Could you please take a look at my sleep study?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
musicfreak
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Could you please take a look at my sleep study?

Post by musicfreak » Sun Jun 05, 2022 12:28 am

Hi everyone,

I haven't posted in a couple years. I've been struggling with CPAP and stopped a couple years ago as I wondered if I had PLMD also. I recently had my first sleep study so I was wondering if you could have a look at it. It was done last year and only got a copy of it recently as I couldn't deal with the incompetence of the office at the time.

To recap I've been sick for approximately 38 years. Finally in 2008 as a last ditch effort I asked to have a sleep study done. As the waiting list was long I was sent to a Respirologist/Internist who diagnosed me with UARS based on symptoms, increased heart rate and an exam (similar to a DISE but I was awake). (We don't do the Pes test where I live).

Since 2009 I've tried CPAP a few times and never felt better. I thought I was misdiagnosed until I remembered I had an increased heart rate. I also learned that the pressure I was using was too low but even if I increased it I didn't feel better. But also I was having a hard time keeping the mask on as find it uncomfortable and I'm claustrophobic. (I've tried a few styles). So I've gone back and forth for years trying to figure this out. Sometimes giving up thinking it was something else but always coming back to it. And there was also a delay in getting a machine as Social Services wouldn't cover it so it took a while for me to save up as I'm on disability. Now it's 13 years later.....

In the PSG there is no RDI or RERA's only Arousal Index so I hope that is enough. I don't know if the Arousal Index and PLM Index are that bad? I guess sometimes I still wonder if I have UARS as treatment has been difficult. What do you think of my heart rate? Does it jive with UARS? I had one Sinus Bradycardia. I remember I had one major leg jerk. It woke me up. It also says my snoring was medium to loud which is surprising as no one tells me I snore and not much is picked up on the Snorelab App.

I've also posted my original UARS diagnosis for you to look at. As far as I know my tongue is the issue but I'm a part of online support group and most of them have structural issues which I was surprised to see. You can see a pic of my jaw in my original diagnosis though it's kinda dark, do you think it's small/recessed? I don't think so. Note my heart rate spikes in this report is a bit higher (reaching 100 BMP) than in my sleep study.

Lately I've been doing inclined bed therapy as well as using a certain type of straw that strengthens the upper airway (similar to myofunctional therapy) but I'm having no luck so looks like I have to get back to trying CPAP again. I'm thinking of trying a regular full face mask as the last few years I was only using nasal pillows (thinking they would be better for my mask issues) and I realized how much I mouth breathe which is probably affecting me. In saying this my new Internist/Sleep doctor who says I have "mild sleep apnea" wants to try the ExciteOSA but I really don't have high hopes it will work.

I've posted my UARS diagnosis and sleep study here:
https://sleeptestresults.wordpress.com/

Let me know what you think.

Thanks.

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kteague
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Re: Could you please take a look at my sleep study?

Post by kteague » Sun Jun 05, 2022 4:55 am

Hi - welcome back! We talked quite extensively back when you were trying to sort through this stuff a couple years ago. I don't have anything different to add, just a mention that people who do happen to have dual disorders of PLMD and OSA may not be able to rely on a sleep study to fully appreciate either or both disorders. The road to a clearer picture is not one most sleep doctors embrace. Treating one sleep disorder then testing while being treated to see if the prevalence of the other has changed would be more revealing than repeat sleep studies that will still be anybody's guess which disorder will be preemminent on a given night. Sometimes the hassle is just too much. I still suggest anyone who has sleep disordered breathing resolve that first then be tested while using CPAP at it's proven therapeutic settings to see what the legs are doing when movements are free to more fully manifest. Or forget about retesting. One could just go ahead and take the steps we discussed before regarding the limb movements - becoming nutritionally sound relative to muscle and nerve function, get ferritin level up to near 100, and use a TENS unit at bedtime. Treatment is not an either/or proposition. Good luck with things.

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Julie
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Re: Could you please take a look at my sleep study?

Post by Julie » Sun Jun 05, 2022 5:07 am

Hi - I'll let experts like Pugsy, etc. comment on your old study, but will ask you to enter ExciteOSA into the search bar under the logo above so you can see what's been said about that here.

I also had trouble finding your machine setting min. and max pressures among all the info you posted - would be helpful if you can find those, but not crucial to the whole thing.

musicfreak
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Re: Could you please take a look at my sleep study?

Post by musicfreak » Sun Jun 05, 2022 1:24 pm

@kteague Thanks for replying. I was hoping you would see my post.

Do you know what an average arousal index is? As well as a PLMD index? I would like to know how my results compare. My doctor said nothing about my PLMD result. I should add I had a god awful sleep that night. I swear I woke up 10 times that night. I have a hard time relaxing as I'm worried I will sleep poor and get a bad result!

Sounds like you think my legs may be affecting me in my sleep.

I guess I could try CPAP again to correct the sleep disorder and then do another sleep test again to see if the PLMD is worse but I'm tired of dealing with doctors that don't get my issues. So with the help of you guys I hope to optimize my CPAP (which I find hard to do when I don't feel better) and then do the TEN's unit as I already have one. But first I'm going to try ExciteOSA. If it happens to work then it's a blessing as I have a hard time tolerating CPAP. It's worth a try.
Last edited by musicfreak on Sun Jun 05, 2022 2:06 pm, edited 1 time in total.

musicfreak
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Re: Could you please take a look at my sleep study?

