Got Copies of Sleep Studies

Now that I have copies of my sleep studies, I will likely have a gazillion questions, but I'll start with one

The AHI per hour listed in my four studies are as follows: 37.1 (initial, without CPAP), 5.1, 5.4, and 39.4 (most recent).

The thing is, with the exception of the most recent study, all of the events were hypopneas. There were no OSA, CA or MA events at all. Is that unusual?

I thought I had read somewhere that the medical community is not even certain that hypopneas are caused by an obstruction. If that is true, is cpap really the right choice for me, or should we be looking for some other cause??

Bonnie

I would try getting a second opinion fro a different doctor.

I agree w/DreamStalker. Take those full data reports to another sleep specialist for that second opinion and let him/her go thru them to see what he/she suggests. You won't necessarily have to go thru yet another sleep study altho he/she may well prefer that you do w/a tech he/she knows and has confidence in.

My understanding of hypopneas is that they can be caused by partial obstruction, or the flow limitation can be caused by:
1. weight on chest restricting expansion (ie, boobs)
2. weak or slow diaphram contraction

Whatever their cause, I believe the effects of hypopneas are the same as apneas if they lower your oxygen saturation more than 4% from baseline. I also believe that hypopneas are treated with CPAP, just like apneas are.

Just my 2 cents.

Best Regards,
Cathy

Thanks DreamStalker and Slinky. I have an appointment to see the sleep doc (who I have not seen since 2004), to give him one opportunity to explain to me what's going on. I doubt that he will be able to justify a lot of what has happened, so at that point I will ask my GP for a referral to someone else. I think we have to have a referral from a primary physician here.

Do you have any suggestions as to what questions I should ask my sleep doc? I certainly have a ton more knowledge from reading here than I ever did previously, so I hope I know enough to question his responses instead of just saying "ohhhh.....", but is there anything in particular I should be watching for?

Cathy, thanks for the thought regarding flow limitation, but my chest is definitely not heavy enough to impact my breathing

And btw, oxygen desats were consistently over 90%, with the exception of a couple of minor spikes no lower than 86%.

One part of me is intimidated about asking my doc questions. As I recall, he has an office almost as big as my house, and a huge desk which he sits behind, presumably to keep him from the riff-raff. But I have learned here that it is MY health, and MY therapy, and I am entitled to understand what is going on with it.

Thanks again.

Bonnie

tangents wrote:My understanding of hypopneas is that they can be caused by partial obstruction, or the flow limitation can be caused by:
1. weight on chest restricting expansion (ie, boobs)

Sorry... can't be silent.....

YOU MEAN I FINALLY HAVE THE 40C'S AND THEY ARE KILLING ME????

I gained all this weight for NOTHING???

Seriously - I keep telling the Primary, when she nags me to lose weight, that I'm against that concept because I finally have boobs.

LOL,
B.

Bonnie-
It looks like you are already on CPAP. How is that going for you?

I see from a previous post that you had some concerns about data on one of your sleep studies seeming to be in error. Did that ever get cleared up or is that still an issue?

The variability in the AHI results for the 4 sleep studies is striking but it may also be revealing. First, were any of these studies done with CPAP? If, for example, the 2nd and 3rd studies were done with CPAP the other 2 without, it would help illustrate how CPAP is having an effect on your hypopneas and you could then also see whether your oxygen levels were improved with CPAP and whether your level of arousals was improved with CPAP.

The other thing that your studies without CPAP will show is whether your level of hypopneas changes with position or with your sleep stage. I have seen sleep results posted where the AHI varies as widely as the 4 scores you posted depending on whether the person was on their back as opposed to being on their side or whether they were in REM sleep or not. And again, look to see whether your oxygen levels and/or your frequency of arousals are affected by sleep stage or position.

I have read of people being treated with CPAP whose sleep studies were either hypopnea-only or almost so. There is also a phenomena called Upper Airway Resistance Syndrome that sometimes benefits from CPAP even with AHI in the normal range. This appears to be based on what are called flow limitations (not in the same sense that this was used earlier) and if I recall correctly on decreased oxygen levels. You might want to read up on this although I am not sure whether you would qualify for the diagnosis or not.

