could someone help me with my sleep report?

My sleep study was done in July, it was a split-study. Here are the results...

Results without CPAP:
The first portion of the study was done without CPAP and lasted a total of 248 minutes,
sleep latency 3 minutes
REM latency 234 minutes
sleep efficiency 91%
total sleep time: 225 minutes

sleep distribution: 6% stage 1; 81% stage 2; 10% stage 3; 3% stage REM

Snoring was mild. There were a total of 66 scorable events, primarily hypopneic and 55 respiratory related arousals. The respiratory disturbance index was 32, supine 59. Oxygen saturation was well maintained. The arousal index was 37 with reactive cyclic tachycardia/bradycardia

Results with CPAP:
applied a total of: 155 minutes
sleep latency: 22 minutes
REM latency: 79 minutes
sleep efficiency: 85%
total sleep time: 131 minutes

sleep distribution: 12% stage 1; 50% stage 2; 20% stage 3; 18% stage REM

CPAP was titrated to as high as 6 cm which was maintained for 7 mins. 5 cm was maintained for 88 minutes, associated with a respiratory disturbance index of 10, and arousal inidex of 12 and included supine REM.

The overall arousal index was 15. PLM activity was reduced from 28 to 14. Reactive cyclic tachycardia/bradycardia seemed to be reduced. Review of the sleep hypnogram shows improved REM progression and sleep consolidation under pressure.

Lab Impression:
1. Severe positional sleep apnea documented the first portion of the study evidenced by mild snoring, a respiratory disturbance index of 32, supine 59 with sleep fragmentation, reactive cyclic tachycardia/bradycardia.
2. Near successful CPAP titration
3. Insufficient sleep syndrome with the patient averaging 5 to 6 hours of sleep per night

Recommendations:
This patient appears to have an insufficient sleep syndrome and underlying anxiety based mood disorder. She will be counseled about an appropriate sleep period of 7 to 8 hours. Further evaluation and pharmacotherapy forh er underlying anxiety may also be of benefit.

My questions:
1. Could someone explain my Sleep Distribution?

2. What the heck is reative cyclic tachycardia/bradycardia? I remember my doc saying that if I had not been dx with osa, that he thought in the future I would probably have a heart attack/stroke. He said that my heart would increase during an episode. But still not sure if I understand this or not.

3. What is pharmacotherapy? and is insufficient sleep syndrome the same as OSA?

Thanks for your help.
Wendy

Sleep distribution doesn't look all that bad for split night sleeping in a strange place to me, depending on age and other factors. But I'm no expert, so maybe others see something I don't. And your doc really should explain it in the context of your medical history.

I think they are saying your heart has times when it beats slow and times when beats fast, apparently in reaction to breathing changes in your sleep. But the significance depends on the details of exactly what is happening, your specific family history, and other health factors. Again, something to discuss with the doc(s). Might be something that matters. Might not. Worth finding out for your specific situation.

It sounds like they think you might do well on meds for anxiety. That is not necessarily their call, though. At least not solely. You should have a role in deciding whether (1) you might want to get your sleep fixed first and then see what meds may or may not be needed, or (2) if meds may help you get your sleep better so that then reevaluation can be done. I would assume most anyone with sleep-breathing problems might tend to be anxious. I know I was, though I never did meds for it. (Unless Benadryl counts.)

They also seem to think you aren't getting enough time in bed. (I read that as blaming the victim, myself, if you are having sleep problems that can make your sleep less effective.) "Sleep hygiene" is important and worth googling.

So are you using PAP therapy now? If so, how is it going? That is where this forum really shines in being most helpful, I think.

jeff

Yes my therapy is going pretty good. My AHIs have gone down to 2 which is great compared to 59. I definitely have more energy during the day but boy do I "crash" around 4pm. I feel like I want to take a nap sometimes. I am not sure why. I generally get up at 6 or 630 in the morning and go to bed any where between 9 and 10 at night. Which before my therapy started I was falling asleep around 730pm. But overall, I feel pretty good.

Wendy

If you are happy with your therapy, there is really no need to answer my questions.
But if you suspect it should be better . . .

How long have you been using your machine?
You never sleep without it?
Is your leak OK?
How is your machine set up? (Is it in auto mode? If so, what is the range?)
How much of that time in bed are you sleeping, do you think?
Have you taken advantage of feeling better by making positive lifestyle changes, like diet and exercise, if needed?
Are there other medical problems that may be having an effect on how you feel in the afternoon?
Are you on any medications that may be affecting your sleep?
Are your doctors being helpful? What about the DME people?
Do you feel calmer now than you did at the time of your sleep study?

No pressure. And none of that is any of my business, of course, so answering at all is up to you. Just curious.

jeff

jnk wrote:If you are happy with your therapy, there is really no need to answer my questions.
But if you suspect it should be better . . .

