Help...brand new to everything

This is cross-posted on another forum, so I apologize if you're seeing it twice or if that's against the rules I'm hoping for some advice before I go back to my Dr.

Hi Everyone! I just found this forum and am grateful for folks who might understand what all of this means! The sleep study process, so far, has been a lengthy one (my first Dr. appointment was over 2 months ago) and I don't go back to go over my sleep study results for another 3 weeks. The hospital did send me the results of my sleep study, though I don't quite understand what most of it means. My fear is that the numbers look low, and I'll be brushed off and sent home with no help or recommendations. Here is some information about me:

I am a 42 year old female, and I think I have always snored. I have woken myself up with my own snoring more times than I can count (embarrassing? Absolutely!) and even though my ex was diagnosed with sleep apnea and was on CPAP it never dawned on me that I might have it as well. I have also had many dreams over the years that I am having trouble breathing and wake up gasping for air, though I shrugged it off as nightmares. Now that I've filled out the questionnaire like how many days a week do I nap, or how often do I doze off when watching TV, etc. I see I have had many symptoms for a long time now.

My current partner and I have lived together for over two years, and the entire time they have mentioned my snoring struggles. I lost a lot of wait about a year and a half ago and this did not make a lick of difference. It wasn't until hearing that I am making choking sounds in my sleep, and that I stop breathing in my sleep, that I started to realize that maybe I do have something going on more than just snoring. They weren't isolated incidents, it is disrupting their sleep when they wake up panicked that I'm choking or can't breathe. I tried those nasal strips, and they were quickly dubbed my "loudspeakers" (lol) because they made it worse. I tried a mouthpiece but it didn't help and just left my jaw sore in the morning. I usually sleep on my side, though my hands tend to fall asleep so I roll over and change positions frequently.

A little over a month ago, I was staying at my Mom's house while she went away to watch the place and her dog. She has recently been diagnosed with mild sleep apnea, and was using a ResMed CPAP machine for it, though she didn't want to risk damaging it when she traveled so she left it home. She had a new, never used, mask and some hoses, so she suggested that I try it while she was gone (she hates it, and has since gone to her Dr. for some sort of mouth piece that is supposed to help instead). Low and behold, no snoring. We both got restful sleep, and for the first time in a long time I didn't feel sluggish throughout the day or want to take a nap at my desk in the afternoon.

Here is all the information in my chart that I can see, maybe it will make sense to someone else? I'm hoping to go to my next appointment with a better understanding, so that I can advocate for myself if necessary. Any insight, even though I know it's just opinion and not medical advice, would be appreciated so I know what I'm walking into! As I mentioned, not knowing what any of these numbers mean (and Google is overwhelming) I'm afraid they're not 'bad' enough to be taken seriously, and I'll have gone through months off appointments and tests for nothing. Thank you for reading, and welcoming me to your group! I look forward to learning more!

FINDINGS

Recording: Total recording time was 555.8 minutes. Recording quality was adequate.
Position: The patient spent 246.1 minutes supine, 309.7 minutes non-supine.
Respiratory: The Respiratory Event Index (REI)* was 16.5, consisting of 0 obstructive apneas, 0 mixed apneas, 74 hypopneas and 79 central apneas. Supine REI was 34.1 events per hour, Non-supine REI was 2.5 events per hour. Mean oxygen saturation was 92.9%, with a minimum of 75.0%. 2.0% of recording time was spent with a Sp02 <90%. Snoring was demonstrated.
Cardiac: Mean heart rate was 58.9 beats/minute. Max heart rate 92.0 beats/minute, min heart rate 43.0 beats per minute.

*"Respiratory Event Index (REI)" on this study is equivalent to the "Respiratory Disturbance Index (RDI) " of 16.5.


Final Diagnosis: Obstructive Sleep Apnea, ICD-10 G47.33

Interpretation and Recommendations: The study documents mild obstructive sleep apnea an d mild central sleep apnea, associated with intermittent moderate oxygen desaturation. Respiratory events are more pronounced supine, with central apneas being of unclear etiology. It should be noted that given the limitations of HSAT, the findings of this study may represent a significant underestimate of the patient’s actual degree of sleep disordered breathing. The patient is advised to follow-up regarding the study results and treatment options as applicable. They are also advised to refrain from driving whenever sleepy, and cautioned regarding the use of alcohol, sedative/hypnotics, muscle relaxants and opioids.

This was a home sleep study and not done in a lab setting????
If a home study....did you wear some sort of belt or restraint around your chest or abdomen?
If home study did they use anything else....like the finger thingy for oxygen and the nasal cannula thingy? Like any little sticky things on your forehead or scalp?

