Help me Interpret my Sleep Study Results

[jeffro2]

Newbie here..... and I'm not even sure that any type of cpap is right for me. I was able to get the results from my sleep study last year though and I'll do my best to type what seems like the most pertinent info below. Hopefully someone here can help me in finding the best course of action as a supplement to the information provided to me by my doctor.

Overall, I don't meet criteria for a diagnosis according to my doctor; however, I do meet the criteria in REM sleep stages only. I have to be honest here.... I have some mornings when I have slept for 9 hours and I don't feel like I slept more than three hours, while other mornings I feel pretty well refreshed. That alone isn't enough to get me to consider doing anything about my condition. Really though, my snoring in these REM sleep stages is supposedly so bad that it's driving my wife crazy about 50% of the time. I try to sleep on my side, which seems to help, but I tend to roll on my back on many nights, which, of course, makes me snore pretty loudly.


Anyway, on to my report. This seems to be a summary report, but I'm not 100% sure. Also, some of the text is hard to read because it is amll and faint on the printout I was provided. It says:

Clinical Information
43 y.o. male, 185 lbs, 5' 8" tall

Scoring technologist Comments: The patient seems to have mile REM dependent obstructive sleep apnea. No periodic limb movements were noted. No cardiac arrhythmias were noted.

Sleep Architecture (Totals)
Lights Out: 10:55 PM
Lights On: 5:56AM
Total Recording time: 420 minutes
Total Sleep time: 386.5 minutes
Sleep efficiency: 92.5%
Sleep Latency: 3.5 minutes
Total Wake Time: 31.5 minutes
REM Latency: 222 minutes (or could be 2.22 minutes? Hard to read)
Wake after sleep onset: 28 minutes

Sleep stages:
Stage 1: 14.5 minutes (3.7%)
Stage 2: 299 minutes (77%)
Stage 3: 0 minutes (0%)
Stage REM: 75 minutes (19.3%)
REM Periods: 3 total

Arousal Events:
Arousal periods: 27 total
Arousal Index: 4.2h? (hard to read, but I think this is what it says)

Respiratory Information:
Total number of Apneas/Hypopneas: 17
Apnea/Hypoapnea Index: 2.6/hr
REM AHI 9.6/hr

Apneas:
Total number: 0
OA: 0 total
MA: 0 total
CA: 0 total
Apnea Index: 0 hr
Longest Apnea: 0s
Lowest Apneic Sa02: ____ (blank value, I presume it was near my baseline of 94%?)

Hypopneas:
Total Number: 17
Hypopnea Index: 9.6 (hard to read.... assuming this is 9.6 based on a text summary at the end of the report though)
Longest Hypopnea: 50s (hard to read)
Lowest Hypopneic SaO2: 88%

RERA:
Total number: 0
RERA Index: 0.0hr

Saturation Information:
Baseline: 94%

90-100%: 99.8%
<90%:0.2%
Lowest SaO2: 88%

Snoring Evaluation: [ ] None [ ] Mild [X] Moderate [ ] Severe

Periodic Limb Movements in Sleep Information:
Total number of limb movements: 0
PLMS Index: 0/h
Bruxism present: No
Limb movements with arousals: 0
Arousal index due to periodic leg movements: 0
Comments: No periodic limb movements were noted

Cardiac Information:
Resting Heart Rate: 75.5 min
High Heart Rate: 83? (hard to read)
Low Heart Rate: 71/min
Comment: No cardiac arythmias were noted.



Scoring: R Williams RRT/RP5GT? (hard to read this)

Impressions:
1. This study shows REM-dependent Obstructive sleep apnea with AHI of 9.6 / hr during REM, but only 2.6 overall AHI.
2. moderate Oxyhemoglobin desaturation with o2 sat nadir of 88%.
3. Moderate snoring noted.
4. No PLM's noted
5. No cardiac events

Recommendations:
Repeat study with CPAP/BiPap titration is recommended. Alternatively, may consider trial of Auto-CPAP to see if patient experiences improved sleep quality and improvement in extreme daytime sleepiness. Evaluation for any anatomic or hormonal abnormalities that may contribute to obstructive sleep apnea and weights loss should also be considered. The patient should avoid driving or operating heavy equipment when drowsy in order to avoid injury.






So, that's my sleep study report. I'm sure this is mostly good news; however, where does this leave me in terms of the snoring? Doctor said that he could remove my tonsils, trim my palet, remove my uvulia, but only gave a 50% chance of any immediate improvement, and a high chance that even if it did improve, the problems woudl likely return a few years down the road. So, I'm not crazy about the idea of all of that surgery with such a low prognosis for short-term, much less, long-term success. So, if a machine will help with the snoring AND have me feeling more well rested on a consistent basis every morning, I'm all in. I called the doctor's office today and spoke to the nurse. She said that getting insurance to pay for any treatment with my current condition was pretty slim. Still, I told her that I wanted to try the ACPAP if at all possible.

