High #of arousals in titration: plz help

RosemaryB · Post by **RosemaryB** » Mon Apr 16, 2007 11:22 am

Today I got my titration study back. Tomorrow I talk with my doctor to convince him to give me an autopap. During the titration study they set my pressure at 5. That brought my AHI down from 20.3 to 0.5.

HOWEVER, in the first study I had 123 spontaneous arousals for 5.125 hours of the study or 24 per hr. In the titration study I had 85 for 4.025 hours of the study or 21 per hr.

In other words, the CPAP set at 5 did get rid of my hypopneas/apneas, but did little or nothing for the spontaneous arousals.

In my first report, there were 6 diagnostic impressions. The first was a diagnosis of OSA with an AHI of 20.3. The sixth was "decreased sleep efficiency with some disruption in sleep architecture and frequent arousals secondary to impression#1" (OSA AHI=20.3).

In the titration study there is no mention of the arousals in the impressions, just that the CPAP setting of 5 took the AHI down to 0.5.

Tomorrow I'm going to try to talk my GP into an autopap. One reason to get one is to see if the setting automatically goes above 5, since the tech didn't try a 6 or higher to see what would happen to the arousals. Or are arousals not helped by an xPAP?

What are your thoughts?

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, AHI

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, AHI

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP, AHI

Snoredog · Post by **Snoredog** » Mon Apr 16, 2007 1:52 pm

you can have spontaneous arousals going back to when you were an infant. they call them spontaneous because they are from unknown origin. Some are caused by apnea/hypopnea and related to respiratory arousals and dissapear with cpap treatment, then others are thought to be caused by acoustic vibrations (snores) then others are completely unknown. You then have to look at medications, muscle-skeletal pains etc. I always thought the snore aspect was interesting, when you think about where the snore is being generated it is at the base of the brain and brain stem. If you can hear someone snore outside the room you can only imagine what those vibrations and noise are doing to that person's brain activity.

http://meeting.chestjournal.org/cgi/con ... 8/4/380S-b

Guest · Post by **Guest** » Mon Apr 16, 2007 5:18 pm

Thank you, Snoredog. That was an interesting article. My arousals don't seem to have anything to do with snoring, because for the most part, I don't snore and then only lightly.

Maybe there is some other kind of brain activity going on. I feel like I've been tired all my life, so maybe I've had those kind of arousals since infancy.

RosemaryB · Post by **RosemaryB** » Mon Apr 16, 2007 5:20 pm

That last post was me, not a guest. I'm still getting the hang of this forum, obviously.

Snoredog · Post by **Snoredog** » Mon Apr 16, 2007 5:28 pm

Anonymous wrote:Thank you, Snoredog. That was an interesting article. My arousals don't seem to have anything to do with snoring, because for the most part, I don't snore and then only lightly.

Maybe there is some other kind of brain activity going on. I feel like I've been tired all my life, so maybe I've had those kind of arousals since infancy.

No no, the "residual arousals" are what is called spontaneous arousals, they are the ones left over they cannot associate to any cause, that is why they are difficult to eliminate.

For example: If the arousals seen are associated with OSA and they eliminate those OSA events the number goes down, then the arousals left over are considered spontaneous. They are read on another channel of the EEG.

RosemaryB · Post by **RosemaryB** » Mon Apr 16, 2007 7:53 pm

Snoredog wrote: For example: If the arousals seen are associated with OSA and they eliminate those OSA events the number goes down, then the arousals left over are considered spontaneous. They are read on another channel of the EEG.

It would be nice to have an "at home" EEG, to measure this response to therapy. I suppose these things are hugely expensive, though. Not that I'd want one every night. I'm sure the xPAP will be plenty .

christinequilts · Post by **christinequilts** » Mon Apr 16, 2007 8:01 pm

Sometimes you can have more the night of your first titration because of the mask & getting use the air blowing on your nose. Definitely talk to your doctor about possible causes, including any medications or supplements you may be taking. It may be worth it to have a repeat study in 6-8 months, if you are still having a lot of symptoms and all other possible causes of the arousals have been ruled out to see if anything else shows up that the apneas & first night jitters may have been hiding.

