My titration results are here!

[MichelleFL]

Well this is why I felt so much better with a cpap! Look at the difference..

Before at sleep study - no cpap

Impression:
1. Primarily REM dependent obstructive apnea of moderate severity which are associated with arousal (overall RDI 4.9 & REM RDI 15.0)
2. Nocturnal desaturation: (minimum SaO2 86%: range 94-86%)
3. Reduced slow wave sleep & REM with severe sleep fragmentation & alpha intrusion which can be seen with chronic mood or pain disorders
4. Moderately severe periodic sleep movements
5. Moderate snoring in all position (supine > non supine)


After at my titration with cpap
Impression:
1. Obstructive sleep apnea and hypopnea resolved with CPAP
(post treat RDI 0.0 at optimum pressure)
2. Nocturnal desaturation: resolved with CPAP
(ave. saO2 95% @ optimum pressure)
3. Reduced slow wave sleep and REM with moderate alpha intrusion
4. Severe periodic limb movements and sleep fragmentation
5. Snorning resolved with CPAP

So from my own impression what I am reading is that CPAP helped my O2 levels greatly and helped to keep my airway open during the evening. What it did not help was my severe periodic limb movements which probably are caused by the pain I have. Also I still have Reduced slow wave sleep and sleep fragmentation which again is probably from pain. But, it's an awesome start and I know things will get better with treatment. Now even if on Thursday I get a prescription of what I want, what do I do with it? Come the beginning of the year with BCBS I start my deductable all over again. Also while it's a wonderful program the Awake in America I think it is called wants a notorized mortgage statement... Notaries are expensive right? Has anyone gone through this program?? It seems they can either give you a used or new machine.. Thanks for everyone's help!

[OutaSync]

In Virginia, the maximum a notary can charge for a notorial act is $3.00. I doubt it would be much more in other states. Your bank may have a notary that will not charge. I have never charged to notarize.

Bev

[looking4zzzz]

Michelle,

I don't think notaries are that expensive. A lot of places will notarize items for free, too...your bank will have a notary sometimes, and a lot of work sites have a notary on staff who will notarize things for free for their employees. As for the periodic leg movement, it may not be from your pain. There actually is a neurologic condition called Periodic Leg Movement Syndrome (PLMS) where your legs jerk around while you sleep, and can often cause a number of sleep arousals. PLMS is different than Restless Leg Syndrome. You might want to check with your sleep center to see if they think you have PLMS, and if so, how bad it is. If it's bad enough, you might need to have that addressed in conjunction with treating the OSA in order to get really restorative sleep.

Good luck!

[MichelleFL]

hmmm I will look into that but I think they charge 20-30 dollars here in Florida.. But again I need to check into it more. Thanks!

[MichelleFL]

I know what apnea is but what is this hyponeas?? It says in the graph that I had 2 of them.

[MichelleFL]

Also I just found my technologist's comments.

Pt had difficulty initiating sleep onset. (I did not think so I went to sleep in 30 minutes.)
Pt had difficulty getting used to the mask and pressure. (again I think that I did well after my initial questions and concerns)
Pressure started at 4cm H2O and only increased to 5 for a short period of time. (so they say I need a pressure of 6?)
Few hypopneas seen on pressure of 4cm H2O.
PLM's noted at times. (what is a PLM?)
Pt restless throughout the night.. (Why am I restless? I always most times wake up in the same position as I went to sleep in)

Either way this is why I feel that an auto would be better for me. Since it seems I am not consistent why deal with a pressure of 6 all the time in my face if I don't need it?

[jules]

The choice to use or not use awake in america is yours of course. I only suggested them last night as I was aware of their program. You can research other charitable places in your own community, as well as use ideas RG provided and search thrift stores and garage sales as well as look for apnea support groups in your area and inquire there (ask your sleep center if they know of support groups).

As was suggested, you need to find out more about the leg movements and how that affects your sleep. Both kteague and birdshell found out about having PLMD well after the initial sleep studies.

Good luck in finding the machine you want at the price you are willing to pay.

[RiverDave]

Michelle,

A hypopnea is a "baby" apnea. Instead of your breathing stopping due to an obstruction, it is reduced by about 50% of normal. As with apneas, there is also a drop in oxygen saturation associated with hypopneas.

A PLM is a Periodic Limb Movement.

You may wake up in the same position, but people move around quite a bit while asleep (some more than others)

Your prescribed pressure may have a CYA (cover your a##) factor in it that would bump it up by 1 cm.

[MichelleFL]

Michelle,

A hypopnea is a "baby" apnea. Instead of your breathing stopping due to an obstruction, it is reduced by about 50% of normal. As with apneas, there is also a drop in oxygen saturation associated with hypopneas.

A PLM is a Periodic Limb Movement.

You may wake up in the same position, but people move around quite a bit while asleep (some more than others)

Your prescribed pressure may have a CYA (cover your a##) factor in it that would bump it up by 1 cm.

Oh! Thanks so much Dave I appreciate you explaining it to me!

[MichelleFL]

Oh no Jules I very much appreciate you letting me know about this program and I have no problem sending in what they want.. I just don't have that much money and was concerned about getting a notary...

[jules]

The mortgage lender probably can provide a notarized copy free or minimal cost if that is all you need notarized.

