My sleep lab report

Dear CPCP users,
I have recently received this report from my sleep lab. Wanted a general info of how bad/good the status of my report is. Doctors have their opinion but in my country, medical field is highly commercialized and so no one believes the doctor. Can you please just state opinion and assist.

Total No of Apnea events 372
Total No of Hypopnea events 60
Apnea Hypopnea Index : 70.8
Average O2 Saturation :83%
Lowest O2 Saturation :65%
Mean Heart rate :72bpm
Blood Pressure 140/100 mm of Hg
Snore Index 303
Epworth Sleepiness Scale 20/ 24
Neck Circumference 18.8" \
Body Mass Index : 32.60

I'm not a doctor and cannot give a diagnosis, but I had a lower Apnea Hypopnea Index (59.6) and was diagnosed as having severe obstructive sleep apnea (OSA).

You will need titration at a variety of pressures for your doctor to determine the appropriate PAP therapy. The titration may be done either on the same night or on a different night from the diagnostic study. Does your sleep study report have a table of different pressures showing how many events (apneas, hypopneas, and centrals) you experienced at different pressures?

Do you already have a machine? If not, you should get a machine that has "full data capability," rather than measuring compliance only. The full data capability would allow you to monitor the effectiveness of your PAP therapy on a daily basis and share this information with your doctor so that pressure adjustments can be made as needed to provide optimal treatment.

This is an excellent place to ask questions.

gtsfze wrote:Apnea Hypopnea Index : 70.8

AHI/RAI Scale is a measurement of both the Apnea/Hypopnea Index (QHI) and the Respiratory Arousal Index. If a person has less than 5 events per hour then that person's AHI/RAI would be 0 and that person would not have apnea. 5 -15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).

wiki/index.php/Category:CPAP_Definitions

gtsfze wrote:Average O2 Saturation :83%
Lowest O2 Saturation :65%

Pretty low. Average should be mid 90s
At your lowest your Oxygen level dropped to 65% which is very low

Your blood pressure is elevated too.

Don't know what your doctor told you but you meet the diagnostic criteria for severe obstructive sleep apnea (OSA)
and hypertension too. Blood pressure may be a side fact to the OSA or it could be there all by itself.

What are the plans? You will need cpap machine. Do they do the formal titration sleep study to see which pressure works best for you where you live? Or do they give you APAP machine and let the machine do the titration?

General status? Pretty severe OSA, that oxygen level drop is significant. So nothing to dismiss lightly. You meet all the criteria in flying colors. Not any doubt or gray areas with these statistics. Good luck. Please stay around the forum and keep us posted as to your progress.

Dear Friends,
So many thanks for your valued opinion. I was just getting worked without much help. Let me take your Q’s first and then talk general.

Jimbo: I just purchased a ResMED Elite II CPAP but having bought it off the net and not having good help in my place, I need all the help possible. My initial questions are related to setting it up? Don’t know what values to set

1. Start CPAP should be how much?
2. Max RAMP should be how much?
3. Mask should be set at Standard? I have a Repreonics soft-gel mask (M)?
4. I am not using a humidifier so I set this at NONE I presume. (Can I get this separately from one of your dealers and how much is it approx.?).
5. SmartStart should be on or off and refers to what feature. To start when the mask is put in automatically?
6. Leak Alert I set it to off for it not to beep when it leaks in the middle of the night but I still want it to switch off when the leak happens?
7. EPR should be what in standard conditions, Full-time, Ramp only or off?
8. EPR Level should be level 1,2 or 3 during normal conditions.
9. EPR inhale should be medium/or fast?
10. What is EPR access? OFF/ON. What does it mean and how does it link to the EPR questions above?

Then I saw I have a memory card inside the unit but don’t have any CD or card reader, so presume I cannot do a “full data capability”.

“Pugsy”: I seem to have a very high AHI value. It scares me. How serious is this issue? Again, what is saturation level. Should it be higher or lower (closer to 100%?)
My doctor told me to use CPAP and go to a Gym and exercise daily. He said, “Severe OSA”. “Hypertension”, no one commented on it and the good thing is that I feel nothing. I use the CPAP and have no problems using it. I still sleep well with it.

I go to sleep usually with a good 6 to 8 hour sleep. No getting up in-between at all, even for a leak. Too. I sleep almost immediately when I lie down. No doubt I snore of not for the CPCP. I don’t feel any weakness or fatigues and never get headaches. Yes, feel sleepy most days in day time. I don’t smoke or drink and never have any health problems. In fact I don’t have health insurance also. Just pay as I go.

So, the subject is new to me, I understand and now read a lot more. I DON"T exercise much and somehow an not the sports enthusiast. 95Kg and can call obese but only in the stomach. Rest, feel fit as a fiddle. So, what to do…....