How long have you been using your machine? 2 months
You never sleep without it? I have only kept it off my face twice since I have had it.
Is your leak OK? Yes
How is your machine set up? (Is it in auto mode? If so, what is the range?) Auto mode 5-10
How much of that time in bed are you sleeping, do you think? hmmm hard to say. I know I wake up when I roll over, but not sure how many times that is. hmmm 6.5-7 hours, maybe
Have you taken advantage of feeling better by making positive lifestyle changes, like diet and exercise, if needed? yes and some exercise. I have a soon to be 3 three year old to chase around
Are there other medical problems that may be having an effect on how you feel in the afternoon? not that I am aware of. I am concerned with the tachycardia/bradycardia though that the report mentions.
Are you on any medications that may be affecting your sleep? no
Are your doctors being helpful? What about the DME people? I have only seen my doctor once and that was last week. I didnt see him during my sleep study. The DME is as help as can be I guess.
Do you feel calmer now than you did at the time of your sleep study? Oh yes! Most definitely. I love to use my machine. I can tell when I do not get a good nights sleep or of the two night I did not use it, I regretted it the next day. My husband has even said he could tell a difference.

No pressure. And none of that is any of my business, of course, so answering at all is up to you. Just curious.

jeff

I don't mind answering the questions. I want to learn more from others. I am glad you are asking.
Wendy

WendyW wrote:

jnk wrote:If you are happy with your therapy, there is really no need to answer my questions.
But if you suspect it should be better . . .

How long have you been using your machine? 2 months
You never sleep without it? I have only kept it off my face twice since I have had it.
Is your leak OK? Yes
How is your machine set up? (Is it in auto mode? If so, what is the range?) Auto mode 5-10
How much of that time in bed are you sleeping, do you think? hmmm hard to say. I know I wake up when I roll over, but not sure how many times that is. hmmm 6.5-7 hours, maybe
Have you taken advantage of feeling better by making positive lifestyle changes, like diet and exercise, if needed? yes and some exercise. I have a soon to be 3 three year old to chase around
Are there other medical problems that may be having an effect on how you feel in the afternoon? not that I am aware of. I am concerned with the tachycardia/bradycardia though that the report mentions.
Are you on any medications that may be affecting your sleep? no
Are your doctors being helpful? What about the DME people? I have only seen my doctor once and that was last week. I didnt see him during my sleep study. The DME is as help as can be I guess.
Do you feel calmer now than you did at the time of your sleep study? Oh yes! Most definitely. I love to use my machine. I can tell when I do not get a good nights sleep or of the two night I did not use it, I regretted it the next day. My husband has even said he could tell a difference.

No pressure. And none of that is any of my business, of course, so answering at all is up to you. Just curious.

jeff

I don't mind answering the questions. I want to learn more from others. I am glad you are asking.
Wendy

If your husband is noticing a difference after only two months, either you are doing fantastic or you have been blessed with a marriage to a particularly observant male.

And anyone raising a three-year-old should feel beat by about 4 pm. Situation normal.

In my opinion, 5 cm is a little low. One day you may want to think about raising that 5 up a cm to 6 cm to see if that improves how you feel. (Maybe even 7, since your titration part of the study wasn't conclusive.) It is an easy thing to do, and your doc may give you permission over the phone. (Most of us do that sort of thing without asking, but we are a very naughty lot, that way.) What is your 90% pressure? Some eventually find one pressure that works best for them and find they get the best sleep using their machine in straight CPAP mode most of the time, using it in auto mode only once in a while to see what pressure it lands on.

It would be great to eventually get that sleep time consistently above 7, maybe to 7.5, and see if that makes a difference. It might be possible now that the terrible twos are soon to come to an end with the little one.

If you are feeling calmer, are getting more exercise, taking care of yourself with how you eat, etc., then you are doing the best things for your heart. How is the blood pressure?

You may want to ask your regular doc about a stress test to see about kicking your cardio exercise up a notch. A stress test might show whether those heart-rhythm abnormalities (if that's what they were) are an issue. (Not exactly what the stress test is designed for, but it can work that way.) It doesn't hurt to ask about it, either way, to let the doc know it is on your mind.

Glad you found the forum. I hope you stick around. I have found it to be a great place to learn.

jeff

My husband has been great during all this. He said he doesnt even hear the machine when it runs. But he does have some hearing lose in his right ear LOL so that might make a difference. My son has been great too. Especially at night. He has been sleeping through the night for a long time now and only wakes when he is not feeling well.

I am not sure what 90% pressure is?

Last night was a really great night. I don't remember rolling over. I must have my hose draiped right on the head board finally LOL I went to bed at 9:30pm and woke at 5:30am or so. A little slow waking up, but feel pretty good.

My blood pressure before treatment use to tend to be on the high side, but not enough to be put on meds. Now after APAP, it has dropped alot, even my pulse rate. My pulse rate use to be in the 90s now they are in the 60s.

I have decided already to call my PCP about my report and Ill ask about the other test.

Thanks for your replies!
Wendy

WendyW wrote: . . . I am not sure what 90% pressure is? . . .

I believe that information is given from the screen after AHI and leak. It is the pressure you were at or below 90% of the time. If it is a lot higher than the minimum pressure, that may (or may not) indicate a reason to raise that minimum. Some people notice a big difference with raising pressure. Some don't and put it back down. It is a very individual thing and may relate to whether or not you are a light sleeper, for example. Many mothers with young children are. At least that seems to be so among my relatives.

I am glad you are responding so well to therapy, noticing differences, and making progress. It sounds like your husband is being very supportive, which can make all the difference at times. Be sure that, just as you plan to do, you do discuss your concerns about your heart with your doc. Why worry about it when you can ask, right? It is their job to address your concerns about such matters, after all. Make them earn their pay.

When you have a family to take care of, a big part of that is taking care of YOU. It is good to hear you are doing exactly that.

May it continue to go well for you.

jeff