[kteague]

Michelle,

My doctors were testing me for everything that could cause joint and muscle pain. In frustration they said, "Well, maybe you have fibromyalgia". Then I was diagnosed with PLMD (or S). During the times it has been somewhat effectively treated, my pain has been markedly improved. For me, rather than my pain causing me to move, my constant movements caused me to have pain. Often people who have PLMD aren't really aware of the movements, because when one wakes up the movements stop. And if the movement is small with a repetitive contract/relax of sometimes just the big toe, foot, or lower leg, their body position may not change.

Also, when my edema is worse, my joint pain worsens, especially in my knees. Guess the added pressure compromises the workings of the joints.

The good news is that your OSA appears to be quite manageable, so when you get settled in with your cpap treatment you should have a little more energy to deal with the rest. If it comes down to you needing meds for the movements, you can either read some old posts or bring up the subject. There are some things to be mindful of. Best wishes.

Kathy

[Wonderingwoman]

Michelle,

Jules is right about the mortgage company providing you with the notarized copy of the statement. they may charge you a few dollars. I used to be a notary here in FL but never renewed the last time and the job I have now (at a mortgage company) I really don't need one. $20-$30 is a bit high to notarize a document, I cant find anything that shows any limits on charges here right now, but I've shredded most of my paperwork. Try a bank, credit union, insurance agency (car, life & property) AAA office just in case your mortgage company will not do it for you. Also ask around, I notarized documents for friends and neighbors all the time for free. I just made sure the information was correct and their intention was honorable.

Good luck

[rested gal]

Also I just found my technologist's comments.

Pt had difficulty initiating sleep onset. (I did not think so I went to sleep in 30 minutes.)
Pt had difficulty getting used to the mask and pressure. (again I think that I did well after my initial questions and concerns)
Pressure started at 4cm H2O and only increased to 5 for a short period of time. (so they say I need a pressure of 6?)
Few hypopneas seen on pressure of 4cm H2O.
PLM's noted at times. (what is a PLM?)
Pt restless throughout the night.. (Why am I restless? I always most times wake up in the same position as I went to sleep in)

Either way this is why I feel that an auto would be better for me. Since it seems I am not consistent why deal with a pressure of 6 all the time in my face if I don't need it?

Michelle, if a pressure of 5 or 6 is all that the sleep study found that you need to prevent OSA, I really wouldn't be looking for an autopap, if I were you, especially if money is tight. Sounds like a plain cpap machine will treat OSA fine for you. A pressure of 6 is not much to "deal with" at all. 4 cm is the low end where the machines start anyway, so an autopap varying a low pressure just a couple of cms up and down wouldn't be of much use to you.

Sounds like CPAP at 5 or 6 can handle any sleep disordered breathing for you ok. It's likely all the other pain related problems you have to deal with that are wearing you down, and probably disturbing your sleep a lot -- even if you sleep through many of the pain issues.

Pain could be causing restlessness...moving a lot during your sleep. Even if you wake up in the same general position you went to sleep in, you have no way to know how much movement you did. That's one of the many reasons to have had the sleep study -- so they could see what was happening while you were "sleeping" through it. They saw that you were restless even if you felt like you slept soundly without moving.

I agree with Kathy:

The good news is that your OSA appears to be quite manageable

and

when you get settled in with your cpap treatment you should have a little more energy to deal with the rest. If it comes down to you needing meds for the movements, you can either read some old posts or bring up the subject.

I think CPAP, not autopap, would be the best machine for you to choose. There are plenty of good CPAPs (probably sitting in closets and garages within a couple miles radius of your house, if you just ask around) that would treat your OSA wonderfully well. The pressure of 6 should be easy to get used to even if the machine has no exhalation relief.

I'd add this... after you get started on CPAP, don't be surprised if you feel even worse than before for awhile. Can take time to get used to trying to sleep with a mask on your face. And...if you do have Periodic Limb Movement Disorder (PLMD) those movements may disturb your sleep even if cpap is doing its part of the job perfectly -- keeping the throat open for breathing during sleep. IF you have PLMD, that's a completely separate sleep disorder...has nothing to do with having OSA or not. PLMD is treated with meds, and Kathy will be able to help explain that disorder.

But cross that bridge when/if you come to it. For now, settle on the idea that cpap (not autopap) is going to treat your OSA fine. You're very, very lucky that a relatively low pressure ( 6 ) was found to keep your throat open well. Start thinking "CPAP", not "autopap", and you'll get good treatment for your OSA.

[MichelleFL]

For now, settle on the idea that cpap (not autopap) is going to treat your OSA fine. You're very, very lucky that a relatively low pressure ( 6 ) was found to keep your throat open well. Start thinking "CPAP", not "autopap", and you'll get good treatment for your OSA.

2 things have me worried rested gal about this sleep study. My first sleep tech did not do a good job and I told her office manager of the issues. I traveled an hour for my titration just so I would not get this tech again. Even though my 2nd tech was super nice she could not get one of the leads to stay on. Each time she came in and put more gel on my head and pressed the lead in she would go back out and nothing.. She came in like 5 or 6 times and did this and I had goop in my hair the size of a golf ball she did it so many times. So was even my titration done properly? The other thing is I don't feel that my level is the same everynight. Even now before cpap on some days I feel wonderful and refreshed! Some days like now I feel as though I could fall asleep at the computer. My thought of it all was, why do I need a straight pressure all night long when I may not need it? Granted 6 is not much but I slept just fine at a 4.. Is 6 much more noticeable?? What are your thoughts on this??

Thanks!