If we can help you make more sense out of your studies, please feel free to ask away.

Best wishes,
Bill

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tangents wrote:My understanding of hypopneas is that they can be caused by partial obstruction, or the flow limitation can be caused by:
1. weight on chest restricting expansion (ie, boobs)
2. weak or slow diaphram contraction

Whatever their cause, I believe the effects of hypopneas are the same as apneas if they lower your oxygen saturation more than 4% from baseline. I also believe that hypopneas are treated with CPAP, just like apneas are.

My sleep study events were hypopneas only as well. My baseline sats were 92, my lowest was 85. I know when my dad was in the hospital whenever the sats went below 90 tons of alarms would go off! I was told by 2 docs they treat hypopneas the same as apneas. It's usually caused by a partial obstruction. And either way it causes oxygen deprivation! Same result, different manner. Interestingly, with my data capable CPAP I do have apneas. One night the average duration of them (even with CPAP was 1.1 minutes!!!!!!!) Holy Batshit, Batman!!! Thankfully that was ONE night only and the average duration is about 10-14 seconds. Long enough IMHO!

I agree with Babs - first thing to go when I lose weight is my boobs so I'm sorta against that since it looks funny Seriously though being a DD does put a lot of weight on my chest. As evidenced by much higher events (75.9) on my back as opposed to my side (43.9) but either way I am severely OA (and that's not overeaters anonymous either )

My average AHI now over the full length of time being treated (almost 2 months) is 2.4. I've had a few nights under 1 as well. Just started feeling better earlier this week!

I went to pick up my copies of my study and all they gave me were the titration notes and tech notes - none of the graphs which I had specifically asked for in my letter. Get this - they didn't know how to get those off their system!!!!! And the woman who would do it said "You don't have to worry about getting zero stage 3 or 4 sleep - it's not surprising. As we get older we quite often get zero 3/4!!!!!" OK - I know we get LESS 3/4, but ZERO - give me a break!

So they're going to have to figure out how to get my studies for me (probably on a DVD). Don't care what they need to do. I want to see the graphs. Especially the ones after the last titration bump at 2:58 a.m. They put me on a mask at 1:45 at 5, fell asleep at 2:09 at which point they raised it to 6 and had 8 minutes of stage 2 sleep. Between 2:17 and 2:58 there was ONLY stage 1 sleep!

Well, at least I got my prescription and got to see the notes.

Best of luck with your appointment. Don't let the doc intimidate you! As you said - IT'S ALL ABOUT YOU!!!!! Who gives a darn what he thinks as long as you get the answers you need!

big breasts causing hypopnes??

I never thought of that


I need to call Dolly Parton ASAP.......she needs my help!!

mth712 wrote: Just sleep on your head so they aren't pressing on your chest and to prevent future sagging.( KneeKnockers)

But there is no xpap in the world that would keep her from strangling

Thank you for your response justplainbill, and for your offer to help.

I was dx with OSA in 2003, but gave up after about 6 months of occasional use. Decided to try it again about a month ago, which is when I found this forum and all of the fabulous information and support.

The first three sleep studies make sense to me. The first was the initial pre-cpap study, and the next two were first titration and re-titration one year later. It is the 4th study, which was a retitration done in November 2006 which confuses me. Although I had not been using cpap, this study was done with cpap. It was worse than the original. I will be seeing the sleep doc on June 25 to see what his explanation is.

During the last study, I slept very little, had 5% stage 3, no stage 4 and no REM sleep. Interestingly, the only desats below 90% were during the brief periods of stage 3 sleep. The longest period of uninterrupted sleep was about 25 minutes, although there was frequent bouncing between stage 1 and stage 2 sleep (arousals?) during that 25 minutes.

Respiratory arousals were 23/hr, spontaneous arousals 8.7/hr and limb movement arousal 11.2/hour. So, that is a total of 42.9 arousals per hour, which seems a little high to me.

