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Lyn, given the severity of your desats during the study, I'd strongly suggest this:

If you and your doctor are going to go the autopap/software route to treat you, I hope he will order the DME to loan you an overnight recording pulse oximeter to use at home during the first week -- to get a good look at whether your autopap treatment at home is effective in keeping your overnight oxygen levels up. I think in your case that will be every bit as important to monitor, if not more so, than the "events" themselves....especially during your early treatment nights at home.

Lyn:
To respond to 2 questions on the table:

Sleep latency is measured from the point you start to try to sleep to the first appearance of any sleep, and that sleep period could be as little as 16 seconds. And the sleep does not have to be continuous after that point. You could have briefly dozed off at 10:30, or they could have defined test start at 11:40.

There are different criteria to define the classification of the severity of OSA, namely AHI and lowest desaturation level. And disagreement about the numbers within each category. A reference is:

The severity of sleep apnea can be categorized as mild, moderate, or severe on the basis of the apnea-hypopnea index. Mild sleep apnea is defined by an apnea-hypopnea index from 5 to 14, an oxygen saturation of at least 86%, and minimal daytime disability. Moderate sleep apnea is defined by an index from 15 to 30 or an oxygen saturation of 80% to 85% and significant work or social dysfunction due to drowsiness and loss of concentration. Severe sleep apnea is defined by an index greater than 30 or an oxygen saturation of 79% or less and incapacitation due to the sleep disorder.
Flemons WW. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22(5):667-89.

So, you can be mild OSA based on AHI, but that is trumped by the desats to make you severe.

Your sleep study had about 750 pages of real data, some of which may or may not have been artifact. This was processed by a tech to a 7 page report, which was processed by a sleep physician to make a one page summary. This one page summary may have been summarized by the attending physician. Then posters take this information and transcribe it to the internet. Where people like us hand out advice. There is no guarantee that the accuracy of the information at any point in the process has been checked against the original record, so mistakes can and will be made. And we're not talking about taking your toaster apart with it still plugged into the wall, we're talking about your health and safety.

There is some excellent advice here. Like Will's original assessment that you might have a whole different issue other than OSA. And if your original statement is correct

my SpO2 was 56% for 70% of the sleep time

you have a whole different problem that relates to diffusion defect, on the order of interstitial lung disease. If the last statement is correct

82% of the patient's saturations were below 89%

then we're talking apples and elephants.

If you have oxygen bled in to your system, it's flow rate is constant. Your therapy was based on a constant flow from the CPAP machine, which is more or less maintained if the pressure is constant. Once you go to APAP, that balance can be severely upset. And you're back to square one. What's the chance of that happening? I don't know. Either about 10% or 90%.

As RG says, DO NOT underestimate the importance of monitoring oxygen saturation!!

But to think every problem can be solved by buying an APAP and pressing the button is absolutely not true. That the physician even gave you one is so confusing to me. As Will noted, CPAP 4 is like nothing. Critical O2 value, no CPAP, supplemental O2, AutoCPAP, was there O2 in the Auto prescription?

Go back and grab the doctor by the throat and say "What am I supposed to be doing and give me my report!"

You could have severe REM or position-related OSA, but at this point who knows.

If you want to get the complete report, I will be happy to explain what I can to try to help.

OK, tough love here, but you have to know where you're going before you start driving 90 miles an hour to get there.

delta,sleepy, whoever I am, dave

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, CPAP, AHI, Prescription, auto, APAP

Dave,

What an incredible reply. You certainly know what you're talking about. It was so nice of you to take the time to give such a detailed and caring explanation.

May I ask you a question now? After reading the criteria, I have only one reason, perhaps two, to believe why they classified me as having OSA and put me on therapy. At my sleep study, I had zero apnea events (this is the first study-have to call today and insist on getting a copy of my second report where they titrated me), an HI of 4 and PLMD of 14+ per hour. However, this is what they wrote about my oxygen desats, which were classified as "moderate":

• Respiratory events are associated with significant decrease in oxygen saturations of hemoglobin (SAO2), with nadir at 84% range.

