Finally did it....had a full PSG sleep study!

[rested gal]

Thanks to sleepydave (manager of a top sleep lab), I finally had a full PSG study! Three nights of being wired up, October 17 - 19, 2005. What a cool learning experience! My account of it is here:

First Sleep Study...finally! - rested gal

Full reports from all three nights of PSG

[Jere]

I am so impressed with your post. I was too anxious about the whole thing to get deeply involved in what was going on around me. It's been months since my study and only recently have I asked for a copy of my test results.

You are one special person and the best test pilot the new lab could have hoped for.

That room is nicer than most hotels.

One question : is there a difference between a standard sleep study (1 night to test and 1 night to titrate) and a 'full PSG sleep study'?

[wading thru the muck!]

So you're officially a hosehead now... congrats.

Could you do me a personal favor and repost your account of the experience here on cpaptalk... I am not able to view the link to your post on the ASAA forum.

How does it feel to be officially diagnosed? Kinda like Amelia Earhart getting her wings after becoming the first woman to fly across the Atlantic?

[Sleepless on LI]

Laura,
I have to say, I was so surprised that you could keep something that big a secret. I guess I know a good person to confide in if need be. I read your studies and was quite taken in by the data. To see you don't reach stage 4 at all and in the last, I believe, no stage 3. Also, your oxygen desats. without cpap were moderate, too. And with therapy, you seem to eliminate all signs of apnea, but still have hypops. PLMs, too, fragmenting your sleep. That's a lot of information to absorb for you that it must have been an eye-opener.

So you are not suprised, of course, that you definitely have OSA that needs treatment. And you are obviously doing very well on your machine. My question is, what made them do three nights of study? Also, why did they seem to recommend 8 cms on the 2nd night and then say on your machine 11 cms?

Well, congratulations on your validation. We all knew you knew what you were talking about before this, though, but now you are officially a hosehead (like you weren't one before). And thank you so much for sharing, in such great detail, ala usual Rested Gal style, your experience. That was very kind of you.

[chrisp]

Rats. LAb rat that is. Glad you enjoyed your visit. RG

[rested gal]

Wader, I PM'd you the text...it was such a long post on the "sleep studies" forum of ASAA that I didn't want to clutter up other boards repeating it. Thus the link to it. I'll do a slightly different clutter here.

Lori, you asked:

"My question is, what made them do three nights of study?"

Well, nothing made them do any of the nights...it was a generously kind offer on Dave's part and a volunteer thing on my part. Heck, I'd have had a study done every night for a month, if I could have! Those were simply the nights when most of their equipment would have already been moved to the new location but no "real" patients would have been scheduled yet. Nights set aside for testing the moved equipment, so... that's why I got the opportunity to be wired up three nights in a row.

"Also, why did they seem to recommend 8 cms on the 2nd night and then say on your machine 11 cms?"

My 420E autopap was not behaving itself the night we used it (of all nights! ) due to at least a couple of possible things, all my own doing:

1. The makeshift sensor tube I crammed through the main air hose possibly got kinked, pinched, or bent. Later, after I was home and had completely removed, then re-crammed the same makeshift sensor tube through, the machine began giving me my usual data. My Silverlining software data from the study night (and from all my nights before and since) showed clearly that something was very amiss that night with my jury-rigged sensor tube.

2. I keep IFL1 turned off all the time. Have to. So, part of the sensing the 420E is designed to do is not ever in operation when I'm using it. I've deliberately "blinded" it to a certain kind of flow limitation...always, and on that night, too. A fairer look at the performance of a 420E along with a PSG would have been with a person (not me) who can use it with IFL1 on...the normal default for that machine.

The 11 cm recommended from the third night while using the 420E and PSG together was probably skewed by the wildly untypical pressures my 420E was using that night.

At home afterwards, with the oddly shaped (an Argyle tube) makeshift sensor re-threaded, everything settled down on my usual data reports, in which 9 is the pressure used almost all night (with my machine set for a range of 9 - 20) occasionally touching 10 or 11 only briefly.

