Newbie-In the process of getting a diagnosis, c-pap needed?

[Masta]

I had an overnight sleep study done in a sleep lab 2 weeks ago. I went back for the results last week. I was told I have mild SA. I'll post the results below.

Some background history:
In 2008 I had an overnight pulse oximetry test done which suggested c-pap was the most effective form of treatment and other conservative treatments are worth looking into, which were: weight loss, hypothyroidism, avoiding supine sleep, and nasal obstruction. I'm now medicated for hypothyroidism, and I have had my septum repaired in 2012. Lowest Sp02 was 90% and Desaturation index was 1.2 per hour. I didnt sleep well wearing the pulse oximetry device that night.

I was recently diagnosed with tachycardia and chest pain. heart problems run in my family. Had a cardiac MRI done last week. I'm waiting on the results from my cardiologist. I have been placed on medication for it since the sleep study.

I wish I knew how to upload a scanned picture attachment of my test scores. I'Il type them below.

Female: 42yr old
Sleep Study: split night? I wasnt given c-pap and I havent been back for another study
Neck: 15 in

Results of my overnight sleep study

Sleep Study Overview
First Lights Off: 11:36:56 pm
First Lights on: 5:59:14 am
Time in bed: 382.3
Total Sleep Time: 210.5
Sleep Efficiency: 55.1%
Sleep Period Time: 351.0
Sleep Maintenance Efficiency: 60%
Sleep Latency: 11.7
WASO: 160.1
PLM Index: 24.8
REM Latency from Sleep Onset: 0
Awakenings: Count 15, Index 4.3
Arousals: Count 67, Index 19.1
Apneas and Hypopneas: Count 18, Index 5.1
Limb Movements: Count 161, Index 45.9
Snores: Count 8, Index 0.00
Sleep Onset Time: 11:48:36pm
Desaturations: Count 14, Index 4.1
Average Oxygen Saturation: Count 95%

Sleep Architecture
Stages
Wake: 171.8 mins, 44.9% sleep time
Stage N1: 151.5 mins, 72.0% sleep time
Stage N2: 36.5 mins, 17.3% sleep time
Stage N3: 22.5 mins, 10.7% sleep time
REM: 0.0% mins, 0% sleep time
Movement: 0.0mins, 0.0% sleep time

Arousal Summary
Respiratory: 0 REM, 6 NREM, 9 Arousals, 5 Awakenings, 14 Ar + Aw, 4.0 Ar + Aw Index

Leg Movements: 0 REM, 24 NREM, 29 Arousals, 5 Awakenings, 34 Ar + Aw, 9.7 Ar + Aw Index

Snore: 0 REM, 0 NREM, 0 Arousals, 0 Awakenings, 0 Ar + Aw, 0 Ar = Aw Index

Spontaneous: 0 REM, 26 NREM, 29 Arousals, 5 Awakenings, 34 Ar + Aw, 9.7 Ar = Aw Index

Total: 0 REM, 56 NREM, 67 Arousals, 15 Awakenings, 82 Ar + Aw, 23.4 Ar = Aw Index

Arousal Index: 0.0 REM, 16.0 NREM, 19.1 Arousals, 4.3 Awakenings, 23.4 Ar + Aw


Respiratory Summary
Sleep Time: 210.5 NREM, 0.0 REM, 25.7 Supine, 184.80 Non-Supine, 210.5 Total

