Help with Sleep Study Results

I am new to the forum but not to sleep problems (8 years or so). But I haven't been cured yet. I was using CPAP at 8 CM since April 2006 and just switched to M Series Auto Bipap a few weeks ago. I have set that to Auto with IPAP at about 7 and EPAP at 13. ENT's sleep lab had recommended 13/11. Below are my stats (There are more but I didn't want to go overboard or get you over bored). The CPAP helped a little in that I didn't snore and wake my wife but otherwise I was still tired.

I take Klonopin (1mg) and Gabapentin (600mg) at night and Provigil (200-400 mg, twice a day for Narcolepsy from previous MSLT). Still don't sleep that great. Am seeing ENT and my own sleep doctor next week and would appreciate some thoughts. Thanks. Ed

Time in Bed (TIB) = 493.8
Total Sleep Time (TST) = 434.5
WAKE = 59.5
Total Stage 1 Sleep = 60 (13.8%)
Total Stage 2 Sleep = 246.5 (56.7%)
Total Stage 3 Sleep = 52.5 (12.1%)
Total Stage 4 Sleep = 1.0 (0.2%)
Total REM Sleep = 74.5 (17.1%)
Total NREM = 360 (82.9%)

Sleep Latency = 7.4
REM Latency = 78
Final Wake Latency = 485
PLM Index = 28.2
Number of Epochs = 1029

Sleep Efficiency 88%
Sleep Maintenance 69.1%
# of Awakenings = 26 (3.6)
WASO = 50.5
AHI = 13.9
RERA Index = 35.4
RDI = 49.3

Min O2 Saturation 83.7% (WAKE)
Max O2 Saturation 98.9% (WAKE)
Average O2 Saturation 95.4%
Oxygen Desaturations = 8
Duration = 520
Average Duration = 65

Arousal Summary
With Apnea NREM = 4 (.7) REM = 0 Total = 4 (.6)
With Hypopnea – NREM = 62 (10.3) REM = 0 Total = 62 (8.6)
With Leg Movement – NREM = 27 (4.5) REM = 1 (. Total = 28 (3.9)
Spontaneous – NREM = 20 (3.3) REM = 10 (8.1) Total = 30 (4.1)
TOTAL – NREM 113 (18. REM = 11 (8.9) Total = 124 (17.1)


Respiratory Events
RERA = 256 (35.4)
Central Apnea = 1 (.1)
Obstructive Apnea = 5 (.7)
Apnea = 6 (.
Obstructive Hypopnea = 95 (13.1)
Hypopnea = 95 (13.1)
Oxygen Desat = 8 (1.1)
Respiratory = 365 (50.4)
AHI = 13.9 (Discrepancy here as Dr. wrote AHI 42 on front of test, and AHI Events were NREM 15.2 and REM 8.1. Not sure how that adds up to 13.9.)

If you are still desaturating, you may need supplemental oxygen along with your auto pap. quick question, bathroom trips? how offen.
your study is very imformative, whoever did this did a good job...

I never make a bathroom trip. They did a good job on data but not on telling me what it means.

I am not a MD, but as a lay person I would wonder about the meds you are taking.

Provigil is there to keep you awake. Klonoptin and Neurontin (Gabapentin) are there to sedate and/or treat restless legss. Klonpotin has a pretty long half life and who knows how long it is still in your body sedating you.

I would suggest you make a list of questions for the new sleep doc and included -

do I really have narcolepsy? (narcolepsy and OSA can co exist so the answer might be yes or it might be we need to do more testing to see)

how are these medications affecting my sleep and ability to function awake? and can they be adjusted or tapered off to promote better quality sleep and hence better ability to function waking up? (in particular if it was me I would want to see if a decrease in Provigil is possible and perhaps a decrease in the neurontin (it comes in 100 mg capsules so it can be adjusted easily if the doctor wishes to script that form).

Also just my gut feelings when I first researched neurontin years ago and talked to my doc at the time about taking it, taking 600 mg of neurontin at night without taking any at any other time during the day is not good - you can take less at night and get away with none during day but ask your own doctor about this. Neurontin was first approved as an antiseizure med and has many uses now.

Just my humble uneducated opinions.

Thanks Jules. I will need to ask those questions and wondered about them too. I also take meds for allergies/asthma so those probably interfere too. The neurontin is there because I do have a lot of leg movements. First sleep study in 2001 showed one every minute for 6 hours. The above sleep study also showed a lot when I had no CPAP in the first two hours, even with my usual meds so that begs the question.

Neurological tests are all fine. I am trying to be more informed when I see my sleep doc next week.

Ed,
Your sleep doctor owes you an at length explanation of your study and the relationship to your current meds. You have PLMD and are taking Klonopin and maybe gabapentin for it, I assume. If this is so, it may not be working. Plus the Klonopin is a central nervous system depressant and actually will make your OSA worse.

There are some newer meds such as Requip for the treatment of PLM that you might want to ask about. This med doesn't make you tired the next day for most folks.

I also would ask you why you have set your bipap to something other than what the doctor ordered.

What are your current stats AHI's and leakage?

I suspect you are not using a high enough pressure. 7/13 is to low.

You have a lot going on and must get each element of your therapy exactly right to see an improvement in how you feel. My humble opinion and recommendation is:

1. See your sleep doctor immediately and discuss the study and your current meds. Are the meds working for or against you?

2. Monitor your therapy daily so you know if your therapy is working the best for you. You really need a smart card and reader and software.

3. Complete your forum profile on the equipment you have. This will allow other members to make more specific comments.

4. Set you machine as the doctor ordered until you are confident a change will benefit you.

5. Keeping working with the folks on this forum and you will benefit greatly from there experiences.

Good Luck!!