As a side note, my brother-in-law has an ACPAP machine that he rarely, if ever, uses. He said he would lend it to me, but that I'd need to get my own mask and hose. Does anyone know if a prescription is required to buy a mask and hose? I noticed that none of the chain drug stores carry CPAP machines, hoses, or masks, so, i guess I'll have to try a medical supply store, if they will even sell it to me. I'd like to see what I'm buying since the masks are a little on the pricey side, and they comes in different sizes, etc.


Please, provide me with you insight on any of this above. I'm not even sure if I should be considering using a machine in the first place, based on what the doctor says; however, I don;t want to overlook it if it will help me and my wife both sleep better by helping my snoring.

[Xney]

So they're recommending a CPAP/BiPAP titration study for REM sleep apnea, why wouldn't that be the next step?

[jeffro2]

Interesting, actually. They never mailed me my results from the sleep lab, and my doctor never gave them to me. That sleep test was from over 6 months ago. I had an appointment with my ENT doctor and he discussed the sleep test with me at a high-level... basically said that he didn't recommend that I do anything unless I wanted to consider surgery, but he doesn;t recommend that because of the low chance of long-term success. He said I'm not going to suffer any heart issues becuase of my condition, so, that was kind of the end of it. I never really questioned it, unltil my wife and my kids (from all the way down the hall) continued to complain about my snoring.

Out of a desire to solve this snoring issue once and for all, I decided to press harder for some answers..... the first being to actually lay my eyes on the results from this sleep test from late last year which I never got a chance to see. It was only today when I actually saw the sleep test results that I saw that anything having to do with CPAP was even recommended. Of course, it could well be that the sleep lab recommends the machines more of ten than not in order to get repeat business for even mild cases..... really though, i don't care..... hey, if it can help me with my snoring, I'm ready to give it a try. I should be hearing back from my doctor tomorrow. I'm pressing hard for the trial with the Auto-CPAP machine if I can get it..... Will see what my wife says in terms of how effective it is. She's the ultimate judge on this because my snoring doesn't bother me one little bit!

[purple]

I am guessing you are not rolling in money, and are concerned about any costs.

If money was not a problem, then, I would do the sleep study over, as it said to do. When I went in for that sleep study, I would focus on sleeping on my back as much as possible, supine. This is likely to give you the numbers which would require your insurance company to pay for a machine, parts.

Yes, a prescription is required to get a mask, hose, et cetra. Altho, that prescription can be written by any doctor. A GP, Primary Care Physician. The down side is that masks are expensive without insurance in two ways. Insurance companies always negotiate a special price for their patients. Those who pay the most for health care in the US are those who have no insurance at all. Also usually if one has insurance, and thereby a DME, the DME is supposed to help you fitting the masks, and keep letting you try free masks, for at least the first thirty days. Altho I have had DME employees tell me that they will keep trying until I am satisfied, thirty days, sixty days. To get an idea of what the least expensive you can find a mask and hose for, you can look at our sponser, cpap.com, who sells things online, and will not work with any insurance company.

And some insurance companies pay so little that others on the forum here say they just buy things online as it is still cheaper for them.

So it still might be cheaper, and less frustrating to do another study. However some people - Well they do not do so well in a sleep study. The data produced might never be accurate.

Curious that your sleep doc did not call with a specific suggestion. Such as, "If you feel comfortable with it, do the sleep study again." I was told that the sleep study could get accurate data even if I did not sleep during the night of the study; Yes, I know that sounds like a contradiction, but it what they told me. Or maybe the doc/sleep clinic has some way to provide you with an at home trial. Still that has the downside that an insurance company might not ever choose to pick up on your treatment needs if a sleep study does not specifically say that you must have treatment for ____ reason. I had always thought if the oximeter said less than ninety, or even a little above, and the issue was not that the oximeter was slipping off one's finger, it was a true reading of less than ninety, then some kind of treatment should happen somehow. (Shows how little I know.) Or your doc saying, he will write all the scripts: Get a machine, and take your chances the insurance company might turn you down. That is not cheap if they turn you down. You may have a co-pay on a machine, even if the insurance company approves of it. But I am mentioning this for others in a similar circumstance who read this post, I do realize the OP said he could borrow a machine.

Not just any mask is likely to satisfy you. Finding the right mask for your face can be frustrating, and time consuming. Finding the right mask for just your face and your temperament is essential to getting rest.

I wrote this to another poster who was thinking of just getting a machine and going it alone:

. . . the insurance company is likely not going to pay for a machine unless the doc writes a script for a specific pressure setting. If the doc wants you to do a Titration (usually a second night study), I would be pretty sure the insurance company will cough up the money for the insurance company portion of that.

