Sleep study results?

I finally got a printout of my sleep study results, and they don't look great. It took me about 5 hours to finally fall asleep due to 98 spontaneous arousals. Every time I doze off, it feels like my lungs stopped putting in the effort to breathe, and I'll wake up gasping for air over and over for 5 hours, sometimes with an adrenaline rush. It happens to me every night for the last month. Here are the results:




- 68 Arousal index
- Sa02 was below 88% for 11% of my sleep time.
- “Severely reduced sleep efficiency”


-



- 98 spontaneous arousals

Has anybody encountered anything like this before? I'm at my wit's end, this happens to me every night for the last month! The doctor is only focusing on the final 2 hours, where I demonstrated very mild "upper airway resistance syndrome", but what could explain the first part where I'm struggling to FALL alseep?

wetwilly wrote: ↑

Mon May 08, 2023 5:23 pm

The doctor is only focusing on the final 2 hours, where I demonstrated very mild "upper airway resistance syndrome", but what could explain the first part where I'm struggling to FALL alseep?

Are you going to a sleep doctor who ignores the major trouble you have in trying to fall asleep?
Or is it that you're arguing with the doctor about the reason you have these problems?

In your previous posts you were adamant that "central apnea" is keeping you from falling asleep. Do you still think that, after reading your sleep study results?

Can you be more specific about the type of help you want from forum members?

ozij wrote: ↑

Tue May 09, 2023 10:18 pm

Are you going to a sleep doctor who ignores the major trouble you have in trying to fall asleep?
Or is it that you're arguing with the doctor about the reason you have these problems?

That is a fair question. I'm not arguing with the doctor's findings, I do have upper airway resistance syndrome. However, I'd like him to look into the first 5 hours of the study, where I had a huge amount of arousals, but he won't focus on that. He says I need to do another study. I feel like it'll turn out the same, since that's how I sleep at home every night.

ozij wrote: ↑

Tue May 09, 2023 10:18 pm

Do you still think that, after reading your sleep study results?

From my internal experience, it feels like my body's effort to breathe stops (or greatly diminishes) as soon as I doze off. Almost every time I try to finally fall asleep, I'm awoken by the need to breathe. So the sleep study results seem to me to confirm this experience (98 spontaneous arousals, Arousal Index: 68, "severely reduced sleep efficiency"). So from my vantage point I thought "CSA", but I don't want to engage in confirmation bias. There are more experienced people in this forum than me, so I'd like to ask them for their input.

ozij wrote: ↑

Tue May 09, 2023 10:18 pm

Can you be more specific about the type of help you want from forum members?

I was hoping to get someone with more experience in sleep studies to let me know if they'd seen something like this before. Does this sound like someone with CSA, or anything else, I'm all ears. I'm hoping for some advice, or some knowledge that could point me in the right direction. A lot of replies to my comments are about "What does your sleep study say"? So I'm finally posting it to hopefully find some answers.

wetwilly wrote: ↑

Mon May 08, 2023 5:23 pm

Every time I doze off, it feels like my lungs stopped putting in the effort to breathe, and I'll wake up gasping for air over and over for 5 hours, sometimes with an adrenaline rush.

The OSCAR chart I saw shows your settings were Min EPAP 4.0, Max IPAP 20.0, PS 3.0 - 4.0 . Your IPAP is running at 7.0. That's pretty low. It could be causing a feeling of suffocation.

You didn't have any central apneas during your sleep study. Clearly something is going on when you're trying to fall asleep, but CSA isn't it. Have you discussed hypnic jerks or panic attacks with your sleep doctor? I hope another sleep study will provide further clues.

Do you normally sleep on your back, or did they require you to sleep on your back during your sleep study?

Every time I doze off, it feels like my lungs stopped putting in the effort to breathe, and I'll wake up gasping for air over and over for 5 hours, sometimes with an adrenaline rush.

"Factors contributing to upper airway narrowing during sleep are disadvantageous anatomic factors and/or reduced neuromuscular compensatory mechanisms to maintain airway patency. Upper airway resistance syndrome occurs in the upper airway most commonly due to partial narrowing and increased resistance in the retropalatal (between the hard palate and the uvula) and retroglossal (between the uvula and the epiglottis) locations.[7] The increased efforts associated with increased resistance and inspiratory flow limitation can lead to multiple arousals from sleep (both cortical or autonomic) and disrupt natural sleep.[8] These frequent respiratory-related arousal (i.e., RERAs) cause non-refreshing sleep, excessive daytime sleepiness, or unexplained daytime tiredness.[4] One of the main parameters of UARS includes flow limitation during sleep without significant desaturation and not meeting the definition of hypopnea (Figure 1).[9]"

