Here is the scoop.

[admiralross]

I finally got my medical records back from my old hospital from last. Here is what it says. I'll post both studies.

First Sleep Study: Findings

Admiral Ross was in bed for 349 mins and slept for 322 mins, yielding a good sleep efficiency of 92%. The sleep latency was 3 mins; the REM latency 129 mins. Stage 1 transitional sleep was very severely elevated at 60% of total sleep time. Slow wave sleep was virtually absent at 3 mins. REM sleep was moderately restricted at 28 mins.

respiratory monitoring revealed 110 obstructive apneas, 2 mixed apneas, and 0 central apneas. These averaged 21 secs, with a max duration of 33 secs. There were 157 hypopneas, avg. 26 secs with a max duration of 60 secs. This yielded an overall repiratory disturbance index of 50 events per hr of sleep, in the severely elevated range. 31% of the recording was obtained in the supine position with a very strong positional effect. The supine respiratory disturbance index was 92 events per hrs of sleep. The index in REM sleep was 71 events per hr. Basal oxygen saturation was 98%, with moderate to severe desaturations to a low of 72% observed. About a quarter of total sleep time was spent with oxygen saturations below 90% Sever desaturations were closely associated with REM sleep. Snoring was characterized as moderate on this night. Leg movements monitoring showed 184 periodic leg movements during sleep. 0 of thse were associated with arousal. The EKG detected isolated PACs. Sleep was very severely fragmented primarily due to respiratory events and snoring, with a total of 364 transient arousals yielding an index of about 68 per hr.

Final Diagnosis: Severe Obstructive Sleep Apnea, with pronounced positional and REM components.

Findings: Admiral Ross was in bed for 352 mins. and slept for 337 mins, yielding a very good sleep efficiency of 96%. The sleep latency was immediate; the REM latency 120 mins. Stage 1 transitional sleep was within normal limits at 13%of total sleep time, compared to 60% seen on baseline. Slow ave sleep was virtually absent at 1 min, comparable to 3 mins on baseline. REM SLEEP WAS WITHIN NORAL LIMITS AT 84 MINS, COMPARED TO 28 MINS SEEN ON BASELINE. 41% of the recordings was spent in the supine position.

During the recording, nasal CPAP was applied from 7 to 14 cm. During nearly 1.5 of primarily supine sleep at 12 cm, which included 25 mins of REM sleep, the respiratory disturbance index was 0 events per hr. Basal oxygen saturation was 98%, with minimal desaturations to a low of 94% observed when titrated. Lev movement monitoring slowed 20 periodic leg movements during sleep. 0 of these were associated with arousal. The EKG detected up to 25 PVCs per hr, primarily in REM sleep. Sleep was mildly fragmented primarily due to spontaneous arousals, with a total of 37 transient arousals yielding an index of about 7 per hr. The transient arousal index when titrated was 2 per hr.

Can someone explain to me what all of this is. Am I reading this correctly that I have PLMD? The dr. never mentioned it to me. Today after reading these records is my first of ever knowing it. Now, I have an appointment on the 3rd of Oct, I can finally go in with these papers. I'm really anxious to get this show on the road.

Thanks.

[Gerald]

After having been on the hose for a year.....and knowing what I know now......I'd go for the following (if my report looked like yours).

1. "M" Series with AFLEX
2. Heated Integral Humidifier
3. Nasal Mask (Aura)
4. Overhead Hose Hanger
5. Recording Card
6. Card Reader and version 1.8 Encore Software
7. James Skinner's Analyzer Software
8. Lensenoh Lanolin for your nares
9. Chin Strap to help keep your mouth closed
10. SPO PulseOX 7500 Recording Oximeter
11. Insulating Hose Cover

Don't let them talk you into anything less. The above will give you the flexibility to correctly manage your own treatment (you'll learn to do that far better than your RT or doctor).

The software is vital. Get Encore 1.8 any way you can. I consider it almost impossible to correctly manage my own treatment without software. Analyzer software from James Skinner will enable you to do a great management job. Encore isn't good enough by itself.

Finally, please let us know what made you go for a sleep study. Were you "tired".....having bouts of high blood pressure?....or other symptoms.

