Newly Diagnosed-Questioning Results. Doctor Was Vague

[Jules_26]

I had a sleep study and felt like I barley slept at all. The report suggest the same. I was told that there was only 2.3 episodes and not enough to qualify for sleep apnea but the doctor was uncertain because I did not have sufficient sleep to really get a good reading. I then was sent home with a device that recorded that in 5 hours of time I had 5.4 episodes, therefore, I was diagnosed with Sleep Apnea. I went back for the CPAP fitting and was told I did well. I tolerated the cpap well. There is somewhat of a language barrier with the doctor and staff and I feel like I didn't get confident answers as it appears to me I am borderline diagnosable. I guess I don't have faith in the staff. Even with the better night sleep the second time I did not get much REM. I have read here that could be due to psychiatric meds. I am on several so can deduct this is affecting that. I could not get the graphs to copy/paste so I am thinking there is more to an image inserted. Please advise how to get the graph to be able to be copied here.

I had a heart attack last year with 2 stents.
Depression


Could I get someone to look at my reports and give me their thoughts?


Initial Sleep Study
SLEEP ANALYSIS REPORT
Patient Name:
Hospital # : 15364 Project : NPSG
Study Date : Nov. 19, 2015 Subject Code : 15364
Sex : Female Referring Physician :
D.O.B. : Sleep Specialist :
Age : 44 Study Indications : (ICSD-G47.33)
Height : 5'7" Physical Findings :
Weight : 230.0 lbs. Medications : Lisinopril, Metoprolol,
B.M.I. : 36.0 kg/m2 Norvasc, Atorvastatin

Test type: Overnight Diagnostic Nocturnal Polysomnography Study (NPSG)

Montage: This is a conventional polysomnographic study performed during the patient's habitual sleep period in accordance with standards established by the American Academy of Sleep Medicine. Parameters include bilateral electrooculographic tracings; electroencephalographic tracings (modified 10:20 electrode configuration, featuring bilateral central and occipital leads); surface electromyography of submental musculature and bilateral anterior tibialis muscles; thoracic and abdominal piezo-crystal respiratory belt recordings; electrocardiography; arterial oxygen hemoglobin saturation via finger pulse oximetry; and snoring intensity via decibel meter recording.

Indication: a very pleasant 44 year-old female reported to Bel-Red Sleep Diagnostic Center for an overnight fully-attended Nocturnal Polysomnography study to rule out obstructive sleep apnea. Patient’s chief complaints were snoring, sleepiness, trouble sleeping and tiredness and she denied breathing pauses during sleep. She indicates that most of the time she feels tired and waking up feeling not getting enough sleep. Her score on the Epworth Sleepiness Scale was 12/24, less than 10 are normal.

The patient arrived at the sleep center unaccompanied. She filled out the sleep center questionnaire. The sleep technologist explained the process of the sleep study. She was very pleasant and tolerated the electrode hook up process very well. She denied nasal congestion and did not have any physical complaint at this time. She took her regular medications and 10mg of Zolpidem prior to the study. She usually goes to bed at between 11:30 pm and wakes up at 10:00 am during weekdays and on weekends as well. Lights were turned off at 9:26 pm.

Summary of Findings:
Apnea/Hypopnea Index: 2.5/hr
Minimum SaO2: 93.0 % Maximum SaO2: 100.0 % Mean SaO2: 97.4 % Total Sleep Time: 415.5 minutes Sleep Efficiency: 83.2%

Snoring Report:
Audibly mild to moderate intensity of snoring was noted during sleep.

EKG Report:
EKG rhythm demonstrated normal sinus rhythm with sleep heart rates of 48 to 76 beats per minute and no significant abnormalities noted.

Movement Analysis:
There were 39 periodic limb movements during sleep and of which, 13 were associated with arousals. This represented a total index of 5.6 events per hour, with an associated arousal index of 1.9 per hour.

The patient slept in the supine position during this diagnostic study. Patient stated in the morning questionnaire that her sleep was lighter, shorter and worse than usual.

Physician report:

Indications: She was referred to this study because of loud snoring, non-restorative sleep, daytime fatigue and somnolence, obesity, insomnia, frequent nocturia (1-2 times), frequent morning headache and heart disease with s/p a heart attack.

