your opinions on my study, please

Have been on cpap for 6 month now and I really don't see much of a change in the way I feel. I went in for a sleep study mainly because of my loud snoring. have been on cpap at pressure of 9. My doctor just upped it to 10. Here is my study:

History: this is a 48 year old male with a history of snoring,observed apneas, and daytime sleepiness.

Procedure: complete polysomnography was performed utilizing digital equipment. Parameters include EEG, right leg, left leg and chin EMG, respiratory oximetry, EKG, body position, air flow, snoring, pulse rate, and respiratory and abdominal effort channels.The study was scored by a PSG technologist and the study data was qualitatively verified and interpreted by a diplomat of the american board of sleep medicine.

Sleep architecture: This was a night study. There were 552 minutes of recording time with 452 minutes of sleep time. The diagnostic portion of the study comprised the first 198 minutes of sleep recorded. Sleep efficiency was good at 95.2% 38 minutes of sleep was in the supine position. Sleep latency was delayed at 42 minutes. Rem latency was slightly delayed at 126 minutes. Sleep was very fragmented with 256.0 arousals and 3 awakenings. The arousal and awaking index was 78.3

Respiratory analysis: The patients baseline oxygen saturation was 100%. During the diagnostic portion moderate snoring was observed and severe sleep apnea/hypopnea syndrome was demonstrated. There 183 respiratory events for a total AHI of 55.3. The rem AHI was 55.8. The supine AHI was 82.1. the non-supine AHI was 49.0. The were desaturations as low as 90% in association with sleep. These findings did qualify the patient for consideration of therapy for sleep apnea.

Limb movement analysis: There were frequent leg jerks during the night. Specifically, there were 79 periodic movements during the night. The periodic movement index was 10.5. these were occasionally associated with arousals such that the periodic movement arousal index was 5. Leg movements do not appear to be a significant contributor to sleep fragmentation.

CPAP titration: The patient was placed on nasal cpap at 1:57. There were 253 minutes of sleep time for the titration. This included 6 minutes of supine rem. A heated humidifier was used for this study. With sleep onset, cpap was ranged from 5 cm of water pressure to 15 cm of pressure. 9 appeared to be the most appropriate pressure. The residual AHI is elevated by the score set, however these were really rem related variability and rarely associated with arousals. The arousal index was lowest of the nigh at 8 and 9 cm of pressure. Supine rem was seen at or near a therapeutic pressure. The patient reported no difference in sleep quality after one night with nasal cpap,

EKG analysis: the EKG is a sinus rhythm with no abnormalities.

Diagnosis: Sleep apnea hypopnea syndrome-severe 780.53

Recommendations: This patient has severe sleep apnea syndrome. There were accompanying mild oxygen desaturations. It is resulting in fragmented sleep. Cpap at 9 cm water pressure appears to be adequate to address events and snoring. Additionally, periodic movements in sleep were seen. An iron deficiency evaluation may be considered. The patient was set up with cpap.

My AHI has been averaging 6, sometimes as low as 4 or as high as 9. My pressure has been upped to 10 for the last 5 days, no real change in AHI. Do I have a good arguement for an auto?

Ask your CPAP machine supplier to loan you a pulse oximeter for an overnight study and give you a printout of the results. If your CPAP machine has a smart card, ask the suppler to read it and give you all the printouts that the software will provide.

Take these printouts to your doc and ask for his opinion.

Milkman,
I'll leave commenting on having a good arguement for an auto to someone more knowledgeable about that. My doc shot down all of what I thought were good arguements, so I bought a used one from a fellow member on this forum. What I did want to mention on your results is really just a "heads up" that with severe sleep apnea causing so many arousals, there's a chance once the apnea is treated, your periodic limb movements could increase in number and severity. Unless I missed it, I don't remember seeing how many limb movements you had while on cpap. But with the cpap giving you more/better sleep, that sometimes frees the LMs to manifest uninhibited by the frequent awakenings. Just didn't want you to think your cpap treatment is failing when it may not be the issue at all.
Kathy

Hi, can you tell me why with cpap treatment your leg movement would increase? I'm just curious because my severe restless leg movement decreased with treatment? and no meds.......thanks

You pose many good question about your study that I believe only your sleep doctor can adequately address. The comment about a smart card is worth considering. I believe its invaluable to your treatment to have the tools/data that a smart card brings.
I to have PLMD and it has gotten worse over time. I am now being treated with Requip. My numbers were similar to yours. I recommend you discuss with your doctor.

