martin

[D18Cat]

Hi, posted this at another forum before finding this one
Hi, sooo glad I found this forum too! I want to thank all of you who take the time to share your knowledge with those of us who are new to sleep apnea. The forum is a tremendously valuable resource.

I am a 37yo thin male. 5'11" 140lbs. In good health, good diet, exercise semi-regularly(1-4 times per week), no medical problems other than the following: I have been suffering from daytime sleepiness and especially from cognative/mental fog for several years now. I usually feel good and well focused for several hours in the AM but begin to experience symptoms by late morning or early afternoon. After pursuing several possible causes with no improvement(diet, exercise, anti depressants) my doctor recommended a sleep test. I was diagnosed with obstructive sleep apnea about a year ago. After going back for titration I was given bipap. I used it for about 3 weeks every night and then on and off for 2 months before taking it back. During this time there were nights when I would wake up with the mask off and other nights where I slept all night with the mask. I never noticed any difference in the way I felt. I have continued to have the afternoon cognative/mental fog and my doctor has recommended I give the bipap another try. I have started back up and have used it the past two nights. I have several questions.

First, Here are my psg results:

<<<<PSG Test>>>>>


Time in bed 476 min
Sleep onset 57.5 min
Total sleep time 366 min
REM onset 231.5 min
Sleep efficiancy 76.9%

Sleep Stage / Duration in minutes / % of time in bed

stage 1 / 14min / 2.9%
stage 2 / 264min / 55.6%
stage 3 / 6.5min / 1.4%
stage 4 / 11.5min / 2.4%
stage rem / 69.5min / 14.6%
movement time / 0min / 0%
wake / 110 min / 23.1%

Respitory

# of events: 0 central / 6 obstructive / 0 mixed / 163 hypopneas /169 total

mean duration: obstructive 22.3 hypopneas 24.6

max duration: obstructive 33.0 hypopneas 66.0

Apnea/Hypopnea Index(RDI/hour) Total index 27.7 REM index 28.5 Non rem index 27.5

Body Position

up 3.4 min 0% of sleep
supine 224.6 min 89.3% of sleep 40.1 RDI/hour
left side 155.1 min 88.0% of sleep 13.2 RDI/hour
right side 35.4 min 81.9 % of sleep 10.3 RDI/hour
supine left, prone right, prone, supine right all zero

Oximetry
O2 avg while awake 96% in rem 97% in non rem 96%
minimum o2 91%

Heart rate
mean heart rate wake 60.2 REM 46.6 Non Rem 40.3
lowest heart rate REM 35 Non REM 7 (can this be right!?! Seven????)
highest heart rate wake 176 REM 127 Non REM 177

periotic limb movements 0

total number of WK or MVT episodes 26
Arousal index 31.6/h(sleep)
% of pages with arousal during sleep 24.3


My first question is can the psg yield false positive results?

During my test I was forced to sleep on my back or side. I NEVER sleep this way, I always sleep on my stomach. Does it matter?

I have been taking 5-10mg of zolpidem nightly for the past 5 years and was not allowed to use it during the psg, I was allowed to use it during titration. Could the zolpidem have skewed the results?

A little off topic but have any here used zolpidem long term(for several years?) Any problems? I have noticed that my mental fatigue, cognitive problems have gradually gotten worse and often wonder if this could be due to the long term use. My doc says its probably not. Perhaps its just the lack of good sleep taking its toll.

Do these results seem on par with OSA? Should I be noticing immediate results from bipap therapy?


FWIW here are the results of my titration study




<<<BI-LEVEL TITRATION>>>>
Time in bed 499 min
Sleep onset 91 min
Total sleep time 347.5 min
REM onset 294.5 min
Sleep efficiancy 69.6%

Sleep Stage / Duration in minutes / % of time in bed
stage 1 / 69.5min / 13.9%
stage 2 / 257.5min / 51.6%
stage 3 / 0min / 0%
stage 4 / 0min / 0%
stage rem / 25.0min / 5%
wake / 147 min / 29.5%

O2 avg while awake 97% avg in rem 97% avg in non rem 96%
minimum o2 95%

lowest pressure tried 5/5
highest pressure tried 13/9
final optimization 11/7

[Sleeprider]

Your sleep study and possible influence of zolpidem is way beyond me. That drug has been used to treat sleep apnea, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670331/ and you have been taking it for a considerable time. Its really hard to say whether your sleep study results are an artifact of suddenly withdrawing that therapy or not. Why are you prescribed zolpidem? Based on that article, removing you from the zolpidem therapy during your sleep study would be expected to result in an increase in central apneas and hyponeas, which is exactly what occurred.

[Julie]

You didn't mention (that I noticed) what masks you have tried, and that can make a huge difference to how well you do. Very often people are sent out the door with one mask, but if it doesn't fit really well, isn't the right size, doesn't address mouth breathing, etc. etc. and no one alerts you to the importance of it all, then you won't feel better and may well give up. Could you talk about what you have and how it felt?

[D18Cat]

The mask I have is a Soyala nasal. I have tried 3 or 4 others briefly at the medical equipment(bipap) suppliers office. I don't recall the brands. I don't like the feel of the full face ones at all. They seem to make the pressure more intense and give me a claustrophobic feeling. The Soyala nasal felt the most comfortable in the suppliers office. The first go round with bi-pap I started with the Soyala. The main problem I had/have with it was it really irritated the very top of the bridge of my nose, right between my eyes. Otherwise it feels very comfy and non intrusive. I did have a couple times where I woke up with my mouth open early on but I don't remember it being a problem after the first week or so. When I went to the sleep doctor for my first follow up after starting bipap, he suggested I try a new mask due to the nose bridge irritation so I went back to the bipap supplier and tried a few others but they all seemed to put some pressure on the bridge of my nose(of course at that point it was already sore and tender). I ended up taking one with just nasal pillows. I used it for only a couple of days but had too many problems with leaks every time I would turn my head no matter how tight I had it. So I went back to the Soyala. Thats where I ended the first go round and that is the one I have started with this time around. I did try several when I went to pick up the machine this time but again in the suppliers office the Soyala felt most comfortable. However, after just two nights the bridge of my nose is already sore and tender to the touch again. Its really weird because I really don't think its that tight although its possibly tighter than it should be. I can make it looser without leaking if im lying on my back and not moving, but in order to be able to turn my head from side to side with out craeting a leak i have to wear it a little tighter. Maybe thats where Im going wrong? I really wish they would just let me take home 4 or 5 masks and try them all at home in my own bed but they won't do that. I have to go over there and exchange each time and its a real pain. I have a business and family and can't take an hour every other day to go drop off and pick up masks.

[REK]

Hi,
When I was (maybe still have) having problems with a proper mask fit. My sleep doctor called the sleep lab (which he also is in charge of) and told the techs to let me take as many masks home for as long as I needed. I did just that before making up my mind as to what style worked best for me.
I also have had problems with feeling quite tired during late morning or early afternoon. My Internist gave me a script for Provigil (100 mg) first thing in the AM. When I informed my sleep doctor of that she questioned the strength and raised it to 200 mg. I am not quite sure that it is working for me and intend to bring it up again during my next visit with both my Internist and sleep doctor. Ask your doctor about using Provigil, it may work for you.