1st Sleep Study results. What do you think of the numbers?

[notyorz]

Every post on this forum has been a wealth of information to me! Is there anything in the results below that *really* concerns you? It does to me, but that's because I'm new to SA and only knew a small fragment about it. Until this forum. I want to thank all of you for taking the time over the years (and recently) to share your experiences and questions. It has been a tremendous help!!!

I know this is a long post, and I've tried to make it as user friendly for reading as I could, but wanted to give as much info as I can to see what you think of the results.

I knew I had sleep apnea, but have been in denial for many years (family members have said I gasp for breath, stop breathing for long periods of time, etc.) I developed high anxiety about bedtime since I have been little and it has carried into adult years. I have a very irrational fear of sleep/bedtime. For the last 2 years, excessive daytime sleepiness, physical and mental exhaustion combined with being in pain from a blown out L5 disk back in 2005 (I'm not a good candidate for surgery to fix it due to high risk with general anesthesia) has been getting to the point where I HAD to do something. I'm also afraid of falling asleep at the wheel, falling asleep during inportant meetings, etc. because I feel like I'm getting to the point of not being able to function/think. I work full time at a desk job 8 hours a day and support a family of 4 (Myself, husband, my 85 yr old father and 24 yr old college son). Most days are real rough for me just to get through.

Physical/Health stats:

I'm a 43 yr old female. 5'11", 260lbs (50lbs of which have come on in last 2 years - no major change in eating, exercise has been slowed due to bad back, but I feel there hasn't been that much change to bring on that much weight). My average weight has been within 175-195 since I was 16. I've always had low blood pressure (110/60 was the highest it would run) until high blood pressure started almost overnight 2 years ago raising to 150/90 without meds, hovers around 130/70 with meds now. I have PKD (polycystic kidney disease) and liver cysts, but both are under control without meds at this time. PTSD/OCD/Anxiety/Manic Depression diagnosed with all at 18 yr old. PTSD was diagnosed in 2004. Gallstones/Heartburn/Acid Reflux. Athsma, controlled with occasional use of inhaler.

Medications:

Lisinopril 10mg 1xday (High Blood Pressure)
Alprazolam .5mg 1.5xday (Anxiety)
Atorvastatin 10mg 1xday (Cholesterol was at total 213, so put on meds last month to see if they can bring it down a tad)
Ranitidine 150mg 1-2xday (Hearburn/Acid)
Xopenex Inhaler 2 puffs as needed (Asthma)


SLEEP STUDY PRELIMINARY RESULTS

REASON FOR STUDY
This patient was thought to have sleep apnea with a history of snoring, witnessed apneic episodes, nocturnal gastroesophageal reflux disease, cognitive dysfunction, morning dry mouth, nocturia, excessive daytime sleepiness and unrefreshing sleep.

DIAGNOSTIC IMPRESSION
1. Severe obstructive sleep apnea with oxygen desaturation (ICSD 2 code 327.23).
2. Snoring.
3. Reduced sleep efficiency with reduction in stage III slow wave sleep and REM
sleep.

DISCUSSION
The patient entered the sleep laboratory on the evening of 05/03/2012 and indicated in the presleep questionnaire that she felt moderately sleepy but there had been no unusual occurrences during the day. Standard montage was utilized including monitoring of the EEG, EOG, chin EMG, EKG, bilateral pretibial EMG, snore microphone, oral nasal airflow, thoracic and abdominal motion sensor and oxygen saturation.

The patient spent 7 hours and 13 minutes in bed with a total sleep time of 4 hours and 57 minutes and a latency to persistent sleep of 36 minutes. There were 264 arousals for an overall arousal index of 53 per hour and a sleep efficiency of 68%. The patient spent 11.6% of the night in stage I, 44.8% in stage II, 5.8% in stage III, 6.3% in stage REM and 31.5% awake after initial sleep onset. Latency to REM sleep was 3 hours and 57 minutes. There were 80 apneas and 195 hypopneas for an overall apnea hypopnea index of 55 per hour. The patient spent the entire night in the lateral position. Oxygen saturation dipped down to a minimum of 72% and the patient spent 34% of the night with an oxygen saturation of less than 90%.

