another sleep study, different results--opinion

svh wrote: It seems to me that hypopneas are my biggest problem. I'm wondering, given that fact, do hypopneas need a higher or lower pressure to correct than apneas? Or should I just not worry about the distinction? Even during the day, I don't think I breathe as deeply as I should. I often find myself taking "catch-up" breaths. I'm just wondering what the best way to deal with this kind of problem is....Thanks in advance!

I don't know the answer, but I have noticed that EPR seems to affect my results. I have a few more hypopneas on EPR of 1 than 2, and a few more centrals on EPR of 3, and EPR of 2 is just right. Not sure why, think it could be connected to my breathing pattern.

Good luck with your home titration, I'm sure you'll find the S9 comfortable to use.

I'm at work now, but I'll double check the numbers when I get home. I'm pretty sure I transcribed them correctly, but you never know....

So, the numbers I posted initially do match the reports, with the exception that in the more recent sleep study, I did have one Central Apnea, which I hadn't mentioned.

Also on the recent report:
Total AHI: 29.7
Supine AHI: 58.4
Lateral AHI: 18.0
REM AHI: 16.3
NREM SpO2 Nadir: 96%
REM SpO2 Nadir: 96%
% of time <90% SpO2: 0.0%

Oxygen Analysis:
Mean SpO2: Awake: 99.1%, NREM: 98.4%, REM: 98.4%, TST: 98.4%
Minimum SpO2: Awake: 93%, NREM: 96%, REM: 96%, TST: 96%
Maximum SpO2: Awake: 100% (100% across the board on this line)

OK, since I've got most of the report on here already, here's some more:

SLEEP ARCHITECTURE:
Lights out: 10:12:08 pm
Lights on: 5:22:35 am
Sleep Latency: 22 Minutes
REM Latency: 368.5 Minutes
Wake after sleep onset: 85.5 minutes
Total sleep time: 323.0 minutes
Total sleep period: 408.5 minutes
Sleep efficiency: 75%
Stage N1: 14.7%
Stage N2: 73.7%
Stage N3: 2.5%
Stage R: 9.1%
REM periods: 1
Awakenings: 39

In the INTERPRETATION section, it says, among other things, "Sleep architecture was notable for decreased slow wave and REM sleep. Her REM latency was prolonged at 368.5 minutes. THere was moderate sleep fragmentation, with an arousal index of 34.4....." The rest of this section was mostly just restating the facts present in the charts, already listed above.

I really appreciate people's help on this. I'm willing to use my (soon to arrive) APAP, so long as I can actually feel better. I was really good about using my CPAP, until I started feeling just as bad with it as without. Then it seemed less compelling, somehow.... I'm trying to do the right thing here, and understand my situation. I feel fortunate I got the DME to just send me the machine I want, instead of making me wait for then to come visit me at home. I know that between you guys and the resources available online, I can get up and running. I tinkered with my CPAP over the years to get it working optimally, and generally maintained an AHI below 1.0, when things were going smoothly. I want to get back to that point!

svh wrote: That said, I no longer travel for weekends with my machine, as I feel I can go that long without it.

NOT a good idea at ALL!!!! Once you start using cpap, any defense mechanism that your body built against oxygen deprivation will be gone, and you will be more susceptible to an overnight heart attack or stroke. That's how i see it anyway. There was an article describing the apneic brain (?) and how it protects itself against low SPO2 levels in people with untreated OSA. Someone here will have a link to it.... NM can correct me if I'm wrong!

Cpap is not like a daily medication which still has an effect the next day(s) and can be skipped once in a while. Every night that you don't use it will bring you blood oxygen desaturations and arousals for the whole night. Why put yourself at risk like this? A diabetic does not skip his injections because it is inconvenient. CPAP IS TOO IMPORTANT TO SKIP A NIGHT OR TWO BECAUSE IT'S INCONVENIENT. Sorry to "shout" like this but I think you are doing yourself a great disservice if you think like this. Even if your oxygen desaturations are not "that bad" right now (or in this case, the night they did the sleep study).

I understand, and it's OK to shout at me. I do know that you're right.....

echo wrote:

svh wrote: That said, I no longer travel for weekends with my machine, as I feel I can go that long without it.