Sleep architectural: Sleep onset latency was prolonged and sleep efficiency was slightly reduced. There was absence of REM sleep and stage III sleep was reduced.

Respiration: She had a normal apnea hypopnea index (AHI) of 2.5 per hour (less than 5 are normal) though snoring was noted; the lowest oxygen was 93% and she slept in the supine position for the entire night.

Cardiac: Single-lead ECG revealed sinus rhythm without significant abnormalities noted.

Movement: No significantly elevated periodic limb movements in sleep were noted.

Interpretation& Recommendations: This study did not reveal either clinic significance of sleep apnea, hypoxemia or significantly elevated periodic limb movements in sleep to explain the non-restorative sleep and the daytime fatigue / sleepiness and sleep fragmentation. This study might be false negative for sleep apnea due to insomnia an absence of REM sleep; thus consider a repeat sleep study if clinically warranted.








Sleep Architecture
Time at Lights Off : 09:26:49
Time at Lights On : 05:46:02
Total Recording Time (TRT) : 499.2 min.
Total Sleep Period (TSP) : 442.0 min.
Total Sleep Time (TST) : 415.5 min.
Sleep Efficiency (SE) :
83.2 %

Sleep Onset Latency (SOL) : 57.2 min.
Number of Stage 1 Shifts : 23
Number of Stage Shifts : 67
Number of Awakenings : 17

Number of REM Periods :
0
REM Latency : N.A min.
REM Latency minus Awake : N.A min.


Sleep Stages
STAGES
TIME
(min.) TST (%) LATENCY
(min.)
Wake: 26.5 – –
Stage 1: 37.0 8.9 0.0
Stage 2: 362.5 87.2 4.5
Stage ¾ Delta: 16.0 3.9 123.5
REM: 0.0 0.0 N.A


Body Position Analysis
PARAMETER Minutes % TST
Supine 415.5 100.0
Prone 0.0 0.0
Left 0.0 0.0
Right 0.0 0.0


Apnea Events
PARAMETER CENTRAL OBSTRUCTIVE MIXED TOTAL
Number: 0 4 0 4
Index: 0.0 0.6 0.0 0.6
Mean Duration (sec): N/A 14.1 N/A 14.1
Longest Duration (sec): N/A 22.0 N/A 22.0
Occur in REM: 0 0 0 0
Occur in Non-REM: 0 4 0 4
REM Index: 0.0 0.0 0.0 0.0
Non-REM Index: 0.0 0.6 0.0 0.6

Hypopnea Events
PARAMETER CENTRAL OBSTRUCTIVE MIXED TOTAL
Number: 0 13 0 13
Index: 0.0 1.9 0.0 1.9
Mean Duration (sec): N/A 20.3 N/A 20.3
Longest Duration (sec): N/A 34.7 N/A 34.7
Occur in REM: 0 0 0 0
Occur in Non-REM: 0 13 0 13
REM Index: 0.0 0.0 0.0 0.0
Non-REM Index: 0.0 1.9 0.0 1.9

Respiratory Events and Body Position
PARAMETER INDEX TOTAL
Apneas & Hypopneas: 2.5 17
Supine Events: 2.5 17
Non-Supine Events: 0.0 0
Prone: 0.0 0
Left Lateral: 0.0 0
Right Lateral: 0.0 0

Respiratory Events Summary

Index Total
AHI (Apneas + Hypopneas): 2.5 17
RDI (Apneas + Hypopneas + RERAs): 2.5 17
Non-REM Events: 2.5 17
REM Events: 0.0 0


Respiratory Events With Arousals
PARAMETER INDEX TOTAL
Total Events: 2.5 17
Non-REM Events: 2.5 17
REM Events: No REM 0

PLMs and Sleep Stages
STAGES PLM AROUSAL INDEX TOTAL PLM INDEX PLM AROUSALS TOTAL PLM's
Total Sleep: 1.9 5.6 13 39
Stage 1: 0.0 0.0 0 0
Stage 2: 2.2 6.5 13 39
Stage ¾ Delta: 0.0 0.0 0 0
REM: 0.0 0.0 0 0


PLM Events with Arousals
PARAMETER INDEX TOTAL
Total Events: 1.9 13
Non-REM Events: 1.9 13
REM Events: 0.0 0


