Need help on study, told I do not have Apnea?

Hi I had a sleep Apnea Study a few yrs ago. I have chronic Illness's and also live in Chronic pain. Takes forever to get referred. If any one knows how these studies work and can offer some advice , I would really appreciate it. First on the trip there, I stopped and picked up a ice tea , so I could take my reg meds on they way. Well, It was a Montleys, Ice tea. This knocked me out. Could hardly even fill out the paper work when I got there. Also had trouble waking up to get out of there, they brought me 6 cups of coffee so I could function to leave. When I read the bottle ingrediantes on the ICE TEA, found out it had 3 different natural ingrediants to sleep. Will kicked my butt, or I thought it did. When I told the nurse she said just tell the Dr when you come back in. So I did, He laughed and said that did not affect the test at all, and I did not have sleep Apnea. Also he said my problem when he realized how much Chronic pain I am in, stated they need to get this under control, this is my problem. He also at first visit stated to me, if the Apnea came out neg, be prepared to stay a other night as he was going to run a other test. Something else he was thinking. So He did not do the second test, Due to insurance is what he said! Wow , needed a approval and I have no idea what he was going to look for. I did get my test results as I do obtain all my records. I need help here, if someone knows how to read these. IF I should worry or get other test? I still do not sleep, but am dealing with so much and Yes in very bad Chronic pain all the time. Test results read: (these test have more date but way to much to write down. The Dr who did this test also My Pulmonary Dr? So don't get the results and he also assured me with my lungs, I only have Chronic Asthma, as i had been diagnosed with other Lung Conditions and went to him for a second opinion. If I have a oxygen problem and my pace spiking, (should this not be then a concern to him?)

Time In bed 512.5 Minutes Total sleep time 421.0 Minutes. Sleep efficiency of 82.1% 14.0 Awakenings

REM ;atemcu pf 201.0 Minutes, With 2 Rems periods, Rem Percentage of 11.0% of total sleep time
stage 1 comprised 3.2%, while stage 2 was 85.7% There was 0.0% Delta Sleep

Shows 0 Sleep Disordered breathing events/ On apneas, (all of them?)

Oxygen saturation date, Lowest 92.0 % Reductions in baseline Sa02 levels of at least 4% for desaturation event of 0.1 event per hr of sleep. O events below 90% all the way down to 0 events below 80%.

There were 32 total arousals during the night for a total index of 4.6 per hr of sleep. 0 all related to apnea and hypopnea. 32 arousal s related to snoring.

5 Noctumal limb movements. o meeting ACSM.


THE INTERPRETATION SUMMARY ( ALL THIS MAKES NO SENSE TO ME)
Low oxygen desaturation of 92%
Mild Snoring
EKG Showed pacemaker spikes

Can someone help me with this, what it means, should I have any other test done ? And any experience with taking something like I did, and told it would not affect this test!! I only recall wakeing up one time to use the bathroom. Any opinions. Thanks and apprciate any help

Welcome to the group.

It sounds like you do have some type of trouble sleeping, though maybe too mild to count as a treatable. Or it could be UARS, something I have heard mentioned it many times but don't understand. Hopefully, tomorrow, several people who are more knowledgeable will respond.

Did you get any graphs showing your sleep cycles, oxygen levels, etc? And does the report mention your body positions during sleep? If you did get the graphs, scan them and post them (without your personal info), and people can look them over.

It is possible that cpap will help you, but that your results aren't enough for insurance to pay for it. If that is the case, you can buy a used machine via craigslist or a few sellers on this list and try it out and see if it helps you. Also, if you want to get one via cpap.com or secondwind, you will need a prescription. YOU can ask any doctor to write a prescription, so you might try talking with your regular doctor about getting a machine and giving it a try.

Not sure about the tea, but from what I understand, sleep medication can often make the sleep apnea worse, but does not typically mask it. I used an ambien my one and only time for the sleep study as I normally go to sleep between 4 and 6 am, and I needed to be asleep before midnight for the study. Now, if the drink had contained caffeine or something like that, it could be a problem.

I think trying the cpap machine (actually, an apap (auto)) is worth a try as the snoring could be part of what is waking you up, and you may just be better at waking up before the oxygen goes too low. And preventing that could help you feel much better. And chances, are you will get worse over time as most people do. In fact, if the study was 2 years ago, you may already be bad enough to meet the clinical definition now.

Thanks for the info. Well this Dr also thought my Pain was a big problem and said I have probably not slept through a night in 10 yrs. That is True. I am exhausted all the time, bad. I feel like I have been awake all night , when I even get up. I nap during the day and at night. No restful sleep. I never sleep through a night. Never feel rested. I am a walking zombie all the time. this is why he did the test. Now I would guess it is possible as my pain is severe, causing this as it sure is not controlled. But I am seeking out help all the time and it is hard and taking a toll on my life. Now yes I know I have Chronic pain, but my questions are concerns if the tea screwed this up? IF not I could buy the Tea as I felt I was knock out for the first time in years!! (surprising though the studies shows I woke up how many times? ) Other test shows I am not even with the tea getting a full night rest? But since no mention to me about the low oxygen level and heart spiking , really scares me. I am not well at all. Thanks and appreciate you help here. Oh And no , did not get no chart or graft?