During the total 387 minutes of recording time (total sleep time 219.5 minutes), cpap was used at a pressure of six for the first 5 hours, and a pressure of seven for the remaining 1.5 hours. I did sleep for longer periods and more deeply with the pressure at 7, but the only appreciable difference in hypopneas, arousals and PLMs was in the final 10-15 minutes of sleep. I figure by then I was more comatose than sleeping

What I don't understand is why the Rx was then written for a pressure of 6 !!

Oh, and the study indicates that I was supine for the entire recording time, which is extremely unusual for me. I rarely sleep on my back. Also, PLMS was noted as severe, with 65.9 events/hour. Nobody has ever mentioned PLMS to me. Sleep efficiency was recorded at 56.7%, which is worse than any other study, even the initial pre-cpap, which was 72.7%.

What upsets me most is that I was told I did not need to see the sleep doc after this last study, and nobody ever contacted me to suggest that there was anything unusual about this study.

Do you see anything unusual or significant about any of this? Would appreciate input.

Bonnie

Thanks for your feedback DeltaSeeker! Sounds like we have very similar results, but with your RDI higher than mine. I just received my data capable apap (purchased out of pocket from a forum member) but still waiting for my software. It will be interesting to see the data and how the apap performs.

Glad to hear you are feeling better. It has been a struggle for me for the last month, but I am not giving up this time

Thanks for your encouragement!

Bonnie

Just found this site. Newly diagnosed but probably had this since teens --40 years ago. I'm impressed with the general knowledge these posts show -- and the humor . Don't understand much of the jargon yet. Don't even have first equipment yet although the sleep center says its coming. Any advise from anyone for a newbie? All they have told me about the first sleep study is I hold my breath avg of 22 times per hour ranging from 10 to 37 seconds each time. Don't yet have results of the recent sleep study with CPAP. Don't know what equipment they have in mind either. Don't even know the questions to ask yet. Thank you for anything offered

Bonnie-

I am not an expert on such matters but the results from your second study do seem unusual. The most unusual factor is the high level of arousals, the next is your poor sleep architecture (in this case the very limited amount of stage 3 & 4 and REM sleep); and your desaturations being limited to your stage 3 sleep also is notable (although it does not strike me as unusual that your desaturations are limited to your deepest sleep, it seems to me that it could mean that is your sleep architecture improves-in the sense that you get more REM and deep sleep-that you could be seeing more oxygen desaturation events too). In addition, there are the PLMs (Periodic Limb Movements).

If you were on any medications (prescribed or otherwise) or were having physical problems or something else not usual for you, it is possible that such factors could have had some influence on these results.

I had a similar level of PLMs in my initial sleep study but they were reduced by more than 1/2 during my titration study and PLM-related arousals were reduced to 0. It seems to be true for some of us that our PLMD (Periodic Limb Movement Disorder) is fairly well-controlled with CPAP but there are others who require additional treatment (usually medication is prescribed in these cases, I would advise you read up a bit on these first: there is also a rumor that a bar of Ivory soap placed at the foot of the bed might help although I do not personally subscribe to this theory).

By the way, if you only have reference to your earlier sleep studies, I would urge you to get copies of those also. Unless you have seen those sleep studies and know that they showed little or no PLMs you might be mistaken in assuming that you did not have as many PLMs before.

It seems to me to be a very good idea to talk with your sleep doctor and/or (as Roberto suggested) to seek a second opinion from a different sleep doctor. I could be mistaken but it strikes me that your high level of respiratory-related arousals suggests that this titration was far from optimal.
I would ask about the arousals and the poor sleep architecture and I would ask why there was no effort to try more pressures (there may be a reason but it does not seem obvious to me).

It might be a good idea to get a new sleep study and in that case you might want to consider starting over with a new initial sleep study off of CPAP just to check on whether there has been a significant change in your sleep. If your CPAP therapy is going well perhaps I would skip that. It may also be that you want to wait for your data-cable machine and get some time on that machine before going back to your doctor.

Please keep us posted on how you are doing.

Best wishes,
Bill