Sleep Study Results

Hello, I was recently on the ramp up to tackle my sleep issues. I went on to do a sleep study and it seems results point to
okayish respiration. However, I am not sure and hopefully someone knowledgeable can give their input. I provide images of the report.

One of the issues that stood out of abnormal REM sleep. It is 5% of total sleep when it should be 20-25%. Any registered PSGs who can
shed some light on it? Is it UARS maybe? But then RERAs would be plentiful and there are none.

imgur (dot) com/a/cwpkO

Fixed a link for you to make it easy for the others to look and offer their thoughts.
http://imgur.com/a/cwpkO
I don't think that anyone here now is an official sleep tech. We used to have one but he left.

You didn't get much REM..wonder why.
Your sleep efficiency is also in the toilet and wonder why.
REM latency is deep in the toilet...and again wonder why
Spontaneous arousals are high...wonder why and this one is extra hard to get any idea as to why.

Points to crappy sleep for sure but you already knew that.

What type of study was this report from....at home or in a lab?

Couple of questions for you.

Do you take any medications and if so what are they?
Do you have insomnia issues...either trouble falling asleep (and the sleep onset number points to that for sure) and/or trouble with waking often once you do fall asleep which is called sleep maintenance insomnia?
What are your main complaints/symptoms?

Have you read this? Explains what a lot of what you see means.

http://adventures-in-hosehead-land.blog ... -test.html

abben123 wrote:Hello, I was recently on the ramp up to tackle my sleep issues. I went on to do a sleep study and it seems results point to
okayish respiration. However, I am not sure and hopefully someone knowledgeable can give their input. I provide images of the report.

One of the issues that stood out of abnormal REM sleep. It is 5% of total sleep when it should be 20-25%. Any registered PSGs who can
shed some light on it? Is it UARS maybe? But then RERAs would be plentiful and there are none.

imgur (dot) com/a/cwpkO

How about overall arousal #? including spontaneous arousal. The algorithm to indentify RERAs are not perfect.

musculus wrote:How about overall arousal #? including spontaneous arousal.

It's shown at the link. Easy to see. Spontaneous arousal numbers are elevated.
I can't get the image to load at the moment...slow internet.

You didn't get much REM..wonder why. I will consult the psychiatrist who interpreted the study about that. A sleep tech I know has no clue why as well.
Your sleep efficiency is also in the toilet and wonder why. It is false. I was plugged to the machine around 19:30 and did not go to sleep until 22:30 or something like that. I was browsing Reddit for 3 hours. The tech left soon after switching the thing on at 19:30. I wasn't in the bed immediately trying to fall asleep.
REM latency is deep in the toilet...and again wonder why This one is flabbergasting. The same sleep tech I asked about said that it is completely abnormal to see how my REM works and I need to see specialists for that. He did not think it is breathing issues.
Spontaneous arousals are high...wonder why and this one is extra hard to get any idea as to why. He has no idea. It is not leg movements, there are few. It could be either breathing difficulties not recorded well or something more sinister.

What type of study was this report from....at home or in a lab? This is in sleep center.

Couple of questions for you.

Do you take any medications and if so what are they? I don't. Sleep tech asked me about anti-depressants. My doctor gave me one because I feel depressed and anxious but I never starter the course, so no meds.

Do you have insomnia issues...either trouble falling asleep (and the sleep onset number points to that for sure) and/or trouble with waking often once you do fall asleep which is called sleep maintenance insomnia? Again, this is an issue with switching on the thing well before I intended to sleep. Note, I put away the phone around 22:00 so, I fell asleep fast according to the graph.
What are your main complaints/symptoms? No problem falling asleep. Wake up after 4-5 hours ALWAYS. Then, stay in some shitty state of half-awake, tossing and turning until it is time to get up. Feel never rested. Would never fall asleep anywhere like heavy apnea people just feel in brain fog, my memory is worsening (imho) and I did not have dreams since idk when (lack of REM explains that, also, REM solidifies memories and I struggle to recall things).

Okay...we disregard the sleep latency numbers as they are misleading.

No meds to mess with sleep architecture or to cause sleep maintenance insomnia...which you do seem to have since you can't easily fall back asleep once you do wake up. Would have been nice to blame meds..makes things easier.

Spontaneous arousals (means you wake up and you may or may not be remembering all the arousals) number are elevated.
I suspect you have more of them than you realize prior to the 4 or 5 hour period where you come to a fully awake state. We don't always remember arousals but they still mess with sleep quality.
They do mess with the normal progression of the normal sleep stages. Sometimes bouncing you out of the stage you were in so that you have to start all over in the sleep stage progression department. This could account for the lack of sufficient REM...you keep getting bounced out before you make it to REM.

