1) It's not at all clear why or how you wound up with an ASV machine based on the home sleep test data.
Why? I felt the APAP that I was originally prescribed was not helping me at all (That may be because of a low prescribed settings of 4.5 and me not being fully adjusted to it yet). I bought an ASV instead and it actually helped on days where I had minimal activity
2) It's not at all clear why the doc agreed to an ASV titration.
It was more of a recommendation from forum users on here.
On the ASV titration study it is not clear how the settings were arrived at. It appears that the tech started you out with the settings that wound up being the recommended pressure settings
How can you tell? Because I can't. I could have sworn though that the pressure was low in the beginning and increased in time to counter the apneas I was having.
3) The split test results seem a bit odd. First there's the fact that all but one of the apneas scored are central rather than obstructive, but the diagnosis remains OSA.
I feel the same way about this. I think the sleep technician was too tired to function at that time.
However, when you look at the hypnograph, it's pretty clear that a lot (maybe all?) of those CAs are being scored as you are transitioning to sleep, and perhaps the reason they disappeared during the treatment part of the study is that the addition of the positive air pressure allows your brain to reset the CO2 trigger for respiration more smoothly.
Is it possible to make certain those were Central Apneas from the information given? Or can it be possibly true that the sleep technician mistakenly swapped Obstructive Sleep Apneas with Central Apneas on the First phase of the split study. I ask that because he seemed somewhat ill when I saw him.
4) Spontaneous arousals: On the diagnostic home sleep test, the arousal index was 43, meaning that approximately 43 times per hour the "surrogate arousal indicators" showed that it was likely you had an EEG arousal, even though there's no EEG data. An arousal is not quite the same a a full wake, but you can loosely think of an arousal as a sudden change from a deeper sleep stage to a lighter one. Most of the arousals on the home sleep test were NOT associated with sleep disordered breathing.
If I can remember quite clearly. My home sleep test was done on my back and without any support to raise my body too far from the mattress. Something that I did the opposite on in the Split and ASV Titration Study. Basically I had two pillows underneath me with one half folded to given me an even bigger boost off the mattress.And I slept mostly on my sides. This is what makes me believe that I have less arousals as compared to the Home Sleep Study. I have self performed raising my body and sleeping on my sides to notice a significant difference in my sleep.
On the ASV titration, there was still a significant number of spontaneous arousals in spite of the ASV treatment (arousal index = 11.something). But on the split test, there were NO spontaneous arousals on either part of the night. And that seems just plain weird.
Not to pick on the sleep technician, but is it possible that he just did not score things properly? Because I find it also weird that I have 0 hypopneas.
5) The sleep architecture seems pretty lousy on the in-lab tests; but it's not as bad on the home sleep test.
Lol I agree. I recall the sleep technician stating that something needed to be updated when I took the ASV Titration Study.
The home sleep test's total sleep time and sleep efficiency were actually pretty good. Now some of the differences could be lab effect---it is more difficult to get to sleep in a strange place.
Yes! On my Split Study, I noticeably had trouble falling asleep because the darn sleep technician coughed every now and then waking me up. I was falling asleep and then I heard his cough which raised my anxiety and woke me up. He definitely had a cold or something. Now, I normally wear earplugs to bed because I am sensitive to noise. I forgot my good earplugs at home but I had some that were a bit above average/average in my car. So while it cancelled out many of the noises, I still heard him cough and I had somewhat anxiety because my mind was racing and replaying things like (Oh no, You do not have your earplugs (the good ones). Your not going to fall asleep. Is that noise that I heard?) Eventually though, I did feel like my anxiety dropped after about an our or two. I normally fall asleep really fast especially at home so I guess I did have a bit on a in-lab effect. I forgot to mention, that during the ASV titration (this is not the study taken with the bad earplugs) it was hot as hell! At least to me it was. I had to take most of the covers off. But by morning I was freezing my ass off
But usually the effect is not going to be as pronounced as it is in your sleep tests. And there's no REM at all on the split study.
6)
Recommendations from the sleep studies. While PAP (of some sort) is mentioned on all of the studies' recommendations for treatment, it is NOT the only recommendation. In particular:
- Home sleep study indicates that the SDB is very mild and appears to be positional. It does say that alternatives to PAP such as an oral device are worth considering. Which raises the question: Did you consider an oral appliance or not?
I considered an oral appliance, yes, but I do not want to rule out CPAP/ASV therapy. I believe that I just need to find which machine to use, and under what pressure.
[*]The ASV study specifically mentions the overall lack of sleep and recommends "Sleep Hygiene Education." Which raises the question: Did anybody ever follow-up and ask you about your sleep hygiene and provide you with some sleep hygiene guidelines?[/list]
I believe that my sleep hygiene is better than 90% of all people (At least in the US).
So where to go from here: You're still feeling miserable, but not as miserable you were:
Correct
And you've commented elsewhere that nights following days when you exercise are much worse in terms of sleep quality than nights following days you don't exercise.
Yes, I have personally tested myself many times doing this.
And you've commented (reasonably I might add) that you don't want to just give up on the exercise routine.
Yes! Exercise is my life. I loved it when I did it.
Which raises the side question: Do you happen to recall if you exercised before any of the sleep tests?
