Questions on my sleep study results

I had a sleep study done (in the lab polysomnogram) and was diagnosed with "Severe Sleep Apnea." But in reviewing the results I am wondering if this is making a mountain out of a molehill. Some anecdotal information first. I definitely snore and its much worse on my back even though I usually sleep on my sides. I'm roughly 50 pounds overweight and the last ~20 pounds has definitely had an impact on my snoring.

Here's my results from the study and then my questions.

• AHI - 81.4/hr
• Supine AHI - 134.6/hr
• Non-Supine AHI - 74.9/hr
• REM Sleep AHI - 43/hr
• RDI - 81.4/hr
• Snore % - 79.1%
• PLMS INdex - 0/hr
• Hypoxic Burden - 2.4% of TST
• Oxy Nadir - 87%
• Sleep latency - 17.7 min
• REM Latency - 177 min
• WASO - 34.3 min
• Sleep Efficiency - 87.6%
• N1 %age - 6.1%
• N2 %age - 70.5%
• N3 %age - 0%
• REM %age - 23.4%

My questions/concerns after reviewing other sites on what these numbers mean.

• A sleep efficiency of 85% is considered "normal" so this seems good.
• ~2% of my night was spent below the "normal" threshold of 90% oxygen saturation. While obviously suboptimal, this hardly seems awful. especially considering...
• my nadir of 87% is barely below what is considered normal.
• REM sleep is close to the 25% "normal" range
• N1 is normal
• N2 was apparently "increased" but not when combined with the next item
• it seems that N3 is not always entered and can thus be considered "normal"
• 134 interruptions in a hour based on a minimum time of 10 secs each equates to waking up for half of every minute. That seems completely infeasible to even happen.
• even the average AHI equates to being awake for over 15 seconds per minute which also beggars belief.

Results from my doctor based on this study. They want me to return for another sleep study in the lab where they will fit me with a mask and a machine to determine the "proper" pressure levels to alleviate the AHI problems. Obviously, this calls for another $$$ visit to the lab and even more $$$ for the eventual machine and equipment.

My question really is this. Do I need to spend the time, aggravation and money on a full CPAP solution to what seems to essentially be a snoring problem? Am I misinterpreting something here? Frankly the whole thing seems like a scam to get me to spend $1,000s of dollars on something of no medical value. Especially when you add in the advice given here that it normally takes "months" to tweak the CPAP environment to see any benefits to CPAP. What are my other options to alleviate snoring without a CPAP? I'm currently using an over the counter mouth guard which stops the snoring although I still "breath loud" and it does sometimes pop out of alignment and lead to snoring. Obviously, losing weight is a no-brainer. But also easier said than done.

If you'd like snippets of the charts from the study, feel free to ask. I was attempting to respect the rules of the forum by limiting my images.

I have a feeling you are really paddling hard up the DeNile River.
You are trying to find excuses to not go down the cpap therapy road.

https://www.youtube.com/watch?v=-gie2dh ... e=youtu.be

There's a lot more to it than just snoring and O2 levels.

What symptoms did you have that lead you to having the sleep study in the first place????

You're cherry picking a few stats and then rationaling them to justify to yourself that you don't need CPAP.

Fact of the matter is your AHI, one of the main indicators, is *VERY* high.

Excessive O2 desats is just one of the potential negative side effects, the stresses of needing to breathe and not being unable to, and the body continuously being woken up all night (over 80 times an hour). You may not remember being woken up because you aren't awake long enough to form memories. But this sleep disruption is interfering with your (restorative) sleep pattern and causing stresses to many of your systems.

You need to be on CPAP. Your numbers are pretty cut and dry.

"But in reviewing the results I am wondering if this is making a mountain out of a molehill."

no, it's a mountain, as explained by forum friend dog slobber.

N3 would certainly be measured in a polysomnogram. I'm not sure why you think it would be omitted.

I'd be curious what the breakdown is of your events (obstructive apnea, central apnea, hypopnea).

Unless you have a lot of central apnea events complicating the picture, I do think you could get by without a titration study. It would probably not take long at all to dial in your settings if you are able to use the Oscar software to understand your nightly results and share them with knowledgeable forum members here or elsewhere.

As others have said, you are actually having these night-time events, whether you are aware of them or not, and whether or not this seems believable to you. They are bad for your long-term health, whether you are having desats that go below 89 or not. Desats of 4% or more are significant whether they dip below 89 or not. Did you get an ODI (oxygen desaturation index) number in your sleep report?

From the Mayo Clinic:

High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. Having obstructive sleep apnea increases your risk of high blood pressure (hypertension).