Electrocardiogram remained in normal sinus rhythm with frequent PVCs. There were no significant periodic leg movements of sleep, other parasomnias or seizures noted. Upon awakening, the patient indicated on the post-sleep questionnaire that she slept about the same as usual.

RECOMMENDATIONS
This patient was found to have quite severe sleep disordered breathing. Due to the severity of her sleep apnea, CPAP would generally be the most effective form of treatment. Also, the patient should be advised that alcohol and other sedatives can make sleep apnea worse and that untreated sleep apnea has been associated with fatal accidents as well as cardiovascular morbidity and mortality.

Lights out: 09:42:59 PM
Lights on: 04:56:28 AM
Recording (TRT) 7h 13.5m Supine: 0h 2.0m Side: 7h 11.5m
Sleep (TST) 4h 57.0m Supine: 0h 0.0m Side: 4h 57.0m

Latency, Actual
NI: 0h 36.0m
N2: 0h 39.5m
N3: 0h 54.Sm
REM: 3h 57.5m
Onset: 0h 36.0m
Efficiency: 68.51%

Stg Dur Total & %
Wake: 136.5, 31.5%
NI: 50.5, 11.6%
N2: 194.0, 44.8%
N3: 25.0, 5.8%
REM: 27.5, 6.3%
MT: 0.0, 0%

Apnea Summary
Total REM: 30
Total NREM: 50

Obstructive Total:
Total during REM: 30
Total during NREM: 49
Central during NREM: 1

Hypopnea Summary
Total Hypopneas: 195
Total during REM: 18
Total during NREM: 177
Obstructive Hypopnea Total: 195

Any and all comments, suggestions, advice is welcome!!! I have a good rapport with the sleep doctor and the sleep center. Sleep doctor has been a sleep specialist in the armed forces (Air Force) and he's seems to be on top of new equipment and information. Doctor and I both agreed that a Resmed S9 AutoSet will be the best option for me and I go fo my titration study Saturday night. I was told I will have the machine within a week's time after the titration. I am excited to start this new chapter in my life and will be compliant with CPAP.

Failure with CPAP is not an option

[notyorz]

Forgot to add this from the study:

Desaturation threshold setting: 3%
Minimum desaturation setting: 10 seconds
Sa02 nadir: 72%

The longest event was a 77 sec obstructive Hypopnea with a minimum Sa02 of 87%.
The lowest Sa02 was 72% associated with a 34 sec obstructive Apnea.

Thanks!

Marianne

[-tim]

The O2 stats are low enough to make some of your other problems worse. I'm guessing your in for another test with the CPAP machine soon?

When you do get a cpap machine, get the hypoallergenic filters as they get rid of pollen and other stuff in the air. Breathing filtered air for 8 hours a day has reduced my sensitivity a great deal.

Good luck on your next test and try all the masks they have so you have a better idea what works for you (while someone is there watching the data)

[Pugsy]

Welcome to the forum.

Pretty typical numbers and very near my own sleep study numbers.

Sounds like you have done your homework and have things all lined out. Good luck with your next sleep study using the machine. You seem to have a good positive attitude towards things and attitude plays a huge part in getting adjusted to sleeping with this stuff on our face.

Did you have any specific questions about your sleep study numbers? Other than yep, your AHI gets you the "severe" category and your oxygen levels drop pretty significantly the other stuff is pretty standard. You did get a good bit of REM sleep which a lot of us don't because we wake up so often we don't get to REM for very long.

[Mary Z]

notyorz, sometimes people experience weight loss and lowering of BP after starting therapy. I hope this is the case for you.
Good luck with the titration and getting the machine. Please keep us posted.

[notyorz]

Thank you for taking the time to read and respond tim!

Yes, I thought the O2 stats were scary and have had a hard time getting any sleep since the results.

