CPAPtalk.com

Posted: **Fri Feb 24, 2023 12:09 pm**

taylermacdonald wrote: ↑
Fri Feb 24, 2023 11:20 am
could that just be because the home sleep studies don’t look at as much compared to the hospital ones?

It depends on the home study. Most don't even measure sleep status itself and if it can't tell if you are asleep or not then they can't tell you if there were any arousals. Gotta know if we are asleep first before we can measure arousals.

A type 2 home study measures sleep status.
Type 3 and 4 home studies do NOT measure sleep status.
Type 1 sleep study is done in the lab setting with tech in attendance and of course it measures sleep status as well.

If the sleep study can't measure sleep status it can't measure arousals......at least accurately measure sleep status
and I would want to know for sure if it was me.

taylermacdonald wrote: ↑
Fri Feb 24, 2023 8:48 am
I take lamotrigine, and just started concerta. However these are recent and I’ve had the issues with tiredness for years. No other physical/mental issues.

those medications are usually given for some sort of mental health issue and it wouldn't be impossible for the mental health issues to be a factor in your unwanted symptoms.
So the medication side effects could potentially be a factor along with the very reason you are taking those medications to also be a factor.
The fact that you had the unwanted symptoms prior to starting the medications....well it does make someone wonder.

Perhaps you were expecting the cpap machine to fix a problem unrelated to airway issues. It happens all the time.
People have a problem sleeping and think that cpap (which only fixes airway issues) should fix the problem.
Only the cpap machine can't fix a problem unrelated to airway issues or apnea issues.

Posted: **Fri Feb 24, 2023 12:29 pm**

ozij wrote: ↑
Fri Feb 24, 2023 11:46 am

taylermacdonald wrote: ↑
Fri Feb 24, 2023 11:15 am
Or were those explanations for others in case they don’t know?
Yes. For others. Like me, for example.

Got it lol makes sense

Posted: **Fri Feb 24, 2023 12:32 pm**

Pugsy wrote: ↑
Fri Feb 24, 2023 12:09 pm

taylermacdonald wrote: ↑
Fri Feb 24, 2023 11:20 am
could that just be because the home sleep studies don’t look at as much compared to the hospital ones?
It depends on the home study. Most don't even measure sleep status itself and if it can't tell if you are asleep or not then they can't tell you if there were any arousals. Gotta know if we are asleep first before we can measure arousals.

A type 2 home study measures sleep status.
Type 3 and 4 home studies do NOT measure sleep status.
Type 1 sleep study is done in the lab setting with tech in attendance and of course it measures sleep status as well.

If the sleep study can't measure sleep status it can't measure arousals......at least accurately measure sleep status
and I would want to know for sure if it was me.

taylermacdonald wrote: ↑
Fri Feb 24, 2023 8:48 am
I take lamotrigine, and just started concerta. However these are recent and I’ve had the issues with tiredness for years. No other physical/mental issues.
those medications are usually given for some sort of mental health issue and it wouldn't be impossible for the mental health issues to be a factor in your unwanted symptoms.
So the medication side effects could potentially be a factor along with the very reason you are taking those medications to also be a factor.
The fact that you had the unwanted symptoms prior to starting the medications....well it does make someone wonder.

Perhaps you were expecting the cpap machine to fix a problem unrelated to airway issues. It happens all the time.
People have a problem sleeping and think that cpap (which only fixes airway issues) should fix the problem.
Only the cpap machine can't fix a problem unrelated to airway issues or apnea issues.

Gotcha, yeah I’m not sure what level my home sleep study was. And yeah I thought they were asking if I had any other mental issues besides what I’d already mentioned. So what exactly would I do if I have other issues, I assume you mean like narcolepsy or something? Do I need a different kind of sleep study for that?

Posted: **Fri Feb 24, 2023 4:31 pm**

Miss Emerita wrote: ↑
Fri Feb 24, 2023 10:22 am
A note in the titration study says that there was a concern about central apnea in your home sleep study, and that may be why the nurse mentioned a bilevel machine. (Central apneas are pauses in your breathing of 10 seconds or more without any obstruction in your airway.) Sometimes a bilevel machine will help to resolve central apnea; when it doesn't, the next step would be a fancier machine called an ASV, for adaptive servo-ventilation.

