehlers Danlos Syndrome; tooth crowding, fragile gums, TMJ dysfunction (which I also have, so I'm wearing a splint and a mask at night), etc. I sought a second opinion with the physician also on staff at that sleep clinic because I had been reading that EDS is correlated with sleep apnea, which makes sense, since EDS is caused by a defect in collagen throughout the body, leading to problems in every system, from gastroparesis to joint pain and nerve pain to dysautonomia and on and on. Lax ligaments would probably account for why I have sleep apnea (there's now a clinical trial underway to investigate obstructive sleep apnea in EDS patients). I knew, because I kept waking up choking, sleep apnea had to account for part of my sleep problems, though I know it doesn't account for all of them.

Thanks again. Much appreciated. It helps to hear (read) words of support and understanding.

Captain Neon wrote:My sleep study showed an AHI > 80. If I have a treated AHI < 3, I get excited! I'll never understand the people that think they are dying with AHI < 1.

I don't really understand this. Are you saying that because my AHI is less than yours, I shouldn't feel as I do or experience what I experience -- being unable to remember how to turn off my turn signal in my car or remember something as automatic as whether I write the tip at a restaurant before or after I give my credit card, and panicking, as I imagine a person with early-stage dementia would, because I just can't figure it out? If this is your intent, to play who-has-it-worse gymnastics, get back to me when you are also exhausted because for most of your life, you've been dealing with the mysterious, body-wide problems that accompany Ehlers Danlos Syndrome and Mast Cell Disorder, and because you don't just have sleep apnea, but also parasomnias, delayed sleep phase disorder, and in general, a hodgepodge of sleep issues that mean a simple tool like CPAP isn't going to fix them all.

Captain Neon wrote:If you think sleep hygiene is bull, you will never have a good night's sleep, and you will be tired. Good sleep hygiene kept me functional for decades before my sleep apnea finally caught up with me. If you are consuming caffeine at all hours, and not getting a full 8 hours every night, you will still be tired. If I stayed up after midnight every night and still woke up at 5 AM, I'd be tired and dragging my tail too. Reducing your AHI does not mean you can go with less sleep.

You are misreading. It was bull for him to suggest I needed a lesson in sleep hygiene because, by necessity, I became my own expert in the ins and outs of sleep hygiene. Sleep hygiene wasn't my problem. Sleep apnea and other issues were.

I'm not really sure why you assume that the hours I spent with the mask on equate to the hours I actually spent in bed sleeping or trying to sleep. I am in bed 12 hours a night.

Captain Neon wrote:What ever time you get up every day, be in bed at least 8 hours before that, and stop the caffeine and alcohol 4 hours before bedtime. CPAP is useless without good sleep hygiene.

Wow, a heck of a lot of assumptions. I'm actually in bed 12 hours a night, thank you very much, do not drink, and don't drink caffeine after noon.

KeepSmiling wrote:

BabyApnea wrote:Hi all,

I have the daytime sleepiness symptoms of sleep apnea, including stumbling around exhausted and without functioning memory, but my sleep study results showed only a mild apnea and no other issues besides "non-restorative sleep" (too much time in REM, too little in deep sleep) and delayed sleep phase syndrome. The sleep specialist loaned me a CPAP (auto-pap) to see what would come of it; he did not enter a diagnosis of sleep apnea into my record. I have data from last night. Can anyone give me their impressions -- does this look like sleep apnea? The number of incidents seem few, but significant nonetheless. I don't really know, though.

Baby Apnea,

I am assuming this is a ResMed machine, which one is it?

I did not see Respiratory Effort Related Arousals (RERA) listed so maybe the machine does not measure them. They may be "just arousals" but that does not mean they do not disturb your sleep.



Did you do a detailed sleep study with (electrodes on head, heart strap leg electrodes, Oximeter on figure etc), or is this one night on the APAP your study? It sounds you are describing the sleep study.

Can you get the results of the sleep study with the graphs very helpful. Things to look for:

Are you going abruptly from one state to another and back again as in an arousal, waking up or maybe an apnea event.