Obstructive Apnea: 0 NREM, 0 REM,0 Supine, 0 Non-Supine, 0 Total

Mixed Apnea: 0 NREM, 0 REM, 0 Supine, 4.55 Non-Supine, 0 Total

Central Apnea: 1 NREM, 0 REM, 0 Supine, 1 Non-Supine, 1 Total

Total Apnea: 1 NREM, 0 REM, 0 Supine,1 Non-Supine, 1 Total

Obstructive Hypopnea: 0 NREM, 0 REM, 0 Supine, 0 Non-Supine, 0 Total

Central Hypopnea: 0 NREM, 0 REM, 0 Supine, 0 Non-Supine, 0 Total

Total Hypopnea: 17 NREM, 0 REM, 4 Supine, 13.00 Non-Supine, 17 Total

Total Hypopnea Index: 4.8 NREM, 0 REM, 9.3 Supine, 3.71 Non-Supine, 4.8 Total

All Apneas & Hypopneas: 18 NREM, 0 REM, 4 Supine, 14.00 Non-Supine, 18 Total

AHI: 5.1 NREM, 0 REM, 9.3 Supine, 4.55 Non-Supine, 5.1 Total

Cheyne Stokes: 0 NREM, 0 REM, 0 Supine, 0 Non-Supine, 0 Total

RERAs: 6 NREM, 0 REM, 0 Supine, 6.00 Non-Supine, 6 Total

RERA Index: 1.7 NREM, 0 REM, 0 Supine, 1.71 Non-Supine, 1.7 Total

RDI: 6.8 NREM, 0 REM, 9.3 Supine, 5.70 Non-Supine, 6.8 Total

Respiratory Event Durations
Average (Seconds): Apnea - NREM 11.0, REM 0, Hypopneas - 19.6 NREM, 0 REM
Maximum (Seconds): Apnea - NREM 11.0, REM 0, Hypopneas - 30.0 NREM, 0 REM

Oxygen Saturation Summary
Average OSat %: 95% Wake, 95% NREM, -- REM, 95% Total
Minimum OSat %: -- Wake, -- NREM, -- REM, 82% Total

# Of Desaturations: 14
Minimum Oxygen Saturation During Desaturations: 84%
Time Less than 88: 12.1 minutes

Limb Movement Summary
Total Leg Movement: 161 Count, 45.9 Index (#/h)
PLMS: 87 Count, 24.8 Index (#/h)
PMLS Arousal: 16 Count, 4.6 Index (#/h)

Cardiac Summary
Average Pulse Rate During Sleep (TST): 78.2 bpm
Highest Pulse Rate During Sleep (TST): 98 bpm
Highest Pulse Rate During Recording (TIB): 104 bpm

Sleep study comments: A baseline study was ordered and completed. The patient had low oxygen for the majority of the night. She had mild respiratory events. She had moderate sleep fragmentation and poor sleep efficiency (55.1%).

The sleep doctor said some inappropriate comments to me (during my 1st office visit) and he physically touched me during both office visits, placing his legs against my mine, his legs were pressing on mine from the outside (1st office visit), and rubbing my knee (2nd office visit).

The sleep doctor is aware of the tachycardia diagnosis during my 2nd visit, while receiving the sleep study results, i was not on any tachycardia or heart medication during the sleep test. He said the sleep test showed I didnt get enough sleep and no rem sleep, he also said my hypopneas would have been higher if i would have gotten REM sleep, therefore the AHI number would have been higher too. He pretty much ignored the sleep test data, saying that the low minimum oxygen saturation was the finger monitor not getting an accurate reading because I rolled over during the night. He said to avoid sleeping on my back. He placed me on 50mg Trazadone for 3 weeks until our next visit (take 1/2 -1 tablet every night). I started off taking half a tab - 25mg at night, woke up very groggy, had a good 8hrs sleep. after 4 days the pill isnt working I need to take a full tablet tonight to see how it goes. The sleep doctor said he might do a overnight pulse oximetry test. He said I dont need a c-pap machine, nor do i need to repeat the overnight sleep study. He said he tries to get people with higher AHI scores down to my scores. I dont know if I should get a 2nd consult, and/or if I need c-pap? I have been waking up exhausted everyday for over 10yrs.

I use S+ By ResMed Personal Sleep Solution device and the app that goes with it to record my sleep . I dont know if its accurate or not. http://www.amazon.com/S-ResMed-Personal ... esmed+s%2B

[Julie]

Are you going to report the doctor for his inappropriate actions?

You'll get a lot more responses re your report, but I wanted to ask you about that as you didn't say anything more in your note.

[cancun]

I had an overnight sleep study done in a sleep lab 2 weeks ago. I went back for the results last week. I was told I have mild SA. I'll post the results below.

Sleep study comments: A baseline study was ordered and completed. The patient had low oxygen for the majority of the night. She had mild respiratory events. She had moderate sleep fragmentation and poor sleep efficiency (55.1%).

