Newbie - Help me interpret Mild/Mod Diagnosis from Sleep Doc

[abagail]

Hi All,

I'm new to sleep apnea and the site,

I have been getting confusing messages - When I first got my sleep study result I was told by the registrar (junior doc) that there was nothing wrong with my sleep study, then the senior doc came in and said I had mild/moderate sleep apnea and that I should do a overnight trial with a cpap.

After the trial i went back to get the results/prescription - and they said it went well. At this appointment I asked for copies of both studies. The reason I undertook a sleep study in the first place was that I have chronic headaches, and my neurologist suggested I get checked out for sleep apnea. The sleep doc has sent a letter to my neurologist saying I have mild/moderate sleep apnea and to my GP saying I have mild sleep apnea - so I am somewhat confused about what category I actually fall into. All the data to me looks like it really falls into the mild category, and he said a number of times that I really didn't need to treat it if I didn't want to.

The data from my initial sleep study -

Epworth score 5/24
429 minutes of sleep
16% REM, 24% slow wave sleep, sleep efficiency 85%

SaO2 97% (NREM and REM), 0% of sleep spent below 90%
Respiratory events
AHI 12.4REM/9.1NREM
all hypopneas (62 in one big cluster over 1.5 hrs) mean duration 21 sec.
8.7/hr respiratory arousals
leg movement 7/hr - not periodic 3.1 leg movement arousals/hr
1 Rera for the night 0.1/hr
0 snore arousals
236 spontaneous arousals 33/hr
= Total 45/hr arousals

I remember the sleep tech coming in and putting the thing back in my nose during the night - When i asked if this falling out skewed the results they kind of ignored me. The registrar who initially said that there wasn't an issue with my sleep study said there was just a blip in the middle of the night -(the cluster of hypnopneas) - the sleep doc said it might be head position related (it was not related to a specific sleep position - i.e. lying on my back).

Anyway all the data looks like it should put me in the mild category??? except for maybe the spontaneous arousals? except I don't really get what that has to do with sleep apnea if they aren't breathing related? Although they get better on cpap - so maybe they are??

On my Cpap trial night I had
8 respiratory arousals 1.1/hr
11 leg movement arousals 1.5/hr
25 spontaneous arousals 3.4/hr
4 RERA 0.5/hr
0 Snore arousals
48 total 6.6/hr

AHI of 2.6REM/1.7NREM

So a lot better except I had some obstructive apneas.

I have been using a auto cpap (pressure 6-16) for the last week. I have actually been doing really well I think. My average AHI has been 0.4 (mixture of OA, H and CA), I've been looking at the data with sleepyhead - and I think I don't have any leak issues generally. I have been keeping the mask on all night and have been sleeping fairly normally. My only issues are the indents from the mask straps - I sleep on my side, so even though it's not tight, it gets pressed in, and the fact I can't scratch my nose if it gets itchy in the night.

Anyway if anyone has an idea what about my sleep data is the "moderate" part that would help my confusion. Also if anyone has an explanation for the spontaneous arousals and why they also improve on cpap that would also be appreciated.

Thanks very much.

[Julie]

Hi, I think if you were to get tested x 5 in 5 different labs (or at home) and interpreted by 5 different techs/doctors, you'd have 5 different labels re mod, mild, etc... so don't get hung up on those but just go by how numbers look on your software and how you feel. Besides, Cpap pressures are gauged by how much is needed to keep your particular airway open, not by the diagnosis of how mild or severe your apnea is (how many events/hr you have). You can have very many apneas and only need a low pressure to do the job for you, to keep your own airway open enough, and you can have only a relative few apnea events but because of anatomy, etc., need a high pressure - another reason to not be concerned about the label.

[englandsf]

I think it helps to distinguish between test results (AHI) and required pressure to treat.

Having a higher AHI does not predicate needing high pressure to treat it. We all "block" for different reasons even though we all need constant air to open us up.

You are at less risk because of your lower scores (although you did mention OK O2 sat numbers) but if the treatment is acceptable I'd certainly stick with it.

[abagail]

Thanks for the replys - I suppose I wasn't really understanding how he could say I was moderate but then also say I didn't really need treatment, but then write a letter to my doc saying I'm mild.

I haven't really had any improvement from treatment, but from everything I've read it can take ages to see improvement. I also only have mild fatigue that could be medication related (it started when i went on a particular medication) - I dont fall asleep during the day at all. My only other symptom is headaches which could also be unrelated. I don't have high blood pressure or heart issues etc.

Despite the first week on cpap (apap?) going really well - I've had a couple of nights (not in a row) where I've had issues. I woke up with major leaks and the pressure seemed really high. When I looked at the sleepy head data the pressure was getting up to my maximum 16 - and I was getting large leaks. I'm not sure what happens to cause the issue - i.e. the mask leaks so the pressure increases to compensate, or the pressure increases which causes the mask to leak. When it has happened I have stopped the machine readjusted the mask and started up again and it has seemed fine - generally on most nights my pressure doesn't get above about 11. (prescription is 6-16 at the moment). One of the nights was when I was in a different bed to my own and I think the hose position might have been dragging on the mask.

I'm not sure yet how to post a screenshot of data - but if someone has some tips that would be great. At my next appt with my sleep doc I will talk about changing the maximum pressure down. I don't want to do it on my own at this point.

[Julie]

Hi - it's your low pressure (6) that probably needs raising - it's the one that has to climb to catch events and when it's that low (never mind that it's hard to inhale at) it may not rise quickly enough to help, so I'd put it up by a couple of #'s to see how you do (10 seems to be an average, but many do fine on 7 or 9). Don't fuss with the high number or bother changing it now - it's not that meaningful - 12 might be ok, as would 18.

Headaches are standard with OSA and raising your low pressure should get rid of them. You're just not getting quite enough treatment as things stand.

As for leakage, that's something you do need to play with as far as the mask goes - if yours isn't doing the job, try others, but make sure you're fitted when lying down (if at all possible with a machine going) because your face changes so much when you do.

[Pugsy]

How to post screen shots of reports.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

[Starlette]

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[abagail]

Thanks - here are some screenshots from sleepyhead including the couple of nights I had the leakage issues - it looks like the mask started leaking after the pressure went right up high. I haven't noticed any leaking issues at the normal pressures.

I don't currently use a ramp but find the 6 mm min pressure really comfortable to fall asleep with - would raising this really reduce the likelyhood that the machine would rise higher later. Wouldn't I still need that pressure later?

All of my AHI values have been between 0- and 0.6 - The high ones were when I wasn't in my own bed, and I have actually had two nights with a zero AHI in the ~ 3 weeks I have been using the machine now. My average is 0.4 and this has been pretty consistent, when sleeping in my own bed, and sleeping my normal hours. The annoying thing is I am still getting up to go to the toilet which I wasn't before using the CPAP.