Sleep Study Results - Help Please

[daveh7]

Hi folks,

can anybody tell me about the sleep study I've attached? I suppose I'm a bit worried that they recomend a mandibular splint yet say I have no significant OSA. I have an appointment with my doctor setup but would like your input as well...

General Information:
The study is technically acceptable. The ECG signal was absent for periods of time in the second half of the study. No alcoholic drinks were consumed on the study night and patient rated sleep as “Okay”.

Sleep Study Report:
Sleep cycling is disrupted with four consolidated periods of slow wave sleep and five periods of REM sleep. There was very mild fragmentation and rare wakeful periods. Sleep latency is significantly prolonged at 115.0 minutes. The quantity of REM sleep (29.9%) is increased with a shortened REM latency (58.0 minutes) sampled. Slow wave sleep (4.8 + 22.2%) is increased. Sleep efficiency = 72.1%. A total of 439.5 minutes of sleep sampled including 0.0 minutes of supine REM sleep. The EEG arousal index = 6.6 per hour, most often associated with periods of decreased respiratory effort. Baseline SpO2 = 96 - 95% in NREM and REM sleep. Respiratory events, including hypopnoeas (0.1 per hour), are sampled throughout this study. Respiratory events are associated with an average oxygen desaturation of 2% in NREM sleep. Nadir SpO2 =91%. Light intermittent snoring sampled for approximately 20% of total sleep time.

AHI /hr
NREM SLEEP
SUPINE....NON SUPINE...TOTAL
N/A........0.2.............0.2

REM SLEEP
SUPINE.....NON SUPINE.....ALL
N/A........0.0................0.0

ALL SLEEP
SUPINE...NON SUPINE.....TOTAL
N/A.......0.1...............0.1


ECG Report: The dominant rhythm is sinus. No arrhythmias sampled. The average heart rate is 56 bpm.
Leg Movements: No PLMS were sampled.

Conclusion: Light intermittent snoring without sigificant obstructive sleep apnoea. Well maintained oxygen saturations throughout. Absence of supine positioning may have underestimated degree of seep disordered breathing.

Treatment Plan:
1. Clinical correlation of symptoms.
2. Weight control ,optimised sleep hygiene and improved nasal and upper airway patency (incl ENT assessment if indicated) may be of benefit.
3. As clinically appropriate, a mandibular advancement splint may be considered as treatment; this should be followed by review of efficacy.
4. Sleep physician review if persistent or concerning symptoms.

many thanks
Dave

[Lizistired]

I want to sleep like you do!
I'm curious what your symptoms were that caused you to have the study.
They really just said a splint may be considered as treatment.
Let us know what you find out.

[daveh7]

Fatigued constantly, before operations had AHI of 56 per hour. I'm still fatigued and am going to be evaluated for ADD innatentive type, but was curious before hand to see if I still had OSA.

[WontGiveUp]

Your numbers look great on your side/face down, but it looks like they didn't get to study you sufficiently on your back/face up. While your numbers show you don't have OSA on your side, OSA is usually worse for people while sleeping on their backs. Many things besides sleep apnea can cause fatigue and from studies I've read it can take as long as 6 months of quality sleep/proper treatment to feel good again.

[secret agent girl]

.

[Big Daddy RRT,RPSGT]

Your REM onset is shortened and this might be an indicator of Narcoplepsy.

Do you have Sleep paralysis, Dreams during a short nap, Cataplexy, episodes of falling asleep inappropriately? These are other signs of Narcolepsy.

Have you had an MSLT?

[roster]

2. Weight control ,optimised sleep hygiene and improved nasal and upper airway patency (incl ENT assessment if indicated) may be of benefit.

It is clear to me there are at least five things you need to do:

Do you have any congestion or frequent colds or other respiratory infections? Do you mouthbreathe? Do you have dry mouth after sleeping? Do you suspect your nasal airway is narrow or constricted? If the answer to any of these questions is "Yes", then 1. have an ENT assessment including a laryngeal endoscopy. The doctor will evaluate the condition of your nasal turbinates and your septum.

2. Get your weight down. Here are some good tips for nutrition - viewtopic.php?f=1&t=58661&p . Reduce your calorie intake. It is likely you are eating too many carbs - work on reducing them first. In the link be sure to take care of points 2 and 8. Start a regular exercise program doing something you enjoy. Walking is a great weight to lose weight and get in shape if you have a convenient place that is good for walking.

3. Work on your sleep hygiene. See http://www.mayoclinic.com/health/insomn ... e-remedies . Entirely avoid caffeine including any foods with chocolate.

4. Never sleep on your back. Sleep on your sides or tummy. I wear a small backpack to keep myself off my back while in bed. Be careful not to fall asleep on your back watching TV on the sofa.

It sounds like you have not discussed the sleep study with the doc. 5. Have that discussion with the doc. Discuss fatigue, operations, ADD, and any other related issues.