SelfSeeker · Post by **SelfSeeker** » Tue Apr 17, 2007 5:39 am

SnoreDog Thank you for the link.

http://meeting.chestjournal.org/cgi/con ... 8/4/380S-b

A quote from the link.

Does this mean you may have UARS?

If your Oxygen level stayed high upper 80% or more, then maybe.

After reading much on UARS, I now beleive that all the AASM Mild hypopneas on Sleep Studies may trigger a spotaneous arousal or at the least yoru brain to react to the least amount of oxygen.

Would the auto help you, Yes, Why, because what if the sleep tech ignored Flow limitations or AASM Mild hypopneas.

There are contradictions to using an auto.

My doctor does not beleive in autos because "they are to sensative" I went back to my titrated pressure (Home titration study with an auto and oximetry). I was left exhasuted again. So he now said yes go and use the auto. (Luckly I had boought the auto on line with the CPAP Rx.)

If the auto is not good for you, it can alawys be set to a straight CPAP. So it is not like the machine will be useless to you.

Rosemary, I could have written the statement in quotes that your wrote.

I thought I was had insonmia. I never had problems falling asleep, but I felt I was awake all night. According to the sleep study, I had a bunch of arousal at those times that I thought I lay awake. I did not lay awake I kpet getting aroused to wake.

Once I went on the CPAP, I know I do not have insomnia because I do not "lay awake" as often. I still do not sleep through the night though. Still working on it.

I would love to see a study done to see if Spontaneous Arousals corrolate with AASM Mild Hypopneas. Or better yet, consider arousals by AASM Mild Hypopneas respiratory related.

AASM Mild Hypopneas do not count towards AHI, they do not count for many insurance as an issue for needing cpap treatemtn etc. I do not which bodies of government recognizes them. Luckly for me they were shown and taken into account in my sleep study.

Sleep arousals are important for reestablishing a patent airway subsequent to an obstructive event and to protect against prolonged hypoxemia. Spontaneous arousals (SA) are also considered among the clinical indicators of upper airway resistance syndrome (UARS). We examined the frequency and clinical significance of SA in patients referred for evaluation of obstructive sleep apnea (OSA).

CLINICAL IMPLICATIONS: The SAI variable does not add appreciably to the available clinical information except when the SAI is high with substantially lower AHI, which would increase the index of suspicion for the presence of UARS.

Anonymous wrote:Thank you, Snoredog. That was an interesting article. My arousals don't seem to have anything to do with snoring, because for the most part, I don't snore and then only lightly.

Maybe there is some other kind of brain activity going on. I feel like I've been tired all my life, so maybe I've had those kind of arousals since infancy.

RosemaryB · Post by **RosemaryB** » Tue Apr 17, 2007 5:42 pm

Snoredog wrote:For example: If the arousals seen are associated with OSA and they eliminate those OSA events the number goes down, then the arousals left over are considered spontaneous. They are read on another channel of the EEG.

Ok, Snoredog, I do understand them now. Interesting about the EEG channels. I think I have to learn more about EEGs and how they work to best understand sleep studies.

ChristineQuilts, perhaps they would have gone down if I weren't nervous. They looked a lot like the first sleep study, spread throughout the night. In the first study I was relaxed because I didn't think I had sleep apnea (my doctor did, though). IN the second one, I was more nervous, plus wearing the mask was unusual. But perhaps they would have gone down with the CPAP had I not been nervous.

selfseeker said:If your Oxygen level stayed high upper 80% or more, then maybe.

After reading much on UARS, I now beleive that all the AASM Mild hypopneas on Sleep Studies may trigger a spotaneous arousal or at the least yoru brain to react to the least amount of oxygen.