Does this mean because I had an 84% oxygen desat with a 4 HI, they put me on therapy or because of the PLMD, as they put it, signficantly framenting my sleep architecture? I was just wondering if you could tell me what their real reason for therapy might have been, or reasons.

Thank you in advance for any help you can offer to explain this. I have no pulmonologist or sleep doctor. I suggested the sleep study to my own PCP and she agreed. I don't think she is qualified to answer these questions, but you certainly seem to be.

Hi LI:
PLMs and OSA are not related. For a snapshot of a PLM take a look here:
PLMS
Limb movements that occur following respiratory events are called exactly that, LMs. And if all the LMs disappear with CPAP, then you KNOW they weren't PLMs. If anything, PLMs get much worse as the CPAP allows you continuous sleep and the PLMs are allowed to come to full fruition. You treat PLMs with drugs.
And actually, PLMs themselves are harmless, unless they cause an arousal, so look for your PLMAI. If it's >5.0 and you have EDS, think about treating the PLMs.
Did you see that subtle difference? Arousals don't cause PLMs, PLMs (may) cause arousals.
In re: your AHI of 4.0, yes, I think your treatment is because of the low sats. But usually when you see only a few events, and some above average response, there's often another factor involved, like supine sleeping or REM. That should be in the report. So if the NREM AHI is like 0.0, but the REM RDI is 20.0, that kinda puts the significance of when and why in perspective.
An individual's sleep is like a fingerprint. Each person's.....
No, that's not right, not even close. A sleep study has about 800 pages of information, each page with about 16 channels of continuously streaming data. There is so much information in these things I am always so afraid that important information is overlooked, and yes, sadly, at all levels. Anyhow, I'm glad to help out wherever I can.
delta dave

Dave, you are incredible! Thanks again.

Between the time I last posted to you and now, I got a copy of my 2nd study, the titration part, faxed to me from my PCP's office. Amazing that it says in this one, after having 14+ PLMDs according to them in my first study significantly breaking up my sleep pattern, the line from this one reads:

• There is no evidence of independent period limb movement disorder or other significant parasomnia.

How could it change so drastically from one study to the next, 10 days apart? This one says the whole 5 hours I had 5 hypops and no apnea and my O2 levels stayed at "well above 90% in REM and NREM sleep.

I am still wondering why they have me on this if I don't fit the criteria? I wish you had the report to look at and tell me what is going on. Now when I use my machine, my AHI is under 1.0 every night, with the other night actually having a zero for the first time. If my O2 levels are fine now, do I really still need this? I should do a split night and see what happens. What is your educated opinion, if I can pick your brain a little more?

Thank you for your help.

Whoa, sleepless one!
If the goal of the CPAP was to fix the desats, you've done that, hooray! As long as you wear CPAP, they're gone.
Yeah, without the reports, we're wandering in the dark. Really need the arousal summary with and without CPAP. However, we can speculate....
So the PLMs were really LMs. Actually, the "LM" isn't the important thing here. If you're talking an LM, you're probably talking an arousal that caused the LM. And that's the important thing. You may have a bunch of "unexplained" arousals.
You have to look closely at the study itself. If there was some respiratory component preceding these arousals, yet not significant enough to be classified as a hypopnea, you would still have a CPAP-able entity. It appears that your auto is thinking along this same line as well, cause it appears to have found something to respond to, perhaps snoring or flow limitations.
And if these respiratory events caused all the arousals, of which the LMs were a part of, then fixing them (FLs, LMs, arousals, everything) would also fix your EDS. So this could be a UARS.
Gotta see the arousal table and sleep architecture to know if that's the case.
deltadave

Dave,
I have the arousal charts they sent on both reports, with and without the cpap. If you tell me what figures you want, I can tell you what they are. Or if you want, I can scan them and send them to you via PM, if you wouldn't mind taking the time to look at them. I find your knowledge fascinating and how you are able to explain it all. Thank you for taking the time to do it.

