Please help me interpret my report

[Isako]

Hi everyone

5 weeks ago my doctor put me on auto-cpap for a month to diagnose whether I had sleep apnea. I know this is not a reliable form of diagnosis, but this is the way they do it here in Malta, Europe. The waiting list for a sleep study is over a year long!
I was given a rental unit (Respironics M series Auto with C/flex) and told that a humidifier was not neccessary(!) and not available. I found it very difficult to sleep with as my throat was incredibly dry (I wear a full face mask and am a heavy mouth breather) and hardly slept at all. When I returned the unit, they miracuously had a humidifer available and offered to allow me to use to for a further week to see what difference it made. Wow! I slept like a baby, it was an amazing difference and my compliance was way better.

The DME that rented me the equipment gave me two PDF reports to give to my doctor but I can only get an appointment in about 12 weeks from now! I want to buy a unit now since I dont want to put my heart under any more stress IF I do have sleep apnea. I know people on this forum are not doctors, but Im hoping that there is someone that could just have a quick look and give me some feedback as it whether they think I need CPAP therapy. Any comments are very welcome and appreciated!

Month1 - http://viewer.zoho.com/docs/yuiGh
Last week - http://viewer.zoho.com/docs/ywDZg

I'd really appreciate any help

Isako

[Julie]

Hi, you're right about the reliability of home testing, but did use a good machine. The problem is that your leak rate was so high (what mask are you using and do you feel it fits well?) that the results may not be much good. As it stands, they would suggest you don't have apnea, and that might be terrific if it could be trusted, but without knowing more it's hard to say (though I'm sure others will add to this).

[Isako]

Hi Julie, Thanks you so much for your reply! Im using a Respironics Comfort 2 Full face mask. I tried adjusting the mask throughout my trial and the only thing that seemed to stop the leaks was by making it so tight that it was very painful the next day around the sides of my nose. My wife often said she heard the mask leaking several times throughout the night. I suspect the mask may not be a good fit but I can afford another one yet. The problem is that I usually sleep on my side and even though I tried hard to sleep on my back, I often woke up on my side with the mask leaking. Is there any other data I could give you that would help?

[Julie]

Well, first of all, do NOT sleep on your back - it provokes a lot more apneas. The only reason you were told to do so (for a study?) was to get a worst-case baseline number for reference. We go to great lengths not to sleep on our backs - from using those big body size pillows behind us to sewing tennis balls onto our night clothes. Secondly, your wife was 'right' in that overtightening masks can cause worse leaks from the cushion trying to compensate in tiny areas for others. Some leakage is to be expected and is normal, but it's the degree that counts. I do think though, that you should do everything you can do get the right mask in the right size and fitting. Have you looked at the Cpap Auction here for possibilities? Or talked to your MD re a new script (that your insce. might cover) that would actually let you achieve proper therapy - after all, what's the point if it's not working? What about using a chin strap (or tape) under the mask to see if it helps, even if they're known to not be as effective as FF masks?

[Isako]

Thanks again Julie, thats very interesting since I was specifically told to sleep on my back to prevent the mask from leaking whilst on my side. There is no doubt my DME has no clue what he is talking about. Can anyone else spare a minute to let me know what my results tell them? I'd love to know if I likely have it or not - Dont worry, Im still going to see my doctor but thats still 12 weeks away. Ciao!

[roster]

Any diagnosis from those reports would be guessing. The reports show very few apneas and hypopneas and the ones that show could be false.

On the other hand, you could have severe sleep apnea that is well treated with the pressure delivered by the CPAP system. As you probably know, sleep apnea is normally diagnosed from a study where no pressure is applied to the airway.

A significant amount of snoring is seen in the reports. Do you or a bed partner know if you normally snore? The "snores" showing in the report could be snores or they could be vibrations from mask leaks.

In the U.S., portable home testing units are becoming popular. These units are not CPAP machines and the patient does not wear a mask. The patient wears sensors and the device records breathing and other data without interfering with the patient's breathing. Accuracy of the devices is comparable with in-lab PSGs.

What are the symptoms that lead your doctor to order a study?

[Isako]

Hey Roster,

Yes that makes total sense. I have no idea why my respiratory physician thought it would be a realible/accurate test in any way. My low apneas could very well be effective therapy. I am definitley a very loud snorer as evidenced by my partner sleeping in another room and my family moaning for hours every morning when they visit! People can hear me through two walls! Regarding the symptoms that lead me to go to my doctor - I have been gaining weight consistently for the last few years and I eat very healthily and exercise daily - I went for a number of hormone tests, but no problems were found. I also felt like I had a really bad hangover every morning and I dont drink. It feel exactly like a hangover and lasts well into the afternoon. Then a friend who slept over told me that he heard me grasping for air during the night and that I stopped breathing many times. I then setup my webcam to record myself sleep and I witnessed myself snoring loudly and very consistently followed by silence for 5-15 seconds and a grasp for air many times during the night. I gave all this to my doctor and he recommended a sleep test which takes over a year with the waiting list unless you have private healthcare which costs a few thousands dollars. Anyway, he then aid that if I used an AUTO cpap for a month the data would give him a good indicator of whether I suffered from OSA. I fear that when I do see him, he is going to agree that the data is ambigious and that I will have to wait a year until I can get a sleep study. I must say that after I got the humidifer, compliance was much easier and I was starting to feel better in the morning - not much better, but better. Thanks for taking some time from your day to read this and assist!

[roster]

Isako,

I am a gambler and would give someone 10 to 1 odds with me betting you do have sleep apnea based on the symptoms you described.

Your doctor may have done you a very good deed if there is a way to use a CPAP for a year until you can have a sleep study performed.

IMO, and some physicians opinion, the vast majority of obstructive sleep apnea cases are caused by an underdeveloped jaw which results in a narrow airway. The jaw may be narrow side-to-side or front-to-back. When the muscles in the tongue and soft palate relax during sleep, the narrow airway is blocked.

Symptoms of an underdeveloped jaw are crowded teeth possibly corrected by braces and extractions, wisdom teeth which had to be extracted, recessed chin and a tongue which is scalloped on the sides where it is jammed against the teeth.

.... I have been gaining weight consistently for the last few years and I eat very healthily and exercise daily - I went for a number of hormone tests, but no problems were found. ....

Gaining weight, especially while eating well and exercising regularly, is often the result of untreated sleep apnea. It has been commonly believed that weight gain causes sleep apnea. I believe underdeveloped jaws cause sleep apnea and the damage to sleep and the hormone system causes weight gain. The weight gain can cause the apnea to worsen and worse apnea causes more weight gain - the so-called deadly circle.

I am curious as to which hospital or clinic the sleep study would be performed at?