PLM Events without Arousals
PARAMETER INDEX TOTAL
Total Events: 3.8 26
Non-REM Events: 3.8 26
REM Events: 0.0 0


Spontaneous Arousals
PARAMETER INDEX TOTAL
Total Events: 60.9 422
Non-REM Events: 60.9 422
REM Events: 0.0 0

Oxygen Desaturation

Index Total
Total Sleep Time (TST): 0.9 6
Wake After Sleep (WAS): 0.0 0
Non-REM: 0.9 6
REM: 0.0 0

Oxygen Saturation
PARAMETER AWAKE NREM REM TOTAL RECORD
Mean SaO2 % : 97.6 97.4 N.A 97.4
Min. SaO2 % : 92.0 93.0 N.A 92.0
Max. SaO2 % : 100.0 100.0 N.A 100.0
% Duration of SaO2 In Range :
90 – 100 % : 100.0 100.0 N.A 100.0
80 – 90 % : 0.0 0.0 N.A 0.0
70 – 80 % : 0.0 0.0 N.A 0.0
60 – 70 % : 0.0 0.0 N.A 0.0
50 – 60 % : 0.0 0.0 N.A 0.0
Below 50 % : 0.0 0.0 N.A 0.0


Pressure Level Analysis:
Pressure (cm H2O) TRT
(min) REM
(min) NonREM
(min) Obs. Apnea Cen. Apnea Mixed Apnea Hypopneas Total Events RDI SaO2 %
Max. SaO2
%
Min. SaO2
%
Mean
Cpap Tags
Bi-Level Tags

Subject Code: 15364 Study Date: 11-19-2015

GRAPHS -Will not paste

**************************************************************************************************************************************************************************************************************
Second night CPAP Fitting

SLEEP ANALYSIS REPORT
Patient Name:
Hospital # : 15374 Project : NCPAP
Study Date : Dec. 03, 2015 Subject Code : 15374
Sex : Female Referring Physician :
D.O.B. : Sleep Specialist :
Age : 44 Study Indications : (ICSD-G47.33)
Height : 5'7" Physical Findings :
Weight : 230.0 lbs. Medications : Lisinopril, Metoprolol,
B.M.I. : 36.0 kg/m2 Norvasc, Atorvastatin

Test type: Continuous Positive Airway Pressure (CPAP) Titration Study:

Montage: This is a conventional polysomnographic study performed during the patient's habitual sleep period in accordance with standards established by the American Academy of Sleep Medicine. Parameters include bilateral electrooculographic tracings; electroencephalographic tracings (modified 10:20 electrode configuration, featuring bilateral central and occipital leads); surface electromyography of submental musculature and bilateral anterior tibialis muscles; thoracic and abdominal piezo-crystal respiratory belt recordings; electrocardiography; arterial oxygen hemoglobin saturation via finger pulse oximetry; and snoring intensity via decibel meter recording.

Indication: for an overnight CPAP titration study. The patient was diagnosed with mild obstructive sleep apnea recently with an overall Apnea Hypopnea Index (AHI) of 5.4/hour without associated hypoxemia. The oxygen saturation nadir was 90%.

Sleep Analysis Summary Report:
The patient arrived at the sleep center unaccompanied. She filled out the sleep center bedtime questionnaire. The sleep technologist explained the process of the CPAP treatment study. The patient was very pleasant and tolerated the CPAP trials at the pressure setting of 5cm/H2O. Different types of mask interfaces were fitted and she preferred to use the Mirage Swift II small size nasal pillow mask interface. She also tolerated the electrode hook up process very well. At bedtime, CPAP was initiated with a starting pressure of 5cm/H2O with 2cm of C-Flex and using nasal pillow mask interface. Lights were turned off at 9:56 pm.

Summary of Findings:
Apnea/Hypopnea Index: 2.3/hr
Minimum SaO2: 91% Maximum SaO2: 100.0 % Mean SaO2: 95.0% Total Sleep Time: 420.8 minutes Sleep Efficiency: 86.1%

CPAP pressure was started at 5cm/H2O and titrated up to 8cm/H2O. The patient tolerated the pressure settings of CPAP at 5cm to 8cm/H2O and Mirage Swift II small size nasal pillow mask interface.

