Sleep Study Thursday Night

[RinR]

I am new (on so many levels) so please excuse any obvious mistakes I make. While I help others use a computer, I have never posted or twittered or accepted friend requests or...

I am with Kaiser in Southern California. At the suggestion of my Primary Care Physician (PCP) I did a sleep study three weeks ago. They wired me up and I went to sleep. I did get up twice to go to the bathroom but felt I got a normal (for me) night's sleep. I asked the Respiratory Technician (RT) how it went as she was disconnecting me. She said she thought I would need another study because I did not sleep enough. I thought this an odd statement since only people that don't sleep well needed the sleep study. Duh!

I have Restless Leg Syndrome (RLS) and take prescriptions to both calm my leg movements and help me sleep. My legs insist on moving when my mind is not challenged, making dull conversations and meetings a real drag. I often stand up and sometimes pace to keep my legs happy. My RLS is more severe when I am sleepy. If I do not get right to sleep, my RLS can keep me awake making me more sleepy but unable to lie still to fall asleep. This causes me to sleep less during the night and be more tired the next day and evening, and makes the leg movements more severe and it takes more time to get to sleep. You can see this is problem feeds itself. I have always said if I could just get a really good night’s sleep I would not have RLS. I am a happily married man over 50 and slightly overweight.

I got a call from Kaiser yesterday (Tuesday). The results were in for my sleep study. I did not listen carefully enough since I did not know the terminology, but I do remember she said I had something like 20 events per hour while sleeping normally. This jumped to 45 events per hour during my Rapid Eye Movement (REM) sleep. I had no idea what was normal.

Since I cannot get there during office hours to take a CPAP (this one I am not going to spell out in this forum) machine home for a week, we scheduled another sleep study. I said I am available for cancelations; they had one for that night. I signed up but later got called to change it to Thursday.

So there is my story. I want to be ready to ask the right questions before I leave their office. I plan to take a letter with me requesting a copy of the results etc. as described on another thread. I do have sinus trouble and often breathe through my mouth, so I know to ask for more than just a nose thing. I am worried that Kaiser will simply get me the low end machine with a nasal mask and expect me to settle. I am hoping for good advice here.

Restless in Redlands (RinR)

[Emilia]

Welcome, RinR! I am a newbie too, and you will find the gang here to be very helpful and nice. Just ask the questions, and someone will be by eventually with helpful advice.

I have gleaned a great deal from reading the forum so I suggest that is where you start. Read, read, read!

I'll take a stab at a few of your issues:

My sleep study tech indicated they needed at least 2 hours of sleep to get the data necessary. If you didn't cycle through all the stages of sleep or sleep long enough to gain that data, you needed to do the second study. However, since Kaiser has told you that they had results to use, I guess they felt the data was sufficient. 20 events per hour would put you into the moderate category for apnea/hypopnea. Since you don't know whether these events were apneas, hypopneas, centrals, or a combination thereof, it is hard to assess. GET A COPY OF THE STUDY REPORT! You are entitled to this under HIPPA law. Ask for the full copy including the doctor's dictated notes on the study.

You say you opted for a second study rather than taking a cpap machine home for a week. This tells me you are going to be titrated tonight. They will fit you with a mask and determine the appropriate pressure setting(s) for your cpap machine. I just went through this last night!! I had 16 events an hr in my first study, and last night on the mask.... NONE!

The lab won't give you the copies of the reports....you need to request this from the doctor. S/he will also get a report of the titration study you are doing tonight.

Insist on a data capable machine! Go to the CPAP Wiki (see yellow lightbulb icon in top menu bar) and review the various machines. I don't know what your insurance covers, and you should inquire with them about how they supply the equipment. Some simply reimburse, some have designated DME's, some will allow you to buy online, etc. If you have a deductible and co-pay on this type of equipment, it may be more advantageous to just buy it online out of pocket. Some insurance only provide cpap as a rental for 10-15 months after which you own it. However, if you have to pay a co-pay or % each of those months, it may well equal or exceed the price you can buy it outright for online at cpap.com.

As you cans see, you have some homework to do! Best of luck tonight... and keep us posted.

[elena88]

great advice from Emelia!

Emelia, I was thinking of you last night!

Congratulations on your wonderful results in your titration study!

RinR, hope you are as fortunate as well!

elena

[Emilia]

Thanks, elena88! I was so surprised at how easy I took to the mask. I almost feel guilty Tech said I had tons of REM sleep, too. I slept about 4 hours total and I felt pretty good when I left there. Got back in bed at home around 8 a.m. this morning and slept until noon....but felt like crap upon awakening. Now I can't wait to get my machine and start sleeping well every night!!

[elena88]

Oh Emelia, you are off to such a good start!

I truly hope this is just the beginning for you, and you are one of those "ducks to water" type cpappers!


way to go lil papper tadbpole!

[Mary Z]

RinR, good luck on your sleep study tomorrow night. I suggest if you have any meds for your RLS or for sleep to take them. As you know it can take awhile to get you all hooked up so you might not get to sleep in time to keep your legs calm. Certainly your first results indicated sleep apnea. I hope the titration goes well. Ask for a FFM for the titration if you feel you need one.
Keep us posted!
Mary Z.

