Help with data from 1st sleep study

[kyteacher]

I just had my first visit with my sleep doctor since having a sleep study 5 weeks ago. A DME contacted me a few days later and said my dr. order a CPAP machine for me and she set me up. I am going on my 4th week of using the APAP and I am totally exhausted. I am able to sleep with the mask almost the entire night, but I wake up several times a night, which is not uncommon for me.
After meeting with the dr and reading my report, I feel like I don't need the machine. I am interested in knowing your opinion.
My results are:
Respiratory Summary
AHI - 16.4/hr
Total Number Apneas - 2
Obstructive Apneas - 2
Central Apneas - 0
Mixed Apneas - 0
Hypopnea Count 106
Minimum 02 Sat - 92%

RDI 16.64 REM RDI =32.73

AHI Supine - 33.44/hr (I don't sleep on my back, and only did in sleep study because the tech. woke me and told me to)
AHI Both Sides - 8.97/hr.

Latency
Stage 1 =41m
Stage 2 =44m
Stage 3/4 =161 m
REM 256
Eff. 81.9%
Not sure what this means, but I feel like I was scammed. My dr. didn't explain any of the report. I asked for a copy as I left and read it after my appointment.

[kteague]

Can you relay what your doctor told you about this all? Are they continuing you on the same machine? Whatever happens, don't let them swap you out for a bare bones machines. First of all, the treatment doesn't seem to be stabilized yet for you. Also, the data gathered from your time already on the machine should give them the ability to set your machine in a more targeted range, and they should be able to share with you the data and why or why not they have decided on your current settings. Did they change the range? It was probably set before in a generic very wide range which is a recipe for trouble.

About your study, note the time to reach REM was increased. You don't quote how much time was spent in REM, but if it is reduced, it's quite likely your AHI would have been higher with a "normal" amount of REM time. Check that out for your own satisfaction.

My opinion - I'm not questioning IF you need treatment. Those hypopneas are significant. I am wondering about the treatment you are getting being effective for you. I know that early on it can be hard to know what to even ask the docs, but as you gain clarity, call them (dont wait for an appointment).

Best wishes as you move forward.

[jweeks]

Hi,

So, you are exhausted, had over 100 events, and your blood oxygen is right at the danger level. I cannot tell you what you need because I am not a MD, but I can tell you that you need something. Perhaps a new doctor that is more willing to work with you. Or maybe you didn't want to hear what he or she had to say. At any rate, it appears that you are near the edge of the cliff, so please do follow up with this. I'd hate to hear that you became a statistic.

-john-

[Sleeprider]

The good news is, you don't have nearly the severe apnea that many people here have. The Bad news is its over 5 events per hour which is kind of a threshold for treatment. You're right that there may be alternatives for you, and perhaps ask your doctor to refer you to a Ear Nose Throat specialist to investigate if there are any physiological anomalies that are correctable, or if an appliance could maintain your airway rather than the CPAP. You are certainly entitled to pursue the best option. There are also ways to tune that APAP to perform better and perhaps reduce the number of arousal events you are experiencing. Your profile indicates you have a data card for your machine. What kind of settings are you using? Are you running a wide-open pressure range from 4-20, or it it narrowed to what you really need? What kind of AHI are you getting on the machine? What pressure range are you averaging? Wide swings? Leaks? Lots of reasons things could not be working as expected, and your doc and DME should be able to help you interpret some of that information from the card.

It can be very frustrating dealing with the medical community due to delays in scheduling appointments and understanding enough to ask the right questions. Reading this forum should put you on the right track fairly quickly. Welcome.

[kyteacher]

Can you relay what your doctor told you about this all? Are they continuing you on the same machine?

Did they change the range?

My doctor didn't say anything about the reading off of my card, nor did she change any settings on my machine. The sleep study report listed three recommendations. One, start an empiric trial of CPAP or Auto PAP. If tolerate then a formal CPAP titration study could be done. Second, I should fail CPAP/BIPAP or cannot tolerate it, then surgical options could be considered. A trial with an airway expanding device would also be a consideration. Third, avoid sleeping supine.
Since I don't sleep on my back the third recommendation would be the easiest and cheapest for me.

time was spent in REM

My study shows I spent 256 minutes in REM

My opinion - I'm not questioning IF you need treatment. Those hypopneas are significant.