The patient slept on her supine and non-supine position during this CPAP treatment study. The patient stated in the morning questionnaire that her sleep was restful and the same as usual while CPAP was in use.

EKG Analysis:
EKG rhythm demonstrated normal sinus rhythm with sleep heart rates of 52 to 86 beats per minute and no significant abnormalities noted.

Movement Analysis:
There were 44 periodic limb movements during sleep and of which, 12 were associated with arousals. This represented a total index of 6.3 events per hour, with an associated arousal index of 1.7 per hour.

Physician Report:

Sleep architectural: Sleep onset latency was prolonged and sleep efficiency was mildly reduced. REM latency was prolonged along with a substantially reduced amount of REM sleep and stage III sleep was within normal limits.

Titration: CPAP was titrated in a range of 5 to 8 cm of H2O. And CPAP at each of these pressures settings was able to treat the sleep apnea with oxygen nadir of 91% and higher; she obtained a fair amount of supine REM sleep at 6 cm.

Cardiac: Single-lead ECG revealed sinus rhythm without significant abnormalities noted.

Movement: No significantly elevated periodic limb movements in sleep were noted.

Interpretation: Mild obstructive sleep apnea with an optimal CPAP titration.

Recommendations: Start CPAP in a range of 5 to 8 cm of H2O if clinically warranted.





Sleep Architecture
Time at Lights Off : 09:56:03
Time at Lights On : 06:04:50
Total Recording Time (TRT) : 488.8 min.
Total Sleep Period (TSP) : 432.8 min.
Total Sleep Time (TST) : 420.8 min.
Sleep Efficiency (SE) :
86.1 %

Sleep Onset Latency (SOL) : 56.0 min.
Number of Stage 1 Shifts : 15
Number of Stage Shifts : 49
Number of Awakenings : 13

Number of REM Periods :
1
REM Latency : 282.0 min.
REM Latency minus Awake : 272.0 min.


Sleep Stages
STAGES
TIME
(min.) TST (%) LATENCY
(min.)
Wake: 12.0 – –
Stage 1: 15.0 3.6 0.0
Stage 2: 370.8 88.1 1.5
Stage ¾ Delta: 20.0 4.8 74.0
REM: 15.0 3.6 282.0


Body Position Analysis
PARAMETER Minutes % TST
Supine 243.7 57.9
Prone 0.0 0.0
Left 89.1 21.2
Right 0.0 0.0


Apnea Events
PARAMETER CENTRAL OBSTRUCTIVE MIXED TOTAL
Number: 0 12 0 12
Index: 0.0 1.7 0.0 1.7
Mean Duration (sec): N/A 13.2 N/A 13.2
Longest Duration (sec): N/A 20.9 N/A 20.9
Occur in REM: 0 2 0 2
Occur in Non-REM: 0 10 0 10
REM Index: 0.0 8.0 0.0 8.0
Non-REM Index: 0.0 1.5 0.0 1.5

Hypopnea Events
PARAMETER CENTRAL OBSTRUCTIVE MIXED TOTAL
Number: 0 4 0 4
Index: 0.0 0.6 0.0 0.6
Mean Duration (sec): N/A 15.5 N/A 15.5
Longest Duration (sec): N/A 18.5 N/A 18.5
Occur in REM: 0 0 0 0
Occur in Non-REM: 0 4 0 4
REM Index: 0.0 0.0 0.0 0.0
Non-REM Index: 0.0 0.6 0.0 0.6

Respiratory Events and Body Position
PARAMETER INDEX TOTAL
Apneas & Hypopneas: 2.3 16
Supine Events: 2.5 10
Non-Supine Events: 4.0 6
Prone: 0.0 0
Left Lateral: 4.0 6
Right Lateral: 0.0 0

Respiratory Events Summary

Index Total
AHI (Apneas + Hypopneas): 2.3 16
RDI (Apneas + Hypopneas + RERAs): 2.3 16
Non-REM Events: 2.1 14
REM Events: 8.0 2


Respiratory Events With Arousals
PARAMETER INDEX TOTAL
Total Events: 2.3 16
Non-REM Events: 2.1 14
REM Events: 8.0 2