Now there is one thing...for some people REM stage is where their OSA is much worse. It wouldn't be impossible for the low AHI numbers to be low because someone simply isn't getting much REM if their OSA is worse in REM.
I have this myself. In non REM the AHI is about 12...but in REM it is over 50. Initially pre cpap tx I wasn't getting much REM because the apnea events kept causing me to wake up or have an arousal.
You may or may not be like me.

It is normal for people to wake after a REM stage completion..most of the time we don't remember it but sometimes we do and we have trouble getting back to sleep (that sleep maintenance insomnia thing again). Since your issues seem to be worse after 4 or 5 hours of sleep...that might be what is happening with you...REM typically starts about 90 minutes after the first sleep onset and as the night goes on it comes more frequently and lasts longer....with the greatest chunks of REM happening in those wee hours of the morning which ends up being 4 or 5 hours after sleep onset.

A sleep lab setting isn't necessarily the greatest of settings to measure sleep quality. Let's face it...sleeping with all those wires in a foreign setting doesn't promote good sleep anyway. We tend to wake more easily and more often from the least little thing.

It wouldn't be impossible for your issues to be related to UARS but as you know that's a difficult diagnosis to make unless one does the sleep study with the PES device that actually can measure the airway directly. Most of the time UARS is a rule out diagnosis...rule out everything else and it might be UARS. Most sleep labs don't do the PES device sleep study.

The spontaneous arousals you have....point to crappy sleep but unfortunately we can't blame them on something specific.
It would be easier if we could but we can't.

Do you happen to have any other health issues that might impact sleep quality?
I have some arthritis pain issues that cause me to have an increase in spontaneous arousals. Pain wakes me up.

I don't know what can be done about the lack of REM...the body pretty much needs the normal progression of the various sleep stages and % of time in each one for the restorative powers of sleep to work.
Insomnia after 4 or 5 hours is definitely going to mess with the restorative powers...fixing it is hard because one first has to try to figure out what is causing it and sometimes there is no known cause.

It doesn't appear (at least from this sleep study results) that you make criteria for OSA diagnosis. OSA is just one in a long list of Sleep Disordered Breathing issues though. Would you maybe have met criteria if you had got more REM and you are like me with REM dependent OSA...maybe. Could this still be UARS....maybe.

Where are you located? Are you willing to try cpap/apap in an effort to see if it helps or not?
CPAP can't fix bad sleep if the bad sleep is caused by something that the machine simply can't address. It can help hold the airway open but if the arousals and subsequent insomnia isn't airway related...it's not going to fix it.
Just like it can't fix my arousals from pain...sure wish it could but it can't.

Right, but my AHI is 2.3/hour not 12. It means they are very infrequent and are considered normal.
All events are in non-REM sleep. No events in REM (less than 30 mins of that) but could easily be coincidence of
being lucky without events in that short time.

I do have health issues which might be related. I went to, mhm, non-traditional doctor. She has her ways of diagnosing,
worked 25 years as a cardiologist before that. She said my nervous system is at 4/5 in tension and I need to relax. She told me start with
drinking hops tea, eat lecithin for brains, replenish nutrients with stuff like spirulina and so on. I mentioned
my concerns of sleep apnea and she suggested to do sleep study. I sent her the data today so hopefully she has time to check that out.
I was also diagnosed with gut dysbiosis (my digestion is very poor).
I also tested positive multiple times for H Pylori. My mother also had it and took meds. She claims her sleep greatly improved but
antibiotics fucked up her stomach so she now needs to undo damage from that...she claims to snore a 90% less as well now.

I have a very sensitive nervous system, I overreact to many things and am high in neuroticism, but it could easily be the consequence of
crappy sleep. I do believe that I am clinically depressed but I refused to take medicines. It made no sense because I cannot sleep and that causes
people to be moody and energetically low.

I did the study in Eastern Europe. I move to UK in the near future. All rentals require a doctor prescription so idk what to do about that....

abben12 wrote:I did the study in Eastern Europe. I move to UK in the near future. All rentals require a doctor prescription so idk what to do about that....

That part is an easy fix should you ever want to go down that road. There are ways of getting machines that bypass the RX thing. You have to be willing to buy the machine though and I have no idea how the rental fees might compare with purchase cost. Rentals are not common here in the US but if it was $100 a week...we can get you in a good machine for about $400 to 500 depending on brand and new vs used...4 months rental if the rental was 100 a week.

I don't know that your symptoms/sleep would be helped with cpap/apap/whatever pap. Based on the data/information so far...doubtful but you never know.

