I don't even know what all this means

Like I mentioned in another post, I got the reports back from the doctor on my studies. But, I don't even know what all this means. Can someone help me translate this?

Initial study:
Had alpha intrusion - even into Stage 1 and 2 sleep
Stage 1 sleep = 23%; Stage 2 sleep = 67.5%; Sage 3 sleep = 9.2%; No REM sleep
Arousal index elevated at 40.8 per hour
81 hypopnea total and 8 obstructive apneas for apnea/hypopnea index of 27.9 per hour
Signif number of periodic limb movements at 29.4 per hour

After CPAP titration portion:
Sleep efficiency poor at 47.5%
Stage N1 17.6%; Stage N2 52.4%; Stage N3 30%; Stage REM 0
35 limb movements with index = 12.1 events per hour
Increased amount of N1 sleep
"Recommend use of BiPAP at 15/11; however, we need to keep in mind that this may actually be a suboptimal pressure. She will need a nocturnal pulsse oximeter for 2 nights after being on BiPAP for 1 week. If there are any residual desaturations, it may be indicative for a higher pressure."

This is all Greek to me, and no one seems to be able to help me figure out what it all means. Doctors don't want to spend the time actually telling you what these things mean.

Hi DottyG

It took my new sleep doctor over an hour to go through my sleep study report line by line, and I must admit that I cannot remember all he told me. At the end he said to me something like - what really matters is how well the machine is working for you.

As you search the Forum you will find answers to most of your queries, and you will learn many other useful things as well. Others on this Forum will be able to help you with a more detailed analysis, and you can ask specific questions on items you are not sure of.

However, the bottom line is that you need good treatment, and it looks like you will be getting that. Make sure you get a data capable machine if you can, and enter it on your control panel.

Good luck with your recovery, and keep determined to succeed.

cheers

Mars

Sounds like there is a plan in place to work with you to assure you reach the goal of effective therapy. Your lack of REM sleep and short time of sleep is one reason they aren't sure the prescribed pressure will be effective. Giving you a week to get used to the treatment and then checking to see if the treatment keeps your oxygen level up is the means they have chosen to follow up. A good plan in my opinion, however, I would want that to be in conjunction with data from the machine. Because of your suboptimal titration, you of all people should have a fully data capable machine on an ongoing basis. Even if your oxygen does not drop a lot, you could still have lots of brief apneas or hypopneas that fragment your sleep, but you wouldn't know that without access to nightly stats.

Right now your priority is to get this treatment working for you. Once that begins to happen, if you still feel tired or wake a lot during the night, you might want to look into if the limb movements have resolved. Often limb movements are related to the struggle to breathe during apneas. For some people, the movements are unrelated and may need reevaluated for their impact on your sleep. You didn't say how many of the movements caused arousals, but they could have hindered you reaching REM during the study. But that's a whole different issue, or maybe not an issue at all.

Did you have any specific questions about your reports?

Kathy

Like I mentioned in another post, I got the reports back from the doctor on my studies. But, I don't even know what all this means. Can someone help me translate this?

Dotty,
I'll take a stab at this for you. I'll preface my comments with an asterisk so you can tell what is what.

Initial study:
Had alpha intrusion - even into Stage 1 and 2 sleep
* This means that they were seeing alpha waves in early stages of sleep. I believe these are deep sleep signals, and are a sign of how bad you need this therapy.

Stage 1 sleep = 23%; Stage 2 sleep = 67.5%; Sage 3 sleep = 9.2%; No REM sleep
*These are the different stages of sleep and what percent of the time you spent in them. Stage 1 is light sleep. Stage 3 is deep sleep. REM sleep is a different kind of sleep, meant more for the brain than the body. The brain waves are more like being awake, and this is where you will dream the most. Your eyes move around a lot 9REM = Rapid Eye Movement), and so would your body if your brain didn't shut off your motor drive system. You lose all muscle tone during REM sleep, and are essentially parylized except to breathe. The fact that you are showing no REM sleep explains why you might fall asleep and instantly dream during the day. Your body is trying to make up for nor REM sleep at night. Happened a lot to me before I started CPAP.

Arousal index elevated at 40.8 per hour
* This is how many times you are waking up, or nearly waking up each hour. This is why you never get much deep or REM sleep.

81 hypopnea total and 8 obstructive apneas for apnea/hypopnea index of 27.9 per hour
* Like a lot of people, you have a lot of 'hypopneas', which are a significant reduction in breath volume, vs apneas, which are where breathing ceases altogether. Hypopneas are just as capable of causing your blood oxygen to decrease as apneas, and many people on CPAP actually have to go to greater lengths to control hypopneas vs apneas. 27.9, which is your 'AHI' is not a particularly high AHI (mine was 96, I have seen one person here who had 130). I believe they would describe your sleep apnea as 'moderate'.

Signif number of periodic limb movements at 29.4 per hour
* This I don't know much about, but this is undoubtedly contributing to your arousals. Some forms of excessive limb movement are referred to as 'restles leg syndrome'. You may eventually be prescribed medicine for this in addition to your xPAP therapy.

After CPAP titration portion:
* The part where you wore a mask.

Sleep efficiency poor at 47.5%
* I am not sure how this is derived, but it means you are sleeping less than half the time. This actually isn't necessarily a bad thing because of the strangeness of being 'jacked in' at the sleep lab.

Stage N1 17.6%; Stage N2 52.4%; Stage N3 30%; Stage REM 0
*These are the same stages noted above, with different terminology. Notice your stage 3 sleep percentage is higher. This is a good thing, and shows even this test therapy was doing you some good. Still no REM sleep, though. Do note that most people spend most of their sleep time in stage 2 sleep.

35 limb movements with index = 12.1 events per hour
*Significant improvement even from this test therapy!

Increased amount of N1 sleep
*Not sure what is meant here, because stage one had a higher percentage before they 'masked you up'.

"Recommend use of BiPAP at 15/11; however, we need to keep in mind that this may actually be a suboptimal pressure. She will need a nocturnal pulsse oximeter for 2 nights after being on BiPAP for 1 week. If there are any residual desaturations, it may be indicative for a higher pressure."
* This means that you will be issued a BiPAP machine-- one that provides a different pressure for inhale, and exhale. The inhale pressure will be 15 cm/H2O (centimeters of water) and your exhale pressure will be 11 cm/H2O. I cannot tell you from what data is here why they recommended a BiPAP, other than the technician expects your final pressures to be quite a bit higher. In any case, they want to measure your blood oxygen saturation again in a week, using a small 'pulse oximeter' they give you to use. This is the thing they clipped on the end of a finger during your sleep study. If they are still seeing your blood oxygen dropping ('desaturations'), they are going to increase your pressures. (They want to keep your pressures as low as possible for your comfort. Thus, they don't raise it unless there is a need )

This is all Greek to me, and no one seems to be able to help me figure out what it all means. Doctors don't want to spend the time actually telling you what these things mean.

Hope this helps!

I think Alpha waves are sometimes associated with pain -- for example, arthritis pain or fibromyalgia "hurting" while you sleep...interfering with sleep.

Delta waves are, I think, the "deep sleep" waves seen in N3 (stage 3 -- formerly divided into stage 3 and 4, but now those two are lumped together as N3, for "Non-REM stage 3 sleep")

Not absolutely sure about what I just wrote, however.