My Sleep Study Results

Okay, you guys (well, a couple anyway ) asked for my sleep study results. I finally got them today. To be honest, they surprised me. But let me present them before I make any of my own judgments:

Patient profile: Twenty six year old female presents with the symptoms of daytime hypersomnolence. This woman is 5'3" tall weighs [there is no way I'm posting that, even for you guys] lbs and presents with an Epworth Sleepiness Scale of 15.

Sleep Architecture:

Sleep period time was 386 minutes with a total sleep time of 157.5 minutes with a markedly reduced sleep efficiency of 37.1%. Sleep Latency was prolonged at 38.5, no REM was seen. Sleep Stage distribution showed excess time in Stage 1 and Stage 2 with little time scored in Stage 3, 4 and REM.

Sleep Fragmentation: The arousal index was markedly elevated at 44.6.

Leg Movements: No significant periodic limb movements were noted.

EKG: The patient was in a sinus tachycardia throughout the entire study with the range between 100 and 115. No dysrhythmias were noted.

Respiratory events: When the patient was documented to sleep, repetitive events were seen which were exclusively hypopneas associated with mild desaturations. The RDI was 38.1 consistent with severe sleep apnea syndrome during the time of sleep.

Impression: Markedly disrupted sleep with a reduced total sleep time. However, during the time of sleep she demonstrated severe sleep apnea.

A follow up study with CPAP titration is indicated, in the meantime, consideration toward the empiric initiation of CPAP at 8cm pending the titration study should be pursued.

Stage 1 Sleep: 53%. Stage 2 sleep: 43%

0 Central Apneas, 0 Obstructive Apneas, 0 Mixed Apneas, 100 Hypopneas.
Mean Hypopnea Duration: 12.7 Secs
Max Hypopnea Duration: 19.5 secs
Total Duration: Minutes: 21.1 minutes
% of Total Sleep Time: 13.4%

RDI REM: n/a
RDI NREM: 38.1

Mean desats associated with respiratory events: 92%
Min Sp02 level associated with a respiratory event: 89

Leg Movements:
Total leg movements: 12
Leg movement index: 4.6
Total leg movements with micro-arousal: 4

Total micro-arousals with respiratory event and no desaturation: 1
Total micro-arousals with respiratory event and desaturation: 33
Total micro-arousals with leg movement: 4
Total unspecified micro-arousals: 77


On second thought, I won’t interpret myself just yet. I’ll see what you guys think first. Thoughts? Opinions? Interpretations? I really want to get to the bottom of why I’m still sleepy.

Thanks.

Well, I'm no doctor or anything in the health care field. I know next to nothing about interpreting sleep studies. My purely amateur take on what you posted is:

Your sleep study lasted a little over 6 1/2 hours, but you racked up only 2 1/2 hours of actual sleep while you were there. If those two and a half hours were being chopped up with frequent "awake" time, no wonder you didn't get into REM or sleep stages 3 and 4. Sounds like the hypopneas may have been constantly bouncing you up and down between "awake" and stages 1 and 2.

However, if you did sleep pretty steadily for a two hour stretch, then it's more worrisome that you never reached REM or stage 3, at least. If you did sleep that long at some point, are you on any meds that might suppress REM?

Your O2 stayed up nicely enough, but probably because your brain was staying on alert to make you breathe better at the least hint of an hypopnea. Looks that way to me, anyway, since the longest hypopnea you registered was under 20 seconds and the average was not quite 13 seconds. Brain almost constantly bounce, bounce, bouncing you back up toward "awake" in order to get full breaths.

Those hypopneas are absolutely wrecking your sleep. Perhaps your brain is ultra sensitive to the least beginnings of a drop in O2 and is arousing you to take in more air well before there's much drop in oxygen levels. Almost like what happens in UARS (Upper Airway Resistance Syndrome) imho.

If this was a typical night for you and not just an oddity from anxiously trying to sleep in unfamiliar surroundings, no wonder you've been so terribly sleepy.