Have you been able to get any success with the chronic pain problem?

I don't have pain all the time, but I do right now (bad shoulder), and I did for several months in 2011. I finally found a solution (primary doctor ignored me, so I had to search online, and then talk to my sleep doctor). Once that problem was treated, my sleep improved immensely. Right now, it is kinda bad again, but I am working on the shoulder.

The pain can easily be a huge factor in the quality of your sleep, causing lots of arousals and preventing deep sleep.

Madmax, your case is complicated. One thing that caught my attention is the 0% delta sleep which means no deep stage sleep. Lack of deep stage sleep (also referred to as N3/N4, slow wave, or delta) is associated with a number of chronic pain syndromes. Deep sleep is when our bodies heal and restore. In some cases it is unclear whether the chronic pain interferes with getting deep sleep, or whether lack of deep sleep is the primary problem and causes chronic pain, or if the causal relationship goes both ways. Either way, it would seem to me that your lack of deep sleep needs attention (also pain management) regardless of whether or not you have sleep apnea.

Keep working with your doctor(s) and asking questions of them until you feel well informed about what's going on.

Get your vitamin D checked. Low vitamin D messes with the sleep control systems in the brain. If it is low start on vitamin D and the B vitamins, and see if that helps you get into deep restful sleep.

What meds are you taking routinely - they can possibly affect your sleep as well.

Madmax334,

You stated the test was "a few yrs ago". How many years ago and what kind of changes in your health have you had since that sleep test? Has the sleep gotten worse through the years? Has your weight gone up (or down)? Have the chronic illnesses gotten worse or are they stable? Has the chronic pain gotten worse? How is the chronic pain being addressed by you and your doctors?

If things have substantially changed in some way since the last sleep test was done, then a new sleep test is probably warranted. Particularly if any of the following is true:

• the snoring has increased
• your weight has increased by more than 10%
• the chronic pain issues have been properly addressed---i.e. you are getting appropriate medication or therapy to manage the pain now
• the subjective quality of your sleep has deteriorated and is not as good as it was when you went in for the previous sleep test
• the previous sleep test was more than 5 years ago

You also ask for help in understanding the previous sleep study's findings.

The sleep architecture results:

Time In bed 512.5 Minutes Total sleep time 421.0 Minutes. Sleep efficiency of 82.1% 14.0 Awakenings

REM ;atemcu pf 201.0 Minutes, With 2 Rems periods, Rem Percentage of 11.0% of total sleep time
stage 1 comprised 3.2%, while stage 2 was 85.7% There was 0.0% Delta Sleep

These results indicate something was keeping you from getting enough Delta (slow wave) sleep and the REM was a bit low.

But your problem does NOT seem to be related to OSA or PLMD since:

Shows 0 Sleep Disordered breathing events/ On apneas, (all of them?) [Note by RS: Should "On apneas" read "No apneas"?]

Oxygen saturation date, Lowest 92.0 % Reductions in baseline Sa02 levels of at least 4% for desaturation event of 0.1 event per hr of sleep. O events below 90% all the way down to 0 events below 80%. [Note by RS: Given that you slept for about 7 hours, there was ONE (minor) O2 desturation that occured all night long since 1/7 = 0.14, which rounds to 0.1][/color]

There were 32 total arousals during the night for a total index of 4.6 per hr of sleep. 0 all related to apnea and hypopnea. 32 arousal s related to snoring. [Note by RS: The arousal index itself is less than 5, so even the arousal index is pretty minor. However all the arousals are related to snoring. While snoring is a major symptom of sleep disordered breathing, not everybody who snores has sleep disordered breathing (i.e. OSA or UARS). However, snoring by itself can be problematic for some people and snoring can all by itself lead to less than restorative sleep when there's no problem with OSA/UARS.]

5 Noctumal limb movements. o meeting ACSM. [Note by RS: So PLMD is not a problem]

The overall result seems to be that you've got an officially mild problem with snoring, but nothing else going on in terms of sleep disordered breathing or periodic limb movements.

The overall interpretation/conclusions of the sleep study are:

THE INTERPRETATION SUMMARY ( ALL THIS MAKES NO SENSE TO ME)
Low oxygen desaturation of 92%
Mild Snoring
EKG Showed pacemaker spikes

The lowest O2 saturation of 92% is not a huge concern because: (a) it is above 90%, and (b) you only had one O2 desat all night long where the O2 dropped by 4% or more. With the history of asthma and "other lung conditions", if there is a problem with O2 levels, the problem is probably NOT sleep related. It's probably related to the asthma or other lung conditions. And that's potentially a daytime O2 problem as well as a night time problem. It is worth asking the doc treating you for the chronic asthma about your overall O2 saturation levels.

Mild Snoring is on the summary because of the 32 snoring arousals. But the snoring arousal index is only 32/7 = 4.6, and that indicates that the snoring problem is (very) mild, but worth noting.

