Sleep study data

[skittlesmcgee]

Today I received my sleep study reports and it kind of shed some light on some things but it also raises more questions. I was aware that I had sleep apnea years ago but the events were so few and far between that when I had a sleep study done nothing happened. No events meant no treatment. I didn't have any symptoms of missing sleep so the doc just brushed it off. Fast forward to the end of December and suddenly I can barely keep my eyes open while walking the dog. I say suddenly because it truly just happened over the course of a week. Now I have hyperthyroidism as well and it is very possible to be hyper with hypo symptoms. Well reading this report it shows I had no apnea events at all, just 32 hypopnea events. If the CPAP is offering no relief and it turns out getting treated for my hyperthyroidism isn't the answer could I possibly have central sleep apnea? The official diagnosis is mild obstructive sleep apnea but how do I find out if it's more than that? What tests are done to see if central is even a possibility?

[Pugsy]

Was this recent sleep study done in a sleep lab or at home?
Centrals are easily identified during a sleep study done in a lab and will be noted on the results.
Not always so easy to identify on an at home sleep study unless some specific equipment is used during the home sleep study.

32 hyponeas...over how long of a sleep period?
Was it 2 hours or 8 hours or something else.

[skittlesmcgee]

"32 hypopnea events occurred for a hypopnea index of 6.5 /hour of sleep. 32 apnea and hypopnea events were observed during the analysis period as follows, 0 obstructive apneas, 0 central apneas, 0 mixed apneas, and 32 hypopneas for an apnea/hypopnea index (AHI) of 6.5 /hour of sleep. Cheyne Stokes was not observed." I slept 295 minutes out of the 366.5 I was monitored

That's from the report. It was done at a sleep clinic.

[Pugsy]

If it was done at a sleep clinic then you didn't have any centrals that mattered. Central apnea isn't an issue.

Now whether or not those hyponeas could be responsible for all your unwanted symptoms....that's an unknown but it wouldn't be impossible for the mild OSA (that AHI of 6 puts you in the mild category) to be responsible for some really ugly symptoms.
Though the fact that you said your symptoms came about rather suddenly..makes me wonder about other health issues especially since you have known thyroid issues.

Does your sleep study mention oxygen levels?
Does it mention arousals?

Obstructive apneas are where the airway is 80 to 100% blocked by collapsing airway tissues...and the blockage lasts at least 10 seconds.
Hyponeas...depending on the criteria used...40 to 80 % reduction in air flow with maybe some oxygen level drops...that lasts for at least 10 seconds.
So Hyponeas are flow reductions that might not be as "bad" as obstructive apneas but they can still cause significant sleep problems and/or drops in oxygen so they are bad enough to be a part of the AHI.

You need to get the thryoid thing fixed for sure......no matter what the sleep study results said or didn't say.

[skittlesmcgee]

First study - A total of 97 arousals (19.7/hour) were observed during the analysis period as follows, 57 respiratory arousals, 12
Leg Movement arousals, 28 PLMS Index of 1.0/hour spontaneous arousals and 0 snore arousals.

Second study with CPAP - A total of 33 arousals (7.3/hour) were observed during the analysis period as follows, 21 respiratory arousals, 7 Leg Movement arousals, 5 spontaneous arousals and 0 snore arousals.

I started medication for the thyroid a few days ago but seeing if it makes a difference can take weeks. It also doesn't help that some of the side effects of the medication are drowsiness and insomnia.

[Pugsy]

Okay....sleepy study without cpap the AHI is 19
with cpap the AHI is still running 7 or 8....so the cpap isn't doesn't a good job. We like for it to be under 5 and actually probably less than 3 if we expect to see much improvement.

So your cpap therapy is sub optimal (it could be improved upon). Most likely need more pressure but without seeing detailed software reports it's impossible to know for sure.

What is your prescribed pressure?

[skittlesmcgee]

Pressure is set at 7.

[Pugsy]

Without seeing exactly what might be going on (and we have already had that discussion about your half assed brick)...we don't know for sure what is happening but since you didn't have any centrals during the first sleep study or the second sleep study with cpap then we would assume that centrals aren't an issue and that leaves the likelihood of that 7 cm pressure simply not doing a good enough job holding the airway open and preventing the hyponeas.

You may need more pressure all the time...you may need more pressure some of the time but not necessarily all of the time. Impossible to know for sure though without more details which aren't available from the machine you were given.

We also don't know how much of your symptoms might be related to the thyroid issue or how much might be related to your OSA not being treated very well. They could both explain your symptoms or maybe it's a combination of both.
They both need to be treated though...AHI of 7 or 8 (even if it is all hyponeas) while on cpap is not adequate treatment.

[kteague]

I have had 3 of the MSLT test and have a bit of input. Unless and until your OSA treatment is optimized and any other identified sleep disorders are addressed, an MSLT isn't likely to give you an accurate picture of your situation. Some symptoms of narcolepsy overlap with being sleep deprived, making for murky waters. I suggest you ask your doctor to order you a 2 or 3 week home trial on a data capable machine so the data can be analyzed to assure your OSA is managed as intended. Once that happens, if they test you overnight in the lab while using CPAP at a proven effective pressure, they will be better able to tell if something else might be contributing to your unrestful sleep. Certain criteria is supposed to be met during the night's sleep before the daytime MSLT is done. Taking these these steps in advance should help make the MSLT justifiable and beneficial.

Not all doctors will agree to this sequence of events, but in my opinion, unless there are other indicators of narcolepsy, ordering the MSLT now is premature and likely a waste of time and money. And doing it after a night of no CPAP will still not tell you what's happening when you are using the machine. When I first started I had a brick for a machine. After coming here I asked for the trial on a loaner autopap. It was the beginning of getting on the road to finding answers. Good luck going forward.

[skittlesmcgee]

I went to the dr yesterday and he suspects narcolepsy so I'm having another sleep study done. I asked about a data capable machine and he said since my current ahi is below 2 he doesn't feel it's necessary. Went to target last night and all but fell asleep walking down the aisles so if it's not narcolepsy I'd be very surprised.

[D.H.]

I took the narcolepsy test in 1999 as part of the overall initial sleep assessment. They wake you up, give you breakfast (I think no coffee or tea allowed), and have you take several twenty minute naps at two hours intervals. At least that was the protocol in 1999. I did fall asleep too fast on one of the naps, but the doc said that he thought it was due to extreme exhaustion from severe (AHI over 50) Sleep Apnea.