Welcome to the hose herd......there's a bunch of good people here who are eager to help the newbies. Read everything listed under the yellow lightbulb at the top of the page. Read carefully what is written by those such as "Rested Gal", "Snoredog", "Goofproof" and others with high posting numbers. These people are a treasure trove of great info. Trust them.....they are sharp and very savvy.

Gerald

[Snoredog]

yes it means you have PLMD, but none of those were found correlated to a respiratory "arousal", meaning they couldn't detect where they interrupted your breathing/sleep but they are present. The number seen dropped to 20/hr during the CPAP titration. Only problem with those PLM's is you don't know what they do once you leave the lab as you have no way to monitor them.

Spontaneous arousals were also seen during the CPAP titration. These are microarousals which can also kick/prevent you from reaching/remaining in deep or REM sleep.

Just as an apnea can interrupt or fragment your sleep architecture so can spontaneous arousals. Only problem is you don't know for sure the cause, can be most anything, from snoring to muscle-skeletal pains, GERD to medications you may be taking.

The thing to remember is:

-You were diagnosed with Obstructive Sleep Apnea (OSA).
-2 or more other sleep disorders were also seen during the PSG (PLMD and Spontaneous arousals).

Once you go on CPAP and get your AHI below 5, you are effectively treated for OSA. So if you remain tired during the day, then you need to ask your doctor about those PLM's and Spontaneous arousals contributing to that residual daytime fatigue.

As already mentioned, those other items you cannot monitor once you leave the lab even with a recording Autopap.

[billbolton]

After having been on the hose for a year.....and knowing what I know now......I'd go for the following (if my report looked like yours).

There nothing in the sleep report or admiralross' message that drives your shopping list. It's just plain silly to jump to that from the information request!

[Snoredog]

After having been on the hose for a year.....and knowing what I know now......I'd go for the following (if my report looked like yours).

There nothing in the sleep report or admiralross' message that drives your shopping list. It's just plain silly to jump to that from the information request!

[RosemaryB]

First Sleep Study: Findings
<snip>The supine respiratory disturbance index was 92 events per hrs of sleep. The index in REM sleep was 71 events per hr. Basal oxygen saturation was 98%, with moderate to severe desaturations to a low of 72% observed. About a quarter of total sleep time was spent with oxygen saturations below 90% Sever desaturations were closely associated with REM sleep. <snip>

Final Diagnosis: Severe Obstructive Sleep Apnea, with pronounced positional and REM components.

This part means that your AHI is much higher when you sleep on your back. One thing you can do is to make sure that you sleep on your side. I do this by wearing a backpack stuffed with a pillow. This makes a big difference to me in the quality of rest I seem to get.

You also have a higher AHI while in the REM stage of sleep.

Both these things are common but not universal.

You also had significantly low oxygen levels associated with REM stage sleep.

If you have the graphs and charts that are part of the sleep study you should be able to see this graphically, the increase in apneas during your REM and supine sleep. (If you don't have your graphs and charts you should make sure to get them).

FYI: REM sleep is the sleep where "true dreams" occur. While dreaming occurs in all other stages, these are often called "sleep thoughts." Sleep thoughts are more like normal thinking, for instance thinking about things that happened during the day and are different than true dreams which often have the bizarre or illogical quality traditionally associated with dreams.

During REM, unlike other stages, many of your voluntary muscles are immobile. (Some people think it's so we don't act out the bizarre dreams). This happens in the brain, not at the level of the muscles. This is why it is so common to have a much higher AHI during REM. Of course, you need REM for your brain to function properly and you cannot get rid of REM by wearing a backpack to bed, even if you stuff it with bowling balls .

The oxygen desats are important. You will want to make sure that you get good treatment as this is dangerous. If it were me, I'd also want to get a pulse oximeter test frequently for a while. Insurance usually pays for this and it is a device you take home and clip on your finger.

With one person I know, her GP prescribed oxygen at night for her while she was waiting for her cpap to get set up. I thought this was great, since at least the desats are taken care of while the slow grinding wheels of the sleep doctor/DME mechanism finally get the equipment to the patient.

It looks like the pressure at 14 did a good job of taking care of your apneas. However, if you have a machine that's FULLY data capable, you might be able to lower that pressure slowly over time if you find ways to sleep on your side. A lower pressure is generally easier to tolerate.