I don't know what "unspecified" things cause arousals, but obviously those were very disruptive to your sleep. Again, might have had something to do with being aware you were undergoing important "testing" Perhaps you were anxious about trying to sleep all wired up. Just couldn't really relax. At home, there are so many things that could cause micro-arousals - noises, uncomfortable mattress, getting too hot or too cold, squirrel running across roof, dog barking, siren in the distance, tv going in another room. Was the clinic environment quiet?

Would be very interested to see the results of your titration night - on cpap.

I'd like to see it too, Laura. I told him I wanted a copy of my sleep study to take to Spain with me to back up my medical necessity for it, or to have in case something went wrong with the CPAP. He gave me copies of my first test without hesitation, but said "You won't need copies of your titration study to satisfy the FAA, I wouldn't think" and put it away. I didn't want to make an issue of it.

I'll try just calling his office staff Monday and getting them to fax it, or maybe I'll just "drop by" when they're busy and ask for it. They won't have time to argue.

Why are doctor's so reluctant to give out copies of studies, anyway?

As for that night, I definitely felt it was not a normal night. I was uncomfortable, and told NOT to sleep in my preferred position (tummy). I didn't even think I'd slept as much as it said I did. The sleep lab was quiet - once or twice there was a toilet flush from an adjoining room, but that was it. I don't believe I'm on any meds that would supress REM (just asthma/allergy medicines). I was also definitely anxious. I hadn't been able to sleep at all in the first study I'd had (when I was 18), and I was anxious it would happen again. When I called to make the appt. at the sleep lab, I asked if I could take something to help me sleep, and was told no, because then it wouldn't be a "Normal night."

If I'm having that many hypopneas on an average night, the Remstar Auto is not picking them up (it usually registers no more than ten total for the night). But I do wonder how I do as far as sleep stages go. I wish there was some way to get more information (like sleep stages) without having another in-lab sleep test.

*Sigh.* It's just so frustrating to have so much information, and still not really be able to tell anything useful from it.

CG,

Definitely get the titration study. It would be very useful to see how well what they did corrected/alleviated your arousals. But there is no wonder you're tired. You didn't show signs of getting anywhere near close to restorative sleep at this study.

One confusing part for me is, "However, during the time of sleep she demonstrated severe sleep apnea." They say you had no apnea at all, only hypopnea, yet they include that line. Is that a blanket term, "apnea," to cover all events in those two categories: Central and obstructive apnea and hypops?

Also, they note you as having sinus tachycardia throughout your sleep, which takes me back to the thread Heather (MissAmethyst2U) wrote about her pulse ox test and it being noted she had a rate of 79-120 (don't quote me) or there abouts. I tried to find something on the subject that would conclusively show if that is okay while you sleep and only came up with one article my non-scientific brain would digest and posted a snip from it having to do with Stage5, REM sleep. If this is NOT an acceptable range while asleep, though, perhaps you may look into a cardiac workup. Just took my 19 year old yesterday, so 26 isn't too young. Actually, you are never too young if there is a symptom that needs addressing. HOWEVER, like I said, I don't know if this is acceptable in even Stages 1 and 2 sleep.

I hope one of the experts can weigh in on this. My son just started his first night Thursday doing sleep studies in the clinic associated with the hopt where he works. He will be supplementing his full time job as an RRT doing them one or two nights per week. I will ask him to look at what you posted until a more experience sleep study member, maybe DeltaDave or Christine, sees this. But he's in training right now in this area so I don't know if he could offer too much feedback. But I will try and see what he says when he awakens in the afternoon.

In the meanwhile, keep sticking with the ff mask. Hopefully you'll work out the kinks. Try a little moleskin on the forehead where you said it's really hurting until perhaps you can get used to it. I'm so sorry you are having such a tough time, but hang in there, as you have been. Sometimes you have to traipse through a lot of you know what before you get on solid ground.