PLMs and Sleep Stages
STAGES PLM AROUSAL INDEX TOTAL PLM INDEX PLM AROUSALS TOTAL PLM's
Total Sleep: 1.7 6.3 12 44
Stage 1: 0.0 20.0 0 5
Stage 2: 1.9 6.1 12 38
Stage ¾ Delta: 0.0 0.0 0 0
REM: 0.0 4.0 0 1


PLM Events with Arousals
PARAMETER INDEX TOTAL
Total Events: 1.7 12
Non-REM Events: 1.8 12
REM Events: 0.0 0


PLM Events without Arousals
PARAMETER INDEX TOTAL
Total Events: 4.6 32
Non-REM Events: 4.6 31
REM Events: 4.0 1


Spontaneous Arousals
PARAMETER INDEX TOTAL
Total Events: 51.3 360
Non-REM Events: 53.1 359
REM Events: 4.0 1

Oxygen Desaturation

Index Total
Total Sleep Time (TST): 0.0 0
Wake After Sleep (WAS): 0.0 0
Non-REM: 0.0 0
REM: 0.0 0

Oxygen Saturation
PARAMETER AWAKE NREM REM TOTAL RECORD
Mean SaO2 % : 94.7 95.1 95.2 95.0
Min. SaO2 % : 93.0 91.0 91.0 91.0
Max. SaO2 % : 100.0 99.0 97.0 100.0
% Duration of SaO2 In Range :
90 – 100 % : 99.5 100.0 99.2 99.9
80 – 90 % : 0.0 0.0 0.0 0.0
70 – 80 % : 0.0 0.0 0.0 0.0
60 – 70 % : 0.0 0.0 0.0 0.0
50 – 60 % : 0.0 0.0 0.0 0.0
Below 50 % : 0.0 0.0 0.0 0.0


Pressure Level Analysis:
Pressure (cm H2O) TRT
(min) REM
(min) NonREM
(min) Obs. Apnea Cen. Apnea Mixed Apnea Hypopneas Total Events RDI SaO2 %
Max. SaO2
%
Min. SaO2
%
Mean
Cpap Tags
5 269.4 0.0 204.8 1 0 0 0 1 0.3 100.0 93.0 95.0
6 85.5 12.5 71.5 3 0 0 0 3 2.1 98.0 91.0 94.9
7 92.7 2.5 88.7 3 0 0 2 5 2.6 99.0 91.0 95.3
8 41.2 0.0 40.7 3 0 0 2 5 2.6 98.0 91.0 95.2
Bi-Level Tags


Patient Subject Code: 15374 Study Date: 12-03-2015

GRAPHS SLEEP ANALYSIS REPORT
Patient Name:
Hospital # : 15374 Project : NCPAP
Study Date : Dec. 03, 2015 Subject Code : 15374
Sex : Female Referring Physician :
D.O.B. : Sleep Specialist :
Age : 44 Study Indications : (ICSD-G47.33)
Height : 5'7" Physical Findings :
Weight : 230.0 lbs. Medications : Lisinopril, Metoprolol,
B.M.I. : 36.0 kg/m2 Norvasc, Atorvastatin

Test type: Continuous Positive Airway Pressure (CPAP) Titration Study:

Montage: This is a conventional polysomnographic study performed during the patient's habitual sleep period in accordance with standards established by the American Academy of Sleep Medicine. Parameters include bilateral electrooculographic tracings; electroencephalographic tracings (modified 10:20 electrode configuration, featuring bilateral central and occipital leads); surface electromyography of submental musculature and bilateral anterior tibialis muscles; thoracic and abdominal piezo-crystal respiratory belt recordings; electrocardiography; arterial oxygen hemoglobin saturation via finger pulse oximetry; and snoring intensity via decibel meter recording.

for an overnight CPAP titration study. The patient was diagnosed with mild obstructive sleep apnea recently with an overall Apnea Hypopnea Index (AHI) of 5.4/hour without associated hypoxemia. The oxygen saturation nadir was 90%.