One good reason to get the A-Flex machine as Snoredog suggested is that for many people it helps them tolerate the machine at those higher pressures. At the higher pressures people can get increased aerophagia and the pressure inhalation and exhalation relief can help them solve that problem.

I don't know much about PLMD so can't answer that part of it.
_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

[admiralross]

Thanks everyone for answers. I'll print this off and highlight important areas to memory to tell the dr when I see them on the 3rd. I was also reading that the spontaneous arousals could be associated with UARS. Wondering if I have this but I will mention it too. This is a lot to handle right now.

[RosemaryB]

Thanks everyone for answers. I'll print this off and highlight important areas to memory to tell the dr when I see them on the 3rd. I was also reading that the spontaneous arousals could be associated with UARS. Wondering if I have this but I will mention it too. This is a lot to handle right now.

I had a lot of spontaneous arousals that weren't handled by the cpap. I wondered if I had UARS, too. It's not official UARS, since that official diagnosis only occurs in the absence of an OSA or similar diagnosis. Doesn't mean they aren't there, though. They are just invisible to the people relying on the diagnosis. I'd like to see a diagnosis that includes "OSA with uars features" or "OSA with spontaneous arousals" or something like that introduced officially. It would give us a shot at better treatment for these complicated issues.

Many other things can cause these arousals. GERD is one of them. Medications are another. Even sleeping in new surroundings (sleep lab?) could cause them. For now, I'd focus on getting optimal treatment for the OSA with an autopap and see if some of the other things clear up.

I find that there is quite a bit of detective work in getting things working, but it's SO WORTH IT! If you get a FULLY data capable machine (like the MSeries with AFLEX) you will be able to see what's happening and adjust for it. Things like mask leaks will wreak havoc with your treatment. You really need to be able to see them.

One reason that I figured out that I needed side sleeping was that clusters of apneas were occuring (this was with cpap, no mask leaks) during the time I would normally have the most REM sleep. With the backpack rigged up, they are gone. I am averaging AHIs of under 1.0 most nights. I feel great with that.

[RosemaryB]

Another thought: Why not call your GP and see if he or she can get you set up with some oxygen while you are waiting for your xpap. The person I mentioned above said it sure helped her feel better.

Edited to add: Or maybe not, unless your doc thinks your oxygen levels were dropping dangerously low. Snoredog says it can damage your heart to have it otherwise.

[crappuppy]

I tried to find where you actually contributed to this board in a positive way, but all I could find was more drive-by snide remarks like the above.

Oh snotdog, you've done it again!

Such elan, such wit, such utter contempt of anything remotely approaching fact, such masterful reference to tasks you didn't actually perform! I'm again amazed and so, so impressed.

crappuppy, No 1 snotdog fan!

[birdshell]

PLEASE STOP THE PERSONAL ATTACKS!



And, just in case it is of ANY use--

PLEASE dispense MEDICAL ADVICE cautiously and carefully.

Thank you.



Additional note to those asking for help:

My suggestion is that you heed the 'advice' given here ONLY if you are sure that it is medically sound and helpful.

[split_city]

Hear, hear birdshell! Some posters need to check their ego in at the door

[admiralross]

PLEASE dispense MEDICAL ADVICE cautiously and carefully.

Thanks. I know that ppl here aren't doctors. However, they do know what the numbers mean. This is all new to me and I'm slowly learning. Everyone has knowledge for certain things. This place is sleep apnea/cpap stuff. This is a wonderful place and I hope it stays that way. As for myself. I'm grateful for the help that I've received thus far. When it comes to a computers, networks and the internet that is my domain... Again thanks for everything guy/gals! We can all benefit from the knowledge shared. That's what the internet is about.

[admiralross]

Another thought: Why not call your GP and see if he or she can get you set up with some oxygen while you are waiting for your xpap. The person I mentioned above said it sure helped her feel better.

Edited to add: Or maybe not, unless your doc thinks your oxygen levels were dropping dangerously low. Snoredog says it can damage your heart to have it otherwise.

That is a good idea. I have 11 days left to go to my appointment. I'll try to rough it out til then. If they recommend me something right then and there is another story. However, I'm going to call the sleep center on Monday and talk the tech that I talked to when making the initial appointment and explain to her what the records contain. If they THINK it's urgent enough then they may ask me to come in sooner. I'm hoping that is the case. Low oxygen would explain the headaches.