Would the auto help you, Yes, Why, because what if the sleep tech ignored Flow limitations or AASM Mild hypopneas.

Selfseeker, that's very interesting. What have you read on UARS? I've never before heard of AASM Mild hypopneas. I was kind of wondering if my arousals were due to some kind of "subclinical" hypopneas, and I think that this is what you are talking about here.

I've always found "subclinical" phenomena interesting. One point over on a given test and you are declared to have the condition, one point under and you don't, even though there's just a smidgen between the person who officially has it and the one who doesn't technically have it.

I'm kind of hoping that the auto will make up for any limitations in what the tech did. Unfortunately, I won't be able to see the arousals on the APAP, but at least I'll be able to see what the readings are and correlate them to how tired I feel. Hearing your story supports this idea at this point. Only time and more information will tell.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal, auto, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal, CPAP, auto, APAP

SelfSeeker · Post by **SelfSeeker** » Wed Apr 18, 2007 2:24 pm

Rosemarie,

Here are the parameters used for my Sleep Study.

Not typed the same, I listed them.

Central From the brain and not from the airway. Body does not try to breath, without receiving air. (My wording.)

obstructive: No airflow was detected for at least 10 seconds

Mixed:

hypopnea: scored when a 30% or more drop in airflow with coincident deesaturation of at least 4% lasting at least 10 seconds was observed.

AASM Mild hypopnea: scored if a 50% drop in flow was seen, or a lesser drop followed by either a 3% desaturation or AASM cortical arousal.

American Association of Sleep Medicine (AASM)

( AHI) APnea Hypopnea Index

AHI does not inclued AASM Mild Hypopneas.

AASM AHI does inclued AASM Mild Hypopneas.

Different states or insurances may use different standards.

AASM cortical arousal

Is that considered a respiratory-related arousal or a Spontaneous EEG arousal?

Hope this helps you.

[/b]

RosemaryB · Post by **RosemaryB** » Wed Apr 18, 2007 5:30 pm

thanks, SelfSeeker. Those are really helpful. The whole "cortical arousal" thing is interesting. I saw you posted a question about it. I hope to see some responses.

[quote="SelfSeeker"]Rosemarie,

Here are the parameters used for my Sleep Study.

Not typed the same, I listed them.

Central From the brain and not from the airway. Body does not try to breath, without receiving air. (My wording.)

obstructive: No airflow was detected for at least 10 seconds

Mixed:

hypopnea: scored when a 30% or more drop in airflow with coincident deesaturation of at least 4% lasting at least 10 seconds was observed.

AASM Mild hypopnea: scored if a 50% drop in flow was seen, or a lesser drop followed by either a 3% desaturation or AASM cortical arousal.

American Association of Sleep Medicine (AASM)

( AHI) APnea Hypopnea Index

AHI does not inclued AASM Mild Hypopneas.

AASM AHI does inclued AASM Mild Hypopneas.

Different states or insurances may use different standards.

AASM cortical arousal

Is that considered a respiratory-related arousal or a Spontaneous EEG arousal?

Hope this helps you.

[/b]

Ergin · Post by **Ergin** » Thu Apr 19, 2007 5:35 pm

Are you sure your arousals are not due to RLS nor PLMD?
Some labs do a really lousy job, I have personally been to one.
I recommend to take another sleep study at a better lab.

RosemaryB · Post by **RosemaryB** » Thu Apr 19, 2007 8:04 pm

Ergin wrote:Are you sure your arousals are not due to RLS nor PLMD?
Some labs do a really lousy job, I have personally been to one.
I recommend to take another sleep study at a better lab.

I'm going to ask for another sleep study but not right away since I want to get a machine and get it working. Then I'll see where I stand. I would also like some time to find a really good sleep lab and even a good sleep doctor, if at all possible. I also want to learn a lot more about it all so I can walk in there knowing everything possible and be more proactive with them.