Sleep Analysis Summary Report:
The patient arrived at the sleep center unaccompanied. She filled out the sleep center bedtime questionnaire. The sleep technologist explained the process of the CPAP treatment study. The patient was very pleasant and tolerated the CPAP trials at the pressure setting of 5cm/H2O. Different types of mask interfaces were fitted and she preferred to use the Mirage Swift II small size nasal pillow mask interface. She also tolerated the electrode hook up process very well. At bedtime, CPAP was initiated with a starting pressure of 5cm/H2O with 2cm of C-Flex and using nasal pillow mask interface. Lights were turned off at 9:56 pm.

Summary of Findings:
Apnea/Hypopnea Index: 2.3/hr
Minimum SaO2: 91% Maximum SaO2: 100.0 % Mean SaO2: 95.0% Total Sleep Time: 420.8 minutes Sleep Efficiency: 86.1%

CPAP pressure was started at 5cm/H2O and titrated up to 8cm/H2O. The patient tolerated the pressure settings of CPAP at 5cm to 8cm/H2O and Mirage Swift II small size nasal pillow mask interface.

The patient slept on her supine and non-supine position during this CPAP treatment study. The patient stated in the morning questionnaire that her sleep was restful and the same as usual while CPAP was in use.

EKG Analysis:
EKG rhythm demonstrated normal sinus rhythm with sleep heart rates of 52 to 86 beats per minute and no significant abnormalities noted.

Movement Analysis:
There were 44 periodic limb movements during sleep and of which, 12 were associated with arousals. This represented a total index of 6.3 events per hour, with an associated arousal index of 1.7 per hour.

Physician Report:

Sleep architectural: Sleep onset latency was prolonged and sleep efficiency was mildly reduced. REM latency was prolonged along with a substantially reduced amount of REM sleep and stage III sleep was within normal limits.

Titration: CPAP was titrated in a range of 5 to 8 cm of H2O. And CPAP at each of these pressures settings was able to treat the sleep apnea with oxygen nadir of 91% and higher; she obtained a fair amount of supine REM sleep at 6 cm.

Cardiac: Single-lead ECG revealed sinus rhythm without significant abnormalities noted.

Movement: No significantly elevated periodic limb movements in sleep were noted.

Interpretation: Mild obstructive sleep apnea with an optimal CPAP titration.

Recommendations: Start CPAP in a range of 5 to 8 cm of H2O if clinically warranted.





Sleep Architecture
Time at Lights Off : 09:56:03
Time at Lights On : 06:04:50
Total Recording Time (TRT) : 488.8 min.
Total Sleep Period (TSP) : 432.8 min.
Total Sleep Time (TST) : 420.8 min.
Sleep Efficiency (SE) :
86.1 %

Sleep Onset Latency (SOL) : 56.0 min.
Number of Stage 1 Shifts : 15
Number of Stage Shifts : 49
Number of Awakenings : 13

Number of REM Periods :
1
REM Latency : 282.0 min.
REM Latency minus Awake : 272.0 min.


Sleep Stages
STAGES
TIME
(min.) TST (%) LATENCY
(min.)
Wake: 12.0 – –
Stage 1: 15.0 3.6 0.0
Stage 2: 370.8 88.1 1.5
Stage ¾ Delta: 20.0 4.8 74.0
REM: 15.0 3.6 282.0


Body Position Analysis
PARAMETER Minutes % TST
Supine 243.7 57.9
Prone 0.0 0.0
Left 89.1 21.2
Right 0.0 0.0


Apnea Events
PARAMETER CENTRAL OBSTRUCTIVE MIXED TOTAL
Number: 0 12 0 12
Index: 0.0 1.7 0.0 1.7
Mean Duration (sec): N/A 13.2 N/A 13.2
Longest Duration (sec): N/A 20.9 N/A 20.9
Occur in REM: 0 2 0 2
Occur in Non-REM: 0 10 0 10
REM Index: 0.0 8.0 0.0 8.0
Non-REM Index: 0.0 1.5 0.0 1.5

Hypopnea Events
PARAMETER CENTRAL OBSTRUCTIVE MIXED TOTAL
Number: 0 4 0 4
Index: 0.0 0.6 0.0 0.6
Mean Duration (sec): N/A 15.5 N/A 15.5
Longest Duration (sec): N/A 18.5 N/A 18.5
Occur in REM: 0 0 0 0
Occur in Non-REM: 0 4 0 4
REM Index: 0.0 0.0 0.0 0.0
Non-REM Index: 0.0 0.6 0.0 0.6