Looks like it was a good study.

Your study indicates your best sleep was obtained at 8cm and 9cm pressure.

Do NOT ignore those pressures, snoring while annoying for your partner doesn't usually result in a drop to oxygen levels. Increasing pressure to 10cm to eliminate those snores may be a wasted effort and may not do much for your sleep architecture.

Leg jerks, or Restless leg syndrome was noted on your study, your doctor should give you a trial on Requip or other medication to see if that improves your sleep quality.

You are clearly in the severe range (198 minutes divided by 60 = 3.3, 183 events divided by 3.3 = AHI: 55.45 ).

Unless you see an improvement to your sleep, I would lower the pressure back down to 8 or 9cm as the lab tech indicated.

Were their any CA's or MA noted on your study?

What was the data shown for the following:

AI= (obstructive apnea)
HI= (hypopnea)

Wake %
Stage1:
Stage2:
Stage3
Stage4:
REM:

Any spontaneous arousals noted? Snoring can cause some arousals if it is very loud snoring, but the arousals noted on your study are probably more from RLS. Your study also mentions "awakenings", awakenings are different than arousals, it means the event that caused these woke you up from a sleep state to an awake state. Those are usually from central type events, but could also be from RLS. Central events should always be avoided since their arousal takes you all the way back to an awake state.

Here is the additional info

Were their any CA's or MA noted on your study? Yes, 9 CA's at pressure 14, 6 CA's at pressure 12. No MA's. No CA's or MA's in diagnostic portion.

What was the data shown for the following:

AI= (obstructive apnea) 1.21
HI= (hypopnea) 54.11

Wake % 4.8
Stage1: 2.4
Stage2: 68.8
Stage3 13.7
Stage4: 0.0
REM: 10.3
Any spontaneous arousals noted? I don't see where any spontaneous arousals were noted.


No One ever talked to me about the leg movements. I thought the leg movements were insignificant. Interesting, I'll talk to my doctor about this.
Thanks a lot for the input.

Whatrdreamsmadeof,

The cause and type of limb movements varies, as well as their response to CPAP treatment. Some say they are caused by nutritional deficiencies and treatment with different supplements is effective (usually magnesium or iron) It is recommended that one's Ferritin level stay above 50 if prone to movement disorders.

If the movements were a part of the body struggling to breathe during periods of apnea, they could very well completely disappear with CPAP.

Restless Leg Syndrome - not sure how it is affected by CPAP, just know that mine stayed the same. Some on here have reported improvement.

But it is not uncommon for people with just mild Periodic Limb Movement Disorder during their sleep study to afterward have enough trouble with it to seek treatment. PLMD and OSA can mask the each other, meaning that sleep is so broken by the dominant one that the other has to take a back seat. But when the primary cause of broken sleep is treated, the other then comes to the forefront. If anyone has had true PLMD, not RLS or the garden variety leg movements, and the PLMD was cured with CPAP, I hope they'll respond for some balance here.

Kathy

I agree you should talk to your doctor about the leg movements.

In addition, this text "The rem AHI was 55.8. The supine AHI was 82.1. the non-supine AHI was 49.0.". indicates that your apnea varies, depending on your sleep positions.

This variability could be a very good ground for asking for (at least) a trial of an automatic machine, you might be in need of more pressure when you're on your back, less when on your side.

The report doesn't really say how much time you spent supine during the titration (cpap) part of the study, it only mentions supine REM, so we don't know if the rest of the time you slep on your side, or not.

A split night study is an even more abnormal sleep situation than a 2 night study. Sleep stages become longer during the second half of the night. So all in all, it's very possible that the study was not the best snapshot of your sleep patterns, and that the doc and you might be wiser if you use a automatic machine for a while.

Keep us posted.

O.