Sorry, I am burdening you with so many questions. I am one of the happy go lucky people who now in my time of need, so thankful to see you unknown people coming forward to help.. Thanks a lot....from the bottom of my heart......

Saturation for O2 is oxygen levels. Yes, closer to 100 percent is more normal.

Here in the US most people with OSA will have a sleep study that we call a titration sleep study where we are hooked up to the machine and a tech watches and decides which pressure is best. Sounds like you will have to do it yourself.
If can be done but will take some work on your part.

Is your machine the Resmed S8 Elite II? There is software available to help you see if pressure setting is the best.
If the S8 machine you will need a special card reader to transfer the data to computer. Check to see if the card that is in your machine looks like this one that is blue card shown here.

https://www.cpap.com/productpage/resmed ... -card.html

http://cgi.ebay.com/Resmed-ResScan-Smar ... 1c1ad94487

There should be data available on the LED screen of the machine. The S8 Elite II is fully data capable.
check this link for how to access your on screen data and how to get the clinician manual for your machine.
I suspect it is the S8 Elite II, make sure it is the S8 and not the S9 which is different machine and has just a regular SD card.

http://www.apneaboard.com/CPAP%20Adjustment.htm

So find out how to access your data at least on the LED screen first of all. You can monitor pressure results on the LED screen. So get familiar with your machine. The clinician manual will help explain many of the features that you are wondering about. Instructions on how to get the clinician manual is also at this link above.

Ramp and EPR are comfort features. Settings will depend on how you can adjust to the therapy. So these settings are optional. Mask selection for a mask other than a ResMed mask is indeed standard.

I would advise that you get a humidifier to use. It will make this therapy much easier on your nasal mucosa. Especially if you live in dry/arid area. Costs will depend on which one you choose and if used or new. You will need to make sure it works with your machine. This links gives ideas on models and costs. As a stand alone humidifier the F & P H150 is well thought of.
https://www.cpap.com/cpap-humidifiers.php

What pressure to start off with? Overall average is around 10 cm if we just take a poll as to what pressures are used among the population. I would start with 8 cm and check data to see how that AHI responds.

At a setting of 8 cm you don't really need EPR or ramp. So those settings can be off for time being. As time goes by and if you need more pressure, then consider using these comfort features. By then you will have a better idea as to whether you need these comfort features or not.

Keep reading and asking questions and things will become clearer to you.

The blood pressure number is high, so yes, you do have hypertension. Exercise helps sometimes, but sometimes it doesn't. It might improve with effect cpap treatment. If it doesn't then you need to work on this separately. It is high enough to cause damage if left untreated. So watch it closely. There are meds to help.

You need a titration study to determine the appropriate pressure. You should have a sleep doctor read the titration study to make this determination. Sleep studies are expensive; there is no getting around that. You can tweak things down the road, but you really do need the medical professionals to get you started.

.

lars4life wrote:I had to have a bipap machine as the Rx pressure was for 25/21. I have since
lowered it to 18/14....

Our friend in Bahrain would not want to use such high pressures unless a titration study says they are appropriate. So far, he has not said whether he has had a titration study or received a recommended starting pressure from a sleep doctor.

.

gtsfze wrote:Dear Friends,
“Hypertension”, no one commented on it and the good thing is that I feel nothing.

I go to sleep usually with a good 6 to 8 hour sleep. No getting up in-between at all, even for a leak. Too. I sleep almost immediately when I lie down. No doubt I snore of not for the CPCP. I don’t feel any weakness or fatigues and never get headaches. Yes, feel sleepy most days in day time. I don’t smoke or drink and never have any health problems. In fact I don’t have health insurance also. Just pay as I go.

I'm happy you don't have or feel the problems with your OSA you are a very lucky person.

How did you find out you have OSA as you don't seem to have any symptoms or signs?

I was diagnosed many years ago and did nothing about it. Now my body at a young age is not doing too good. Fatigue, memory loss, don't focus too well, low energy and more.

I'm glad you are here gtsfze. The people here are very friendly and helpful.

The journey is new to me also as i've been waiting on my equipment to get started.

Please keep us posted on your progress and I wish you wellness and good health!

Dear All,
Frankly I felt very upset with myself seeing all your comments and thought of taking some time off thinking about it. While, I have no problem whatsoever except some fatigue and sleeplessness in the daytime, all your comments seems to scare me that its much more serious and life threatening that it initially seems. I am sorry but with no symptoms (headache, sleeplessness, lack of any pains etc) I am not able to accept the seriousness. I hope I am wrong. Maybe a test to myself will prove the truth about my status.