The sleep doctor said some inappropriate comments to me (during my 1st office visit) and he physically touched me during both office visits, placing his legs against my mine, his legs were pressing on mine from the outside (1st office visit), and rubbing my knee (2nd office visit).

The sleep doctor is aware of the tachycardia diagnosis during my 2nd visit, while receiving the sleep study results, i was not on any tachycardia or heart medication during the sleep test. He said the sleep test showed I didnt get enough sleep and no rem sleep, he also said my hypopneas would have been higher if i would have gotten REM sleep, therefore the AHI number would have been higher too. He pretty much ignored the sleep test data, saying that the low minimum oxygen saturation was the finger monitor not getting an accurate reading because I rolled over during the night. He said to avoid sleeping on my back. He placed me on 50mg Trazadone for 3 weeks until our next visit (take 1/2 -1 tablet every night). I started off taking half a tab - 25mg at night, woke up very groggy, had a good 8hrs sleep. after 4 days the pill isnt working I need to take a full tablet tonight to see how it goes. The sleep doctor said he might do a overnight pulse oximetry test. He said I dont need a c-pap machine, nor do i need to repeat the overnight sleep study. He said he tries to get people with higher AHI scores down to my scores. I dont know if I should get a 2nd consult, and/or if I need c-pap? I have been waking up exhausted everyday for over 10yrs.

I use S+ By ResMed Personal Sleep Solution device and the app that goes with it to record my sleep . I dont know if its accurate or not. http://www.amazon.com/S-ResMed-Personal ... esmed+s%2B

I am too new to say whether or not you need CPAP or not but there are a lot of knowledgeable people on this forum who should be able to help you.
I do however want to say I hope you are going to report this doctor for his inappropriate comments and actions and that you find will find a new sleep doctor as soon as possible.

[kteague]

Gonna pick and choose some things that jumped out at me. Hope it doesn't confuse the issues.

1. I was recently diagnosed with tachycardia and chest pain. heart problems run in my family. Had a cardiac MRI done last week. I'm waiting on the results from my cardiologist. Arrythmias are not uncommon in people with sleep apnea. Some find they improve with CPAP treatment, depends on the cause. Good that you are following up on this.
2. PLM Index: 24.8... PLMS: 87 Count, 24.8 Index... PMLS Arousal: 16 Count, 4.6 Index Too much can be said about this to cover it in one post without knowing if it's even a need. Nutshell: You don't know how those limb movements might respond to CPAP treatment. Some get better. Some get worse. They can be detrimental to sleep. Anyone with both limb movements and sleep apnea runs the risk of neither disorder being accurately diagnosed as they can mask each other in a study. For instance, if you had not had breathing events, you may have had more limb movements. And if you had not had limb movements disrupting your sleep, you may have had more apneas. Did your doctor even mention the possibility of your legs being a problem?
3. He said the sleep test showed I didnt get enough sleep and no rem sleep, he also said my hypopneas would have been higher if i would have gotten REM sleep, therefore the AHI number would have been higher too. Exactly. With no REM sleep my doctor would have termed the study "technically suboptimal" and would have considered the data lacking when deciding a treatment plan. It sounds like your doctor did not allow for the possibility (? probability) your apnea is not as mild as this study showed.
4. He pretty much ignored the sleep test data, saying that the low minimum oxygen saturation was the finger monitor not getting an accurate reading because I rolled over during the night. That may or may not be true. Actually your test raw data should give some indication. An experienced eye could see patterns that indicate a loose monitor. Not sure if that applies to the person who interpreted your test or not. I thought the data isn't included in the results if it was obviously bad data. Out of my league on this one so I'll dip out.
5. The sleep doctor said some inappropriate comments to me (during my 1st office visit) and he physically touched me during both office visits, placing his legs against my mine, his legs were pressing on mine from the outside (1st office visit), and rubbing my knee (2nd office visit). Without knowing what those inappropriate remarks were, I couldn't form an opinion just by the physical contact. Some people are more comfortable with touching than others. For him to have a new patient whose comfort level he did not know, he certainly was not acting wisely or professionally or being considerate of your boundaries. If his remarks truly stacked the evidence against him, I'd report him. But I'd want to be very sure I had interpreted his intent correctly. You sound convinced.
6. He placed me on 50mg Trazadone I would be concerned about being given a sedating medication with admittedly under diagnosed and untreated sleep apnea.
7. He said I dont need a c-pap machine, nor do i need to repeat the overnight sleep study. He said he tries to get people with higher AHI scores down to my scores. And again, he acknowledges your test is likely not fully revealing of your condition. UGH.

