Sleep test results - apparently negative

[Chasecaleb]

Hi, I just had my follow up appointment about the sleep study that I did. The sleep specialist that I went to said that the results came back negative, and I simply had Delayed Sleep Phase Syndrome, which I have already been diagnosed with, and was just going to have to learn to deal with it. Basically, that sleep disorder means that my body doesn't adjust to a regular schedule waking up early enough for a 9 to 5 job but instead wants to stay up later and sleep in.

Anyways, last week he recommended that I do a home sleep study based on symptoms that I was complaining about: tired even when I get "enough" sleep, easily falling asleep during the day, having times in the day where for ten or fifteen minutes it's all I can do to stay awake, and being extremely fatigued, groggy, and having a headache in the morning where it's a challenge just to get up and shower. Also, my dad is suspected to have sleep apnea, although he refuses to be tested.

Back to today, I was a little surprised when my results came back negative. I don't have them with me, but my blood oxygen level stayed above 90% the whole time except one point at which it sharply dropped. However, he said he looked on the computer at the detailed results and I was still breathing the whole time, so the finger sensor must have just come loose... Although it was wrapped and taped around my finger and it managed to reattach itself later. The results also showed that I stored off and on a good amount through the night, so he was concerned that later in life as I got older I could be at risk if I gained weight (I'm 5'11" and 165 lbs). I also saw on the chart somewhere around 5-10 times through the night where my pulse briefly shot really high - around 120.

So I guess long story short, I'm a little surprised that the test came back negative considering how I match all the symptoms I've heard about sleep apnea pretty much exactly, and I'm wondering if I should pursue things further or not. Is it possible that either the home study didn't gather enough information (it had a finger sensor, nasal cannula even though I mostly breath through my mouth, and a thing strapped around my chest to measure breathing), the doctor missed something, or I only have sleep apnea episodes on certain nights? Maybe I should try to get a regular sleep study done at the sleep center?

[chunkyfrog]

No EEG leads glued to your head?

[jamiswolf]

Chasecaleb,
From what I understand, the home sleep studies "cherry pick" the obvious positives (thus avoiding a complete sleep study for them). But a negative home sleep study does little to prove that you do not have sleep apnea. You're in the gray area and if you're having bothersome symptoms...I would suggest a full lab sleep study (PSG)
J

[Chasecaleb]

No, no eeg leads. Just a pulse oximetry sensor, a nasal cannula (although seeing as I was on the tail end of a cold and don't tend to breath through my nose a lot in the first place, i'm not sure how much that did), and the base unit of it strapped around my chest to measure how much I was breathing.

Jamiswolf, that makes a lot of sense. I've definitely been having problems that seem a lot like sleep apnea, some days a lot worse than others though. I think I'll call my doctor back and ask about getting a full sleep study done. At the worst, I waste a night after all and be certain I guess.

[Chasecaleb]

Update: talked to a nurse, or someone along those lines, at my sleep specialists office. My specialist is gone for the day, so they're going to make sure my insurance covers it and double check with the specialist about actually doing the study tomorrow and call me back. Sounds like it's happening though, and the actual study will probably take place on around a week. Not really looking forward to more tests, but I guess this is a good thing.

[DougVK]

I thought a home study shouldn't be used to rule out sleep disorders. I was under the impression that a full sleep study was best if it could be done. A full sleep study would include an EEG and EKG.

[Chasecaleb]

I thought a home study shouldn't be used to rule out sleep disorders. I was under the impression that a full sleep study was best if it could be done. A full sleep study would include an EEG and EKG.

That's surprising, because the doctor didn't say a thing about a lab study until I called and ask. He just said well, results say you don't have apnea, guess the symptoms are all from delayed sleep phase syndrome.

What you're saying sure makes sense to me though. So I guess I shouldn't think too much of those results yet then, I guess?

[Pugsy]

I think if the home study is positive (shows obvious problems) that is pretty well cut and dry but sometimes things aren't clearly obvious. So while a "positive" test pretty much tells the story, a "negative" test has some limitations and may not tell the full story.