Respiratory Events and Body Position
PARAMETER INDEX TOTAL
Apneas & Hypopneas: 2.3 16
Supine Events: 2.5 10
Non-Supine Events: 4.0 6
Prone: 0.0 0
Left Lateral: 4.0 6
Right Lateral: 0.0 0

Respiratory Events Summary

Index Total
AHI (Apneas + Hypopneas): 2.3 16
RDI (Apneas + Hypopneas + RERAs): 2.3 16
Non-REM Events: 2.1 14
REM Events: 8.0 2


Respiratory Events With Arousals
PARAMETER INDEX TOTAL
Total Events: 2.3 16
Non-REM Events: 2.1 14
REM Events: 8.0 2

PLMs and Sleep Stages
STAGES PLM AROUSAL INDEX TOTAL PLM INDEX PLM AROUSALS TOTAL PLM's
Total Sleep: 1.7 6.3 12 44
Stage 1: 0.0 20.0 0 5
Stage 2: 1.9 6.1 12 38
Stage ¾ Delta: 0.0 0.0 0 0
REM: 0.0 4.0 0 1


PLM Events with Arousals
PARAMETER INDEX TOTAL
Total Events: 1.7 12
Non-REM Events: 1.8 12
REM Events: 0.0 0


PLM Events without Arousals
PARAMETER INDEX TOTAL
Total Events: 4.6 32
Non-REM Events: 4.6 31
REM Events: 4.0 1


Spontaneous Arousals
PARAMETER INDEX TOTAL
Total Events: 51.3 360
Non-REM Events: 53.1 359
REM Events: 4.0 1

Oxygen Desaturation

Index Total
Total Sleep Time (TST): 0.0 0
Wake After Sleep (WAS): 0.0 0
Non-REM: 0.0 0
REM: 0.0 0

Oxygen Saturation
PARAMETER AWAKE NREM REM TOTAL RECORD
Mean SaO2 % : 94.7 95.1 95.2 95.0
Min. SaO2 % : 93.0 91.0 91.0 91.0
Max. SaO2 % : 100.0 99.0 97.0 100.0
% Duration of SaO2 In Range :
90 – 100 % : 99.5 100.0 99.2 99.9
80 – 90 % : 0.0 0.0 0.0 0.0
70 – 80 % : 0.0 0.0 0.0 0.0
60 – 70 % : 0.0 0.0 0.0 0.0
50 – 60 % : 0.0 0.0 0.0 0.0
Below 50 % : 0.0 0.0 0.0 0.0


Pressure Level Analysis:
Pressure (cm H2O) TRT
(min) REM
(min) NonREM
(min) Obs. Apnea Cen. Apnea Mixed Apnea Hypopneas Total Events RDI SaO2 %
Max. SaO2
%
Min. SaO2
%
Mean
Cpap Tags
5 269.4 0.0 204.8 1 0 0 0 1 0.3 100.0 93.0 95.0
6 85.5 12.5 71.5 3 0 0 0 3 2.1 98.0 91.0 94.9
7 92.7 2.5 88.7 3 0 0 2 5 2.6 99.0 91.0 95.3
8 41.2 0.0 40.7 3 0 0 2 5 2.6 98.0 91.0 95.2
Bi-Level Tags

[jnk...]

Sounds like you are going to get to try PAP [positive airway pressure] therapy.

If so, don't worry too much about the details of the studies. Although the studies sometimes give clues to us patients about our condition, the primary purpose of them is to document enough data to prove to insurance that they should pay for you to try PAP therapy to see if that helps you feel better.

I would not discount the severity just because your AHI [apnea hypopnea index] is borderline. Sometimes people with so-called borderline OSA [obstructive sleep apnea] benefit the most from PAP. Many of us don't sleep during the studies the way we normally sleep.

On the other hand, I would not let the diagnosis of OSA upset me--it is just a useful medical label that allows you to try something that may help you feel refreshed in the mornings and during the day.

It appears you have some limb movements during sleep that may be disturbing your sleep. Those may go away on their own. But if they don't, you may still feel rough in the mornings and during the day. So that may be worth looking into if PAP doesn't seem to fix how you feel.