Honestly, I understand your concerns. It's really hard to have a good relationship with a doctor you don't have confidence in. Unless something dramatically turns this around, I think a new doctor is in your future. One good thing he did tell you based on the info available is you probably should avoid back sleeping, particularly while untreated.

[Masta]

Thank you for your replies

Are you going to report the doctor for his inappropriate actions?

You'll get a lot more responses re your report, but I wanted to ask you about that as you didn't say anything more in your note.

I am too new to say whether or not you need CPAP or not but there are a lot of knowledgeable people on this forum who should be able to help you.
I do however want to say I hope you are going to report this doctor for his inappropriate comments and actions and that you find will find a new sleep doctor as soon as possible.

Julie and cancun: I hadnt even thought about reporting him. I have too many health issues and family issues going at the moment. I woudnt know who to report the doctor to in the U.S. I will think about it.

kteague:
During my 1st doctor consult, I told the sleep doctor I was under huge amounts of family stress, with adult kid problems, a death, my ongoing health concerns, and I also mentioned my marriage and lack of support and understanding from family. The sleep doctor said, my hubby gives me insurance so I'm getting something (meaning some sort of support, its better than nothing), then he said: "he wouldnt take me on with all of that baggage" (I explained some marriage and family issues I was having, which resorted in having panic attacks for the 1st time in my life). When the doctor said he wouldn't take me on because I have too much baggage, I said to him "that's the least of my concerns right now, I wasnt there (having an office visit with a sleep doctor) for that, I just wanted some answers". That's when he came close to me, he sat directly in front of me, his legs were apart, my legs were closed, he put both of his legs up against mine - the inside of his legs were touching the outside of his legs, his legs looked like a V, if that makes sense, this went on for at least a minute or so, I couldnt move (this was my 1st office visit). The 2nd office visit he rubbed my knee while trying to show me the graph of my sleep study. I live in a very conservative religious State (Utah) I'm not from here (I'm an Aussie). He has a nurse in the room with him the whole time, she is typing whatever he says, so she didnt see what he was doing during both visits. by the way, the panic attacks stopped before the sleep study.

The sleep doctor did not read my report. He briefly skimmed it. I brought the comments section of the report to his attention, he then said "where does it say that". He briefly read the comment and that's when he said the oxygen monitor may have came off during the night. He did not discuss my limb movements at all. He did not explain my test results with me.

I do suffer from chronic pain, I see a pain management doctor for multiple spine issues, I have refused narcotics but will take a muscle relaxer when the pain is bad, I took one the night of my sleep study. My pain management doctor sent me to this sleep doctor for a sleep study. I explained to the sleep doctor that the bed was hard as a rock, and that the room was hot. He said to me I was the 2nd patient who complained about the beds, and asked if I was informed if they were sleep number beds, I said no, I was not informed. I asked if I could do the overnight sleep study again, he said no it wasnt needed.

[Julie]

Hi - a muscle relaxer unfortunately is not a good thing to take for a sleep study as the study is deliberately testing muscle tone in your throat (opening of your airway and how much it closes off), and there are other meds such as Ambien which can be used for the one night.

In any case, you have a legal right to your full sleep study results so get hold of them (not just the summary) because you may want to refer to various parts in future.

You would report the doctor's behaviour to the American Medical Association (find out which dept. of course when you call, but you can probably get lots of info just online).

[kteague]

...During my 1st doctor consult, I told the sleep doctor I was under huge amounts of family stress, with adult kid problems, a death, my ongoing health concerns, and I also mentioned my marriage and lack of support and understanding from family. The sleep doctor said, my hubby gives me insurance so I'm getting something (meaning some sort of support, its better than nothing), then he said: "he wouldnt take me on with all of that baggage"

Wow. If that was his best effort to get you to "see the sunny side" in that you do have some support from your husband through insurance, he missed the mark. He shoulda stopped right there and not implied that you are a burden. Good grief.