Help interpreting OSCAR data?

[Rubicon]

An arousal is a break in sleep continuity for at least 3 seconds, determined by EEG changes. They usually result in a sleep stage change, moving from deeper to lighter sleep, or sometimes even wake. They are also used to score hypopneas in one of the scoring formats (the "Alternative Rule").

[taylermacdonald]

An arousal is a break in sleep continuity for at least 3 seconds, determined by EEG changes. They usually result in a sleep stage change, moving from deeper to lighter sleep, or sometimes even wake. They are also used to score hypopneas in one of the scoring formats (the "Alternative Rule").

Oh okay. So after figuring that out, what do I do with that info?

[Rubicon]

Oh okay. So after figuring that out, what do I do with that info?

First, I would go back to

I used it for a few months but stopped as I felt absolutely no difference between using it and not.

and ask "What difference were you expecting? Exactly what problem are you interested in finding a solution to? Do you, in fact, have a problem at all?"

Then get the arousal table from the sleep place cause they're supposed to have it.

Then based on those 2 pieces of information, go through your download in 5 to 10 minute blocks to see if you have a sleep continuity problem (not a real scientific way to analyze it, but when that's all you got to work with, you gotta do the best you can).

[robysue1]

In addition to Rubicon's comments, I want to add: It would be useful for us if we knew something about your diagnostic sleep study. How bad is your untreated apnea?

In other words, try to get your hands on the diagnostic study as well as the titration study, including the summary graphs and the definition that was used to score hypopneas.

Also, your titration study report should come with some summary graphs that show what was happening in the night in terms of the sleep stage, any recorded events, your SaO2 level, and the CPAP setting and any adjustments made to that setting during the night.

[taylermacdonald]

Oh okay. So after figuring that out, what do I do with that info?

First, I would go back to

I used it for a few months but stopped as I felt absolutely no difference between using it and not.

and ask "What difference were you expecting? Exactly what problem are you interested in finding a solution to? Do you, in fact, have a problem at all?"

Then get the arousal table from the sleep place cause they're supposed to have it.

Then based on those 2 pieces of information, go through your download in 5 to 10 minute blocks to see if you have a sleep continuity problem (not a real scientific way to analyze it, but when that's all you got to work with, you gotta do the best you can).

The difference I was expecting was to not struggle to avoid taking naps throughout the day, especially at work, or trying to not fall asleep while driving. Just to not feel tired all day no matter if I get 4 hours or 8 hours or 12 hours of sleep. And okay, I will call and ask for that.

And robysue1, I will also ask for that info when I call. Thanks!

[Pugsy]

Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues?
Do you remember waking often during the night?

[taylermacdonald]

Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues?
Do you remember waking often during the night?

I take lamotrigine, and just started concerta. However these are recent and I’ve had the issues with tiredness for years. No other physical/mental issues. And yeah I wake up maybe 3-4 times a night that I can remember at least, but I know my boyfriend says I toss and turn a lot at night so I might wake up more but not remember.

[Rubicon]

concerta

eww.

[Rubicon]

And lamictal's no bargain either...

[robysue1]

Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues?
Do you remember waking often during the night?

I take lamotrigine, and just started concerta. However these are recent and I’ve had the issues with tiredness for years. No other physical/mental issues.

Lamotrigien (brand name Lamictal) is a pretty powerful anti-seizure medication with a slew of potential side effects. While it is usually thought of as a drug to treat epilepsy, it is also used to treat certain mood disorders. And occasionally it's prescribed off label as a migraine preventative.

Concerta is a stimulant usually used to treat ADHD.

Why have these medications been prescribed? Is there any chance that the condition these medications were prescribed for are/were contributing to your long history of daytime tiredness and daytime sleepiness problems?

And yeah I wake up maybe 3-4 times a night that I can remember at least, but I know my boyfriend says I toss and turn a lot at night so I might wake up more but not remember.

Sounds like you may have a problem with sleep continuity insomnia, which can be pretty difficult to treat.

What do your sleep habits look like?

Do you have a consistent bedtime? What about a consistent wake-up time?

How long do you think it takes you to get to sleep at night?

What's the first thing that goes through your head when you find yourself awake during the middle of the night? How long does it take to get back to sleep?

And with the tossing and turning, there's also a possible problem with either restless legs or periodic limb movements. Does you boyfriend say you kick during the night? And did your diagnostic sleep study say anything about the number of PLMs?