I will definitely take your advice on the filters. I think that may help with the asthma in the long run.

I had the 1st sleep study on May 3rd and just got the results May 14th. This coming Saturday night (May 19th) is the 2nd sleep study where they will titrate and I cannot wait. I'm told there will be several masks to try. I'm a predominant mouth breather and doc thinks a nasal mask isn't going to be a good choice, so I think we both agreed the full face will be the one I end up with, although I am encouraged to try many different types. I just don't think I could ever do a chin strap - I pull at anything too close to my neck when I'm trying to get to sleep (i.e. t-shirt, sheet, blanket).

My sleep doctor seems to be moving things along at a pretty fast pace. I hope that continues through getting my xPAP machine. I am excited/nervous to start treatment.

[notyorz]

Thank you Pugsy! Your posts have been so incredibly helpful to me throughout these last 2-3 weeks...

At this point, I don't have any specific questions about the numbers. I guess I posted for 2 reasons. 1) Looking for confirmation that what I *think* about the numbers and that the research I have done is accurate. So far, it sounds like I am on track with my thoughts on the numbers. That's comforting in some weird way. I'd rather I didn't have SA, but then I am glad I will be a hoser soon and not suffer any longer. 2) Maybe my stats/results will help other new people in similar situations understand too.

I'm surprised at the REM sleep, because I never remember any dreams. The only ones I get are about an hour into sleep and they're never pleasant...

[notyorz]

mary, I am crossing fingers that CPAP and more changes in my diet (along with some swim time this summer) will help me lose the BP meds and the weight. Thank you for wishing me luck! I will definitely update after titration..

[Pugsy]

Good luck Saturday. It happens to be my birthday...the big 60....OMG I still can't believe it.

Your take on the overall numbers is pretty much spot on. Regarding REM sleep and dreams..they say we don't remember a dream unless we wake up during it. My OSA happens to be worse in REM sleep and prior to CPAP I never remembered a dream because as soon as I would get to REM my events would come fast and furious. I think even during the titration sleep study I only had 6 minutes of REM. It was a bad night and I sure hope you have better luck than I did.

My oxygen level also dip down to 73%....that sure explains some of those morning killer headaches. Those were greatly reduced once I was on the machine (still have a bad neck so still get some headaches from the neck).. Never did help my BP though..darn it.

How you will respond to the mask and machine is anyone guess but a good positive attitude sure helps. None of us want to sleep with this alien being stuck on our face but the sad fact of things is that without it....we don't really get good sleep anyway. The mask is the hardest part to all this IMHO. Finding the right one that is comfortable and seals well for your need is the biggest challenge.

[notyorz]

Seeing as it's your borthday on Saturday, maybe that will give me some good luck mojo

[Pugsy]

I will try to send some good mojo your way. I was thinking of going to the horse races Saturday. Last day of the season for Clairmore races. I might need all the mojo I can muster up.....

When you go for your sleep study...make sure you are totally comfortable with whatever mask you end up with.
If you can't sleep...they can't get a good titration. I had an idiot sleep tech who if I ever see him in the cross walk I will probably try to run him over.... Long story that I won't go into but when I left the next morning my blood pressure was 180/120 and I felt every bit of it. He tried to force me to use a mask that I simply could not breathe with and if I can't breathe I can't sleep so out of 8 hours....I had 156 minutes of sleep. It's no wonder they didn't get the pressure right.

Getting to sleep with a mask on is hard enough without adding pain and suffocation into things....so make sure you are totally okay with whatever mask is used. If you have a little sleeping pill....take it.

[kteague]

Sounds like you are on your way to better health. Just want to mention for you to be in tune to how you feel in relation to your various meds. Some have reported their needs changed as they began getting restorative sleep and were no longer oxygen deprived. One person on here who was on bipolar medication said her symptoms actually worsened because with a healthy balanced brain, her brain didn't react the same way to the same dosage of medication. Don't remember what med she was on, just thought in general it might be helpful for you to be aware. Everyone is different. My blood pressure and edema meds are now a fraction of the dose they once were. At one point my BP got low enough I was feeling weak and woozy.