You qualify for some sort of cpap machine but given the number of central apneas I don't know how the doctor will want to proceed.

Keep that appointment for sure.

Oh goodness, I didn't even think to include that info. So the home sleep study had 4 things I wore throughout the night. I had something that went into my nostrils (resembled the tubes used for oxygen), a pulse oximeter on my finger, a strap with a sensor around my chest and another around my waist. I believe the straps were there to see what position I was sleeping in.

I don't know what the central apneas mean, but it's nice to hear that you think I should qualify for some sort of treatment. Thank you for your input!

Home sleep studies are a good starting point but your doctor is correct...sometimes their limitations can cloud the results and more often they cloud things by under reporting.
Then the presence of very many central apneas (per machine reporting...that's where that chest restraint comes into play)
along with the lack of OAs to speak of but a lot of hyponeas makes for us not knowing if those hyponeas are central in nature or obstructive in nature. Everyone assumes that hyponeas are always obstructive but they can be central in nature for some people (and/or home sleep study equipment) and that can mess with what someone wants to try to do about their problem.

You are self reporting a lot of snoring and snores are obstructive....
Technically, per this home study report, you have complex sleep apnea because you have both obstructive events (assuming those hyponeas are obstructive in nature) and central apnea events. A few (handful) of centrals is no big deal but you are having a lot more than just a few.

The snores themselves can be sleep disrupting....been there and done that myself. It wouldn't be impossible for those snores to be causing wake ups that then cause the airway to not be collapsed and thus maybe some real obstructive events simply don't happen because the snores woke you up.

And that drop in O2 levels to 75%.....that's a big red flag for apneas (whatever they are from) being a problem that needs attention.

Most likely your doctor will want you to start on regular cpap and hope it also takes care of the central apneas.
Regular cpap isn't designed to treat centrals but some lucky people have found that regular cpap/apap can also reduce the centrals to a "handful" and fall out of the "it's a problem" category. Sometimes it works....more often it doesn't but it doesn't hurt to try easy and cheap first because you might get lucky. The type of machine used to deal with complex sleep apnea costs a LOT more than the regular cpap and insurance might not want to pay the big bucks anyway.....at least until cheap and easy if tried first and doesn't work out.

You do most definitely qualify for further evaluation and use of some sort of cpap machine.

Your doctor might also want to do an in lab sleep study with and/or without cpap use. I have no idea where he/she will want to start.

That was so helpful, thank you so much for all of that information! I'm hoping I don't have to do an in-lab study (I only live in this area half the year, and I'm afraid they'll be booked past when I leave) though of course I'll do whatever I need to if there are no other options!

Where are you located now? Where are you going? Moving permanently???

It really wouldn't hurt things if you just started with regular cpap/apap and went from there.
You may or may not need one of those high dollar machines anyway....and your insurance might even prefer regular cpap/apap anyway because it might work and they would save money by not doing the in lab sleep study. Insurance companies are all about saving money and paying as little as possible for anything.

I'm a little worried about what insurance will cover, but that's true for just about anything! It baffles me when a medically trained physician can tell a person they need medical assistance / medication / testing done and an insurance company can decide whether it's necessary enough to pay for. That's been a little bit of the delays in making the appointments, but only a small percentage overall.

We live half the year in the northeast US and then we go south for the winter, so I'll be there from Nov-May ish. Living at the beach in the winter is wonderful, but the area is so remote compared to here that I leave anything medical to the Northern hospitals and doctors instead of small town family practices or driving over an hour to the nearest mediocre hospital. I'm from here (north) originally, so all of my doctors are here anyway, and until this all popped up it wasn't a big deal. Now with every appointment taking weeks to schedule, I'm nervous that'll I'll be here longer than planned or it'll have to get pushed back. Perhaps they'll start me on one treatment and observe online for the 6ish months I'll be gone? I have family here, I suppose if I have to come home for an appointment I can (it would just be a lot of gas money or airfare but having the option is an extremely lucky position to be in). I had no idea how involved this was going to be, but I'm glad I didn't put it off!

Ahhh.....you are a snow bird.
I am envious. I can't go anywhere because I have animals to care for and no one (that I can trust) to take care of all my critters.

How long do you have your mom's machine to play with??? Is she not using it now?
If you could still use it we could play around with it... maybe....depends on what machine she has and does it have a SD card in it? Do you wish to give it a go or just wait?

Reports from it might help the doctor decide what to do and maybe accelerate the whole process (whatever it ends up being).