For a long time I've not believed there is necessarily one magic number of a pressure that is the ONLY pressure that can treat a person well. For me, there are several straight single pressures that would probably be fine... 8, 9, or 10, or even 11... any one of those would give me good treatment, comfortably and effectively enough to feel well rested if I were a patient prescribed straight CPAP at just one of those pressures for the rest of my life.

Sleep doctors apparently feel that way too, as we often read posts by people whose doctor has ordered the single cpap pressure raised or lowered a few notches without sending the person back for yet another PSG titration.

As it is, I've been using my autopaps (420E and REMstar Auto with C-Flex) essentially as if they were straight cpap machines -- since I've kept the lower pressure set at 8 or 9 for the past year.

People given to tweaking (as I am) seem to usually be most interested in setting their low pressure very low with an autopap and then concentrating on fiddling with the high pressure. After a year of all kinds of tweaks to both ends of the pressure range, I stopped trying to use a very low "low" and settled on using 8 or 9 as my autopap "low" for the next year. I used either of those because of the physical feeling of absolute throat closure when I was lying in bed with the machine going and I deliberately relaxed my throat as much as possible. Any pressure less than 8....I could feel my throat slam shut. Plain and simple.

Also, it didn't matter what range I set, 9 was usually what any autopap (420E, REMstar Auto, Spirit) used most of the night. Seemed to work well for me and happily was confirmed closely enough in the second night (titration night with the lab's machine) as being "right" for me. As I've said many a time, I'm probably a straight cpap-er at heart, although my machine of choice is autopap for many reasons.

Several consecutive nights of PSG using any machine - theirs or mine - might have come up with 10 as "the pressure" on one night, 8 on another, 9 on another, and so on.

What really matters, in my non-techie opinion, is that a sufficient approximate pressure is found...whether it's found through using an autopap or found through a good PSG titration. In other words, finding that 8 or 9 or 10 treats a person well as opposed to needing, say 15, 16, 17 or 5, 6, 7.

To me, the real value of a full PSG (polysomnogram) sleep study and titration is not to find one magic number as being the one and only pressure that can give good treatment for OSA. Autopaps can do the titrating well enough in most cases of simple OSA. Rather, the PSG's value is to get a very thorough look at a person's sleep architecture, their oxygen saturation, and to reveal other disorders besides plain OSA that could be causing sleep problems. Such as the PLMs which, even though they are causing arousals part of the time for me every night, are apparently not preventing me from feeling consistently good after each night of sleep using cpap of any kind -- cpap, autopap, bi-level, whatever. I'm glad to know about the PLMs though...for future reference if I ever start feeling not so rested.

"To see you don't reach stage 4 at all and in the last, I believe, no stage 3."

Actually, I was pleasantly surprised to see any stage 3 showing up at all on any nights, and wasn't concerned a bit at not having stage 4. Stages 3 and 4 diminish as people get older. I'm definitely getting closer and closer to "Medicare eligible" age, even though I don't feel "old".

[Sleepless on LI]

To me, the real value of a full PSG (polysomnogram) sleep study and titration is not to find one magic number as being the one and only pressure that can give good treatment for OSA. Autopaps can do the titrating well enough in most cases of simple OSA. Rather, the PSG's value is to get a very thorough look at a person's sleep architecture, their oxygen saturation, and to reveal other disorders besides plain OSA that could be causing sleep problems.

I hear you. In your case, you did such a thorough job in finding the method/settings to self-treat your condition that it was not necessary. But very interesting finally to see what the PSG had to tell you about your sleep architecture, I'm sure. I'm glad you shared it with us and that you were finally given the opportunity to see your results in black and white for yourself. And how sweet of SleepyDave.

[wading thru the muck!]

RG,

Just out of curiousity... and to make a point of course.