Obstructive sleep apnea might also increase your risk of recurrent heart attack, stroke and abnormal heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes.

Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.

Complications with medications and surgery. Obstructive sleep apnea is also a concern with certain medications and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs.

Before you have surgery, tell your doctor about your sleep apnea and how it's being treated.
Liver problems. People with sleep apnea are more likely to have abnormal results on liver function tests, and their livers are more likely to show signs of scarring (nonalcoholic fatty liver disease).

Here's another way to look at the O2 numbers not being what you would think is alarming.

It is possible that with your number of events happening that they wake you up BEFORE they can cause much of a drop.
Once you wake up the potential dropping of the O2 levels will cease and the O2 returns to a more normal number. If you stayed asleep there is a high probability the desats would be a much greater.

The Nile is not just a river in Egypt and I'm perfectly willing to be called out for it (otherwise, I wouldn't be here). I don't want any of you to take this as me doubting your expertise but as me trying to understand the need for the level of effort that seems to be required to go down this path. As has been stated here and many other places, getting to effective CPAP takes a long time and "overnight magic" is rare. If I need to go through all of the expense, trouble, loss of sleep, and the giant PITA that is wearing a dead octupus on my face then I want to understand the benefit I will receive from it.

Should I expect (eventually) giant levels of extra energy? Weight loss? Hair growth ?
Throw me a bone, here. I want to quit snoring, I want to be healthy, I'm just not convinced CPAP is the solution (yet).

Some answers to the questions in this thread -

• Snoring was the sole symptom that prompted the study. I'm not any more tired than any other dad of 3
• ODI numbers (9 minutes below 90% and 1 min below 88%) avg drop 3.6%
  • Total - 35.1/H
  • Supine - 77.1/H
  • Non-Supine - 30/H
  • REM - 26.4/H
  • non-REM - 37.7/H
• Breakdown of Interruptions per hour (Overall/Supine/Non-Supine/REM/Non-REM)
  • Obstructive Apneas - 2.9/19.7/0.9/0/3.8 - 18 total
  • Mixed and Central - 0/0/0
  • Obstructive Hypopneas - 78.4/115/74/43/89.3 - 483 total
  • Central Hypopneas - 0/0/0
• I didn't say N3 wasn't tracked in a study, I said that not having any N3 isn't abnormal.

Follow up question:

Fact of the matter is your AHI, one of the main indicators, is *VERY* high.

and CPAP is the sole solution to this? Living the rest of my life with a dead octopus on my face is the fate I have been consigned to? I realize I'm whining more than a little and certainly denying. But surely science has a better solution than shoving an airtube up my nose? Maybe I've moved to the bargaining stage?

Correction from original post
A misunderstanding of mine from earlier where I said I couldn't believe I was awake for half the time I laid on my back. I misunderstood the metric on AHIs. The 10 second metric isn't how long you stay awake but how long the breathing interruption lasts. So that's clearly possible in the study.

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

The 10 second metric isn't how long you stay awake but how long the breathing interruption lasts.

The 10 second metric is the minimum duration of the apnea event to earn a flag.
If it only lasts 9 seconds it wouldn't earn a flag or be counted...I would bet my last dollar you had some that lasted 9 seconds...and don't think for one minute that there's that big of a difference between 9 seconds and 10.
They can last a lot longer...and yours probably would if you didn't wake up or have an arousal so often.

Overall average AHI of 80 +...that means that more often than once a minute your airway is collapsing.
How about I come over to your house tonight and poke you with a pin in the butt and wake you up once a minute.
Don't kid yourself...your sleep quality is going to leave a lot to be desired and we need decent sleep quality for the restorative powers of sleep to work their magic.

You have so many pre conceived negative expectations about cpap that I don't know where to start and to be honest I don't know that I want to start...but you did come here and I assume the fact that you are here asking/ranting is some sort of small cry for help that you probably can't see.
So let me address a couple of them.

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

CPAP is the sole solution to this?

It is considered the gold standard for a reason but there are other options...google Inspire cpap therapy. It involves surgery and implanting a device that sends electric pulses to some nerves in your airway. It's not for everyone though...a lot is involved in getting okayed and the determination that you are a suitable candidate. How effective it might be for someone whose OSA is as severe as yours....I have no idea....but it is an option to investigate.

There are oral devices (think fancy bite guards) that might help but for the most part "success" usually means a 50% reduction in apnea events and even if you had a 50% reduction you would be left with around 40 AHI....still in the severe category...but it is an option....but not a particularly attractive option.