Post by musicfreak » Sun Jun 05, 2022 1:29 pm

Julie wrote:
Sun Jun 05, 2022 5:07 am
Hi - I'll let experts like Pugsy, etc. comment on your old study, but will ask you to enter ExciteOSA into the search bar under the logo above so you can see what's been said about that here.

I also had trouble finding your machine setting min. and max pressures among all the info you posted - would be helpful if you can find those, but not crucial to the whole thing.
ExciteOSA is for snoring and mild sleep apnea. Because I have UARS I think it's worth a try. I have a hard time tolerating CPAP so a daytime therapy would be nice. I don't like how expensive it is and the fact you have to keep replacing the mouthpiece but if it works I guess it will be worth it.

All my sleep study and at home tests were done without CPAP so there is no machine settings on them. I do have some from OSCAR but they're from a couple years ago. I will post OSCAR data when/if I start CPAP again.

Thanks.

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Julie
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Re: Could you please take a look at my sleep study?

Post by Julie » Sun Jun 05, 2022 5:45 pm

Did you read the comments in Search? I would think you have enough trouble without chasing those.

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kteague
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Re: Could you please take a look at my sleep study?

Post by kteague » Wed Jun 15, 2022 3:05 am

Glad to see you working to address things. I don't have the guidelines at hand of the number of limb movements needed to merit a diagnosis of PLMD. But if you were also having UARS arousals during the same study, both conditions could be under represented on the results as they would both be vying for prominence and it would be "win some lose some". I'm all for getting your breathing disorder effectively treated and then ask the doctor to do a test to monitor your legs while using your CPAP at it's proven effective pressure. Short of that, trying the TENS on your own may help. I found that the longer I used it the more effective it became, and for years I used it without fail as I believed consistency was key. Several years into it I was finally able to use it intermittently without being miserable. It's actually been months now since I've used it, but I've seen hints I may need it again so it's at the ready. Good luck with everything.

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musicfreak
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Re: Could you please take a look at my sleep study?

Post by musicfreak » Sat Jun 18, 2022 12:44 am

Thank you Kteague. You've been very helpful. That's amazing how much the TENS unit helped you.

I talked to my sleep doctor. She wants to send me to an ENT for a second opinion. In the meantime I think I'm going to get my ferritin up and possibly try CPAP again. Maybe take Nyqol again or maybe try Melatonin to sleep.

Thanks again.

dataq1
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Re: Could you please take a look at my sleep study?

Post by dataq1 » Sun Jun 19, 2022 9:00 pm

Periodic Limb Movements Index of more than 5 and less than 25 is considered mild; PLMI of >25 and <50 is considered moderate and >50 is severe.
https://www.jpgmonline.com/article.asp? ... gh%20PLMI.
The information provided on Cpaptalk.com is not intended nor recommended
as a substitute for professional medical advice.

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Rubicon
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Re: Could you please take a look at my sleep study?

Post by Rubicon » Mon Jun 20, 2022 5:37 am

IMO you don't have any PLM to worry about.

According to Da Rules, you need at least 4 PLMs in series, no more than 90 seconds apart, to be counted as PLMs, so all those isolated movements need to be discarded. Simultaneous movements in both legs are counted as one and it looks like they didn't do that either so those extras should be discounted if not already done.

That salvo looks odd because a lot of it is in REM, and PLMs rarely occur in REM.

Image

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Rubicon
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Re: Could you please take a look at my sleep study?

Post by Rubicon » Mon Jun 20, 2022 5:47 am

In addition, you cannot score limb movements that occur during a respiratory event or during wake, so a couple that might be included in the salvo should be discarded as well. And if you're left with <4 in the salvo then all are discounted.

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Rubicon
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Re: Could you please take a look at my sleep study?

Post by Rubicon » Mon Jun 20, 2022 6:15 am

There should be at least four leg movements in a 90-s period.
Wrong.

What else is new.

dataq1
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Re: Could you please take a look at my sleep study?

Post by dataq1 » Mon Jun 20, 2022 7:57 am

Rubicon wrote:
Mon Jun 20, 2022 6:15 am

Wrong.

What else is new.
Seriously, are you going to start up again?

kteague didn't have " the guidelines at hand of the number of limb movements needed to merit a diagnosis of PLMD."

I quoted and provided a citation to "the numbers".

If you think that information is wrong, you can propose that the author of the journal article is wrong and provide some counter argument.

But your implication that I am wrong, is misdirected.
The information provided on Cpaptalk.com is not intended nor recommended
as a substitute for professional medical advice.

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Pugsy
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Re: Could you please take a look at my sleep study?

Post by Pugsy » Mon Jun 20, 2022 8:31 am

I think the implication is that there's a "what is to be scored" is part of the overall greater than so and so number to earn a diagnosis....is a huge part of the diagnosis and there's a lot more behind a diagnosis than just a single number.

If this thread is going down the road of another pissing contest, profanity laced, heated "discussion".....folks please don't go there.
I am giving a clear warning that such talk will be promptly removed.

Rubicon is a well known expert in sleep problems and what constitutes a flagged whatever event and does it warrant "counting" or not to establish a diagnosis. It's in the nitty gritty details as to what earns a "countable" number of anything.
Just like awake events don't count in establishing criteria for sleep apnea diagnosis...there are certain data criteria that need to be met for a diagnosis of PLMD. It's more than just a general number and if not "counted" or "discounted" per criteria then the criteria to meet the diagnosis is in question.

Play nice or get out of the sandbox please. This in fighting is driving away members...2 just this past weekend.
I cannot tolerate this.
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