Did Sleepydave tell you how much those three nights in his posh hospital lab would have cost you?

You looked like you were in "Lab Rat" heaven.

[Mikesus]

RG - Great info!

What you found in regards to titration was the same question that always has been lurking regarding a single night, and a single pressure. (asked Dr Rappoport this question back in March Here) What Dr Rappoport does is to take an average over a period of time. Not very cost effective as someone would need to do EXACTLY what you did, have multiple sleep studies to determine a single pressure. (or they can get an Auto, but in a case like yours, it requires someone to be on top of the programming so it responds properly. (someone that isn't near a sleep center or even a doc, could have a problem there, and believe it or not, there are still folks that don't use the Internet!) But, remember there was a study done THIS YEAR showing that ANY pressure is still better than no pressure! (Link)

Its a simple fact that not everyone has the means to have a sleep study done, or be able to afford anything other than a straight CPAP(and sometimes can't even afford that!) Would someone be treated better by an AUTO? Jury is still out, but it does seem to be that way (no specific studies yet, but the preliminary data looks good, as we already know!) But as you pointed out, people can get very effective therapy even if they can't afford an auto, and the earlier study gives us the idea that any therapy is still better than no therapy.

Of course all the Auto advocates are going to jump on me now, but I am not saying that Auto's aren't a boon to us and could keep us from having additional sleep studies, I am saying that for the folks that don't have an Auto as an option (financially, or otherwise), a straight CPAP can and will treat them. In an ideal world, everyone would have an opportunity for a sleep study, and the best machine available to treat them. Unfortunately (as we saw with the folks from Katrina) not everyone has these opportunities , its sad but its true.

[Guest]

Mike,
While we all love our autopap, downloadable software, and being "proactive" in our treatment, I have to agree, straight cpap is often better for many people. There are many patients who have short arousals with the pressure change of autopaps, and NO those won't show on our printouts, and we won't remember them in the morning. I also agree with keeping the low pressure very close to the titrated pressure. Why require our bodies to endure a few hypopneas and apneas to achieve the needed pressure....also keeping a tight cap on the ceiling to prevent "runaways". So even though like many, I have all the latest "toys", I sleep equally well on my original straight cpap and use it often. I am sometimes concerned that we encourage some patients ,who are spending money they really can't afford, to invest in autopaps, thinking they are far superior in treatment.....which they just aren't!!
CPAP is still the gold standard, more affordable, and produces great results for most patients.

[frostman]

Thanks to sleepydave (manager of a top sleep lab), I finally had a full PSG study! Three nights of being wired up, October 17 - 19, 2005. What a cool learning experience! My account of it is here:

RG, what is the bottom line, what titrated pressure did the study recommend for you? I though you had gone back to straight CPAP using your auto. What do you do for living, you seem to have a good scientific mind?

[rested gal]

frostman, bottom line for a single pressure for me from the titration night (second night) at the study? Probably 8.

This was a voluntary lab-rat thing...not a doctor referral formal sleep study, so there was no doctor writing a prescription after it was over. Maybe one doctor would scribble 8 on the pad, another doctor would choose 9, and another doctor 10 or 11.

Any of those, if used as a single pressure, seem to do fine for me. I choose 9.

Sorry about the confusion if you were under the impression I had gone back to straight cpap at any time. I've always been using my autopap in auto mode with a range of pressures - sometimes a wide range, sometimes narrow, but always a range.

For a number of months I've been keeping the low pressure set at 9. Since my autopap uses just that one single pressure (9) so much of the time, my treatment, in effect, is as if I were using my autopap like a straight cpap.

However, because I use an autopap in auto mode and usually have the range set for 9 - 15, there is always that extra room up at the top, pressure-wise, if the machine ever needs to use more than 9 for me at some point during any night. It usually doesn't need to. Any autopap I've used usually just rocks along at my "low" of 9 all night, briefly hitting 10 or 11 for a very few minutes on some nights, or touching 12, 13 momentarily once in a blue moon.