Nail on the head, LoRi, these high heart rates in young adults are not normal. At some point, they may be explainable, but that's a big difference.
CG, what meds are you taking, and when? For example, if you're taking an allergy medication like Allegra-D, which has a ton of pseudofed, just before bed (or really anytime) that's going to create a problem.
Doesn't that refusal to share the CPAP titration results just make you all the more curious?
SAG

WOW Collegegirl we having matching sleep studies! LOL..I am dead serious yours sounds alot like mien adn you knwo what is even funnier...I had NO apneas the first study but did have 120 hypopneas yet it was said on there that I had OSA?!...What in the world is going on with these docs?! my heart rate too is up where yours is...Are you my long lost twin lol...anyway, I also have the Asthma/Allergy what meds are you on? I have probs going into Sinus Tach for no reason yet my heart is fine according to docs...I know how you feel about all this being soooooo frustrated...I will have to try and post a copy of my sleep study later today...Hopefully we will both get to the bottom of this!!!

Still another guest, I actually *do* take Allegra-D. I take it when I wake up in the morning, and right before I go to bed at night. Could that be causing the heart rate issue? Anytime I've asked about it in the past I've just been told "it's your weight," and that's it.

Other meds I'm on: Nasonex, Advair, and Albuterol.

Side effects with Allegra-D 12 Hour and Allegra-D 24 Hour were similar to Allegra 60 mg alone (headache, insomnia or nausea) and Allegra 180 mg alone (headache, cold or backache) respectively. Due to the decongestant (pseudoephedrine) component in both Allegra-D 12 Hour and Allegra-D 24 Hour, these products must not be used if you: are taking an MAO inhibitor (a medication for depression) or have stopped taking an MAO inhibitor within 14 days; retain urine; have narrow-angle glaucoma; have severe high blood pressure or severe heart disease. Side effects with pseudoephedrine may include nervousness, restlessness, dizziness, or insomnia. Headache, drowsiness, increased heart rate, palpitations, increased blood pressure, and abnormal heart rhythms have been reported. You should also tell your doctor if you have high blood pressure, diabetes, heart disease, glaucoma, thyroid disease, impaired kidney function, or symptoms of an enlarged prostate such as difficulty urinating.

Just a few things to watch for...not that you are experiencing any of these things at all or from the Allegra-D, and they HAVE to list any and all side effects, but they are listing increased heart rate and insomnia.

CG:
The incidence of insomnia with Allegra D is 12.6% as reported by the manufacturer. Might be a low ball figure, check out this web forum list of people taking it and their comments, half of them are jumping out of their skin:

AllegraD

240 mg of pseudophedrine a day is a lot. I think it'd be well worth trying to find an alternative.

SAG

My own experience is that albuterol can increase my heart rate and taking a lot will affect my sleep. Advair has two meds in it one of which is close to albuterol (or so I have been told) - more like a long lasting albuterol and I haven't noticed the heart problems on it but that doesn't mean others might not have them.

I agree that 240 mg of pseduo--- is a lot for 24 hours and can also affect my heart rate. I know I sure can't sleep with that much in my system and it kept me awake at night any time I had taken that much. I do take some to keep my head clear but it is part (1/3) of an actifed tablet at night so that is only 20 mgs not the 60 immediate release of an allegra D or claritan D or other meds on that order.

I think a workup by a competent cardiologist with a discussion of the affects of these allergy and asthma meds on the heart rate would be in order.

MissAmethyst2U wrote:I had NO apneas the first study but did have 120 hypopneas yet it was said on there that I had OSA?!

I may be mistaken, but I think hypopneas would be included in events that fall under the diagnosis of "OSA" (Obstructive Sleep Apnea.) While hypopneas are partial collapses of the throat and are not completely stopping breathing like an apnea does, hypopneas are, indeed, obstructing the airway in varying degrees. You can still be getting some air through, but not enough. Hypopneas can cause arousals, fragmenting the sleep. O2 levels can drop with some hypopneas.

If hypopneas were all that turned up on my study, I'd sure still want a diagnosis of "OSA" and would want to be put on CPAP to keep the airway fully open.

rested gal, I didnt think about it being classified as the same thing...I don't know but soo much about all this thats why I brought it up glad you pointed that out...

CG, I also take Advair and Albuterol, I know Albuterol speeds up your heart rate but I usually dont have to use it I do however of course take the Advair everyday, I am starting to wonder if its something with that...who knows, all meds seem to have a lot of the same poss side effects...just why in the world does all this have to be so darn complicated