Help understanding sleep studies reports

[monarch22]

Help!! I feel like I'm in a rut and need some help getting out. I've been using CPAP for just a little over 5 weeks. I know it’s still early in the game. Aside from what I've read here and talking to the RT at my DME, I feel like I've just been proceeding in the dark with little knowledge about my specific sleep issues. This forum has been especially helpful in learning about apnea and using CPAP, but I'm just trying to understand my particular problems.

For instance, my sleep studies sucked. I didn't feel confident in the lab. I question the accuracy of the results. My PCP who ordered the studies apparently has little knowledge on OSA and is of little to no help. He has actually made me more frustrated and less motivated to stick with my therapy. I just need some direction. I’m in the process of finding a sleep doctor on my insurance plan.

A little about my history... I started having sleep issues about 4 years ago. First starting with falling asleep easily (I was always very tired by 7-8 pm, just dragging) but only sleeping for about 2 hours, then waking up and not being able to back to sleep for 3-4 hours, then sleeping for an hour or so before having to get up. After a few years of this, it got even worse and I couldn't even fall asleep at night, so I had maybe an hour here and there throughout the night. At least in the beginning I got that 2 hours when I first went to bed. I felt like a walking zombie all the time. My body hurt all over, I had no energy, I was irritable (still am) and my memory and comprehension was shot. I was scared. I felt like I was loosing my mind. My blood pressure kept going up and the doctor kept adding meds to try and control it, but nothing to help me sleep.

Finally, last year I went to a pain specialist because I was barely functional with daily activities. I didn’t get anything for pain, but he was concerned about the sleep issues and he prescribed Ambien. It has helped me sleep, but I don't think it has been restorative sleep. I think my sleep studies confirm that.

My first study shows:

Sleep Architecture Summary
Total recording time: 360.5 minutes
Total sleep time: 187 minutes
Sleep onset latency: 45 min
Sleep efficiency: 52%
Stage N1: 28.5 min = 15%
Stage N2: 112.5 min = 60%
Stage N3: 46 min = 25%
Stage R Latency: None, 0 minutes, 0%
Total numbers of arousals: 50
Arousal Index 16
There is absent Stage R sleep

Respiratory Event Summary
Number of Apneas: 0
Number of Hypopneas: 30
Hypopneas Index 10
% of TST Snoring: 38.2
Snore Severity: Mild
Baseline O2 Saturation: 91, Low Saturation 87
AHI on back: 6, REM AHI: 0

Periodic Limb Movement Summary
Number PLMS, 91, PLM Index: 29.2/hour, PLMS w/arousal index: 2.6 PLMS/hour
There are moderate periodic movements of sleep causing mild sleep disruption.

Titration Study shows:

Sleep Architecture Summary
Total recording time: 372 minutes
Total sleep time: 169 minutes
Sleep onset latency: 69 min
Sleep efficiency: 44%
Stage N1: 29.5 min = 17%
Stage N2: 95 min = 56%
Stage N3: 44.5 min = 26%
Stage R Latency: None, 0 minutes, 0%
Total numbers of arousals: 31
Arousal Index 11
There is absent Stage R sleep

Respiratory Event Summary
Apneas & Hypopneas: 0
Baseline O2 Saturation: 92 (I question this because I didn’t have the thing on my finger at any point during this study. Maybe they measured a different way??)
Nasal CPAP therapy was administered at pressures of 4-8

BTW, I took Ambien before both studies and am still on it. The first 3 weeks after starting CPAP, I felt worse. I couldn’t sleep at all. My pressure is 7. Then I started getting more comfortable with my mask and started seeing a small improvement. I’ve been working on issues as they come up (straps slipping, leaks, etc.) but I question whether I’m even working with the proper pressure. So, while waiting to find a sleep specialist, I would like to hear thoughts on what the sleep reports show…all I know is that I don't sleep well and I feel like crap!

[Slinky]

Well, it sounds like their thinking is that CPAP therapy to reduce the 02 desaturations and the hypopneas (maybe UARS is a contributing factor) might also reduce the number of leg movements and preferable to starting you on a medication such as Requip or Mirapex for the leg movements until they see what CPAP can do for them. That maybe the arousals are what is causing the leg movements.

But, I'm no sleep professional, just a patient. And sleep studies sure are NOT my forte! We have much more knowledgeable and experienced people here who will be jumping in w/some answers and suggestions, etc.

[Pugsy]

Finally, last year I went to a pain specialist because I was barely functional with daily activities.

First of all "ditto" to what Slinky has said.

Regarding your other statements about trouble sleeping, BP increasing, etc. That could have been me.

Just wanted to address your statement about pain. Pain alone will cause awful sleep interruptions. I can state that from first hand experience. While my OSA is classified as severe because of REM related events, it isn't so bad other times. I sorted through all the CPAP issues yet still felt awful for months and months and months.

It wasn't till I finally got my pain under control that I have finally seen some marked improvement. Don't know what your pain stuff is but even with or without OSA and CPAP, this may need some investigation. The fact that you went to pain specialist hints that you have some sort of long term pain that bugs you.