Of course, I know nothing of your co-pay or your personal financial situation. (For the record, I receive Social Security Disability and am underwater on all my medical bills, and I can not pay for the pleasurable things I personally want. Translate that, to I know where a lot of -We need to get out of paying for as much as possible" comes from).

I am not aware of an insurance company refusing to pay for the second night Titration. Can some of you others chime in if you have?

If your doc is a qualified sleep doc, and is OK with writing you an initial pressure setting, perhaps with an Auto machine. Then of course, he is a better judge of your medical needs than I am.

That being said, a lot of folks on this board seem to say one can titrate one's self by using an auto machine. I do not agree with that. Some can develop a problem exhaling against pressure (one example of a central) and perhaps kill themselves by playing this auto titration at home. That is a pretty rare circumstance. and truly your doc may already be sure you do not have that problem or one of several others that might rule against using an auto machine to to a home titration.

You might look at the wiki entry on Cheyne-Stokes. http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration

If you were looking at your data, would you recognize a Cheyne-Stokes breathing pattern?

I am OK with some people doing things to tweak their therapy by changing pressures themselves. I do.

I would also say that some do better on a straight pressure than an auto setting of pressures. Sometimes a machine on auto can chase things other than apneas, (leaks being one thing an auto can chase) which leaves the patient with an uncomfortable set of circumstances, running a far higher pressure than they actually need.

I also feel that starting Sleep Apnea Therapy can be very frustrating, and trying to self titrate at home with a machine on Auto multiplies the frustrations. Why anyone would try to make starting xPAP therapy harder by trying to self-titrate at home is beyond me.

If have not seen it: To lift it entirely out of someone else's post:
"Read and re-read JanKnitz's Mask Arrayed blog before you meet or talk with the DME and your insurance company. Her

[url=http://maskarrayed.wordpress.com/what-y ... me-part-i/

What you need to know before you meet your DME is chock-full of important info. "

Myself I have found DME's to be kind, caring people. At some points I was frustrated in that every time I spoke with my DME they could not tell me how much I owed them, or how much something would cost. They said they were the part of the DME that provided service, and did not have access to Billing information. What I have come to realize is, that after it was on my record that I had Medicare, meaning the company would get paid something for everything they provided, the person I spoke with was never concerned with whether their company made or lost money on me, whether I owed them money or not. They just sent me whatever I needed. They do keep records of like when I am entitled to a new cushion or mask every (three months for the mask), but they those who provide me service do not know whether my bill is paid up or not.

On the other hand, I do get bills from the DME billing arm every month. If never paid anything, that might be a problem. And I guess what I owe them is less than a hundred dollars. What I am trying to say, DME employees are not always evil trolls trying to cheat us. But do follow Janknitz's advice and keep your guard up.

If you do go to an overnight sleep titration, try not to be like me. I am such a smart mouth I can fail to create the space for the tech to tell me things about doing the treatment when I get home. All kinds of little things they know, but are not going to occur to us when starting treatment at home in a sleep deprived state. Every thing arranging the mask, pillows, or sometimes, the tech or sleep doc can look at our face and suggest the right mask, then coach us in using in. Instead of us, or me that is, trying to do it my way and suffering for it. I would observe that sometimes, the late night sleep techs do that part of the work because they prefer not to talk to people very much. All the ones, I actually I shut up long enough to listen to, knew an incredible amount how to do the treatment the easy way.

You can ask the sleep clinic for a payment plan of say, ten dollars a month for your co-pay.

Please keep in mind that a DME has employees that are to do different things. The first person who answers the phone is usually a receptionist whose sole job is to get your phone call onto a the next level of person who (yes, must first worry about doing the paperwork to sign you up - but if after most of the paperwork, then you can still go on to another DME. You can go onto another DME any time you want, the paperwork does not obligate you to do anything until you actually sign the receipt for having gotten equipment from that DME), and then the second level of person should help in finding you the right mask, helping you to use it. Be there for questions when you call back. In addition, the DME should employee a qualified Respiratory Therapist. Obviously the DME does not pay a lot of money to have a licensed RT to sit by the phone and wait for any phone call that comes in, but the RT usually can be relied on to call you back to talk, or arrange a face to face, according to your needs. Some on this forum seem to think when they first call a DME the phone should only be answered by a licensed RT. And like I said before, it is likely that no one at the DME you will speak with is going to be able to quote to you prices. Their job is to help people, another part of their organization handles the money part. All insurance policies are now in a constant state of flux, while insurance companies try to save themselves as much money as possible.

best wishes

[jeffro2]

purple,
Thanks so much for the info. i will continue to read up on this!