I got a copy of my 2nd study, the titration part, faxed to me from my PCP's office. Amazing that it says in this one, after having 14+ PLMDs according to them in my first study significantly breaking up my sleep pattern, the line from this one reads:

There is no evidence of independent period limb movement disorder or other significant parasomnia.



How could it change so drastically from one study to the next, 10 days apart? This one says the whole 5 hours I had 5 hypops and no apnea and my O2 levels stayed at "well above 90% in REM and NREM sleep.

Dave is the best, isn't he! I always love reading his posts - great information, great explanations, and just plain "fun" to read, too...the way he puts things.

Lori, if I understand you correctly, what you are saying about the report in your quote above is from the TITRATION night, while you were ON cpap. Right? If so, then I'd sure hope things would "change so drastically" from the first night study...the diagnostic study.

Looks to me as if the report from the second night ten days later...if it was a titration study with you on cpap ...is saying cpap therapy was doing exactly what it's supposed to do. The very kind of "drastic change" for the good you'd expect to see, and want to see, with cpap applied.

Dave's wonderful explanation of "LM" vs PLM, and the importance of looking at the arousals and sleep architecture probably already cleared that up for you, anyway.

RG,

Dave is wonderful. He now has my arousal statistics and was nice enough to offer to look them over for me. What a generous person.

Yes, I think this is exactly what happened, as you wrote. The second study, which was the titration portion, was able to totally eliminate my events and snoring, according to the report, said 100% elimination, and the oxygen desats were all above 90% with 10 cms. of pressure. Nice to know it was that easily fixable. I am so grateful.

Also, on both nights, I never had one apnea event, which I find odd since they come up now on my software usually nightly, if not every other night. It's strange how things fluctuate. Some nights I have no apnea and other nights no hypopnea. Then some nights I have a little of both. It's like my body thinks, when it comes to OSA, it's in an old-fashioned Chinese restaurant. It gets to choose one from Column A, one from Column B or the Family Style dinner where you can have some from both!

In any event, I am a happy camper. I am feeling wonderful on the auto setting now, have very low statistics each morning and the Aura, as you feel, is the best thing that has come along, as far as I'm concerned, to sleep with if you have OSA. I don't seriously mind wearing it. No marks on the face in the AM, no leaks, no discomfort, no dislodging during the night, a truly amazing interface. Don't know how they would be able to improve on it. Maybe just the XL pillows. Sometimes when I first put it on, the very top of my right nare seems to need a bit more coverage. But with a little adjustment, I'm good to go for the night.

I wish I had listened to you long ago about the Aura, but I thought you HAD to deconstruct yours, not that you did it just to see how it would be without the lockbox; which, by the way, doesn't bother me a bit. I just love the interface. No bubble bursting here yet...and don't expect it to.

Dave,

Thanks for your great response. But please let me emphasize &/or clarify a couple things.

1. It was my Internist & not my sleep dr (who is a Pulmonologist) that wrote me the script for the apap.

2. Yes, I want to get an apap, but I DO NOT intend to use it as such. I do intend to use it as a cpap.

3. The info in my first post was what I received verbally from the sleep dr's office when I called but I don't know if it was the nurse, receptionist or who giving it to me. So I guess we might be better off to just use the summary info.

Sorry for all the confusion. Although that does seem to be my normal state of being lately.

Before he did the sleep studys, the Dr did several pulmonary tests & said everything looked ok. This makes me hopefull that the low oxygen problem can be resolved simply by the compliant use of cpap stoping the apneas & hypopneas. I would LOVE to get rid of the supplimental oxygen.

As I said before, I have an appointment with the sleep dr on the 26th so guess I'll just have to wait to see what he says.

Thanks all!
Lyn