[monarch22]

Slinky, my dr has never mentioned the leg movements. No medication has been discussed for it either. My DME expressed concern over the O2 desaturation, but when I questioned the dr, he stated it would be fine with using the CPAP. I'm considering buying an oximeter to see what it's ranging while on CPAP. I'm not familiar with UARS. I'll have to look that up.

Pugsy, yes, I have chronic pain. Diagnosed with fibromyalgia. It started right around the same time as my sleep problems...not sure which came first. I often wonder if I slept better would I have less pain and if I had less pain, would I sleep better?? I say yes to both, but can't seem to get the drs to really help! I feel like here are so many pieces to this puzzle and I'm getting exhausted trying to figure them out. Is your blood pressure better now?

Thank you both for your responses!

[avi123]

Hi, I have entered my sleep study results next to your in [ my ]. They are very similar to your! I also took Ambien (10 mg) in the titration night.


***********************************************************

Finally, last year I went to a pain specialist because I was barely functional with daily activities. I didn’t get anything for pain, but he was concerned about the sleep issues and he prescribed Ambien. It has helped me sleep, but I don't think it has been restorative sleep. I think my sleep studies confirm that.

My first study shows:

Sleep Architecture Summary

Total recording time: 360.5 minutes [417]
Total sleep time: 187 minutes [ 208]
Sleep onset latency: 45 min [41]
Sleep efficiency: 52% [56%]
Stage N1: 28.5 min = 15%
Stage N2: 112.5 min = 60%
Stage N3: 46 min = 25%
Stage R Latency: None, 0 minutes, 0% [R latency of 368 (normal 90 min)]
Total numbers of arousals: 50 [141]
Arousal Index 16
There is absent Stage R sleep

Respiratory Event Summary

Number of Apneas: 0 [ 0]
Number of Hypopneas: 30 [149]
Hypopneas Index 10
% of TST Snoring: 38.2
Snore Severity: Mild [moderate]
Baseline O2 Saturation: 91, Low Saturation 87 [ lowest 84%]
AHI on back: 6, REM AHI: 0 [43 on back, 96 at brief REM]

Periodic Limb Movement Summary

Number PLMS, 91 [24], PLM Index: 29.2/hour [1.2], PLMS w/arousal index: 2.6 PLMS/hour [0]
There are moderate periodic movements of sleep causing mild sleep disruption.

Titration Study shows:

Sleep Architecture Summary

Total recording time: 372 minutes [407]
Total sleep time: 169 minutes [228]
Sleep onset latency: 69 min [38]
Sleep efficiency: 44% [56%]
Stage N1: 29.5 min = 17%
Stage N2: 95 min = 56%
Stage N3: 44.5 min = 26%
Stage R Latency: None, 0 minutes, 0% [25 min (normal 90)]
Total numbers of arousals: 31
Arousal Index 11
There is absent Stage R sleep

Respiratory Event Summary

Apneas & Hypopneas: 0 [ 2.4]
Baseline O2 Saturation: 92 [89%] (I question this because I didn’t have the thing on my finger at any point during this study. Maybe they measured a different way??)
Nasal CPAP therapy was administered at pressures of 4-8 [ 5 to 7 cm H2O]

BTW, I took Ambien before both studies and am still on it. The first 3 weeks after starting CPAP, I felt worse. I couldn’t sleep at all. My pressure is 7. Then I started getting more comfortable with my mask and started seeing a small improvement. I’ve been working on issues as they come up (straps slipping, leaks, etc.) but I question whether I’m even working with the proper pressure. So, while waiting to find a sleep specialist, I would like to hear thoughts on what the sleep reports show…all I know is that I don't sleep well and I feel like crap!
**************************************************************

My suggestion:

(I am not a physician)


1) Continue CPAPing for at least two more months (see #3 below)

2) Find a sleep specialist who holds an MD in pulmonology plus an MD in internal medicine (or two separate MDs)

3) If the above Doc would not help you with the pain/anxiety treatment then see also a psychiatrist, MD

4) IMO, if there is nothing serious then you must get an UN FRAGMENTED sleep of 3 to 5 hours (to include REM) to feel better
**************************************

My present situation:

I came down with Peripheral Neuropathy just about wheh my sleep disorders started, 4 mos ago. Sleeping pills did not help to avoid the sleep fragmentation. Luckily my Internist/Geriatric sent me to the sleep study plus to a neurology center to rehab my vestibular system.

Presently, I have improved a lot. Go to sleep at midnight by taking 5 mg Ambien when I put the CPAP mask on, and sleep till 4 a.m. Then I put on anoyher FF mask and fall a sleep till 7 a.m. O yes, my psychiatrist put me on Xanax taken thru out the day, as needed, to help me with withdrawal from the Ambien. But I still don't like the data from the CPAP:


(just started on this CPAP)

Serial No.: 23101067352
Product: S9 Elite
2/4/2011 - 2/4/2011

Device Settings

Therapy Mode: CPAP Set Pressure: 7.0 cmH2O EPR: Full_Time

EPR Level: 2.0 cmH2O

Leak - L/min

Median: 3.6 95th Percentile: 31.2 Maximum: 49.2

(the leaks are hi b/c I am trying diff masks)

AHI & AI - Events/hr

Apnea index: 24.1 AHI: 25.4 Obstructive: 16.4
Central: 3.9 Unknown: 3.7 Hypopnea index: 1.3

p.s. It's a son of a gun to reduce the AHI.