But in the titration study, no CA was observed. Hence no bilevel machine.

I'm puzzled that the recommended minimum pressure was 7, yet your machine was set with a minimum of 5. I'm glad you're implementing Zonker's suggestion of a minimum of 7. This might help with your OAs and maybe your Hs.

I'm going to guess that most of the CAs follow arousals, which is a pretty common pattern. Getting more information about arousals might be helpful, so let us know what you find out.

Here’s a more specific report!

https://imgur.com/a/nKHnWY0

And looking back at the original report, it said the diagnosis is obstructive sleep apnea… but all of my events during the study were central apneas. I had no obstructive apneas. How does that make sense?

Also, I did end up adjusting my CPAP last night to a pressure setting of 7. My AHI was actually higher at 10.5

Posted: **Fri Feb 24, 2023 4:33 pm**

robysue1 wrote: ↑
Fri Feb 24, 2023 8:07 am
In addition to Rubicon's comments, I want to add: It would be useful for us if we knew something about your diagnostic sleep study. How bad is your untreated apnea?

In other words, try to get your hands on the diagnostic study as well as the titration study, including the summary graphs and the definition that was used to score hypopneas.

Also, your titration study report should come with some summary graphs that show what was happening in the night in terms of the sleep stage, any recorded events, your SaO2 level, and the CPAP setting and any adjustments made to that setting during the night.

Here’s my diagnostic study:

https://imgur.com/a/nKHnWY0

What I don’t quite understand is you asked about how bad my untreated apnea is… but during my study I was always wearing a CPAP. Shouldn’t I have not been wearing it first to get an idea of what my sleep apnea was like without being corrected, and then have the mask put on? Or is that not how it works?

Posted: **Fri Feb 24, 2023 4:44 pm**

The original sleep study is/was what we call a diagnostic sleep study....without cpap to establish the need or diagnosis.
The sleep study done using cpap is what we call a titration sleep study...with cpap to establish optimal pressures to be used.

Sometimes people have what we call split night studies...if a person meets diagnostic criteria for OSA and there is time left they will sometimes put the person on cpap and do the rest of the night using cpap.
Sometimes people don't meet criteria initially for any number of reasons and they have to come back for another sleep study with cpap to get optimal pressures. That's what happened to me.

From the looks of the sleep study you posted...even if it was a home study it appears to have measured sleep status.
It appears to show sleep stages and mentions REM...you don't get that data without sleep status being measured.
Since they did...they should also have documented arousals both airway related and spontaneous.
Spontaneous arousal meaning an arousal but not related to airway issues....spontaneous means we don't know what caused it but we do know that it wasn't related to the airway.

Your sleep report above does mention RERAs...and that would be respiratory event related arousal...or related to airway issues. It really was unremarkable.

It does mention total arousals and includes spontaneous arousals and it mentions 68 total with an hourly average of around 12 or 13. Something was messing with your sleep during that titration study. Now what it might have been....we don't know but it wasn't related to the airway.
Hourly average of 12 arousals....you may or may not remember the arousal but it happened and roughly once every 5 or 6 minutes. For sure it could/can mess with your overall sleep quality and definitely impact how you feel during the day even if the "OSA" is perfectly treated. Probably not getting good complete sleep stage cycling which is needed for the restorative powers of sleep to work their magic.

taylermacdonald wrote: ↑
Fri Feb 24, 2023 12:45 pm
And looking back at the original report, it said the diagnosis is obstructive sleep apnea… but all of my events during the study were central apneas. I had no obstructive apneas. How does that make sense?

Doesn't make much sense unless you also had a bunch of hyponeas which are normally considered obstructive in nature and people sometimes think that you must have OAs to earn the diagnosis. Hyponeas also count.
We would need to see the initial diagnostic sleep study to better discuss how or why they came up with the diagnosis.
If you see a number of hyponeas noted on that original study without cpap....that's what likely earned your the OSA diagnosis.

edit...I see you posted the original diagnostic sleep study and it appears to be the same one I was looking at above.

I am confused....which is it???