Not saying this is your problem but sometimes it is when people don't seem to have classic OSA.
You need an in lab sleep study. It simply gathers more information than a home study can.
You might want to investigate UARS...Upper Airway Resistance Syndrome. http://en.wikipedia.org/wiki/Upper_airw ... e_syndrome

http://www.centerforsoundsleep.com/Uppe ... ndrome.php

[Chasecaleb]

That's quite interesting, Pugsy. Thanks. Is that something I should explicitly talk about it with my specialist tomorrow, or is that something that would turn up on its own during the lab sleep study? I've dealt with doctors enough to know that I don't want to be seen as the hypochondriac, but I've also seen plenty of times where they need a definite nudge or two in the right direction.

[Carmen]

My sleep study--full sleep study in the lab--came back "negative." On closer examination, I had very high AHI only during REM, and I had only a few minutes of REM during the study. An APAP does help my sleep.

[BlackSpinner]

I thought a home study shouldn't be used to rule out sleep disorders. I was under the impression that a full sleep study was best if it could be done. A full sleep study would include an EEG and EKG.

Correct - they should be a gateway to full study if nothing conclusive shows up

[Chasecaleb]

My sleep study--full sleep study in the lab--came back "negative." On closer examination, I had very high AHI only during REM, and I had only a few minutes of REM during the study. An APAP does help my sleep.

That's really interesting - so you have sleep apnea, only because of the way it worked no one caught it at first? That brings up a new question: if after this next study the results come back negative again, where should I go from there?

[Pugsy]

Yes, it probably should be brought because it is a possibility. If you read much about it...the jury is still out on a lot it. Very new and just now starting to be accepted widely.

Couple of years ago I did a screening on my sister with my APAP machine. She presents with every one of the classic symptoms of OSA and she didn't have any events to speak of and the machine didn't try to raise the pressure to fend off anything. So unless her sleep apnea was treated at the low pressure had to use...something else is going on. She did have some flow limitations though. Not huge though. But interestingly she reported she felt hugely better the 3 nights she use the machine to test. Not a whole lot was known about UARS back then. Now I am trying to get her to do a longer trial on the cpap machine. She is having a hard time agreeing to it because she doesn't understand "why use the darn machine if I don't have sleep apnea" She just can't understand the UARS thing. With the new stuff out on it...I am going to push hard for her to try it. They have no money at all for a formal sleep study. So we do what we can. Typically with UARS not a lot of desats in O2 but disturbance enough to mess with sleep architecture and anything that messes with sleep architecture can be a problem that needs to be address.

Hopefully it won't be long before more is known and UARS is a well known and accepted diagnosis in all areas and not just a few areas with some doctors who aren't afraid to go out on a limb.

Have no idea if you have this but it is something that needs to be evaluated for sure.

[Chasecaleb]

Ha, can't deny how intriguing all this, even though it's definitely a pain. Would having asthma (although minor enough I haven't treated it since being a child) and somewhat decreased peak lung flow/capacity contribute to UARS?

The doctor is calling me back tomorrow, I'll say something along the lines of, "I heard about Upper Airway Resistance Syndrome, that sounds a lot like what's going on if it's not apnea. While we're coin a sleep study anyways, could we check for that too?"

[cre8vmynd]

Chasecaleb,
Your situation sounds very similar to mine. I had gone to see an endocrinologist about symptoms I was having and he ordered a home sleep study, just like the one you did. It showed an AHI of 7 with the majority of that being hypopneas, with no serious drops in 02. I then was sent to a sleep doc who wrote me a RX for APAP based on that study.

Looking back, I really wish I had just done the sleep study in the lab because I think it would have given a much better picture of what my problem was. And definitely look into the possibility of UARS as others have mentioned. After looking over my home sleep study, researching UARS symptoms compared to my own, and doing some experiments with my PAP settings, I feel very strongly that I actually have UARS and not OSA. Had I gone to the lab for my study, it may have found this.

Casey