My Sleep Study Results

[mazsdps]

I had my first sleep study almost 5 years ago and I had another one this past Monday. My insurance company suggested I get another one because I quit smoking and wearing a duragesic pain patch. I guess I'm dumb because I really don't understand the results so I'm going to post them in hopes of someone helping me understand them. First let me say that they had to put a mask on me during the night and they ended up putting one on that was too big. I had taken a sleeping pill right before I went to sleep and when they came in to put the mask on I was really out of it, but I could tell that air was leaking really bad. Anyway, here are the results. Thanks in advance for anyone that can help me.

The patient was in bed for 451.5 minutes. Total sleep time was 420.5 minutes. 1.9% of sleep was stage 1, 45% was stage 2, 0.9% was stage 3, 34.2% was stage 4, and 13.6% was REM. Sleep efficiency is 93.3%. Normal should be 95% in this age group. Latency to sleep onset was 7 minutes. 72 arousals were noted during the night, 35 apneas and hypopneas, 19 with paroxysmal limb movements, and 8 were spontaneous. During non-REM sleep, there were 20 obstructive apnea events. During REM sleep, there were 23 obstructive apnea events. Short events occurred when the patient was placed on C-PAP. The respiratory disturbance index which includes all of the apneas and hypopneas divided by total sleep time was 12.4; normal is up to 5. There is oxygen desaturation down to 90.6% during the non-REM events and down to 87.4% during REM events but he majority of those were in the 90 percentile or above. Only give spells occurred resulting on oxygen desaturation in less than 90%. Because of apneas and hypopneas with the elevation of the respiratory disturbance index, the patient was placed on C-PAP. C-PAP did not improve the patient's condition and in fact, lead to an increasing frequency of central apneas and BiPAP was started. BiPAP pressure was markedly increased again leading to no benefit. The patient continued to have episodes with BiPAP, however with the little oxygen desaturation. There were 106 paroxysmal limb movements for a myoclonus index of 15.1 which normal is up to 10. This is slightly elevated and there were 719 snoring episodes for a snoring index of 102.6 which is just moderately elevated.

IMPRESSION: This nocturnal polysmonagram is abnormal. It is abnormal because of abnormal sleep architecture because of deficiency of REM sleep. It is also abnormal because of mild elevation of respiratory disturbance index but, however, with little oxygen desaturation. Use of C-PAP and BiPAP appeared to really not provide any significant improvement in the patient's nocturnal respiratory pattern and therefore, I do not think C-PAP or BiPAP are very helpful for this individual at this time.

I've been using C-PAP for almost 5 years and I feel a lot better if I use it than if I don't. Also, my first sleep study is almost the same, this last one is a tiny bit better, so I wonder why the first doc started my on C-PAP? I really don't understand all this stuff, but what I do know is I feel like crap all day if I don't sleep with my C-PAP.
Sorry this was so long you all, I'm just desperate for some answers.

[kebsa]

I can't help you with the interpretation of the study as i am new to all this stuff but i am an RN who has worked with the medical community long enough to know that it is not that uncommon to have 2 widely differing opinions about the same clinical issue. I know this does not help a great deal and i can understand your confusion and distress- is there a chance that you could get in touch with the Doctor who dealt with you after your first study??

there are a lot of very knowledgeable people on this board so i am sure that someone may be able to help you

[mazsdps]

I can't help you with the interpretation of the study as i am new to all this stuff but i am an RN who has worked with the medical community long enough to know that it is not that uncommon to have 2 widely differing opinions about the same clinical issue. I know this does not help a great deal and i can understand your confusion and distress- is there a chance that you could get in touch with the Doctor who dealt with you after your first study??

there are a lot of very knowledgeable people on this board so i am sure that someone may be able to help you

Thanks, I'm going to see if I can get in touch with the first doctor. Hopefully I can get some answers.

[SharkBait]

I'd see if I could get the first doctor to prescribe me a machine with decent reporting on it (the M-Series APAP would logically keep you in the Respironics family), and get the software to monitor what's going on.

If you're on CPAP and feeling better, then that is telling you something right there. I've noticed that when my mask shows some massive uncorrected leaks, then the data is relatively useless. You've had a machine for 5 years and have obviously tolerated it, so you are most likely due for another machine.

I would...

1. Find someone that will prescribe me an APAP. Obviously I'm partial to the one in my sig.

2. Get the reader and EncoreViewer (or surf around for EncorePro)

3. I would then begin to monitor my leak rate and my AHI's every day and post results and questions on this board.

If it turns out that CPAP is doing nothing for you, then I would explore what surgical remedies and/or dental devices might be of some help. But there is no way I would ditch CPAP with one night of leaky data, especially if I had already become accustomed to it and I felt it made me feel better.

[riverdreamer]

I don't know if this will be helpful or not, as I am new to the whole sleep disorder thing. However, when I got my report from my sleep study, they reported it was not necessary for me to receive treatment, because my mild apnea showed up when I slept on my back during the study, and they claimed I did not usually sleep on my back. Well, this was not true! I sleep on my back almost exclusively, and because of other health issues, don't have a lot of options to change it.

Under HIPPA law, if there is a mistake in your medical record, you have the right to have it corrected, or to have a disclaimer placed in the record yourself. I wrote a letter to my sleep doctor, with copies to my other doctors, stating clearly that I DID sleep on my back almost all of the time. It was added as a correction to my records, and changed my therapy recommendations. It seems like it would be clinically relevant that your mask was leaking so badly. When I had my study, they were very concerned about whether my mask leaked, and the machines they used were very capable of recording leaks. If you need insurance to pay, you may want to see if they will change the report to take into account the facts.