Do you think 40 hypopneas are significant? This is how many hypopneas I had while on my side as opposed to 66 on my back.

So, you are exhausted, had over 100 events, and your blood oxygen is right at the danger level. I cannot tell you what you need because I am not a MD, but I can tell you that you need something. Perhaps a new doctor that is more willing to work with you. Or maybe you didn't want to hear what he or she had to say.

I have to agree with you, I need a new doctor. I wasn't that I didn't want to hear what the doctor had to say. She didn't talk about my condition very much at all. She pretty much told me the three recommendations mentioned above and said to let her know what I wanted to do. As I was leaving her office I asked to get a copy of the sleep study report and the report from my card. The receptionist made a copy of my sleep study, but said she didn't find the report from my machine. For all I know, they didn't even scan my card. They asked for it before I went in and handed it back to me about 5 minutes later.
I guess since I have only mild apnea, they don't need to spend much time with me.

[kyteacher]

You're right that there may be alternatives for you, and perhaps ask your doctor to refer you to a Ear Nose Throat specialist to investigate if there are any physiological anomalies that are correctable, or if an appliance could maintain your airway rather than the CPAP.

My doctor is going to leave it up to me if I want to continue using the APAP machine, or be referred to a Ear Nose Throat Specialist, or just sleep on my side.

What kind of settings are you using? Are you running a wide-open pressure range from 4-20, or it it narrowed to what you really need?

My settings are as follows: Max setting = 15m; Max pressure = 14; Min pressure = 5.0; Mode = Auto set; EPR Acess off; EPR level =2; EPR Full Time.

What kind of AHI are you getting on the machine?

My AHI range from 2.2 to 6.7 with a weekly average of 2.8.

What pressure range are you averaging?

My pressure is running between 8.0 and 10.

Wide swings?

I don't know what wide swings mean?

Leaks?

My leaks run around 0.02.

It can be very frustrating dealing with the medical community due to delays in scheduling appointments and understanding enough to ask the right questions. Reading this forum should put you on the right track fairly quickly. Welcome.

It is very frustrating. I am new to all of this, but what I gather I'm not severe enough to use a machine, I definitely don't want surgery. I'm thinking that I just need to sleep on my side which is one of the recommendations given.
Any advice that you or anyone else can give me will be greatly appreciated.

[GaryG]

It is very frustrating. I am new to all of this, but what I gather I'm not severe enough to use a machine, I definitely don't want surgery. I'm thinking that I just need to sleep on my side which is one of the recommendations given.
Any advice that you or anyone else can give me will be greatly appreciated.

I'm a newbie as well but it all depends on how you feel. If you feel miserable and tired, fall asleep during work meetings, then its "severe" enough to use a machine. Sleeping on the side should help somewhat. But really, it all depends how lousy you feel and what symptoms you have.

I had no choice. Sure I was tired, but I've been tired for many years. It was only when I fell asleep when driving that I got the sleep study which revealed my OSA. So I have no choice, and will keep this up until I get my ideal mask working properly.

[fishhead]

I am able to sleep with the mask almost the entire night, but I wake up several times a night, which is not uncommon for me.

many (myself included) find that the constant changes in pressure is what wakes them up through the night. and from what i've learned so far, the resmeds in APAP do tend to 'hunt' for the right pressure it thinks is needed, making many small adjustments until it feels the event has passed, then many more small adjustments to bring the pressure back down.

you may want to think about running in CPAP mode, maybe set at 8cm, which seems to be your average you could also reduce the EPR to 1, and possibly limit it to ramp only, or perhaps none at all, if you can get by without it.

but, if you decide to make any changes, remember - do one at a time and leave it be for a few days, even a week and see how you respond before making any other adjustments. and use the way you feel as a gauge more so than the numbers.

[old64mb]

My doctor is going to leave it up to me if I want to continue using the APAP machine, or be referred to a Ear Nose Throat Specialist, or just sleep on my side.

Ok, this last recommendation alone is enough to make me strongly suggest that you find a new sleep doctor to reevaluate your treatment and come up with suggestions.