Posted: **Fri Feb 24, 2023 5:07 pm**

Pugsy wrote: ↑
Fri Feb 24, 2023 4:44 pm
The original sleep study is/was what we call a diagnostic sleep study....without cpap to establish the need or diagnosis.
The sleep study done using cpap is what we call a titration sleep study...with cpap to establish optimal pressures to be used.

Sometimes people have what we call split night studies...if a person meets diagnostic criteria for OSA and there is time left they will sometimes put the person on cpap and do the rest of the night using cpap.
Sometimes people don't meet criteria initially for any number of reasons and they have to come back for another sleep study with cpap to get optimal pressures. That's what happened to me.

From the looks of the sleep study you posted...even if it was a home study it appears to have measured sleep status.
It appears to show sleep stages and mentions REM...you don't get that data without sleep status being measured.
Since they did...they should also have documented arousals both airway related and spontaneous.
Spontaneous arousal meaning an arousal but not related to airway issues....spontaneous means we don't know what caused it but we do know that it wasn't related to the airway.

Your sleep report above does mention RERAs...and that would be respiratory event related arousal...or related to airway issues. It really was unremarkable.

It does mention total arousals and includes spontaneous arousals and it mentions 68 total with an hourly average of around 12 or 13. Something was messing with your sleep during that titration study. Now what it might have been....we don't know but it wasn't related to the airway.
Hourly average of 12 arousals....you may or may not remember the arousal but it happened and roughly once every 5 or 6 minutes. For sure it could/can mess with your overall sleep quality and definitely impact how you feel during the day even if the "OSA" is perfectly treated. Probably not getting good complete sleep stage cycling which is needed for the restorative powers of sleep to work their magic.

taylermacdonald wrote: ↑
Fri Feb 24, 2023 12:45 pm
And looking back at the original report, it said the diagnosis is obstructive sleep apnea… but all of my events during the study were central apneas. I had no obstructive apneas. How does that make sense?
Doesn't make much sense unless you also had a bunch of hyponeas which are normally considered obstructive in nature and people sometimes think that you must have OAs to earn the diagnosis. Hyponeas also count.
We would need to see the initial diagnostic sleep study to better discuss how or why they came up with the diagnosis.
If you see a number of hyponeas noted on that original study without cpap....that's what likely earned your the OSA diagnosis.

edit...I see you posted the original diagnostic sleep study and it appears to be the same one I was looking at above.

I am confused....which is it???

So I don’t have my initial at home sleep study, I didn’t realize that’s what everyone was referring to. I thought it was just the more in depth sleep study results that they were asking for. I’ll try to get the results of my at home study and post it. Sorry!

Posted: **Fri Feb 24, 2023 5:27 pm**

It really helps when people understand the correct terminology when talking about results.

The above sleep study done while using cpap...even if a home study...is fairly comprehensive and does measure sleep status so a type 2 study. Other than the number of spontaneous arousals....I don't see anything just standing out screaming "fix me".
It points to whatever OSA you had on the diagnostic sleep study being well treated at the pressure you were using.
The 3 centrals it mentions...not alarming at all. It's normal to have a few centrals here and there either on a diagnostic study or with cpap use.

My gut is telling me you have a sleep quality problem and not a OSA therapy problem....at least unless I see something to the contrary on the diagnostic study report.
Now what that sleep quality problem might be other than a bunch of spontaneous arousals....dunno what that could be but I don't think minor tweaking of your machine is going to give you the results you want. I wish it were that easy.
I suffer from similar sleep quality problems myself with lots of spontaneous arousals and it's not an easy fix at all.
We don't know what is causing the arousals and even if we knew the cause it isn't always so easy to fix it.
Getting nice low AHI numbers is easy....feeling those good numbers is a whole different ball game.
Trust me...been in this same boat for coming on 14 years cpap use now.

Posted: **Fri Feb 24, 2023 6:20 pm**

Pugsy wrote: ↑
Fri Feb 24, 2023 5:27 pm
It really helps when people understand the correct terminology when talking about results.

The above sleep study done while using cpap...even if a home study...is fairly comprehensive and does measure sleep status so a type 2 study. Other than the number of spontaneous arousals....I don't see anything just standing out screaming "fix me".
It points to whatever OSA you had on the diagnostic sleep study being well treated at the pressure you were using.
The 3 centrals it mentions...not alarming at all. It's normal to have a few centrals here and there either on a diagnostic study or with cpap use.