Lots of people have sleep maintenance insomnia for any number of reasons. They hope cpap will fix it and end up disappointed when it doesn't and think cpap failed when in fact they had unrealistic expectations in the first place. These machines can only fix insomnia issues when the insomnia issue is directly related to sleep apnea or airway collapsing in some manner.

And yes, I understand your REM AHI was essentially 0 but I had to mention the possibility because it is out there and your REM time was so short. I doubt that you are like me with the REM dependent thing...but it wouldn't be totally impossible...but I admit a very slim possibility.
Now why your REM time is so low....that's going to take a lot of detective work and you may not be able to figure out why.

I found comments online where a person states having below threshold AHI, very high spontaneous arousals
and the start of using drugs to manage reflux. Her symptoms improved and sleep became better. Sleep was also
highly fragmented.

However, I am honestly disappointed with sleep apnea research so far. It seems like you need to be starving for oxygen
for X amount of time before it is registered. It is stupid imho. If you stop regular breathing, then you are bound to have
all kinds of signals waking you up.

Finally, I forgot to mention. I have a confirmed deviated septum, my jaw is a bit recessed and this is actually what led me
to investigate OSA possibility.

abben12 wrote:It seems like you need to be starving for oxygen
for X amount of time before it is registered. It is stupid imho. If you stop regular breathing, then you are bound to have
all kinds of signals waking you up.

I hear your frustration.

Here in the US there is an alternative standard for diagnosis criteria that doesn't include so much of the oxygen level stuff but does include the arousal stuff. I forget the official name and standards at the moment. You might not still make that criteria since your arousals don't seem to be respiratory related. They use RDI instead of AHI and some other slightly different criteria.

Plus there's always the line in the sand for event duration that cloud things.
To earn an apnea flag certain criteria have to be met and one of the criteria is duration...it needs to last at least 10 seconds...what happens to the people who would otherwise meet the other criteria (reduction in air flow) but their events only last 9 seconds? In terms of effect on the body those 9 second (or less) people are treated like nothing happened but in reality they missed a flag by one second. I can't believe that the body isn't going to react in some fashion to a 9 second event. The body is still going to be impacted by 9 seconds and probably just as much as 10 seconds.

But the medical community had to come up with some sort of line in the sand and that's what they came up with. Gotta be one somewhere though.

abben123 wrote:

How are your sleep hygiene, diet, exercise, caffeine usage (including hidden sources like chocolate) ... ?

Unfortunately during one night in the lab all our issues might not manifest. Would a repeat study with a one-time prescribed pill to help you sleep catch anything different? That's a gamble, but a possibility. I have had so many sleep studies I've lost count, and the results have varied greatly. For me, that was because I also have limb movements masking the sleep apnea. BTW, what was the actual number on your limb movements? I think Pugsy's thought of trying out a CPAP to see if it helps is reasonable, and probably less expensive in the long run. If you buy a used one and end up not using it long term you could always resale it and recoup some of your money. If you do decide to go that route, become informed so you get a machine that gives you your best chance at success with the possible scenarios mentioned. (Like UARS) I would just like to encourage you to not give up on resolving your sleep issues. Any chance you could get a doctor to prescribe a pulse oximeter to watch your oxygen for a few nights? It would be interesting to see if there are a lot of small flucuations. Good luck going forward.

Unfortunately during one night in the lab all our issues might not manifest. Would a repeat study with a one-time prescribed pill to help you sleep catch anything different? That's a gamble, but a possibility. I have had so many sleep studies I've lost count, and the results have varied greatly. For me, that was because I also have limb movements masking the sleep apnea. BTW, what was the actual number on your limb movements? I think Pugsy's thought of trying out a CPAP to see if it helps is reasonable, and probably less expensive in the long run. If you buy a used one and end up not using it long term you could always resale it and recoup some of your money. If you do decide to go that route, become informed so you get a machine that gives you your best chance at success with the possible scenarios mentioned. (Like UARS) I would just like to encourage you to not give up on resolving your sleep issues. Any chance you could get a doctor to prescribe a pulse oximeter to watch your oxygen for a few nights? It would be interesting to see if there are a lot of small flucuations. Good luck going forward.

I have almost zero limb movements. You can see that in the data provided with the link to Imgur.
I am thinking of just getting puloximeter anyways because my cardio state is bad and I need to start fixing that.
It would measure my pulse so I don't get over prescribed limit but also can be used to measure oxygen at night. Just need to look into designs because
it might be uncomfortable to run with that thing attached to the finger. I am of course looking into the wrist pulseoximeter, models like CMS-50F

I have no problems with trying CPAP but need to convince a doctor to prescribe me one ...