You have sleep disordered breathing, and you need to find out why. Your sleep study was somewhat odd in that you are so heavily hypopnea-weighted (where they are not turning into apneas). On the other hand, I don't know of a reputable sleep doctor that would suggest a treatment of sleeping on your side when:

a. you're at an AHI of over 15 (which is considered the cutoff for when xPAP treatment is mandatory, so yes, you're 'severe enough')
b. your AHI on your side was almost 8, which is higher than most people with positional apnea (most end up with scores below 5), and not an acceptable level longer term without some sort of treatment.

In the meantime, I would suggest that if you've had a range between 8 and 10 consistently that you raise your minimum APAP setting to 8 to see if that might help a bit. The "wide swings" someone else discussed are if you were going wildly back and forth between the minimum and maximum pressures; you're not, so if you can narrow the range that might help.

[DoriC]

.
About your study, note the time to reach REM was increased. You don't quote how much time was spent in REM, but if it is reduced, it's quite likely your AHI would have been higher with a "normal" amount of REM time. .

Kteague, I guess I should know this but are you saying that the more REM sleep, the higher the AHI? And if so, can you explain why that would happen.

I interpret the Dr's recommendation to not sleep in supine position as being "in addition" to whatever course of treatment you take. Most cpappers have trained themselves to sleep on their side to avoid apneas and hypopneas. You're getting some good advice.

[kteague]

DoriC - Maybe someone can jump in with explanations, but it seems many on here report more apneas in REM than in NREM. In some of my studies where I had little or no REM, I had fewer apneas, but in the studies with more REM, events were abundant. Just from what I've read I don't think I'm too unusual on that. I always worry when people are told they were not diagnostic for OSA or were in the mild range if their REM time wasn't the expected.

kyteacher - Looks like you did have a substantial amount of REM time recorded. In looking at that 8.97 AHI while on your side, if that was for instance over the course of an 8 hour night, that would be over 70 measurable episodes of either apneas or hypopneas. That just sounds like a whole lot of stress on the body, not to mention if a lot of those cause sleep fragmentation. But count is not the only consideration. Duration of events and how low the oxygen drops are important.

I agree that the option of side sleeping was not a stand-alone alternative. Since surgery is not a preferred option, maybe a dental device could be of benefit in your situation.

About yours being mild - would you think of cancer as only mild and not treat it until it was severe? Or a stroke? Or a heart attack? Mild OSA is not the same as negative for OSA. So many hear "mild" and think it means not enough of a problem to do anything. Not true. Just think of mild as meaning May Influence Life and Death. Granted, likely a bit more slowly, but it can be like sun damage - everything looks good for a long time, then one day the consequences become irreversibly evident.

Best wishes in figuring out how to best take care of your health.

Kathy

[Pugsy]

Okay, I will chime in with my history. Very much like yours kyteacher. Long sleep latency to get to REM, mine was 246 minutes which means it took me 4 hours to finally get to REM. If we don't get to and have the proper amount of restorative REM sleep, we feel like crap. You may or may not we worse with events in REM sleep. I was.

I also had trouble getting restful sleep when I first started treatment. While the many nocturnal pee breaks ceased I still woke up often and that plays hell with your body getting through the needed sleep stages to get restorative sleep so..... even though the therapy according to the numbers is being effective, the frequent awakenings from whatever cause, still impacts significantly how we feel. If you don't get the needed sleep stages, the best therapy in the world won't help you feel better. Gotta get some semblance of uninterrupted sleep to feel better.

It doesn't really matter if you are worse in REM sleep because your AHI is diagnostic and your hypopnea count is significant. 40 Hypopneas on side vs 66 on your back?? Hmm, I would still want to use the machine. I would only consider not using the machine and trying to stay on my side if hypopneas were under 10 on my side. There really isn't that much difference in the number of hypopnea events at this point.

How many hours of sleep are you actually getting??? If I get 5-6 I don't feel so good but if I get 7-8 I feel decent.
Maybe the pressure variations with the auto machine are enough to impact your sleep. Maybe they are waking you up??? Hence the recommendation from someone to try cpap mode at 8 cm which seems to be your average. Or a smaller window in the auto mode of say 7-9.

Finally can you determine what is causing you to wake often? Habit? Pain? Outside influence? Mine was partially habit and partially from discomfort from arthritis. Ambien short term has helped with the habit part. Before you give up try doing some detective work to see if you can decrease the awakenings. There is so much more to this therapy than just hooking up to a machine and getting blissful sleep. I wish it were that easy because the mask and machine use was a piece of cake.