Good luck going forward.

[notyorz]

* I meant birthday not borthday in that post. Darned keyboard LOL


As a horseperson, I will send good mojo back to you if you should go to the race

So far, the sleep techs at the center have been wonderful, but I get a different set of techs for Sat. I have armed myself with so much info about what to expect, my husband is scared to go with me for my check in, LOL. I promised him I wouldn't embarrass myself, or him, but I will insist in trying on each and every mask they have to find the "right one" (or as close to that as possible).

If they can ramp me up with the pressure at first, I think I'll be fine. I sleep at home with a huge fan circulating the air in the room (not to mention noise, oy vey!) so I'm kind of used to air and noise. The 1st study went very well for me and I had such worries beforehand. Seems silly to me now that I worried so much. It was much easier to fall asleep with the hookup than I expected. I am wishing on stars this time goes as smooth.

Thanks for everything and for making me feel welcome here Pugsy. You've been quite helpful and I look forward to getting to know everyone on this site.

[notyorz]

kteague, I will definitely keep that in mind! I'm optimistic that it will help the BP meds, since I am on the low side of the range, but I could be wrong. I will keep aware of any changes in BP. I know that woozy feeling well and I hope you found out fast so it didn't last long.

Although I keep a prescription for alprazolam for anxiety/ocd, I stopped taking meds for PTSD about 3 years ago. I had been on and off medications due to insurance coverage/non coverage for most of the time period between 2003-2009. The withdrawals were so horrible and the effects of the meds weren't adding that much to my pro-con list to make me want to continue them. I decided to get educated about my disorders and, although I still see a psychiatrist 2-4 times a year for check ins, I had to learn to deal with it head on without medications. I told the psych doc that there isn't a magic wand that can erase the memories. I would need the meds for life, and they're really not approved for that. They're meant to be short term. I wasn't willing to commit to a lifetime of psych drugs, going on and off of them or to keep ramping them up. I am hoping CPAP therapy will give me the daily strength to deal with it even better (since I will be better rested and not exhausted, cranky, anxious, etc.). Funny how everything is easier to handle with a little sleep.

Having said that, BiPolar is a whole 'nother issue and I can say I have friends with that disorder. I know that many could not function without the medicine and I believe there the meds have their value. BiPolar meds have been a true blessing for them and I'm happy they have an alternative available to them instead of just suffering with it. No one should have to suffer...

[Pugsy]

forum spelling..no problem.. I actually "saw" birthday and didn't notice the typo. My mind and fingers often go in different directions and I go back and read what I typed and think "what in the heck was I thinking"...makes no sense to even me sometimes.

So you are a horse person too? I have 2 Paso Finos. I used to ride a lot (endurance races) but had to give that up when neck and back decided it was too hard on me. So mainly sporadic pleasure riding is all I do now. The horse races are fun. I enjoy all the beautiful animals and I get to bet el cheapo $2 bets and then kick myself in the butt for not betting more when they win and pat myself on the back when I choose poorly. A few years ago I went up to place a $2 bet on a long shot (I like long shots) but the line was long and I needed to go to the bathroom (line there too) and I missed my time to place the bet...wouldn't you know it..200 to 1 odds and it won....still kicking myself over that one.
Plus they have a little casino there also I think. Different place to waste my money. Just a fun day away from the farm chores.

Keep us posted on how things go with your sleep study. If you aren't a dedicated mouth breather (badly congested nose for some reason) the nasal pillow masks are the easiest to get sealed and much more comfortable. I think they are commonly offered now during titration studies. Back when I had my titration study they weren't offered nearly as much and I had to fight the idiot sleep tech to let me try one when his over the nose mask caused immediate suffocation.

Hope you stay around the forum. Some people come and stay for a little while then move on and some of us have been here for a while...we like to pay it forward. I have made some really wonderful friends here. It really is a nice little family.