NOT a good idea at ALL!!!! Once you start using cpap, any defense mechanism that your body built against oxygen deprivation will be gone, and you will be more susceptible to an overnight heart attack or stroke. That's how i see it anyway. There was an article describing the apneic brain (?) and how it protects itself against low SPO2 levels in people with untreated OSA. Someone here will have a link to it.... NM can correct me if I'm wrong!

Cpap is not like a daily medication which still has an effect the next day(s) and can be skipped once in a while. Every night that you don't use it will bring you blood oxygen desaturations and arousals for the whole night. Why put yourself at risk like this? A diabetic does not skip his injections because it is inconvenient. CPAP IS TOO IMPORTANT TO SKIP A NIGHT OR TWO BECAUSE IT'S INCONVENIENT. Sorry to "shout" like this but I think you are doing yourself a great disservice if you think like this. Even if your oxygen desaturations are not "that bad" right now (or in this case, the night they did the sleep study).

Echo, what about naps? Sometimes Mike falls asleep in his recliner while I'm busy or don't notice it. He only naps for about 45mins and it doesn't happen every day. OK, hit the Cap Lock !

Supine AHI: 58.4
Lateral AHI: 18.0

It would be nice to know the time slept in each position and the sleep architecture in each position.

But, even without that information, I would start immediately (like tonight) sleeping exclusively on sides or tummy. This is highly likely to give you some significant relief.

On your back, gravity is working directly to collapse your tongue and soft palate into the airway. In the other positions the effect of gravity is moderated.

I wear a small backpack which prevents me from rolling onto my back. Others use tennis balls and other fixes.

echo wrote:Once you start using cpap, any defense mechanism that your body built against oxygen deprivation will be gone, and you will be more susceptible to an overnight heart attack or stroke. That's how i see it anyway. There was an article describing the apneic brain (?) and how it protects itself against low SPO2 levels in people with untreated OSA. Someone here will have a link to it.... NM can correct me if I'm wrong!

But svh's oxygen level is normal without CPAP.

Apparently, they used the Alternate definition of hypopnea where desaturations are not required, only arousals. Indeed, if the Recommended definition was used, her diagnostic AHI might have been darn near 0.0.

With the sleep architecture and efficiency being horrid, this may be a case where some to all of the "respiratory" events are not really respiratory, but normal changes in breathing following sleep disturbances-- in other words, a "sleep" problem instead of a "sleep-disordered breathing" problem.

Overly aggressive scoring would result in a high AHI (we can also argue that that's an "RDI").

Do you have the arousal breakdown?

Can you scan and post the graphs? That position dependency needs a closer look as well.

That said, we could still end up with a UARS-type of thing (which would still need CPAP), but overall sleep quality seems to be a major issue.

BTW, what medications are you on? Looks like an SSRI.

NM

I really appreciate the interest you're taking in my case! To answer your question:

I'm not taking an ssri at this time, and haven't for several months now. I do take Doxycycline, regularly, but I can't imagine that has any effect?

I didn't get any graphs. Is there something in particular I should ask for? I'd be glad to. I just flipped through the 3-page report I got (I had to request it, since all I got at first was a phone call saying "You do still have sleep apnea." There isn't really anything on it that I haven't posted. It doesn't mention time spent in different positions, nor is there anything that seems to match an "arousal breakdown," unfortunately.

I will say, I sleep much better at home than I do anywhere else, particularly than I do at a sleep study. I was wrecked after this one--totally shot the day to h*ll. On a normal basis, I get sleepy in the daytime, but nothing whatsoever like I was after the test nights. That said, I've always slept really lightly, heard every peep any child makes, etc. When I was going through my separation, I tried a lot of different sleep meds to try to get some sleep. At that point, my CPAP was working, but anxiety was keeping me up. Ambien worked best, but only for about 4 hours....Clonopin has also been helpful. I'm not anxious anymore, thank goodness, but am still waking each night, for at least a short time. I'd say normally, I'm aware of it taking me about 20 minutes to fall asleep, and I know I wake maybe twice in the night, for maybe 10 minutes or so. Whenever I am aware, I prefer to sleep on my side. The thing is, and here's why I know I need something--Even on a weekend, when I can sleep as late as I want, I don't feel refreshed. Eventually, I'll get bored and get up, but I don't have that lovely wide awake feeling I did when CPAP was working well for me.