How low did your Oxygen get.

To know if these results are an improvement, you need to know how you did without the machine on, this can be done by looking at the sleep study. Another way, which I am not advocating in any way is to use the machine at the lowest setting for the mask and see how many events are recorded with the machine. Not by switching to CPAP mode but by setting the high and low pressures to the same number.

With graph of the APAP results you can see how the pressure went up with the events.


The term Sleep apnea is general. Unfortunately many professionals including doctors only consider the Obstructive Sleep Apnea (OSA) which lowers saturated oxygen levers (SO2). Just because the OSA is mild does not mean you are not having other events that are disturbing your sleep. Then again there may be a combination of things not seen on the machine that can also add to the bad sleep.

Usually once you get the sleep study done, you then get titrated on an APAP machine for a week (hopefully.) This will show how much the different events were eliminated that were seen during the sleep study.

Hi Keep Smiling,

Thank you for your response. I did have a sleep study -- I will try to post it tomorrow. It did show mild apnea. This is an APAP machine that they loaned me to try to get more data. There aren't any RERAs or oximeter numbers available in the report I pulled up in the Sleepyhead software. I'm not sure the model of the Resmed? I do know that after the spate of OSA events in the middle of the night, probably right after, I started talking in my sleep, which is why the session ended -- I pulled off the mask because my mouth movements was pushing back the air and I panicked. I do remember the sleep studying noting a number of non-apnea arousals in addition to the apnea-related ones. I have parasomnias that include not just the sleep-talking, but also REM behaviors like kicking and punching. I do not think those were captured by the sleep study, nor the sleep talking, as I don't exhibit the same issues every night. I definitely go abruptly from one state to the other. I think my issues are a hodgepodge, which is unfortunate. I spend 12 hours a night in bed sleeping and sleeping, but quite inefficiently. I wake up every morning exhausted. I have tried sleep aids like Trazodone, but because of my other disorders I cannot tolerate medicine very well and end up in worse shape -- hungover for hours and hours the next day.

Thank you for the response. I'll try to get more data posted. I appreciate it!

We are all different. I felt horrible when my AHI was only 13.
Each apnea interrupted my sleep, leaving me desperate for rest.
The number of events is only PART of the equation.
Length of each one is important too, as that determines how bad the effect.
Sleep hygiene may sound like BS, but it can also be a useful tool.
It is just too bad it is often treated as a cure-all, and too frequently as another way to blame the PATIENT.

chunkyfrog wrote:We are all different. I felt horrible when my AHI was only 13.
Each apnea interrupted my sleep, leaving me desperate for rest.
The number of events is only PART of the equation.
Length of each one is important too, as that determines how bad the effect.
Sleep hygiene may sound like BS, but it can also be a useful tool.
It is just too bad it is often treated as a cure-all, and too frequently as another way to blame the PATIENT.

To clarify, sleep hygiene itself isn't bull to me, but the suggestion that I didn't know what constitutes sleep hygiene, when I've been dealing with sleep problems for years and years and so of course learned what good sleep hygiene was -- and practiced it -- was bull.

You got it: blaming the patient. As someone with rare disorders, I've experienced that all my life.

I'm interested to see what the data shows me tonight! I'm going to try to put the mask back on if I tear it off. Unfortunately, it's not just talking in my sleep that makes it hard, but my super, super sensitive skin, which gets inflamed and itchy and burning easily, especially when the silicon leads to beads of sweat. Ugh.

If OSA is your only or at least primary culprit, things should settle down. Yes, other things may be at play, but treating the known factors is your best bet for getting a clearer picture. Just wondering if the REM related stuff will resolve with healthy sleep. One question - Exactly how much was that "too much time in REM"? A journal to accompany your nightly reports might be helpful, noting things like daytime symptoms and any of the nighttime abnormalities you mentioned. Sounds like you're off to a good start using the machine and gaining an understanding of what's going on with you. Hang in there.

Captain Neon wrote:My sleep study showed an AHI > 80. If I have a treated AHI < 3, I get excited! I'll never understand the people that think they are dying with AHI < 1.

