Sharing some of my study results. They don't sound good.

[ShallowBreather]

Hi all

Thought I'd share some of the results off my sleep study, so maybe you can tell me what I can expect during my follow-up meetings.

First, I failed it. The study was 7 1/2 hours long, of which I slept 3 hours 3 minutes. Part of that was just the new surroundings and wires. I had 33 awakenings after sleep onset. Sleep latency was 55 minutes and REM latency was 218 minutes. 94 stage shifts in sleep patterns.

I didn't have a mask on until 12:30 am. During the no-mask period, I had 42 respiratory events consisting for 15 apneas (3 obstructive, 1 mixed, and 11 central) and 27 hypopneas. I can't figure out the difference between a central apnea and a hypopnea. ??? AHI was 35.5 and CAI (central apnea index) was 9.3. REM AHI was 0.0. non-REM AHI was 35.5 and arousal index was 34.6. Average oxygen 92.0% and minimum oxygen saturation of 80.0% YIKES! I was below 90% about 10 total minutes. Supine the entire time.

Then they put an Eson 2 on me. Only minor leaking. About 5 hours on the mask. Snoring was eliminated at 6 cmH20. 52 respiratory events (more, but it was a much longer time) consisting of 43 apneas (0 obstructive, 0 mixed, 43 central (100%)) and 9 hypopneas. So, there I am with my mask on, and the average oxygen saturation was 95.0% with a low of 84%. I was under 90% oxygen for about 3 minutes. What gives with that??

No arrhythmias. no movements with arousals.

The diagnosis from this first study is two part:
G47.33 (severe) Obstructive sleep apnea
G47.37 Treatment emergent central sleep apnea (I disagree with the "treatment emergent" part as this was one of my complaints to the doctor that led to the study. See avatar name. But I understand that it can also apply to CPAP persistent central sleep apnea.)

There's a note that the baseline AHI is probably higher because of my inability to maintain REM sleep during baseline portion of the study. There's a second note that they never normalized my AHI at the tested PAP settings (fixed CPAP levels of 5,6,7,8,9) due to residual events and the presence of central events raising concern for complex sleep apnea. They suggest the centrals were maybe due to lack of acclimation to PAP even though I mentioned it while they were putting the mask on me.

Recommending a 2nd study for full night titration starting at 10 cmH20 and during which there should be a low threshold for transitioning to bilevel if central events are observed, which they will be.

Oh boy! That's a ton to type. I think I'm going to be on a machine moving forward, n'est-ce pas?

What does all this mean to you?? I'm just a little scared and hopeful. Should I push for Adaptive Servo Ventilation? Will they be able to learn what they need from just a bilevel?

Thanks!!!

[JLROhio]

The study was 7 1/2 hours long, of which I slept 3 hours 3 minutes. Part of that was just the new surroundings and wires.

First, Welcome... The experts will be by soon to offer their opinions.

Second, I think you got more sleep during your sleep study than I did during my sleep study
I had the worst night of sleep during my sleep study. Your findings were somewhat similar to mine - including the O2 range levels (normal).

When I went back the 2nd night (for CPAP mask tryout/fitting and figuring out the pressures that I would be treated with), my doc prescribed me a sleeping pill (Ambien??) to try and help me. It helped a bit - it was the 2nd worst night of sleeping I've ever had!

Anyways, just wanted to say welcome - again, the experts will be by shortly with a breakdown of your numbers and what to expect going forward.

Oh, and for your 2nd night - ask your doc if he can prescribe a sleep aid that will help you have a better night of sleep.

BTW, you did NOT fail = You've probably saved your own LIFE!

[Miss Emerita]

Central and obstructive apneas are events during which you stop breathing for 10 seconds or more. With central apneas, there's no obstruction of the airway. Hypopneas are intervals of reduced breathing that last 10 seconds or more. One commonly accepted standard is that the reduced breathing is accompanied by a drop in O2 sats of 4% or more. Hypopneas can be either central or obstructive, though I can't recall seeing a sleep study that tried to distinguish between the two.

Your diagnosis of obstructive apnea puzzles me; your results seem to me more congruent with mixed apnea. You might want to press for more information or clarity around that.

ASV machines are used to treat central or mixed apnea. They are fairly expensive, so patients need to go through more hoops before one will be prescribed. Titrating you on a bilevel machine is a fairly common practice, though I'm not sure why, since using bilevel support can actually increase CAs. I STRONGLY urge you to request that the night of titration move on to a trial on an ASV machine if (as I would expect) the bilevel machine still leaves you with a signification number of CAs. You may need to really push on that.

[ShallowBreather]

Your diagnosis of obstructive apnea puzzles me; your results seem to me more congruent with mixed apnea. You might want to press for more information or clarity around that.

They gave me a duel diagnosis of OA and CA. Beats me why they didn't combine them, but I'm not familiar with the medical numbering system; plus, they seemed to think that CAs were due to me not being used to the PAP machine.

Throughout the study, they called it "complex". The honest truth is that the obstructive apneas were because I was on my back, which is something that I don't do, but all those wires had me kind of locked into supine. Normally, I'm a side sleeper or on my stomach. The CAs are my biggest concern.

[ShallowBreather]

Titrating you on a bilevel machine is a fairly common practice, though I'm not sure why, since using bilevel support can actually increase CAs. I STRONGLY urge you to request that the night of titration move on to a trial on an ASV machine if (as I would expect) the bilevel machine still leaves you with a signification number of CAs. You may need to really push on that.

I'm very worried that my CAs will go through the roof with even a bilevel. I'm such a slight breather (even just sitting here) and just know that it will not help.

Yes, I'm going to suggest the ASV machine be kept on standby. That makes sense.


I am sooooo tired.

[Miss Emerita]

Our wonderful forum member Pugsy has noted to me that bilevel PAP therapy does resolve central apnea for some fair number of people, so that would make it a sensible thing for them to try next. But I still strongly encourage you to request that they have ASV ready to try if your central apnea doesn’t resolve with bilevel treatment.

Keep us posted, would you?

[ShallowBreather]

Keep us posted, would you?

Yes, of course.