Hahaha yes, we are snowbirds! Which feels ridiculous at my age to say, but it's technically true. The animals came with us while we had them, now that they're gone it's just the two of us

I do still have my Mom's to play with, while she is trying some mouth piece from her Dr. I don't want to change any settings on it (though if her Dr is happy with her progress with the mouth piece she said I can have her CPAP because she HATES it). If my Dr. thinks it will help, that is. It's a ResMed Air Sense 10 Autoset, and she only got it in March so it's practically new. I just downloaded the app today, so I have no data yet but I think I have another week before she goes to her Dr. I don't have an SD card in it, but I can grab one or have one delivered from Amazon. I've used it for a few days, just because I figured it can't hurt, and other than trying to figure out how to sleep on my side without dislodging the nose piece, I don't have any complaints!

Any generic SD card 32 GB or less (one can use a bigger capacity card but the AirSense 10 machines have trouble with a big card and besides it costing more...there's more work to make the card compatible with the machine.
I get mine at walmart. Get the smallest capacity that is the cheapest...4 GB is more than sufficient but it's getting really hard to find those smaller SD cards and when we do they end up costing more than a bigger card.

I can walk you through it all over the phone if you wish. It's easier than my having to type out a small novel.
If you want to do that just send me a PM with your name and phone number and a good time to call and I will call you and explain it all. I am in Missouri so central time.
We won't change her settings yet. We just want to look and see what is going on with current settings.

What mask are you using? One of hers???

That is so kind, thank you!! I completely forgot to respond last night to you, I was digging around online and think I figured out a few things. Enough to get some information, anyway!

I managed to find an older SD card in my camera bag, so I used that last night in the CPAP and imported the results into Oscar this morning. I was able to go into the machine settings last night to and take pictures of all the settings on the machine, so at least I know what I'm working with (lol). I also have the app on my phone that has limited info, but it's a little snapshot at least. I'm working at the moment, and Oscar and info is on my personal computer, so I can work on figuring out how to share and what to share from there later on. In glancing quickly, it looks like I had 60 Clear Airway (which seems to be the same as Central Apnea?) events last night, 21 Obstructive Apnea events and 9 Hypopnea. It also lists 7 RERA (RE) events and 4 Large Leak. It's showing an AHI of 10. The app just says I averaged 10 incidents an hour overall. It's all very interesting, honestly!

The mask that I'm using is a ResMed Airfit N30, which I'm not a huge fan of because I prefer to sleep on my side and when I do it becomes just loose enough so that I feel cold air blowing onto my face. My mom had an extra mask, etc. so I'm the only one that's used al the pieces except for the machine itself so far. In the event that I qualify for my own, and my insurance cooperates, I'll definitely be looking into different mask options but for the sake of experimenting this is OK.

SleepyKTR wrote: ↑

Fri Jul 26, 2024 10:07 am

looks like I had 60 Clear Airway (which seems to be the same as Central Apnea?) events last night, 21 Obstructive Apnea events and 9 Hypopnea. It also lists 7 RERA (RE) events and 4 Large Leak.

Yes...clear airway apnea is the term that OSCAR uses for central apneas.
If you happened to be using the ResMed software (called ResScan and a huge PITA to use) you would see the term central apnea used.

Central apneas are cessation of breathing but the airway is still open. No effort to breathe. Hold your breath for 15 seconds...that's like a 15 second central. No air is moving but in this case you are holding your breath on purpose so not alarming and if we do that occasionally it is no big deal. Have a bunch of them back to back for for several minutes and we got a problem.

Obstructive apneas are when the soft tissue in the airway sags/collapses and blocks the airway either completely or partially. You will try to breathe but be unable to (at least fully) and then your brain says "whoa...my human is having problems so I had better wake my human up so she can get air moving"...and arousals happen.

Occasional central apneas or even occasional random obstructive apneas aren't a big deal but they become a problem when they come on often and/or cause the arousals or even drops in oxygen.
Yours number in the "it's a problem" arena.

Once I see that OSCAR report from last night I will have a better idea what to try to see if we can get lucky with this machine or not in terms of dealing with the centrals. The obstructive stuff is fairly straight forward to deal with but the centrals really muddies up the waters. Fixable for sure but may not be all that straight forward.

When you have time read this because it explains how to present the report in a manner we can use to evaluate the results.
OSCAR will give you a lot of information but we don't need ALL that information to form ideas.
http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

I think I've done this correctly, here is the Oscar data for my first night:

Any chance you were awake or half awake from about 6:00 on?

I think I woke up around 6 but fell back to sleep, and then when I woke up again I turned the machine off and took the mask off. Maybe I wasn't fully asleep during that time?