Help interprete sleep study results

[TedVPAP]

I am trying to help my friend Tom.
Here are the results from his home test.

[TedVPAP]

Here are the results of his split night study.

[Pugsy]

From the way I read it I am betting some significant clustering of events happened...which is probably typical. Some parts of the night not much happened and at other times things were rocking and rolling. It's very similar to what I saw on my report with my "REM makes it worse OSA".
Of course it could also be "sleeping supine makes it worse OSA".
My OSA overall was just 12 per hour average but in REM it was 53.

Whatever it is...it's enough to cause significant desats and earn a severe diagnosis. Don't let that overall AHI of 15 mislead you.
The RDI helped out with the severe part.

Was there something you or he had a specific question about?

I would be welcoming him to the hose head club. How does his doctor/insurance plan to proceed?

Edit....just saw you posted more...I haven't read those yet.

[Julie]

I saw sleep position numbers and would think that if he can stay off his back, he might even want to be retested to see if he needs cpap at all.

A backpack stuffed with pillows, or a foam wedge that stays in place, many ways to adjust until it becomes natural to side sleep.

[TedVPAP]

From the way I read it I am betting some significant clustering of events happened...which is probably typical. Some parts of the night not much happened and at other times things were rocking and rolling. It's very similar to what I saw on my report with my "REM makes it worse OSA".
Of course it could also be "sleeping supine makes it worse OSA".
My OSA overall was just 12 per hour average but in REM it was 53.

Whatever it is...it's enough to cause significant desats and earn a severe diagnosis. Don't let that overall AHI of 15 mislead you.
The RDI helped out with the severe part.

Was there something you or he had a specific question about?

I would be welcoming him to the hose head club. How does his doctor/insurance plan to proceed?

Edit....just saw you posted more...I haven't read those yet.

Take a look at the titration information. The tech recommended a pressure of 13. I look at the data and it is not clear to me that pressure helped him.

[Pugsy]

From the way the report reads it sounds like they were targeting snoring as much if not more than apnea event elimination with the pressure increases.

They briefly put him on bilevel at even higher. But that short of a time really wasn't enough to make much of a determination.

If REM is a factor he had a lot more REM time at 13 cm than the other times so that in itself could affect that total event count...more time spent where things could maybe be worse increases the chances of the numbers being worse.

Do you know if he was on his back all the time during the titration?
There is obviously a strong chance of a positional component to the diagnosis but not enough time was spent on his side to really have a decent idea as to how much.

Looks like a good candidate for auto adjusting machine of some sort. He may or may not even need bilevel for final pressure needs and/or comfort.

[TedVPAP]

I saw sleep position numbers and would think that if he can stay off his back, he might even want to be retested to see if he needs cpap at all.

A backpack stuffed with pillows, or a foam wedge that stays in place, many ways to adjust until it becomes natural to side sleep.

He says he always sleeps on his back. Since he started using PAP (about a month) he has tried to stay on his side more but it hurts his back. He has been struggling for many reasons.

[TedVPAP]

From the way the report reads it sounds like they were targeting snoring as much if not more than apnea event elimination with the pressure increases.

They briefly put him on bilevel at even higher. But that short of a time really wasn't enough to make much of a determination.

If REM is a factor he had a lot more REM time at 13 cm than the other times so that in itself could affect that total event count...more time spent where things could maybe be worse increases the chances of the numbers being worse.

Do you know if he was on his back all the time during the titration?
There is obviously a strong chance of a positional component to the diagnosis but not enough time was spent on his side to really have a decent idea as to how much.

Looks like a good candidate for auto adjusting machine of some sort. He may or may not even need bilevel for final pressure needs and/or comfort.

He said he was on his back entirely during titration.
It is interesting that the home test showed only 2 central apneas. The first part of the split night showed more of a central issue than the home test. It also shows that REM is not that different from non-REM.

[Pugsy]

So what has he been using this past month and how is he doing?

[TedVPAP]

So what has he been using this past month and how is he doing?

He was prescribed Dreamstation Auto CPAP set to CPAP of 13.
I got involved at that point and started using sleepyhead to look at his data. I'll post some results. His sleep hygiene is really bad and he struggled with leaks. His recent numbers are pretty good but I am not sure if it is due to the higher pressure he is now using, or just that he is doing better with all the other stuff. At some point I would like to have him go back down to lower pressures to see. That is what caused me to closely review his lab test results. Looking at his titration data it is not even clear to me what to concluded. And that is considered to be the most accurate information.

[Pugsy]

When reading through the titration my first thoughts was also "why 13 because it isn't leaps and bounds better than anything else" then I read the snoring section. I think they are targeting snoring as well so maybe that's why they came up with 13. Snoring itself can be disturbing as well.
I probably would be also tempted to try lower just because I would be curious.
Or try apap mode with a lower minimum and see just how bad the machine wanted to kill those snores (if he has many).

I wouldn't worry so much about trying to force side sleeping on someone who really doesn't sleep well on their side unless it was something they really wanted to do/try for whatever reason.
Staying off one's back is much easier said than done for a lot of people. Sleeping with cpap/mask, etc can be difficult enough when the sleep is already fragile and then trying to sleep in a position we simply aren't comfortable with sure isn't going to help the sleep in general and we gotta get the sleep first before anything else can even have a chance to work.

[TedVPAP]

When reading through the titration my first thoughts was also "why 13 because it isn't leaps and bounds better than anything else" then I read the snoring section. I think they are targeting snoring as well so maybe that's why they came up with 13. Snoring itself can be disturbing as well.
I probably would be also tempted to try lower just because I would be curious.
Or try apap mode with a lower minimum and see just how bad the machine wanted to kill those snores (if he has many).

I wouldn't worry so much about trying to force side sleeping on someone who really doesn't sleep well on their side unless it was something they really wanted to do/try for whatever reason.
Staying off one's back is much easier said than done for a lot of people. Sleeping with cpap/mask, etc can be difficult enough when the sleep is already fragile and then trying to sleep in a position we simply aren't comfortable with sure isn't going to help the sleep in general and we gotta get the sleep first before anything else can even have a chance to work.

It also looks like the tech ran out of time; only got 6 minutes in at the bilevel.

I will soon be posting sleepyhead charts where he started with CPAP=13, and is currently using APAP 17-20.
This is an interesting case study and I am not yet sure what to conclude and why.

[Pugsy]

It also looks like the tech ran out of time; only got 6 minutes in at the bilevel.

Yep, I noticed that. Not enough time to really give it a fair trial.
If he is using 17 to 20 now he might like bilevel. Is EPR being used?

[TedVPAP]

It also looks like the tech ran out of time; only got 6 minutes in at the bilevel.

Yep, I noticed that. Not enough time to really give it a fair trial.
If he is using 17 to 20 now he might like bilevel. Is EPR being used?

Yes he is using EPR. He says the pressure doesn't bother him at all. Leaking bothers him. He is using simplus FFM. He started with large cushions from his split study. Complained of leaking so they gave him a small. No good with that so he will try a medium next.
I'll post SH data in an hour.
Thanks

[Pugsy]

Leaks are going to be a challenge with any mask at those pressures.
I assume you have discussed liners and different masks, etc?
Facial hair by chance?
Any chance at all he could get by with a nasal mask of some sort or is his nose so congested there's no way?