My gut is telling me you have a sleep quality problem and not a OSA therapy problem....at least unless I see something to the contrary on the diagnostic study report.
Now what that sleep quality problem might be other than a bunch of spontaneous arousals....dunno what that could be but I don't think minor tweaking of your machine is going to give you the results you want. I wish it were that easy.
I suffer from similar sleep quality problems myself with lots of spontaneous arousals and it's not an easy fix at all.
We don't know what is causing the arousals and even if we knew the cause it isn't always so easy to fix it.
Getting nice low AHI numbers is easy....feeling those good numbers is a whole different ball game.
Trust me...been in this same boat for coming on 14 years cpap use now.

Yeah I’m sorry I am new to all of this so the terminology is a bit confusing to me…. But that’s disappointing to hear if the CPAP won’t really change things. Why would my AHI be so low in the hospital sleep study but when I use my machine at home it’s high? My AHI last night was 10.5

or are you saying that even though it was low in the hospital and I get a different CPAP at home that could make it lower, I might still feel the same tiredness since it could be something other than sleep apnea?

Posted: **Fri Feb 24, 2023 6:28 pm**

Did you post last night's detailed report? Did I miss it?

taylermacdonald wrote: ↑
Fri Feb 24, 2023 6:20 pm
My AHI last night was 10.5 or are you saying that even though it was low in the hospital and I get a different CPAP at home that could make it lower, I

I don't remember seeing last night's report so I can't comment.
Sorry.

Do you remember waking very many times last night?

Posted: **Fri Feb 24, 2023 6:32 pm**

Pugsy wrote: ↑
Fri Feb 24, 2023 6:28 pm
Did you post last night's detailed report? Did I miss it?

taylermacdonald wrote: ↑
Fri Feb 24, 2023 6:20 pm
My AHI last night was 10.5 or are you saying that even though it was low in the hospital and I get a different CPAP at home that could make it lower, I
I don't remember seeing last night's report so I can't comment.
Sorry.

Do you remember waking very many times last night?

Oh yes I didnt post the OSCAR data of that, I was just saying that in response to:

Pugsy wrote: ↑
Fri Feb 24, 2023 5:27 pm
Getting nice low AHI numbers is easy....feeling those good numbers is a whole different ball game.

Posted: **Fri Feb 24, 2023 7:15 pm**

Without seeing last night's report I can't offer anything at all in the way of ideas but my first thought would be a lot of false positive flagged events because of arousals or being awake since the in lab sleep study was really unremarkable except for the arousals.

Telling us just the overall AHI number without the category breakdown doesn't tell us much at all.
Gotta see what is going on first...and often even that doesn't tell us much but without the details it is impossible to make any sort of accurate supposition or guess as to what is going on.

If you didn't sleep solidly though...that could sure explain the higher AHI numbers.

Posted: **Fri Feb 24, 2023 7:38 pm**

taylermacdonald wrote: ↑
Fri Feb 24, 2023 6:32 pm
Oh yes I didnt post the OSCAR data of that, I was just saying that in response to:

Pugsy wrote: ↑
Fri Feb 24, 2023 5:27 pm
Getting nice low AHI numbers is easy....feeling those good numbers is a whole different ball game.

And I only said what I said because I almost always have extremely low AHI numbers but my sleep is still poor quality and thus how I feel the next day is also quite often of poor quality but it has nothing to do with my apnea issues and everything to do with just plain old crappy sleep because of pain preventing good solid sleep or enough sleep.

Your AHI was 10 last night and I assume you probably feel like crap today....if you didn't sleep well because of something else going on unrelated to the airway then it would not come as a big surprise.

These machines only measure air flow or your breathing. They don't have any way to know if we are asleep or not.
Our awake breathing is very irregular when compared to asleep breathing and these machines can and will mistake awake/arousal breathing irregularities as some sort of apnea event and flag it. If we aren't asleep when flagged....it doesn't count in terms of therapy effectiveness anyway.

Gotta be asleep for sure for the flagged events to mean anything beyond poor sleep.

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