Anyhow, I am thankful to all of you for your "selfless valuable comments". By the way, what is this titration you talked about. I did only a sleep lab report and dont know much on titration. Also I need and still need assistance to correctly set my RESMED Elite II settings. Can you please elaborate on the subject?
Regards,

The titration is when the sleep lab puts a mask on you and tries different pressures to see how you respond. The result will look something like the following, but will have different numbers, depending on the pressures tried and your response to each pressure:



Does your sleep study contain a data table resembling this? (Your numbers will be different.)

During your sleep study, did they wake you up and put a mask on you for part of the night?

No, I never was woken during my sleep and seeing the data, seems I have not done Titration test. Now I cannot go back to the country where I did sleep lab test and where I am presently, I dont have cheap ways to do Titration. so can I go by some approx settings? What do I set the readings to for the Elite II RESMED unit? Can you advice? I have readings such as

Start CPAP should be how much?
Max RAMP should be how much?
Mask should be set at Standard? I have a Repreonics softgel mask (M)?
Tube Length I think is 2m.
I am not using a humidifier so I set this at NONE I presume. (Can I get this separately from one of your dealers and how much is it approx.?).
SmartStart should be on or off and refers to what feature. To start when the mask is put in automatically?
Leak Alert I set it to off for it not to beep when it leaks in the middle of the night but I still want it to switch off when the leak happens?
EPR should be what in standard conditions, Full-time, Ramp only or off?
EPR Level should be level 1,2 or 3 during normal conditions.
EPR inhale should be medium/or fast?
What is EPR access? OFF/ON. What does it mean and how does it link to the EPR questions above?

You would need an auto-PAP machine to do self-titration. Unfortunately, that is not what you have. Can you return or exchange your current CPAP machine for an auto-PAP machine? Can you rent an auto-PAP machine from a local medical supplier for two weeks?

Does your sleep study make any pressure recommendations?

Unfortunately, without a titration study or at least an auto-PAP machine to do self-titration over a week or two, any recommended pressure would be a wild guess. A wild guess is not a good way to set your pressure. You need hard data as to how you respond to different pressures. Everyone is different.

The Elite II has on screen data to follow your progress. There is software available but you will need the special card reader to transfer the machine data to software. ResMed Card reader is needed. Only place I have seen it is on Ebay from someone in Israel. ResMed dealer in your area might have one. The Elite II is an older model and older model stuff is harder to find.

That said. You still have on screen data so you need to figure out how to access data and keep a log of the nightly results.

Humidifiers are available, unsure cost to you due to where you are at. In the US cost about $150 to $200.

gtsfze wrote:Start CPAP should be how much?

I would start at 10 cm of pressure.

gtsfze wrote:Max RAMP should be how much?

Comfort feature to get you used to the pressure. This is usually in minutes. Time till you get to 10 cm of pressure.
I use 10 cm and don't use ramp, never have. It isn't that hard. Your choice though. Strictly comfort feature.

gtsfze wrote:Mask should be set at Standard? I have a Repreonics softgel mask (M)?

Yes, Standard is fine

gtsfze wrote:SmartStart should be on or off and refers to what feature. To start when the mask is put in automatically?

Yes, your choice. Machine starts after you put mask on and with a few breaths the machine turns itself on.
Leak alert is your choice also.

gtsfze wrote:EPR should be what in standard conditions, Full-time, Ramp only or off?
EPR Level should be level 1,2 or 3 during normal conditions.
EPR inhale should be medium/or fast?

EPR is a comfort feature to help with exhaling against the pressure. Select Full Time for now. Choose 3 to start with. It will lower the pressure by 3 cm while during exhale. This can be changed if needed later.
EPR inhale, I would do medium to start with. If it seems to slow, then choose faster. It is the breath rhythm.

gtsfze wrote:What is EPR access? OFF/ON. What does it mean and how does it link to the EPR questions above?

EPR Access ON means you have the ability to make the changes above in EPR settings
OFF would mean you couldn't make any changes and you want to be able to make changes so set it to ON


Do you have the clinician manual for your machine? If not, you should get it because it explains in detail how to get to the data and what each of the settings mean.
http://www.apneaboard.com/CPAP%20Adjustment.htm
Link above has instructions on how to get the clinician manual for your machine. Just scroll down till you see the instructions and follow them.

Once you get things set up and figure out how to access the data, then start and keep a log of all the data you see on the Machine screen. Self titration can be done with the machine you have but it takes a LOT more dedication, education and hard work but it can be done.
Make sure you know what all the terms mean on the screen.
ResMed machines report excess leak, so any leak noted is unwanted. Anything above 0.4 sec/L is more than the machine can handle. Overall AHI goal is less than 5. Don't expect to get it there the first few nights.

Pressure of 10 cm is fairly average and the 3 cm EPR drops it down to 7 cm during exhale. Nice average starting point. Get very comfortable with explanations of all the features and terms. You will need to understand each and every aspect of things.. so keep the questions coming till you are satisfied you understand.