Help to Interpret PSG Report Please

[countman88]

I have been using cpap for 8 yrs following diagnosis of moderate OSA. Have been on pressure of 10 for last 5yrs or so.
Recent sleep study results are:
Total Sleep time 352 minutes Sleep latency 6 min
Sleep effieciency 94% REM latency 111 min
NREM Sleep 291 min (82.6%) Supine Sleep 114 min (32.3%)
REM Sleep 61 min (17.4%) Lateral Sleep 238.5 min (67.7%)
Awakenings 11 Ave.Heart rate 56 bpm
Stage 1 0 min Arousal Index
2 221 min (62.8%) Total 8.5
3 24 min (7 % ) NREM Sleep 8.7
4 45 min (12. REM Sleep 7.8
StageREM 61 min (17.4%)
Abnormal leg movements did not occur during sleep. ESS 12/24 BMI 28
Nasal airflow studies showed 1327 ml/sec at baseline
There were adequate periods of REM and NREM sleep for analysis
There were several prolonged periods of consolidated sleep. Total time spent awake after sleep onset was 16.5 mins
CPAP Titration : was well tolerated and achieved a sleep efficiency of 94%. A CPAP of 8cmH2O proved suffiecient to eliminate snoring and almost all obstructive respiratory events and maintain a satisfactory SpO2%
Suggested anagement: Decrease to 8cmH2O. Patients mask proved satisfactory during the study. Follow up titration in 12 months.xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
I have been considering buying an apap for sometime, but based on these results do you think it worthwhile? I do not want to become obsessed with checking figures and striving for the absolute best outcome. Are there any indicators in the above results which point to a much better outcome using apap. My main concern iare the words "eliminate snoring and almost all obstructive respiratory events" . Will apap provide a significantly better outcome, considering it will cost me over $1000
to buy apap. Thanks

KenD Bris OZ

[kteague]

Hi. Was this study a routine follow-up, or done because you were having trouble? I notice it recommends a follow up titration in 12 months and was wondering if you are getting them every year? Also wondering, if you weren't having trouble at a pressure of 10, if there's a real need to drop it to 8 if you're not sure of how well that will work.

As far as whether an apap would be of any benefit, what issues do you hope to resolve? Though everyone is different, I started out on cpap, went to apap and was doing fine with it (according to data) for a couple years, then went back to cpap as my sleep was fragile and my doc wanted to eliminate the possibility of fluctuating pressures disturbing my sleep. I have found them both to give effective treatment. I've come to the opinion that having data should be a non-negotiable for all users, and while having an apap is a need for some users, for most it's just a nice option. Unless you have a problem an apap is reported to resolve, I think I'd put my $1000 to other use. Is that a DME price, your co-pay cost, or an online price? If you're going to buy a new machine, I think I'd prioritize by getting a machine with treatment data capabilities and software. Might save you some money on follow-up studies. If you just want an apap, do some price shopping. Just one opinion.

[Big Daddy RRT,RPSGT]

What was your AHI on 8cmH2O during this recording?

[countman88]

thanks kteague
The study was my regular "yearly" followup titration study which I have overlooked for the past few years. I have had no real problems and was quite happy at 10, even bumped it up to 12 for a month or two last year to see if there was any noticeable difference with my daytime fatigue at that level. There wasn't. I am surprised that they have recommended a decrease to 8, but I have changed it, and again haven't noticed any difference. I start work at 0430 each morning and am always a bit tired, and was just trying to work out for myself whether it is caused by OSA or just natural for a 63 year old starting work at that time of the day. I usualy get about 6 hours sleep a night. My wife assures me I don't have any of the noticeable sleep issues I used to have before cpap.
I was just wondering if if an apap would further improve the "sufficient to eliminate snoring and almost all obstructive respiratory events". I am not aware if the numbers I have quoted are quite good, or could be improved with an auto adjusting machine. Are the 11 awakenings over 352 min and the arousal index per hour of 8.5 ok or of concern?
I would have to pay the full price of the machine, cpap not covered in Oz, and I was looking at buying possibly a Devilbis auto Intellipap from either cpap.com or SecondWind (new), which would be close to $1000 landed. Closer to $2000 for an apap bought in Oz. The studies are free to me (bulk billed to the government) so the data capapble machine would not be a saving in that regard, and I could imagine myself becoming obsessed or preoccupied with the available data.

