First PSG last night, disappointing(?) results

[awh]

Hi there,

I went in for a sleep study last night and I don't think I did a very good job of sleeping. I am not used to sleeping on my back and I was worried that I would pull out all the wires if I rolled over onto my side. After several hours of drifting in and out of sleep, and seeing weird visions while still being aware of my surroundings (and knowing to breathe properly), I finally, very gingerly, managed to work my way over onto my side and finally drop off into real sleep.

When I woke up, I went in for my "consultation" with the doctor which lasted all of 30 seconds and he just said "your results will be ready in 2 weeks, come back then." Doctors here in Japan are not used to answering questions from patients (there is still a lot of "doctor=God" attitude here and few people really question their doctors) and he wouldn't give me any other information than that.

I finally convinced the nurse afterwards to show me the printout from the PSG (it was labelled "auto-PSG" in Japanese and was apparently just the diagnosis from a computer program with no human analysis), and I could see, as I expected, the first 4 hours in Stage 1 sleep or Stage 2 sleep, then a couple 1-hour periods of Stage 3/4 sleep. The pulse oximeter readings during the deep sleep hit as low as 65% at times, and during those times there were a lot of apneas and hypopneas (and of course the snoring). The total AHI for the study was 17 or so (in Japan it needs to be 20 to be diagnosed). What she did say was that the reason that I need to wait for 2 weeks was "you didn't sleep very much, so we have to send this data off to be analyzed".

What I want to know is the "AHI" average, how was that calculated? As an average over the entire time I was there? As an average over the "sleep" time counting the 4 hours I spent drifting in and out of sleep? Normally when I hit the sack I am out like a light in the next couple minutes.. Is the 2 weeks of analysis going to be used to "strip out" all this data and instead concentrate on the time that I spent "really" sleeping instead of just having weird visions?

Thanks for any insights...

[awh]

After doing a lot more reading on the subject, I figured out that by "sending the data off to be analyzed", they mean send it somewhere for scoring; the printout that I had seen was scored by software and they'll have it scored by a human. I guess Japan doesn't use the overnight scoring services that I see online; we have to wait 2 weeks!

For National Health Insurance to cover CPAP therapy, AHI needs to be 20 or greater; my score which probably included all of the hours of "stage 1 sleep" that was really just me lying there waiting for sleep to come, was 17. When the human scores my PSG, is there any data in there that will let him know that during the times the softwawre scored as "stage 1" I was often awake?

Now that I know I can turn over, I would probably do better on another sleep test (and, come to think of it, if I *had* pulled out a wire, the cute nurse would have come back in to hook me up again), but I don't really want to have to pay another 30,000 yen, and another 30,000 after that for titration...

[nobody]

I can't really answer most of your questions, but if your oxygen really dropped that low during the time you did sleep I'd be surprised if they wouldn't pay for a CPAP for you.

[bap40]

I have to agree. That oxygen level was very low..

Good Luck!
PS I have a son stationed in Japan so it's kinda cool to see a person from the same Country.

Brooke

[awh]

Thank you all for your encouragement. I just wanted to follow up to my own post. I have the human re-scored PSG and a lot of the "waiting to fall asleep" time, scored as "Stage 1" by the computer was re-scored as "Wake". This made the AHI go high enough to qualify for Japanese health insurance.

Stats were AHI 30.5; REM AHI 72.4. Most of these are hypopneas rather than flat-out apneas, so I am lucky (I guess).

Interestingly there are never any apneas or hypopneas during Stage 3 sleep; even though I was lying on my back and sawing logs. My apneas and oxygen desaturation corresponded quite a lot with REM sleep.

The report gave times for face-up, face-down, and sideways sleeping, and interestingly enough there is a "standing" one, I wonder if that one ever gets used.

I didn't want to pay another 30,000 yen for another full-on sleep study, so they just let me have a nap for a couple hours with an APAP machine. Then they sent me home with one (strangely enough it costs exactly the same to rent my machine, a S8 Autoset Spirit II, as it does for my buddy to rent his S8 Escape).

Will give it a try tonight and see how it goes...

[ozij]

Thank your for the follow-up awh.
It sounds like your on the way to good treatment!
Standing up, huh? That's a beauty.
O.

[nobody]

The standing one is probably for sleep walking. Glad you got it covered.

[rested gal]

Interestingly there are never any apneas or hypopneas during Stage 3 sleep; even though I was lying on my back and sawing logs.

I think I've read that we don't usually have apneas or hypopneas during Stage 3 (or the old way of staging -- Stage 3 or Stage 4) sleep. I think the Stage 3 (and 4) sleep is usually "stable" sleep with no apneas happening in that slow wave sleep.

My apneas and oxygen desaturation corresponded quite a lot with REM sleep.

Yep. That's when those things happen the most often, for most people.

The report gave times for face-up, face-down, and sideways sleeping, and interestingly enough there is a "standing" one, I wonder if that one ever gets used.

Guess that means a person either sits up in bed or gets out of bed.

they just let me have a nap for a couple hours with an APAP machine. Then they sent me home with one (strangely enough it costs exactly the same to rent my machine, a S8 Autoset Spirit II, as it does for my buddy to rent his S8 Escape).

You got a great machine. Very, very good going, awh!

[MurphysLaw]

I wish my stage one and two sleep had been scored as "wake" because I was awake and could have done mental math until after 3 a.m. when I fell quickly asleep and dropped right into REM where I scored 60+ AHI. But because I had 0 AHI in the other stages, they averaged it out across all the hours they claimed I slept. I barely made it high enough to qualify. My low oxygen levels helped my case.

I think they're pretty smart to score it that way.

I'd love to be able to watch the cameras while the patient is sleep walking.