There is surgery to alter the airway by breaking your mandible and moving things/bones around. It's called MMA.
https://www.pennmedicine.org/-/media/do ... 20(1).ashx

Both the MMA and the Inspire surgeries are usually only considered when someone just can't tolerate cpap therapy.

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

Should I expect (eventually) giant levels of extra energy? Weight loss? Hair growth ?

Do you need lots of energy?? I know I do or rather I want more energy but there are so many other factors potentially affecting energy levels that are likely a factor in how we feel that it is an unrealistic expectation to expect cpap to fix all our potential problems. CPAP fixes one problem...airway issues...that's it. It can't fix lack of energy due to anything else and there are a lot of "anything elses" that can affect our energy levels. Optimal cpap therapy will greatly increase the chances of someone seeing an increase in energy levels though...or even dealing with the other stuff that can affect our sleep and anything that affects our sleep will affect our energy levels.

You probably do need to lose weight...most of us could benefit from shedding a few pounds but the notion that OSA can be totally blamed on being fat is so totally wrong. Skinny people get OSA too. I weighed all of 110 lbs when I got diagnosed 13 years ago. I my case it was good old Mother Nature who I suspect was my primary culprit....female age 57 and good old menopause on the horizon. I always said that with menopause everything starts to sag....boobs, belly, butt...and airway tissues. I have often wondered how much of an impact hormone levels decreasing age in the males might also be a factor in the male species and OSA as we age. Logic tells me that it has to impact things to some extent. Since I am female I never researched it though.

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

Living the rest of my life with a dead octopus on my face is the fate I have been consigned to?

I always called the "alien plastered on my face" and I fought the diagnosis only up to the point I actually had the sleep study. My husband told me for 2 years that I quit breathing during the night and scared the hell out of him and I already knew my snoring would shake the windows because I woke myself up often from the snoring.
Be glad and thankful that your O2 levels haven't dipped yet...your OSA will only worsen and eventually they will dip and it's not pretty when they do. Mine went to 73% for nearly an hour over the night of the sleep study and for several years I woke up with some killer headaches due to that low O2. Do you have to get up and pee during the night? I did and often and with a full bladder each time. Those 2 common sleep apnea symptoms went away pretty quickly with optimal therapy (took me about 2 weeks to get it dialed in) and I have always said that the elimination of just those 2 symptoms made having the alien plastered on my face so very worth it. CPAP didn't fix my high blood pressure though...bummer but it is what it is.

I looked at cpap as a preventative medicine...preventing that heart attack or stroke or god forbid the stroke that comes up short and leaves a person in a permanent incapacitated state where someone gets to change my diapers and feed me because I can't take care of myself.
The complications of untreated sleep apnea are very real and very scary if you really look closely at them.
Count your blessings instead of paddling on the DeNile River....you are young and have a reasonably good chance of avoiding all those ugly complications from untreated sleep apnea.

CPAP therapy isn't as horrible as you are thinking...

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

But surely science has a better solution than shoving an airtube up my nose?

Big misconception there....there is only one cpap mask out there that actually shoves any tubes up your nose...and I actually tried it for grins and it's not as gross as it sounds.
All the other masks just blow air either up your nose or into your mouth or both. Nothing gets shoved in/up the nose and in fact you might check the link in my profile for the mask I use.

CPAP therapy doesn't involve surgery...no modifications to your body...no bite guards to mess with your teeth or TMJs (and they do mess with them)....
You put it on when you go to bed and take it off in the morning....it is considered the gold standard in treatment.
Put your big boy pants on and at least give it a try. You can do it while considering the other options....get yourself really educated about all this. You might find that it isn't as big of a deal as you thought and if it is absolutely the worst experience that you have ever had in your life....you do have options.

What do you have to lose???

BTW...try to talk your doctor into letting you trial an auto adjusting machine at home and not do the in lab titration.
Your insurance might even prefer it anyway....they are going to have to buy a machine anyway but it would get them out of paying for another sleep study. A lot of insurance companies are going this route anyway....and saving the in lab titration sleep studies for the problem cases. Saves them money.

Pugsy wrote: ↑

Fri Jun 24, 2022 3:06 pm

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

The 10 second metric isn't how long you stay awake but how long the breathing interruption lasts.

The 10 second metric is the minimum duration of the apnea event to earn a flag.
If it only lasts 9 seconds it wouldn't earn a flag or be counted...I would bet my last dollar you had some that lasted 9 seconds...and don't think for one minute that there's that big of a difference between 9 seconds and 10.
They can last a lot longer...and yours probably would if you didn't wake up or have an arousal so often.