Doctors can seem particularly vague when they are humble enough to realize they don't have all the answers based on a few studies designed to prove things to insurance.

Bottom line is that you may benefit a lot from CPAP and you might not. The real test will be from how you respond to therapy, and your team thought your body responded well to it from what they saw. Hopefully it will be of benefit to you over time if you use it every night all night. If so, GREAT! If not, that doesn't mean you or they failed. It is worth a try just to find out, so try to file it under that for now.

In other words: "Do I have OSA or not?" may not be as useful a question as "Might I benefit from trying PAP to see if that will help?" Practically speaking.

The above is only the personal opinion of a guy on the Internet with no medical training whatsoever--me. In fact, I am not even very good with band aides.

-jeff

[Julie]

Hi - I strongly suggest you try sleeping on your sides or front rather than back - make an effort to not do so, if necessary wearing a backpack or something to prevent you turning onto your back while asleep for at least a couple of nights, and then see what results look like. I imagine you might well find that snoring is much less, if not gone, and that your AHI numbers are lower - could even be low enough to not qualify as your having apnea. Please let us know how that goes, and good luck.

[highstick]

Careful with the "junk in the back"...That's what my cardiologist told me after failing to tolerate the mask in two titration attempts after being diagnosed with moderate sleep apnea. Well, now my back hurts so bad that I can't sleep on my back much anyway. More comfortable on the side, but that did not cure anything. He wouldn't give me a machine unless I could log 6 hours on it in a one night session. So I quit, messed around for 6 years and went to another Doc...Same thing happened. I was ok with the wires, obviously had apnea events high enough to start the titration test. But I had gotten extremely claustrophobic after 3 tests.

After going back to the new Doc(an ENT), we discussed oral devices, etc, but I was convinced if I could take the machine home, I could beat it. Well, I got my compliance letter today. Only 1 night when I was sick with a horrible cold did I tolerate it less than 4 hours, in fact I'm averaging over 6 and have gone as high as 10. Sleep is better, attitude is better, but I'd like to shove that "tennis ball in my tee shirt" up the backside of that first cardiologist.

[jnk...]

. . . but I'd like to shove . . .

This just in: A cardiologist mumbling something about a T-shirt and a tennis ball was reportedly seen limping into a proctologist's office earlier today. Details at eleven.

[tiredandscared]

I don't think it might be too much worse. Not clinically significant worse anyway. Even with 15% rem sleep your AHI only went up 5.4. Your oxygen saturation looks excellent. Try the cpap see if it gets better.

[WindCpap]

It looks like they have given you cpap based on your own self reported clinical observations for the Titration study, and not on lab numbers.

Hi - I strongly suggest you try sleeping on your sides or front rather than back - make an effort to not do so, if necessary wearing a backpack or something to prevent you turning onto your back while asleep for at least a couple of nights, and then see what results look like. I imagine you might well find that snoring is much less, if not gone, and that your AHI numbers are lower - could even be low enough to not qualify as your having apnea. Please let us know how that goes, and good luck.

And how are you supposed to know apart from a sleep study that your AHI numbers are lower absent your CPAP?. Without loaner equipment from the sleep lab, you cannot diagnose untreated sleep apnea at home. If you are a back sleeper, and you have positional sleep apnea, the CPAP will treat it, and you don't have to worry about it. Sleeping on your back is the easiest position for tolerating sleep apnea, and I would recommend just the opposite of this post. Sleep how you are most comfortable, and learn to use to the CPAP.

Any airway issues were fully treated at the titrated pressure when you were laying on your back. You should use the CPAP at the prescribed settings, get used to it, and then evaluate the level of improvement a few weeks after you are sleeping full nights with it on. This will give you your final diagnosis. If improved, you need to treat/modify for sleep apnea. If you don't, it is something else. Losing weight/sleeping on your side/wearing an oral appliance all will help with the very mild sleep apnea, but CPAP is easiest.

[chunkyfrog]

+1000
Cpap is easiest!
Heck yeah!

[Sonnyboy]

. . . but I'd like to shove . . .

This just in: A cardiologist mumbling something about a T-shirt and a tennis ball was reportedly seen limping into a proctologist's office earlier today. Details at eleven.

Appreciate your humor.
Laughter is healing.
Thank you