So, if you tell me what to request from my doctor, I'd be glad to do so. I'd really like to get to the bottom of all this.

svh, so nice to see you posting again! Just sorry you're having a problem now.

To get the graphs Muffy wants to see, ask for "the full NPSG report." Mention that you mean the full report that contains histograms -- graphs showing stages of sleep, positions you were in, when the events occurred, when the arousals occurred, etc.

You're not asking for the raw data. You're asking for the NPSG report containing histograms -- graphs showing frequency distribution -- that was sent to the doctor to enable him to prepare the summary report that was given to you.

Good luck!

[quote="NotMuffy
Apparently, they used the Alternate definition of hypopnea where desaturations are not required, only arousals. Indeed, if the Recommended definition was used, her diagnostic AHI might have been darn near 0.0.

With the sleep architecture and efficiency being horrid, this may be a case where some to all of the "respiratory" events are not really respiratory, but normal changes in breathing following sleep disturbances-- in other words, a "sleep" problem instead of a "sleep-disordered breathing" problem.

Overly aggressive scoring would result in a high AHI (we can also argue that that's an "RDI").

Do you have the arousal breakdown?

Can you scan and post the graphs? That position dependency needs a closer look as well.

That said, we could still end up with a UARS-type of thing (which would still need CPAP), but overall sleep quality seems to be a major issue.

BTW, what medications are you on? Looks like an SSRI.

NM[/quote]

Since both of her sleep studies show similar findings, I'm convinced she has obstructive sleep breathing of some sort. The sleep architecture is also characteristic of sleep disordered breathing with prolonged latency to REM and little slow wave sleep. However it goes, the numbers are in. A good titration will fix all of that right up! Good Luck SVH and keep us posted!

svh wrote:I understand, and it's OK to shout at me. I do know that you're right.....

I was also shouting a bit for those who might read here and think "people on cpaptalk skip nights with cpap so I can too?" ... while your case might be very different from theirs.

DoriC wrote:Echo, what about naps? Sometimes Mike falls asleep in his recliner while I'm busy or don't notice it. He only naps for about 45mins and it doesn't happen every day. OK, hit the Cap Lock !

Am I gonna have to put YOU in time-out Dori?

Normally Naps fall into the same category, and would also require some SHOUTING if someone is napping without the cpap. However on the recliner, sitting up, his events might be more mild. It would be worth checking out his oxygen levels while he's napping on the recliner, if he's not having events then no problem I would guess? (yes I know that's the next thing on your list )....in my humble non-medical opinion.

svh wrote:I'm not taking an ssri at this time, and haven't for several months now.

How about the night of the study?

Try to get the long reports from the other two studies as well.

With those Sleep Efficiencies at

Sleep Efficiency = 67.4 pretreatment, 64.1 on titration night

although they're dated (and probably influenced my medication) they're at least worth a look.

NM

sleepmba wrote:[quote="NotMuffy
Apparently, they used the Alternate definition of hypopnea where desaturations are not required, only arousals. Indeed, if the Recommended definition was used, her diagnostic AHI might have been darn near 0.0.

With the sleep architecture and efficiency being horrid, this may be a case where some to all of the "respiratory" events are not really respiratory, but normal changes in breathing following sleep disturbances-- in other words, a "sleep" problem instead of a "sleep-disordered breathing" problem.

Overly aggressive scoring would result in a high AHI (we can also argue that that's an "RDI").

Do you have the arousal breakdown?

Can you scan and post the graphs? That position dependency needs a closer look as well.

That said, we could still end up with a UARS-type of thing (which would still need CPAP), but overall sleep quality seems to be a major issue.

BTW, what medications are you on? Looks like an SSRI.

NM

Since both of her sleep studies show similar findings, I'm convinced she has obstructive sleep breathing of some sort. The sleep architecture is also characteristic of sleep disordered breathing with prolonged latency to REM and little slow wave sleep. However it goes, the numbers are in. A good titration will fix all of that right up! Good Luck SVH and keep us posted![/quote]
Is this the thread for that bet?

NM