Good luck.

[daveh7]

What surgeries did you have, if you don't mind saying?

MMA - Mandibular Maxilla Advancement of 10mm
Submucos resection of middle and lower turbinates
Septum has been straightend
On Nasonex for chronic rhinitis

Not allergic to anything, had full blood tests done as well as skin prick test.
All blood tests fine for iron, thyroid etc, all came back good.

[daveh7]

Your REM onset is shortened and this might be an indicator of Narcoplepsy.

Do you have Sleep paralysis, Dreams during a short nap, Cataplexy, episodes of falling asleep inappropriately? These are other signs of Narcolepsy.

Have you had an MSLT?

What is sleep paralysis?
What is an MSLT?

I always dream during short naps, however I've never fallen asleep inappropriately.

[daveh7]

2. Weight control ,optimised sleep hygiene and improved nasal and upper airway patency (incl ENT assessment if indicated) may be of benefit.

It is clear to me there are at least five things you need to do:

Do you have any congestion or frequent colds or other respiratory infections? Do you mouthbreathe? Do you have dry mouth after sleeping? Do you suspect your nasal airway is narrow or constricted? If the answer to any of these questions is "Yes", then 1. have an ENT assessment including a laryngeal endoscopy. The doctor will evaluate the condition of your nasal turbinates and your septum.

My airway breathing is very good now due to surgeries, I no longer wake up in the morning with my nose blocked. And I'm sure I breathe through both my mouth and nose.

2. Get your weight down. Here are some good tips for nutrition - viewtopic.php?f=1&t=58661&p . Reduce your calorie intake. It is likely you are eating too many carbs - work on reducing them first. In the link be sure to take care of points 2 and 8. Start a regular exercise program doing something you enjoy. Walking is a great weight to lose weight and get in shape if you have a convenient place that is good for walking.

Yeah I do sometimes eat snacks etc around 1 hour before going to bed, I'm always hungry and I recon I can put some of that down to dehydration, I don't drink enough.

3. Work on your sleep hygiene. See http://www.mayoclinic.com/health/insomn ... e-remedies . Entirely avoid caffeine including any foods with chocolate.

Chocolate - my favourite food , I've never liked coffee and don't drink a lot of fizzy drinks so that's alright.

4. Never sleep on your back. Sleep on your sides or tummy. I wear a small backpack to keep myself off my back while in bed. Be careful not to fall asleep on your back watching TV on the sofa.

I absolutly have apneas when on my back for sure! Only the other day did I take a nap in the afternoon (two young kids are a handfull ) and I lay on my back, several times I awoke with snoring, my wife said she could hear me snore from the other room. But my sleep study says I didn't sleep on my back at all so I'm thinking I must not do it when in bed at night?

It sounds like you have not discussed the sleep study with the doc. 5. Have that discussion with the doc. Discuss fatigue, operations, ADD, and any other related issues.


Good luck.

Going to Doctors today to discuss results.


many thanks
Dave

[roster]

.... I'm always hungry and I recon I can put some of that down to dehydration, I don't drink enough. ....

daveh7,

All of us should stay well hydrated. However there is another likely reason for continual hunger in your case. Leptin is a hormone produced by our bodies when we sleep well. Leptin signals to the brain that the body has had enough to eat, producing a feeling of satiety. If we don't sleep well the body does not produce enough leptin and we may feel continually hungry.

Another possibility is that a lack of sleep is affecting your blood sugar levels leading to constant hunger.

You have a lot of items to act on and a lot of items to discuss with your doc. I suggest making a list of them to check off when in front of the doc.

[Big Daddy RRT,RPSGT]

Sleep paralysis is a brief episode of being unable to move upon awakening especially from dreaming. You don't have to have all the signs/symptoms to have narcolepsy. You sound like you have UARS...Upper Airway Resistance Syndrome except your sleep study looks very good. Patients with UARS usually have very disrupted sleep with lots of snoring but few "scorable" respiratory events (low AHI...Apnea Hypopnea Indices). Could you be sleeping on your back and not know it?

Do you ever have sleep paralysis?
Do you ever have dreams so vivid you briefly confuse them with reality especially at sleep onset (hypnogogic hallucinations)?
You do mention dreams during a short nap...Do you ever have very vivid dreams just after falling asleep at night?
You do complain of excessive daytime sleepiness but you say you never fall asleep inappropriatley? Do you feel like a nap should be a normal part of your day?
Does anyone in your immediate family have narcolepsy?
Do you fall or faint when emotional...laughing, crying, angry etc.?
How much sleep do you get each night?

MSLT...Multiple Sleep Latency Testing...used primarily to evaluate you for sleep onset REM (Narcolepsy indicator). If you sleep well without excessive sleep disruption and other causes of sleepiness have been eliminated and you still suffer from excessive daytime sleepiness an MSLT is a good next step.