"EKG Showed pacemaker spikes" indicates that the only "abnormal" heart rhythm stuff the test picked up was due to the pacemaker. Whether the "pacemaker spikes" are a concern or not is a question for the cardiologist who treats you for the heart disease that lead to the pacemaker.

And so given the data you've quoted from the study, it's pretty clear that (a) your sleep is not particularly good, and (b) the sleep problems are NOT caused by OSA or PLMD and are probably not caused by just the mild snoring that was found on the study.

Which leads us back to your medical history:

I have chronic Illness's and also live in Chronic pain.
...
Also he said my problem when he realized how much Chronic pain I am in, stated they need to get this under control, this is my problem.
...
I still do not sleep, but am dealing with so much and Yes in very bad Chronic pain all the time.
...
I only have Chronic Asthma, as i had been diagnosed with other Lung Conditions and went to him for a second opinion. If I have a oxygen problem and my pace spiking, (should this not be then a concern to him?)

Chronic pain all by itself will mess with your sleep. And for some people, it will seriously mess up their sleep. I think the doc gave you sound advice when it said that that the chronic pain was the cause of your problems at the time the sleep test was done. And the doc is right: You and the docs treating you for the conditions that lead to the pain need to get the pain under control as best you can. Because until the pain is under control, your sleep is likely to remain "bad sleep."

This is, of course, not a chronic pain forum. But I'll give my two cents opinion on this anyway:

1) You need to look at how you and your docs are attempting to manage the pain. First, since you say that you are currently in "very bad Chronic pain all the time," whatever you and your docs are doing to attempt to manage the pain is NOT working very well. It is worth having a very long conversation with the docs treating the chronic illnesses about the pain. If you have not seen a pain specialist, it's worth asking for a referral to a pain specialist. Because the sleep doc is right: Until you get the pain under control, things aren't likely to get any better.

2) If you are on medication for managing the pain, then it's worth considering whether those meds need to be adjusted or switched to something else. Since some potent pain medication can also cause sleep problems, it's worth finding out about potential side effects for each of the medications you are on. Some of them may be triggering sleep problems as a side affect.

3) If the chronic asthma is not under control, you need to work with the doc on getting it under control. Likewise, whatever other lung problems there are need to be addressed. If you are not breathing right during the daytime, then you're also not breathing right during the night time. The night time breathing may even be more of a problem; but since the root cause of the poor breathing are known lung conditions, getting those conditions under control should help the night time breathing problems as well.

4) You need to talk to your cardiologist about the pacemaker spikes. I have no idea how a pacemaker works. Perhaps the pacemaker spikes are just part of what's expected in a working pacemaker. Or perhaps they indicate a potential problem. That's for the cardiologist to decide.

Thanks so much for the relies. I appreciate it. Well, for Vit D, yes mine is always low. I take Vit D supplement now all the time. Also Magnesium. For the meds I am on, None of them should or would affect my sleep. I am glad the sleep study seems Good and confirmed what I wanted to know. Throws me back to my sleep problem what I guessed and always has thought is because the chronic pain I am in. I will ask my Cardo, about the spikes, (None of this was mentioned to me, only know from obtaining my own records) My thought as I have a pace maker was why a copy did not go to the Cardo, again unless it is nothing to worry about. I don't think any sleep study would be correct for me with this chronic pain issue. That needs to be controlled and then to see if I am going into the REM and Delta sleeps. This is the only thing that makes any sense to me Even the Dr is correct and clearly stated this on the report, (My Pain needed to be addressed and put under control) Was again ignored by PCP. Thanks to all who responded.

I hope you manage to get the pain under control, I think that has the potential to really help your sleep. A repeat sleep study is needed at a later date to check that your sleep quality has improved because the pain is better managed.

I have no problem with opioid meds for pain management when it is appropriate and you make an informed choice. Sometimes it is the only realistic option. If you go down this route it will be even more important to get a repeat sleep study because opioid meds can lead to sleep disordered breathing problems and you would want to know if this is the case so you can treat it with a VPAP Adapt SV machine (similar to ordinary CPAP but designed to treat central apneas, which can result from opioid meds).

It is a difficult decision to make (opioids) but pain must be managed somehow and sometimes in medicine we have to choose the "least worst" option and manage the trade-offs as best we can.

Thanks so much for the advice. Makes sense to me. yes I am hoping with the back surgery I am having tomorrow, (first hope I have had with this chronic pain) Helps me. The test study did. So I agree, I would think with my results as I posted here, It would be warranted to have the pain under control, and make sure there is not any other underlying issues, as I mentioned I drank a tea (which had 3 natural sleep things in it) And it knocked me out. That was a lot of my concern as I thought it was a normal ice tea, so thinking I slept all night like I haven't i years, but then seeing the heart spike, the 35 or so times i awoke and never going in a delta sleep, REM low, has me concerned. So thanks to all of your for you help, I am greatful and God Bless all of you and hope you are doing better now with treatment.