[Pugsy]

Pugsy, yes, I have chronic pain. Diagnosed with fibromyalgia. It started right around the same time as my sleep problems...not sure which came first. I often wonder if I slept better would I have less pain and if I had less pain, would I sleep better?? I say yes to both, but can't seem to get the drs to really help! I feel like here are so many pieces to this puzzle and I'm getting exhausted trying to figure them out. Is your blood pressure better now

Ahh, I wish I could report that my BP is entirely normal. I still have times when we get a very borderline reading. So I continue to work on losing that extra 20 lbs I seem to have accumulated over the years. I don't take any BP meds. It has only been the last 2 months that I can finally say that I see some marked improvement in my general sleep's restorative powers. So here's hoping that with the additional exercise I now feel like doing, things along the BP line will get better and my few extra pounds will go away. My BP did improve with cpap, just not quite enough improvement to put me in the normal range all the time.

Pain does create a nasty circle. Especially fibromyalgia. You are right, if you had less pain you would sleep better and that helps you to have less pain. Hard to break that circle though. Believe me I know. I don't want to bore everyone with my history nor hijack this thread of yours. Short version is that I have very bad arthritis in lower back and pelvis from multiple fractures. Rod in neck due to arthritis eating away at things and causing spine to become unstable. I am sure that I also had some fibromyalgia too.

All we can do is try to whittle away on these things to see if we can get better. First the OSA because it needs to be optimized to even have a chance to address any other issues. There is always something it seems like. Should wish to talk privately, feel free to PM me. I will tell you this that I have been on CPAP for almost 2 years and just recently have found some energy and seen the need to nap disappear. My OSA has been well treated pretty much after the first month. It was only after I kept whittling away at my pain issues that I have seen marked improvement.

[monarch22]

avi123, yes, our results are very similar. I hope you can get that AHI down. You mentioned withdrawal from Ambien? What does that consist of, are you just not able to sleep or are there other symptoms? I would like to stop taking it and was hoping I could with CPAP, but honestly it's the only way I can sleep. Also, why do you switch to another mask at 4:00 am (just curious)?

I wish that it hadn't taken so long to get a dr who took my sleep problems seriously. I just never realized how many things it would affect. I think it's time to start again with a new doctor.

[avi123]

avi123, yes, our results are very similar. I hope you can get that AHI down. You mentioned withdrawal from Ambien? What does that consist of, are you just not able to sleep or are there other symptoms? I would like to stop taking it and was hoping I could with CPAP, but honestly it's the only way I can sleep. Also, why do you switch to another mask at 4:00 am (just curious)?

I wish that it hadn't taken so long to get a dr who took my sleep problems seriously. I just never realized how many things it would affect. I think it's time to start again with a new doctor.

Hi, I been taking 10 mg Zolpidem (generic Ambien), when going to sleep, for a decade before staring CPAP. It was prescribed by my internist. However, when I came down with a peripheral neuropathy, 4 mos ago, I could not then sleep at all even when taking twice the dose of the Zolpidem. My sleep was fragmented. Changing from Zolpidem, to Restoril, to TraZodone, DID NOT HELP. So I decided to go to another Internist, MD who happened to also be a Geriatric. He hit it on the head by sending me to a Sleep Study and sure enough, I had a severe OSA. The sleep Doc (a pneumologist) who happened to work with the same group as the Geriatric, wrote in the study result:

Avoid alcohol, or sedative medications, prior to bedtime, as these will worsen sleep apnea.

So here I am trying to withdraw from Zolpidem by cutting the dose in half.

Read this:

http://www.non-benzodiazepines.org.uk/zolpidem.html


In the mean time I was prescribed Xanax 0.5 mg daily, by another Doc, to reduce my anxiety and to see if it helps.

As to you writing: "I wish that it hadn't taken so long to get a dr who took my sleep problems seriously. I just never realized how many things it would affect. I think it's time to start again with a new doctor", as I posted above, seek someone with the credentials as my sleep doc, which are:

xxxx, M.D., F.C.C.P.

INTERNAL MEDICINE & PULMONARY MEDICINE

Undergraduate: Union College, Schenectady, NY
Medical School: Albert Einstein College of Medicine, Bronx, NY (with honors)
Internship: Bellevue Hospital, New York University Medical Center, NY, NY
Residency: Bellevue Hospital, New York University Medical Center, NY, NY
Fellowship: Pulmonary Medicine, N.Y.U., NY

Membership:

Alpha Omega Alpha, Honors Medical Society
Fellow, American College of Chest Physicians
American Thoracic Society
American Academy of Sleep Medicine
North Carolina Medical Association
Wake County Medical Society
Board certified: Internal Medicine, Sleep Medicine, and Pulmonary Diseases

Dr. xxxx practiced Pulmonary and Internal Medicine for three years in central Massachusetts
prior to joining YYYY in 1991.