Overall average AHI of 80 +...that means that more often than once a minute your airway is collapsing.
How about I come over to your house tonight and poke you with a pin in the butt and wake you up once a minute.
Don't kid yourself...your sleep quality is going to leave a lot to be desired and we need decent sleep quality for the restorative powers of sleep to work their magic.

Yeah, the section quoted above is essentially a mea culpa to some misunderstandings I had about my results in my 1st post. It shouldn't be interpreted as me trying to wiggle out of things on a 9 sec vs 10 sec technicality. Although given the tone of my entire post, I can certainly see why it might be taken that way.

Pugsy wrote: ↑

Fri Jun 24, 2022 3:06 pm

You have so many pre conceived negative expectations about cpap that I don't know where to start and to be honest I don't know that I want to start...but you did come here and I assume the fact that you are here asking/ranting is some sort of small cry for help that you probably can't see.

Let's face it, I haven't really seen any positives yet. I get to have an annoying mask, a noisy machine and apparently lots of sleepless nights in my near future. Did I miss anything?

Pugsy wrote: ↑

Fri Jun 24, 2022 3:06 pm

So let me address a couple of them.

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

CPAP is the sole solution to this?

...

There are oral devices (think fancy bite guards) that might help but for the most part "success" usually means a 50% reduction in apnea events and even if you had a 50% reduction you would be left with around 40 AHI....still in the severe category...but it is an option....but not a particularly attractive option.

There is surgery to alter the airway by breaking your mandible and moving things/bones around. It's called MMA.
https://www.pennmedicine.org/-/media/do ... 20(1).ashx

Both the MMA and the Inspire surgeries are usually only considered when someone just can't tolerate cpap therapy.

I have an OTC mouth guard. It's an improvement (no snoring) if it stays in place. So that's something. But I can feel the tightness in my jaw in the morning and even with my retainers in I am sure my teeth have or will shift. Only an idiot would go for getting their jaw broken before trying other options. I'm denying, not stupid.

Pugsy wrote: ↑

Fri Jun 24, 2022 3:06 pm

BTW...try to talk your doctor into letting you trial an auto adjusting machine at home and not do the in lab titration.
Your insurance might even prefer it anyway....they are going to have to buy a machine anyway but it would get them out of paying for another sleep study. A lot of insurance companies are going this route anyway....and saving the in lab titration sleep studies for the problem cases. Saves them money.

Yeah, I'm going to shoot for this route. I delayed after my study long enough for my referral to expire so I'm waiting a day or two for my insurance to reissue it and then I'll try to skip the 2nd study and just get the stupid thing. Suggestions on a machine to ask for? What about masks?

Your ODI is concerning, along with your AHI. For you, one of the main benefits of PAP therapy will be to reduce avoidable risks to your long-term health. Look at that list from the Mayo Clinic again.

Please ask for one of these three machines:

ResMed Airsense 10 Autoset
ResMed Airsense 10 Autoset for Her (has an extra mode that some women and men find valuable)
ResMed Airsense 11 Autoset (has the "For Her mode; relatively few differences from the 10 Autosets).

Be sure you stress "Autoset" at every possible juncture!

The mask that will work best for you might not be the one that works best for me. Our faces may be different, along with many other important variables. But one question might help guide you: did you breathe through your nose during the day? If yes, you might want to start by using a nasal pillow mask. The ResMed P10 is lightweight and minimalist. You'd want to get the fit pack, which includes small, medium, and large pillows.

Once you have your machine, please come back. There are a lot of tips we can give you about starting out, as well as guidance about self-titrating.

chipva wrote: ↑

Fri Jun 24, 2022 3:37 pm

I get to have an annoying mask, a noisy machine and apparently lots of sleepless nights in my near future. Did I miss anything?

Another misconception...machine noise. Let me tell you what my husband did until I slapped his hands.
These machines are essentially silent....my husband would poke me in the ribs to wake me up and tell me to put my mask on because he couldn't hear anything. Only problem with that....the machine and mask was on...he just couldn't hear it.
Eventually I had to show him where the vented air comes out of the mask and tell him that when he wakes up in a panic because he can't hear the machine to just reach over and put his hand in front of the vent holes and feel the air moving then he will be reassured that I am doing fine and the mask and machine is indeed on.
And my husband isn't deaf or hard of hearing. His hearing is just fine except for when I tell him to do something...then he doesn't hear so great. I would bet your wife says you also have selective hearing loss.

chipva wrote: ↑

Fri Jun 24, 2022 3:37 pm

Suggestions on a machine to ask for? What about masks?