Thanks
kenD
Bris Oz

[countman88]

G'day Bigdaddy
Unfortunately the report doesn't mention AHI, which I found a bit strange. I was hoping that the Arousal Index and perhaps sleep time details may allow some learned people to calculate it, or another meaningful indicator. If not, I can try contacting the Sleep Physician. In Oz, the sleep study report is sent to the referring doctor, who in my case has no real understanding of OSA or cpap.
Cheers
kenD
bris Oz

[kteague]

Some added thoughts... I see you are using a nasal pillows mask. How certain are you no air is escaping from your mouth and that you're not mouth breathing when asleep? That's a common cause of continued tiredness. With your morning starting so early, guess you'd have to be in bed mighty early to get more than 6 hours. Can you do a test run for a couple weeks to see if an extra hour each night might result in feeling more rested? Hate to see you jumping thru hoops and spending money if short sleep or mouth leaks is the problem. I'll leave the data comments to others.

[countman88]

thanks kteague
The sleep study technician was very happy with how the latest sleepover went and I assume he checked those things out. However when I first started with the nasal pillow mask I was very conscious of the very unpleasant feeling when I allowed my mouth to open and am confident that doesn't happen any more. I also wear a chinstrap to be sure. I sometimes get 7 or more hours sleep and it doesn't seem to make any difference to how I feel during the day, but sometimes don't get that dead tired feeling as early the next night. Perhaps I am expecting too much as I am in a reasonably physically demanding job which is probably too much for an old fellow like me, but I no longer fall asleep at traffic lights on the way home from work, or in meetings, which used to happen before cpap.

KenD
Bris OZ

[OCSleeper]

I have been considering buying an apap for sometime, but based on these results do you think it worthwhile?

That depends...
...on whether the 'arousals' on the report could be reduced with increased pressure (OA, HYP) or whether they are spontaneous. (i.e. Is your AHI 8+ ?)
...on whether or not your interface (nasal pillows?) leak or you're a mouth breather outside the lab. (i.e. The chin strap isn't enough)

In general, you have a well-confirmed pressure range of 8-10cm. A lower pressure of 9cm might be good to start with. Less leaks, better mask seal and not too dramatic a change. An APAP wouldn't be called for as so little adjustment seems needed.

I do not want to become obsessed with checking figures and striving for the absolute best outcome.

If you're still tired on the morning that may indicate you're not getting the full benefit of this therapy. You don't need to be obsessed with the data, but your continued interest in achieving a healthy outcome here may be worthwhile. I'm not sure I'd be bothering with a titration every year if the changes are so small. A data capable machine would be invaluable in getting a handle on leaks and AHI results. You could also experiment with a different mask like a full-face to see if leaks are eliminated.

I sometimes get 7 or more hours sleep and it doesn't seem to make any difference to how I feel during the day, but sometimes don't get that dead tired feeling as early the next night.

A major change you could try without expense would be to sleep longer than 6 hours--maybe 8? You may be robbing your body of an entire 90 min REM period at the end of the night. It sounds like this could be a factor based on your comments. You'd need to do this for at least few weeks probably to start to eliminate the sleep debt.

Edit: Opps...I noticed also that your sleep latency was 6 mins in the study. This is quite fast. You may still be very sleep deprived.

[countman88]

Thanks OCS
Some good points. Have checked with the Sleep technician and my AHI was 8.5. She said it was not caused by my breathing or with problems with cpap or the mask. She felt that number was not a concern but if I wished i could discuss with their specialist, for a hefty fee of course. I think she said my SpO2 was 94 and she was happty with that. She will send a more detailed report which I should receive next few days. She doubted apap would assist reduce my AHI.

KenD
bris Oz

[sleepmba]

Please post back when you get your results.

[countman88]

Received the report and it doesn't appear to give much more information.
SPO2% 93NREM, REM Baeline and Mean, no AHI figure but she said the Arousal index of 8.5 meant AHI 8.5

[OCSleeper]

... no AHI figure but she said the Arousal index of 8.5 meant AHI 8.5

OK. So, if the best they got you to was an AHI of 8.5. Sounds like they didn't do a very good job of titrating you.

...A CPAP of 8cmH2O proved suffiecient to eliminate snoring and almost all obstructive respiratory events and maintain a satisfactory SpO2%

Their task is to reduce AHI to Zero using the final pressure. Doesn't look like they achieved that goal.

Sounds like you'd do better with an APAP that reports AHI and leaks. You don't need an annual sleep study of such poor quality as this.

[countman88]

thanks OCS
Inclined to agree

KenD
bris

[Big Daddy RRT,RPSGT]

AHI and Arousal index are not the same. An arousal index of 8.5 is OK but an AHI of 8.5 is still treatable. You might benefit from an auto, you might not. As for getting obsessed about the data...you will but you'll settle down after a little while...looking at data weekly instead of daily for example. I would Recommend the S9 Auto from Resmed. It is the most quiet unit I have used, the heated tubing is awesome and it titrates the pressure very well (ignores central apneas). Good luck.

[countman88]

Thanks BigDaddy
Interested in your comment that AHI and Arousal Index are not the same. I don't really understand the terms and figures, are you able to elaborate. Particularly with regard to Arousal Index of 8.5 being ok.
KenD
bris Oz