The only exceptions to my using autopap were:
1. the borrowed straight cpap I used for about three months when I first got started in Oct. 2003.
2. a few days or a week from time to time when I'd get hold of bi-level machine to try just for the heck of it.
3. the several random nights when I'd run my autopap at a straight single pressure just to see what the data showed.

I've bought a few machines, but most that I've tried out have been through temporary swaps or permanent trades of machines with others.

I trained and showed American Saddlebreds for almost twenty years, trained and showed dogs (was a dog show handler and Rottweiler breeder) for thirty years. Happily retired and working only as much as I wish at home -- boarding and grooming dogs. Loved science courses in high school and college. Hated math, though. Loved languages, majored in Spanish. Thoroughly enjoyed the careers I chose - horse trainer and dog trainer. Have always liked to read and learn.

Everything, literally everything, that I've picked up about OSA and cpap treatment has been from the apnea message boards -- from people far smarter about this stuff than I could ever be. There are wonderful nuggets of good sound information in the mix if one digs for them. I was lucky to have been (and still am) healthy all my life, other than this little physiological quirk of throat tissues relaxing too much when I sleep. Have always been an advocate of fixing what you can yourself, if you can. Worked for me.

[wading thru the muck!]

Of course all the Auto advocates are going to jump on me now, but I am not saying that Auto's aren't a boon to us and could keep us from having additional sleep studies, I am saying that for the folks that don't have an Auto as an option (financially, or otherwise), a straight CPAP can and will treat them. In an ideal world, everyone would have an opportunity for a sleep study, and the best machine available to treat them.

I agree with all you've said (in this post ).

My point with regard to this has always been that ANYONE that can afford a fixed pressure machine purchased through a local DME can more than afford the best auto-pap equipment available if purchased from cpap.com. A company that can provide me with the best available equipment for less cost than the average equipment purchased elsewhere is a company that I want to do business with.

[rested gal]

Wader, I don't know how much a regular one or two night study would cost in that lab. Based on what people post on the message boards about the cost of their sleep studies, I've read of PSG studies running anywhere from $1,500 - $4,000 a night.

If I had not been getting a "well rested" response to my autopap treatment within a very short time, I'd certainly have bitten the bullet and sought a formal sleep study a long time ago. The PLMs would have been revealed. Thankfully, even though I have them, they are not causing me any "sleepiness" problem. But they could have interfered with sleep, and I'd have never known it without a PSG.

A person can guess (as I did) that the only problem they need to treat is plain old OSA. And that's probably going to be the case most times. But if trying CPAP (autopap) doesn't help, there are organizations that can help people who are in financial difficulty and without insurance find a way to have a sleep study done.

[frostman]

Probably 8. This was a voluntary lab-rat thing...not a doctor referral formal sleep study, so there was no doctor writing a prescription after it was over. Maybe one doctor would scribble 8 on the pad, another doctor would choose 9, and another doctor 10 or 11.

For a number of months I've been keeping the low pressure set at 9. Since my autopap uses just that one single pressure (9) so much of the time, my treatment, in effect, is as if I were using my autopap like a straight cpap.

I trained and showed American Saddlebreds for almost twenty years, trained and showed dogs (was a dog show handler and Rottweiler breeder) for thirty years. Happily retired and working only as much as I wish at home -- boarding and grooming dogs. Loved science courses in high school and college. Hated math, though. Loved languages, majored in Spanish. Thoroughly enjoyed the careers I chose - horse trainer and dog trainer. Have always liked to read and learn.

Very interesting RG. My wife and I used to train dogs and show golden retrievers. I recently retired from the US Forest Service, it was a great job lived in 5 different states, wouldn't have changed anything. I wonder if the lower pressure being closer to what the titrated pressure shows would elimentate more of the hypoapneas and maybe reduce the snore index. For me it seems I have more of that type activity til I reach 9-10