[Miss Emerita]

A note in the titration study says that there was a concern about central apnea in your home sleep study, and that may be why the nurse mentioned a bilevel machine. (Central apneas are pauses in your breathing of 10 seconds or more without any obstruction in your airway.) Sometimes a bilevel machine will help to resolve central apnea; when it doesn't, the next step would be a fancier machine called an ASV, for adaptive servo-ventilation.

But in the titration study, no CA was observed. Hence no bilevel machine.

I'm puzzled that the recommended minimum pressure was 7, yet your machine was set with a minimum of 5. I'm glad you're implementing Zonker's suggestion of a minimum of 7. This might help with your OAs and maybe your Hs.

I'm going to guess that most of the CAs follow arousals, which is a pretty common pattern. Getting more information about arousals might be helpful, so let us know what you find out.

[taylermacdonald]

concerta

eww.

What?

[taylermacdonald]

Do you take any medications of any kind? If so, what?
Do you have any other physical or mental health issues?
Do you remember waking often during the night?

I take lamotrigine, and just started concerta. However these are recent and I’ve had the issues with tiredness for years. No other physical/mental issues.

Lamotrigien (brand name Lamictal) is a pretty powerful anti-seizure medication with a slew of potential side effects. While it is usually thought of as a drug to treat epilepsy, it is also used to treat certain mood disorders. And occasionally it's prescribed off label as a migraine preventative.

Concerta is a stimulant usually used to treat ADHD.

Why have these medications been prescribed? Is there any chance that the condition these medications were prescribed for are/were contributing to your long history of daytime tiredness and daytime sleepiness problems?

And yeah I wake up maybe 3-4 times a night that I can remember at least, but I know my boyfriend says I toss and turn a lot at night so I might wake up more but not remember.

Sounds like you may have a problem with sleep continuity insomnia, which can be pretty difficult to treat.

What do your sleep habits look like?

Do you have a consistent bedtime? What about a consistent wake-up time?

How long do you think it takes you to get to sleep at night?

What's the first thing that goes through your head when you find yourself awake during the middle of the night? How long does it take to get back to sleep?

And with the tossing and turning, there's also a possible problem with either restless legs or periodic limb movements. Does you boyfriend say you kick during the night? And did your diagnostic sleep study say anything about the number of PLMs?

I was told lamictal didn’t have many side effects by my psychiatrist. But yes I know what they both are for/do, I’ve spoken with a psychiatrist lol. Or were those explanations for others in case they don’t know? my lamictal is for bipolar 2 and concerta for ADHD. I’m not sure if they could contribute to the sleep issues that’s not something me and my doctor have talked about. Sounds unfortunate about the insomnia thing if I do have that. :/ how would that be diagnosed/figured out? I go to bed between 9:30-10:30, usually fall asleep within 30 minutes. I wake up at 7. On the weekends I go to bed at the same time and don’t end up waking up until 9 or so. Honestly I don’t know what goes through my head lol. It’s just like “oh I’m awake,” and then I go back to sleep. Doesn’t usually take me long to fall back asleep. Sometimes a nightmare will wake me up every now and then but not typically. So restless leg syndrome isn’t just issues with it when you fall asleep? I don’t have to move my legs a lot when I’m trying to fall asleep. I don’t know if I kick in my sleep but I’ll ask him. I don’t see anything about PLMs. Interestingly it doesn’t say there were any limb movements though either. Hopefully I answered all your questions lol.

[taylermacdonald]

A note in the titration study says that there was a concern about central apnea in your home sleep study, and that may be why the nurse mentioned a bilevel machine. (Central apneas are pauses in your breathing of 10 seconds or more without any obstruction in your airway.) Sometimes a bilevel machine will help to resolve central apnea; when it doesn't, the next step would be a fancier machine called an ASV, for adaptive servo-ventilation.

But in the titration study, no CA was observed. Hence no bilevel machine.

I'm puzzled that the recommended minimum pressure was 7, yet your machine was set with a minimum of 5. I'm glad you're implementing Zonker's suggestion of a minimum of 7. This might help with your OAs and maybe your Hs.

I'm going to guess that most of the CAs follow arousals, which is a pretty common pattern. Getting more information about arousals might be helpful, so let us know what you find out.

Gotcha, could that just be because the home sleep studies don’t look at as much compared to the hospital ones? And will do!

[ozij]

Or were those explanations for others in case they don’t know?

Yes. For others. Like me, for example.