[mazsdps]

Thanks for your replies. I have the encore pro and the reader so I'm going to post when I get it downloaded. My insurance company is going to pay for another machine and mask going by the first sleep study. I'm just at a loss to why the report came out like it did when cpap is making me feel so much better. I don't know if I'll have to send the latest sleep study to the company that is providing my machine and mask, but I'll try to get away without sendng it for awhile. I appreciate you all responding, you were very helpful!
Angie

[N6CRV]

Hello, I may be way off base but could the sleeping pill of make the difference ? You might of been so far out that the machine was not able to get the brain working right.
Just a thought.
Don

[SharkBait]

Thanks for your replies. I have the encore pro and the reader so I'm going to post when I get it downloaded. My insurance company is going to pay for another machine and mask going by the first sleep study. I'm just at a loss to why the report came out like it did when cpap is making me feel so much better. I don't know if I'll have to send the latest sleep study to the company that is providing my machine and mask, but I'll try to get away without sendng it for awhile. I appreciate you all responding, you were very helpful!
Angie

Good deal. I mis-read the description of your machine as not having your therapy data, but I see know it was referring to the older models...

[ozij]

The technician who ran your sleep study didn't find the pressure that would stop all events satisfactorily. But preferred presnting this as an objecitve diagnosis, instead of his failure.

Based on that study I don't see why they - at the very least they didn't suggest a titration on and SV machine. I'm not saying that's what you really need, but it does seem to me to be missing from the study the way it was run. CPAP and BIPAP are not the only machines that can help people with sleep disorderd breathing. Most certainly if you suddenly had centrals on CPAP.

The study couldn have achieve much since within one night they tried no machine, a cpap, a bipap -- did not manage to titrate to REM - and concluded you couldn't be helped by either device.

Sounds ridiculous to me.

O.

[mazsdps]

The technician who ran your sleep study didn't find the pressure that would stop all events satisfactorily. But preferred presnting this as an objecitve diagnosis, instead of his failure.

Based on that study I don't see why they - at the very least they didn't suggest a titration on and SV machine. I'm not saying that's what you really need, but it does seem to me to be missing from the study the way it was run. CPAP and BIPAP are not the only machines that can help people with sleep disorderd breathing. Most certainly if you suddenly had centrals on CPAP.

The study couldn have achieve much since within one night they tried no machine, a cpap, a bipap -- did not manage to titrate to REM - and concluded you couldn't be helped by either device.

Sounds ridiculous to me.

O.

You have summed it up good! I said the same thing, "sounds ridiculous to me" I'm going to call the hospital and let them know that I'm not satisfied. I don't know if it will do any good or not, but I'm going to be $1200 out of pocket for this test. My husband said the doctor sounded like he might have been on drugs! You never know these days. I do know that the results sound really messed up though.

[DyannaK]

Good luck and let us know what happens... It sounds very strange to me as well...

[mazsdps]

I have another question. What kind of doctor usually reads the sleep study? The doctor that read mine is in Neurology.

[mazsdps]

I went to see my primary care doc today and asked him about the sleep study results and he is as puzzled as I am. He told me to keep using my cpap and don't even worry about the last test. He said that if the insurance company gave me any trouble about the test saying I wouldn't get any benefit from cpap he would call and tell them I didn't need to be off of it.
I called the sleep center and talked to the manager and asked him to explain the results. He said that sometimes it's just not a good night for some people to have a sleep study. I was like, geez I guess I'll just have one every night until I have a good one. I have $1200 to shell out every night so I might as well go for it I didn't get the answer I was wanting that's for sure!
I was going to post my leak rate and my AHI's, but I have such bad sinus infection right now that I can't wear my mask because I can't breathe with it on. I'm supposed to be getting a mirage liberty next week so I'll be able to sleep with the mask on and be able to breathe. As soon as I get the mask or if I can start breathing through my nose before then I'll post my results. Thanks for all your replies!

Angie

[kteague]

Most sleep doctors are either neurologists or pulmonologists.

Does your copy of the report include things like how many centrals at what pressures? An occasional central with pressure changes seems to not be unusual, from what I've read on here. But if you have significant pressure induced centrals, I would think there needs to be further determination to assure your cpap treatment is not causing as many problems as it fixes. Sounds like the choices you've been given may leave something to be desired - Treat obstructives and ignore centrals, or don't treat obstructives to avoid centrals. How about a 3rd option - fully address all the issues.

I for one will be interested is hearing how things go from here.

Kathy

[mazsdps]

I have an appointment with the doctor that read the sleep study, but it's not until May! It takes forever to get in to see those doctors. My family doctor told me to not stop using my cpap so that's what I'm going to do for now. When I called the doctors office that read my study last week and asked for more info the nurse looked at my results and said the best bet would be for me to have surgery There is no way I'm having that surgery. My friend had it done and she said she had never hurt that bad in her life. I'm a whimp when it comes to pain so that is not an option for me, lol! I feel so much better when I use my cpap so I say if it's not broke don't try to fix it. I'm getting a new machine and mask this week sometime so I may just cancel my appt. with the neurologists. My stupid sinus probs are still with me and I haven't been able to use my cpap so I'll be so happy when I'm over this. I use nose pillows so I can't breathe with them in. I'm getting a Mirage Liberty this week so I can use that when I'm having allergy or sinus problems.