[RinR]

I am home again after my sleep study. They used an adjusting CPAP (APAP I think) and a nasal mask. I am accustomed to having something on my face when I SCUBA dive, but then I am trained to breath through my mouth. I had to consciously keep my mouth closed. Talking is bizarre while hosed, but I guess you all know that already. Just something I had not thought about.
I did sleep well and kept the mask on all night. I am not sure if I feel any more rested today than usual, but I do feel a very slight headache. Hmmmm.
Anyway, I got my numbers from my first study. I can post them but with so many numbers, I am not sure which ones to post. Ideas?
RinR.

[elena88]

Here is an example of some of the info you might post for a more complete view of your study:




Patient: age
Patients estimate of sleep latency _____ minutes, patients estimate of sleep duration _____. Patient reported quality and quantity of sleep as_________
Epworth score: ____________
Sleep data: ______________
time in bed ___________
total sleep time: ____________
stage one sleep minutes___________ percent_______________
stage two sleep minutes___________ percent_______________
stage three sleep minutes ___________ percent______________
Rem minutes______________ percent__________
WASO (wake time after sleep onset) _______minutes or hours __________
sleep latency __________minutes or _______ hours to get to sleep
Sleep effienciency ______________ percent

Respirtory events:
Central _________ obstructive ________ mixed __________ hypopnea _____________
total number of events ______________
maximum seconds _________________

oximetry data: desaturation events index __________ lowest SA02 ___________%
arousal data: total number of arousals ____________
leg movement arousals _______________
snoring arousals ________________
arousal index ______________/hr
spontaneous arousals __________
respiratory arousals ___________ respiratory arousal index __________ /hr

Comments and conclusions____________________

[Jaylee]

Thanks, elena88! I was so surprised at how easy I took to the mask. I almost feel guilty

I feel the same way sometimes.

[RinR]

I do not understand most of this, but here is the text of my first study. I have removed the personal data.
------------------------------
Results
POLYSOMNOGRAPHY (PSG), ATTENDED, 19 LEADS
Dates Date Ordered Jul22,2010
Date Performed Jul07,2010
Date Resulted Jul22,2010
Result RinR, who is a 54 year-old male patient, was evaluated Narrative for sleep breathing disorders in an all-night polysomnogram on 7/7/2010.
SUMMARY OF RESPIRATORY/MOVEMENT INDICES:
AHI 20.9
REM AHI 46.6 RDt 45.3 ODI4% 22.1
Supine AHI 19.9
(Supine 30.8% of TST)
Min Sat 81.0% 02 Saturation >=90% (t of TSr): 93.6%
PLM Index 0.0 (PLM arousal index 0.0)
STUDY PARAMETERS: The study was performed with a sleep technologist in attendance for the entire test period. Video monitoring was carried out throughout the study_ EEG, EOG, chin EMG, limb EMG, flow (via nasal pressure), flow (via thermistor) I EKG, Sa02, thoracic and abdominal effort belts (RIP), and snore (via microphone) are other parameters collected as part of this study setup. PSG was scored according to the AASM Manual for Scoring Sleep (2007). A hypopnea was defined by a decrease in flow of at least 30% and associated with an oxygen desaturation event of at least 4%.
SLEEP ARCHITECTURE & STAGING: Testing began at 10:02:10 PM and ended at 5:38:07 AM, for a total recording time (TRT) of 455.9 minutes. The sleep period lasted 453.0 minutes and the total sleep time (TST) was 382.5 minutes, which resulted in a sleep efficiency (TST÷TRT) of 83.9%. The sleep latency (SL) was 3.0 minutes, and the latency to the first occurrence of Stage R was 93.5 minutes. There were 3 Stage R periods observed on this study night, 43 awakenings (i.e. transitions to Stage W from any sleep stage), and 202 total stage transitions.
Wake after sleep onset (WASO) time accounted for 70.5 minutes, while the time spent is each sleep stage was 119.0 minutes (Stage Nl); 154.0 minutes (Stage N2); 76.0 minutes (Stage N3); and 33.5 minutes (Stage R). The percentage of Total Sleep Time in each stage was: 31.1% (Stage Nl); 40.3% (Stage N2); 19.9% (Stage N3); and 8.8% (Stage R).
RESPIRATORY: The patient experienced 9 apneas in total. Of these, 2 were identified as obstructive apneas, 0 were mixed apneas, and 7 were central apneas. This resulted in an apnea index (AI) of 1.4 apneas/hour of sleep. The patient experienced 124 hypopneas in total, which resulted in a hypopnea index (HI) of 19.5 hypopneas/hr. The overall apnea-hypopnea index (ARI) was 20.9 events/hr, while the AHI during Stage R sleep was 46.6/hr. AHI results by body-position showed: supine AHI = 19.9/hr: right-side AHI = 24.6/hr; left-side AHI = 20.7/hr; and prone AHI = N/A/hr.
For other respiratory disturbances, there were 156 respiratory effort-related arousals (RERAs). The RERA index was 24.5 events/hr, and the total respiratory disturbance index was 45.3 events/hr.
OXIMETRY: Analysis of continuous oxygen saturations showed a mean Sp02 value of 93.8% throughout the study, with a minimum oxygen saturation during sleep of 81.0% and a mean value of 93.5% for the same period. Oxygen saturations were below <=88% for 6.4 minutes of the time spent asleep.
------------------------------
RinR

[elena88]

hi there,

Now that you have new information on this thread,
I bet if you change your title now to: please help, here are my sleep study results
You will get someone on here to help you.

just click on the thread, find your first post, and click edit to change the title..

elena

(that is if nobody answers after I bump this thread up)