Results of July titration - severe

Results of PSG done in March showed AHI 35.3 hr

July titration, slept 58.5 min out of 98.9
stage 1 8.5
stage 2 11.1
stage 3 80.3
stage 4 0
O rem sleep

AHI 3.1
3 obstructive hypopneas with a mean duration of 21.6 (a long time?)
saturation was good 90-100 range (not so good on sleep study, so improved)
heart rate 74-100
49 spontaneous arousals index 50.3 hr

titrated pressures of 5 to 6, no effective pressure found, time was not adequate. (that was when he sent me home instead of trying another mask.)

recommendations - BiPap, don't drive when sleepy, don't sleep on back, avoid alcohol before bed (got to drink in the morning I guess), take benzodiazepines before sleep (Dr didn't give me any)

allergyridden wrote:Results of PSG done in March showed AHI 35.3 hr

July titration, slept 58.5 min out of 98.9
stage 1 8.5
stage 2 11.1
stage 3 80.3
stage 4 0
O rem sleep

AHI 3.1
3 obstructive hypopneas with a mean duration of 21.6 (a long time?)
saturation was good 90-100 range (not so good on sleep study, so improved)
heart rate 74-100
49 spontaneous arousals index 50.3 hr

titrated pressures of 5 to 6, no effective pressure found, time was not adequate. (that was when he sent me home instead of trying another mask.)

recommendations - BiPap, don't drive when sleepy, don't sleep on back, avoid alcohol before bed (got to drink in the morning I guess), take benzodiazepines before sleep (Dr didn't give me any)

Not to downplay/grade the severity of your condition, but I'd probably be looking for a new doctor or sleep lab or both.

First, I don't think your test lasted long enough to determine your actual OSA severity. Most diagnostic portions of the test have to last a minimum of 240 minutes before insurance will cover the procedure, not all but most. Yours only lasted 98 minutes. It can take some people 200 minutes to reach the deeper stages of sleep such as REM, so your test doesn't really demonstrate your worst possible condition.

Your Stage2 sleep should be about 50%, so it is low, you didn't get any REM, but you did spend a lot of time in deep sleep or Stage3/4.

Spontaneous arousals, again test didn't last long enough to come up with a valid score in my opinion, while I'm sure a good tech could determine from that period a diagnosis.

Those 50 per hour spontaneous arousals may be a problem with daytime fatigue. You better hope your doctor is better at lowering those then they are in selecting the Bipap therapy mode for a pressure of only 5-6 cm. If you have insurance, I doubt they would approve such a machine for that pressure unless it was an oversight.

At this point, you need to obtain a complete copy of the PSG your doctor received and read that report for yourself. You will need that report going forward.

Going on CPAP most likely won't lower those spontaneous arousals, meaning those events destroy your sleep quality similarly to apnea events even on CPAP therapy.

The exact cause of those are unknown, can be from most anything including snoring. If they are from snoring and CPAP eliminates the snoring then the spontaneous arousal is not a spontaneous arousal. Cross your fingers and hope they are OSA related, because if they are not it becomes a treasure hunt to find the cause of them.

If you have OSA events that wake or arouse you from sleep 30 times per hour (every 2 minutes) and you have 50 spontaneous arousals on top of that that is like having 80 events per hour or an event less than every minute you sleep.

I would:

Look at any medications you might be taking, those can sometimes contribute to those arousals and also could be the cause of why you spend so much time in deep sleep (should only be about 10% in Stage3/4).

Normal Sleep Architecture:
Stage1: 5%
Stage2: 50%
Stage3: 10%
Stage4: 10%
Stage REM: 25%

Note: GERD and/or vocal cord dysfunction (PVCD) has been thought to contribute to those spontaneous arousals most recently, if you have had past bouts of losing your voice and/or horseness you may want to visit a GI specialist for an exam for GERD.

Most people that have OSA also have GERD.

I had a lot of trouble with the mask, it drove me crazy. I would try to get it more comfortable & try to adjust it. I think that accounts for the arousals. I may be wrong though, because even though I haven't seen my full night sleep study, they told me I had like 240 arousals, in like 375 minutes sleep.
Thank you for your observations!