Upper Airway Resistance Syndrome
Margaret D. Maggard; Abdulghani Sankari; Marco Cascella.
"In addition, the patient may complain of sleep disruptions and unexplained awakening from sleep, mainly after 2 to 3 hours of sleep. These frequent unexplained arousals are associated with increased respiratory effort and lead to sleep fragmentation, resulting in fatigue and excessive daytime sleepiness.[3] In addition, individuals with URAS and OSA have exhibited a low quality of life compared to the general population (5 to 6 times worse).[5]"
https://www.ncbi.nlm.nih.gov/books/NBK564402/

Interesting information, Calle; thanks. The timing seems wrong for the OP, though, at least according to his subjective experience. To the OP: do you have a timeline from the study showing when your RERAs occurred?

Miss Emerita wrote: ↑

Wed May 10, 2023 8:07 pm

Interesting information, Calle; thanks. The timing seems wrong for the OP, though, at least according to his subjective experience. To the OP: do you have a timeline from the study showing when your RERAs occurred?

I'm not sure what you mean by, "The timing seems wrong for the OP".

I do find it odd that his O2 sats are dropping to the 80's. That's atypical for a patient with UARS; however, it's possible to have both OSAHS and UARS.

The second quotation mentions unexplained awakenings after 2 to 3 hours of sleep. The OP experiences repeated gasps as he tries to fall asleep.

Miss Emerita wrote: ↑

Wed May 10, 2023 8:07 pm

Interesting information, Calle; thanks. The timing seems wrong for the OP, though, at least according to his subjective experience. To the OP: do you have a timeline from the study showing when your RERAs occurred?

I don't have a timeline, but my issues are twofold:
1. I struggle with falling into sleep because I keep waking up gasping for a breath.
2. Once I'm asleep, I often wake up a few hours later with an adrenaline rush, & pounding heart.

I don't know why #2 happens, but I do know that #1 happens because my breathing gets super shallow, it feels like it stops when falling asleep.
I got a sleeping app, and it shows I have a light snore. That's the upper-airway-resistance thing. But it doesn't explain O2 dropping, and waking up with a racing heart.

It would help a lot to see an Oscar chart illustrating these two phenomena. Please include your respiration rate graph, along with events, flow rate, pressure, leaks, flow limitations, and snores. Include a chart for the whole night and also somewhat zoomed-in views of each phenomenon.

Miss Emerita wrote: ↑

Thu May 11, 2023 8:18 pm

It would help a lot to see an Oscar chart illustrating these two phenomena.

Thank you for asking.
1. I struggle to fall asleep because my lungs don't keep breathing once I'm asleep. Yesterday morning I tried to sleep with the BiPAP from ~4-7am, and I kept waking up because I had stopped breathing as soon as I dozed off. It's like my automatic brain doesn't take over, so I have to breathe manually.

Whole period from 4-7am. Only 1 flow limitation:


Centrals while falling asleep at 4am


Centrals while falling asleep at ~6am.


This one also woke me up, and I took the mask off in frustration:


Unfortunately I don't have data of this night once "asleep" because I had to get up for the day.

wetwilly wrote: ↑

Thu May 18, 2023 10:42 am

1. I struggle to fall asleep because my lungs don't keep breathing once I'm asleep.

If your lungs didn't keep breathing while you were asleep, you'd wake up dead.

wetwilly wrote: ↑

Thu May 18, 2023 10:42 am

Yesterday morning I tried to sleep with the BiPAP from ~4-7am, and I kept waking up because I had stopped breathing as soon as I dozed off. It's like my automatic brain doesn't take over, so I have to breathe manually.

Seems much more likely that your pressure is too low, your airway closes up, and you have an obstructive apnea, which you have to wake up and gasp for air.


Please review how to do screenshots so that we have the info we need:
wiki/index.php/Oscar:organize

Thanks for the zoomed-in views.

The best match to feeling you describe is the 4 a.m. graph, where the CAs seem to occur without any prior arousals. The first and third CAs are followed by arousal breathing.

But in the two graphs from around 6 a.m., your CAs occur AFTER arousal breathing. In other words, you're aroused from falling asleep and THEN you have a CA.

Your sleep study showed an arousal index of 68; only 13.5 of that was generated by arousals related to respiratory effort. Your sleep doctor apparently isn't focusing on the arousals that aren't respiratory-related. I would suggest that you ask about medications that might be able to help you sleep with fewer arousals.

You might also want to ask the doctor whether you might be experiencing sleep-transition central apnea or other arousal disturbances connected with the neurochemical regulation mechanisms at work when you fall asleep.