Got Additional Sleep Study Data

Getting the graphs will help to shed some light on a few of these questions.

If the sleep on the left side was composed entirely of SWS (which is a quite stable sleep stage in re: arousal threshold) that could explain the lack of events. Or, a simple change of head position can sometimes affect the airway.

Of note, the Medicare criteria for desaturations is not >3%, it's 4% or greater. It might be interesting to see how many desats fall out (because the values are measured to tenths) since overall your sats are pretty good. That would further reduce the AHI (hey, maybe we can get the AHI <10. See prior reference to UARS definition).

In re: the centrals, an index of >5 would probably start to become significant. Anyway, if these centrals are post-arousal (an arousal generates a brief period of relative hyperventilation, followed by a compensatory pause), then they're really harmless.

Right, all positions should be assessed, even in the titration. I suppose one could argue that if you had REM dependency for events, and you were going to go on a fixed pressure, then you would titrate to the worst case scenario (which would be supine REM). Or if you had someone with poor sleep efficiency, that one would avoid waking them to change body position (although that's probably not a real good reason).

With a REM dependency for respiratory events, you gotta wonder how good a job you can do in 6.5 minutes.

Just for laughs, ask if there was any alpha intrusion, especially in the slow wave sleep. And the answer should not be "well, it doesn't say anything about that in the report." If so, we can talk about density later.

Ever get light-headed when you suddenly stand up?

The other stuff.
SAG

SAG wrote:Getting the graphs will help to shed some light on a few of these questions.

I asked for them. Specifically. I really wanted them before today. I know by law they have to give me the records. I don't think there's anything that says they have to do it in a timely fashion...

SAG wrote:It might be interesting to see how many desats fall out

Is this something that will show on the graphs or is there something else I need to ask for?

SAG wrote:Just for laughs, ask if there was any alpha intrusion, especially in the slow wave sleep. And the answer should not be "well, it doesn't say anything about that in the report."

I'm assuming there's some data somewhere that is necessary to answer this question. Would this data be on the graphs as well?

SAG wrote:Ever get light-headed when you suddenly stand up?

Yes, but rarely these days. I remember it happening quite often years ago.

Sandy wrote:

SAG wrote:It might be interesting to see how many desats fall out

Is this something that will show on the graphs or is there something else I need to ask for?

They'd have to rerun the software again to calculate that, which I'm pretty sure they wouldn't do. But if those hypopneas are really all RERAs, then it's not a matter of "like" UARS, it "is" UARS.

Sandy wrote:

SAG wrote:Just for laughs, ask if there was any alpha intrusion, especially in the slow wave sleep. And the answer should not be "well, it doesn't say anything about that in the report."

I'm assuming there's some data somewhere that is necessary to answer this question. Would this data be on the graphs as well?

No, that would need to be commented on by the physician or scorer.

Sandy wrote:

SAG wrote:Ever get light-headed when you suddenly stand up?

Yes, but rarely these days. I remember it happening quite often years ago.

Y'know, unlike OSA, which can generate high blood pressure, UARS can generate low blood pressure (and orthostatic BP changes)(which is a little like Daylight Savings Time - "jump up, fall down.") Anyway, it's important to be able to differentiate OSA from UARS because of the different types of functional somatic issues UARS can have associated with it. Stuff like headache, GERD, CFS symptoms, depression.

And oh yeah. Insomnia.
SAG

My appointment with the new sleep doc went great.

I was nervous because the new sleep doc is the head of the sleep clinic, which he also founded. I was worried he would be intimidating and with my fatigue comes raw emotions and with raw emotions come tears if people aren't nice to me. Fortunately, he was understanding, honest, and compassionate.

While he didn't outright state it, I got the impression he isn't overly impresed with the other sleep doc or sleep clinic. He said he is ultimately going to want to get me into his sleep lab, which is accredited. I expected this was going to happen. Since I've been generally frustrated with everything about the first sleep clinic / sleep doc, I don't have an issue with another study. If my meds are going to be changed an added benefit will be seeing if the new meds improve my sleep architecture. The new sleep study isn't going to be right away - he wants to address my meds and some other things first. So, it looks like the UARS question isn't going to be answered for a while.

During my appointment, he didn't just focus on my physical apnea symptoms. We also discussed the fact that some of my inability to accomplish things may not be just fatigue. It could be tied to depression or some other thing. Everything is interwoven. He's going to talk to my therapist and they're going to discuss having me see a psychopharmacologist to evaluate my meds.

He was also very concerned about the affect my fatigue / inability to do things is having on my marriage / job / self-worth / etc. I was surprised he expressed such concern over my marriage, but he's seen situations similar to mine and understands how much damage it does to a marriage. So, we discussed how I AM able to accomplish things despite my fatigue if I'm under stress or have some other urgent motivation. One possibility is for me to have someone help me around the house in the short-term. It's always urgent if someone ELSE is going to see my messy house .

In addition, he wants to know exactly how much I'm sleeping. I'm supposed to do a sleep diary and I'm also wearing an Actiwatch. It's an odd little thing I'm wearing on my wrist for the next two weeks. It's supposed to give data about my amount of sleep. I hope it's doing more than just tracking what hours I sleep, though. I could do that on my own with the sleep diary, which is considerably less expensive.

Finally, he wants me to lose some weight. Fortunately, I was prepared for that. I've gained about 25 pounds over the past 2 years and I'm not happy about it. He didn't just say - go home and lose some weight and come back when you do. He recommended a place I can go that can help.

So, I'm thrilled with how my appointment went. He seems to be exactly what I need to work through this in a methodical way.

Thanks for all of the help and support. I'll keep you posted.

Sandy

Sandy,

A great report and such a positive outcome - without doubt a great 'kicker' to getting things under control.

You seem to be in the right frame of mind to benefit. Go for it !

Cheers

DSM

OK, great, sounds like you're going to do well.

My biggest regret is that although your 3 threads discuss some of the most important concepts in sleep:

Getting the right diagnosis;
UARS vs OSA; and
The influence of other factors on sleep,

Scotty's "Children's Hour" Poll (AKA "Mommy, Billy's pickin' on me!") commands 5 times more views per day than these. I was gonna put a link there to the threads that might offer real help (kinda like advertising on the Super Bowl) but then said, "Ah, forget it, if people just want to stop and watch an auto wreck, they're probably all NASCAR fans anyway."

Oooh, I better be careful. RG's lawn ornament in front of her double-wide is a blown Hemi from the BMS Gift Shop. Don't want to get clubbed upside the head with a torque wrench (I was gonna say, "Clubbed upside the head with an Isky Roller Cam", but that might give too much away).

Go #24.
SAG

AHAH!! So, SAG, that was YOU in the Med-VAC helicopter that skimmed over lower than usual the other day!!

Sandy, your report about your new sleep doctor sounds very encouraging. Good for you!

Thanks, dsm, SAG, and Rested Gal. I'm very encouraged. I'm still exhausted, but encouraged. It's amazing how finding the right doctor can lift your spirits.

SAG - I agree about communicating the importance of your 3 points. I might consolidate my situation into one hopefully-not-too-long message. I really thought that going on CPAP would make me feel better. I have to imagine there are others out there who are in a similar situation.