This is where the in lab titration might come in handy because it would spot potential issues or pressure needs that might mean a different kind of machine but if playing the odds....you will do well with regular cpap/apap machine and chances are slim you will need anything special.

You can't go wrong with the ResMed brand. Essentially silent and lemons are rare.
I would suggest looking at ResMed AirSense 10 AutoSet or the latest model (but hard to find sometimes) AirSense 11 AutoSet

Avoid any Philips Respironic product at this time. They are on my crap list for several reasons and I don't have time to explain them all right now.

For masks....it depends on your own personal preferences, wants and needs and you won't have any idea what they might be until you try one/them.
One question which is very important....do you normally breathe through your nose during the day easily?
Or do you have chronic significant nasal congestion that means you have to mouth breathe a lot.

If you can easily breathe through your nose I suggest looking at a couple of ResMed masks that I think would be great for a new to therapy person.

The ResMed AirFit N30 under the nose cushion
https://www.cpap.com/productpage/resmed ... h-headgear

or its brother the ResMed AirFit P10 nasal pillow
https://www.cpap.com/productpage/resmed ... k-headgear

They use the same headgear and are very similar in design except one just sits under the nostrils and the other sits sort of on the nostrils (but NOTHING touches the insides of the nostrils...if it does either wrong size or too tight).
The most common error made with these masks is people think they have to crank them down like a vise grip to keep sealed and that's actually the worse thing to do. It prevents full inflation and they have to inflate to seal.

Now if you have a lot of chronic nasal congestion issues that you can't clear up with other traditional ways then you may need a mask that covers both the nostrils and the mouth so that air pressure doesn't leave your mouth and not get to the airway when you need to breathe through your mouth. I am not the best person to advise on those masks...never used one, don't want to, don't need to, don't own one and don't particular like them.
But if you end up needing one...I can try to help out as best I can. I think I might even have a donated full face mask you could just have....donated by someone who tried it and didn't like it but others like it just great.

One thing important about masks....preference is highly individualized and what one person might just love the next person might hate with a passion. One man's treasure is another man's trash when it comes to masks.

Unless you are a chronic hard core mouth breather because of nasal congestion....start with some sort of nasal mask.
Much smaller octopus on your face.

The 2 I linked to above...have a very special diffused venting system and are essentially silent and you don't get vented air bouncing off something hitting you or the wife in the face. I have to put my hand about an inch from the vent holes to just barely feel the air moving. Hubby greatly appreciated it when I changed to the P10 some years ago as the prior mask blew cold air on his back if I got close.
The Bleep I use now...I have a diffuser on it as well...so silent with the diffuser on it. There's going to be a new improved Bleep coming out late summer...keep and eye out as there will be a lot of talk about it for sure. There has been a little bit lately but there won't be a lot yet until other people get to use it. I was one of the Beta testers....just about as nothing of a mask as possible.

More thoughts later. I got some chores to do.

chipva wrote: ↑

Fri Jun 24, 2022 3:37 pm

Let's face it, I haven't really seen any positives yet. I get to have an annoying mask, a noisy machine and apparently lots of sleepless nights in my near future.

If you haven't seen any positives yet, you haven't read the responses given to you.

chipva wrote: ↑

Fri Jun 24, 2022 3:37 pm

Did I miss anything?

Yes, the responses people took time out of their day to give to you.

chipva wrote: ↑

Fri Jun 24, 2022 2:02 pm

dad of 3

There's three reasons to actually consider CPAP.

I have some of those masks that PUGSY is referring to, in fact, I got them from PUGSY. I'm getting ready to send them back to her, but give me your address, I will send them to you, instead. (If it is alright with PUGSY). Give me a day or two to wash them, as I have beeen trying all of them out to see which ones I like.
NO CHARGE!! As PUGSY did not charge me anything.

Iamstumped wrote: ↑

Sat Jun 25, 2022 12:17 pm

I have some of those masks that PUGSY is referring to, in fact, I got them from PUGSY. I'm getting ready to send them back to her, but give me your address, I will send them to you, instead. (If it is alright with PUGSY). Give me a day or two to wash them, as I have beeen trying all of them out to see which ones I like.
NO CHARGE!! As PUGSY did not charge me anything.

By all means...cut out the middlewoman.
Just same guidelines...any that are hated and will be unused come back to me so I can pass them along again.
Too nice of masks to go in the trash.

Just thought that I would save you the time and trouble of mailing them out, unless you would rather that I send them back to you, PUGSY