The OP did not have an ahi of less than one, and was actually diagnosed as mild which is 5-15. So, no idea why you are complaining about people with less than 1.

That said, an ahi of 3 is not the same for each person. It really depends on how long the events are, and if they are clustered together. My mom was not doing well at an ahi of 3.4, but when i looked at the graphs, I could see a cluster of events, all over 30 seconds, and one over a minute long. By the numbers, that is mild. But when you consider the oxygen deprivation that goes with a minuted long event, and 7 other 30 second or longer events, all in less than 10 seconds, and there is a serious problem.

The OP has an untreated ahi between 5 and 15. We have not seen oxygen saturation levels. We have no idea how long the events are, or if they are clustered. Some people have "mild" sleep apnea and have a lot of symptoms. Some people have high untreated ahi numbers, but not always as many symptoms. Having more events, often means that they are shorter events. I have a 79+ ahi. I did not make it to REM sleep in my diagnosis phase. Most of my events were in the 10-15 second range. Nothing long. My oxygen rarely went below 86%. I ignored my sleep apnea for 20 years because I blamed the symptoms on other things.

If you think sleep hygiene is bull, you will never have a good night's sleep, and you will be tired. Good sleep hygiene kept me functional for decades before my sleep apnea finally caught up with me. If you are consuming caffeine at all hours, and not getting a full 8 hours every night, you will still be tired. If I stayed up after midnight every night and still woke up at 5 AM, I'd be tired and dragging my tail too. Reducing your AHI does not mean you can go with less sleep.

Guess what! The ideal sleep hygiene is not the same for everybody. I also have a delayed sleep phase syndrome. If I followed the official sleep hygiene rules, I would sleep like crap. I had to learn what worked for ME. Going to bed at the same time every night does NOT work for me. I need to wait until my body is ready to sleep. Otherwise, I toss and turn, and I end up sleeping worse than if I had just waited until I was ready. While I do try to get enough sleep, I have learned the quality is a little more important that quantity. Just like with sleep apnea. 6 hours with cpap is way better than 8 hours, 10 hours, etc without cpap.

I also have 2 very different time schedules. I am a severe night owl with an afternoon/evening job that works for me. But I also have a small business/hobby that requires early mornings 1-2 weekends a month. So, I have to alter my sleep schedule completely for that weekend, and then I have a crash & burn day to reset to my internal clock.

Also, 8 hours at one time is not the same as 8 hours at another time. Several years ago, my boss moved from my preferred closing shift to the mid shift. I was getting 8 hours of sleep per night, but I felt like a zombie. I would get home from work and veg in front of the tv. I felt like crap. After 2 months, my boss moved me back to the closing shift. After the first day, I felt good again., I was in my zone again.

What ever time you get up every day, be in bed at least 8 hours before that, and stop the caffeine and alcohol 4 hours before bedtime. CPAP is useless without good sleep hygiene.

For some of us, this simply can't happen every day. We do the best we can. During my work week, I can usually get 8 hours per night. I don't have to get up until 12:30pm for work, so I need to get to bed by 4:30am. Usually doable. But my cat show weekends. I am thrilled to get 7 hours, happy to get 6. It is extremely hard for a severe night owl to go to bed 8 hours before 6am. That's 10pm. For me, going to bed at 1am is really early and about the best I can do. Anything earlier, and I will toss and turn, get upset, and not sleep. But, if I get 6 or 7 hours STRAIGHT with cpap, I feel totally awesome and full of energy.

Keep in mind that people are different. Those of us with DSPS have some different issues to deal with. And to me, the worst problem with DSPS is having family, friends, and doctors that don't have a clue what it is like to try to sleep 6 hours before your internal clock is ready. We can't just pretend we want to sleep at a better time. There are multiple systems in our bodies, and they all work together. Temperature cycles, digestive cycles, hormones, etc. Moving one does not automatically move the others. When i get up really early, I freeze so bad that my teeth chatter, even if it is 70 or 80 degrees. It takes about half an hour for my temperature to come back to normal.