Yes. During both the ASV Titration and Split Study, I did exercise but not too much. It was much more exercise than I usually do. (I usually have zero or near zero forms of exercise (I will not even lift or carry heavy things) every damn day except for the days I masterbate) But compared to other people, it is considered highly minimal. For example, on the ASV Titration Study, I changed all four of my tires and masterbated. And didn't exercise before others??? I do not remember the Home Sleep Study, but I would believe that I might have exercised there too because it was around that time where I actually did exercise like normal people exercise e.g running a mile or two and going to the gym. Overall I purposefully exercised more before the tests because it disrupts my sleep more because maybe it brings me to a more relaxed state when trying to sleep. I did this because I wanted a titration number that is in line with when I exercise, because I plan on exercising until I can no longer. But please note that I do not overexercise. It is weird but I think that since exercise is highly related to deep sleep, that it will trigger more apneas because it makes my throat more relaxed. But who knows?! Right?
Under ideal circumstances, I'd suggest starting over with a full in-lab diagnostic sleep test, preferably on a night that you can sleep. And I'd personally recommend starting over with a different sleep doc and a different sleep center.
Yes. I am willing to do another test, but I need a good sleep center. Are there any good recommendations that you or anyone reading this may have in the northeastern region of New Jersey?
It's just that the sleep tests are all over the place and I think you actually need a proper in-lab diagnostic test based on more than 75 minutes of fractured sleep where it's clear that a large part of the problem on that night was getting to a sound sleep state.
Personally I think it was the low level of the pressure on the Split Study (A starting pressure of 4.0? Really? I am better off breathing without the machine!) in conjunction with the damn coughs in the beginning of my study that showed the low fractured sleep. Also the ASV Titration little sleep because of the high pressure and the warm temperature. When I am at home, I do dream. How do I know? Because I remember having them, and on some rare occasions, on days where I have not had exercised I feel more well rested.
But I also understand that money is tight and that this starting point is probably NOT financially feasible.
Yes I have spent thousands of dollars already and I am still stuck.
I also think you need to be considering the sleep continuity problems as being caused by other things in addition to the SDB that you happen to have. It's important to understand that the CPAP and ASV treat only the SDB issues: they don't fix bad sleep that is bad for other reasons. And since the data you've posted from your ASV machine seems to indicate that whatever SDB you do have is well controlled by the ASV, it's time to start considering other things that you need to address.
Yes, but as someone suggested before, that my ASV data shows a pressure support throughout the data and that it may cause my wakefulness.
A sleep log is one thing that might be useful. Track when you go to bed, when you get up, and estimates of how long you think it took you to fall asleep, how many times you woke up during the night, and how long you think you actually slept during the night. Since you think that exercise makes the sleep worse, you need to track that as well as how you (subjectively) about the sleep each morning.
While this requires effort, I will do. But I can also act on memory because I usually sleep near the same time and it usually does not take long for me to fall asleep. 10-15 minutes most nights. The differences I can draw from exercising vs not exercising is that I wake up many more times when I exercise and notice/wake up from my dreams much more. Usually exercising one day requires for me not to exercise about three days consecutively for me to feel well rested. I have experimented myself in this situation many times and it indeed is true. I definitely also breathe harder during these three days which might mean that I need a higher pressure from my machines because my breathing is too strong for the weak 5.5 EPAP pressure that I have. I notice that usually on the second day and third day after exercise that I feel really tired. This may possibly be because the first night after exercising I am not as terribly sleep deprived that it would take another full night for me to feel its effects, because as I did mention, I feel somewhat okay if I do not exercise for longer than three days.
It could be that you need to pay careful attention to when you exercise. For many people exercising too close to bedtime will make it more difficult to get to sleep and stay asleep. You might also find that too much intense exercise on one particular day is problematic, so you may need to cut back on how much exercise you do at any given time, but increase the number of days per week that you do something.
I exercise on very good times. I have done my research of many things related to exercise and read a great book on the science part of it. I definitely do not do intense exercise anymore, but even a little will disrupt my sleep.
Also look at things like caffeine consumption. We tend to consume more caffeine than we realize and we tend to drink it later in the day than we think---particularly when we're feeling excessively sleepy or tired during the day.
I had Zero caffeine (No chocolate, coffee, soda, tea, etc.) for over two years
And finally, it's worth considering other causes of the daytime sleepiness and fatigue. If it's been a while since you've had a full physical exam, it's time to set one up and have all the usual (non-SDB) suspects for daytime fatigue investigated: Get your thyroid checked and your vitamin levels checked in particular.
I eat very healthy food so my vitamins are definitely good. Better than many people. As for thyroid, I will get that checked too along with a physical exam. But that would have to be after school semester ends in May. In conclusion, I still do think that I need to know what proper settings and machine to use because the ASV has helped me a lot. This raises a question that I have. What is the downside of having a slightly higher CPAP or ASV setting than is needed? Will it cause harm? If so, how and why?
And by the results of these tests, there is no way to tell what machine I should be using under which pressure?
Edit: I would also like to thank for you looking at my data!
Basically I am writing this because I feel like I have little options left from having a potentially good life, to living in a state of hopelessness...
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