Heh, heh. I didn't mean "contradictory" in the sense of meaningless, or that they are invalid. I meant it more in the sense that it is peculiar and worth investigating as to how what seemed to be not OSA and possible PLMD in the past, has apparently in fact morphed into OSA and no PLMD. And I am aware that the science has evolved quite a bit, so the data evaluation process is different.robysue wrote:Welcome to the forum.
On the first big question: Why two completely "contradictory" sleep studies?
I think it's as simple as the enormous amount of time that elapsed between the two studies. You indicate that there was at least 10 or 15 years between the two studies. A lot can change with one's health in 10-15 years.
Perhaps at the time of the first study your sleep disordered breathing had not yet developed---it is a progressive disorder after all. Or perhaps it was because your sleep disordered breathing was manifesting itself as UARS back at the time of the first sleep study---which was almost twenty years ago. And back then, they weren't yet looking for UARS. Or perhaps it's because twenty years ago hypopneas were scored under what is now called Rule 4A---which requires a 4% O2 desat. And you don't desat. But sleep medicine has come a long way in the last twenty years and one thing that's changed is not just focusing on desats, but also focusing on the repeated arousals that sleep disordered breathing can lead to. Rule 4B for hypopneas allows a lab to score a hypopnea if there is a 50% drop in the amount of airflow into/out of your lungs for 10 seconds AND there is an EEG arousal at the end of it. And note that an EEG arousal is not the same as an EEG awakening.
So I think calling the studies "contradictory" is a bit too strong. After all, if you had a test done for diabetes in 2000 and it came up negative and you had a second test for diabetes in 2010 and it came up positive, would you say the tests were contradictory? Or would you conclude that you developed type II diabetes at some point during the ten years between the tests.
What's "UARS?"
I see. Well, that's why I posted here, rather than waiting another month to get some interpretation from my Dr. It was quick to get into the study at Stanford, but 2 months to get the followuprobysue wrote:You also write:First of all, an AHI = 15 puts you at the border between mild and moderate sleep apnea. And the fact that flow limitations are disturbing your sleep in 85% of your total sleep time is also significant (and was probably NOT tested for back during that first sleep test.) And then there's the fact that you've got some pretty significant daytime symptoms and problems that are likely due to OSA or at least aggravated by the OSA. So all in all, I'd say that your are definitely not in the mild end of mild, but at the other end. In other words, when everything is taken into account, you may want to think of the severity of your apnea as mild to moderate OSA rather than just "mild OSA".AHI=15/hr, lowest O2=91%, "flow limitation not included in AHI but disrupting sleep was noted in 85% of total sleep time." PLMi=0!
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So I am perplexed by this. Since it does appear that I have OSA, but it appears mild, and my O2 doesn't go very low, I gather from what I've read here that mild OSA cases with not very severe O2 desats. are the least likely to benefit from CPAP. Is that correct?
Oh goody. Well, that is encouraging. Thanks. I hope it works out that way. I have a co-worker with severe OSA, and severe daytime sleepiness. He just doesn't seem to be getting better at all. Very saddening.robysue wrote:Next, the folks who tend to react least positively to CPAP are those who have the fewest daytime symptoms---regardless of the actual severity of their OSA. And the severity of the daytime symptoms does not always depend on the severity of the OSA. Some people with very mild OSA find it almost incapacitating in terms of their daytime functioning. And some folks with severe apnea don't really feel sleepy or tired in the daytime.
So don't automatically assume that CPAP won't help you all that much.
Wowie-wow! That's exactly the kind of nightmare I've been expecting, but with a happy ending. This is a great story. Thanks a lot! Hopefully I can avoid the lost time of resisting CBT. I am very interested in that.robysue wrote:Finally you write:First the easy stuff: Although it seems impossible to a non-hosehead, there's nothing about using a CPAP that prevents you from side sleeping. Indeed, it's important to try to maintain as much of your prefered sleeping style as possible. So go ahead and allow yourself to believe that you'll be able to continue side sleeping as a hose head.I have a pretty open mind, and have been mentally preparing myself for the idea of living the hosehead life. If that can possibly makes me feel better, I'm willing to commit some serious time and effort to trying to get it to work.
But there are just two worries: I have a rather nervous personality, prone to insomnia in general, and I can never, ever sleep on my back anymore. I always side sleep.
Second, attitude and a willingness to make a commitment are critically important. And you seem to have that covered. And you seem to be realistic in not expecting an instant cure, but rather have an understanding that adjusting to CPAP may take some serious time and effort on your part.
But third and finally, you say you're a nervous sort to begin with and a bit prone to insomnia. Those two things describe me to a T. And these two things can make it a bit harder to adjust to CPAP.
I'm a far outlier when it comes to "how long did it take to start feeling better" and my story is pretty well known around here: I started CPAP on September 23, 2010. And I immediately felt much worse on CPAP than I had before CPAP. And it took me months of hard work to just begin adjusting. And during the early dark days, my pre-cpap occasional, not really a problem insomnia grew into a very large insomnia monster. At the end of my first three months of therapy I realized that my problems were more insomnia-based at that point than strictly CPAP-adjustment based. And it took me five or six more months of hard CBT work on the insomnia to bring it under control. But finally---some eight or nine months after starting therapy I began to feel better on most days with the CPAP than I had before starting CPAP. And during the last year, I've continued to notice very slow, but steady progress in how I feel with CPAP. And in the end, much as I hate having to sleep with a hose on my nose, I'm actually quite glad that I didn't give up and that I did fight this through. Not only am I doing serious good for my long term health, but on my best days, I feel much younger than I have in years.
And I tell you all of this as a way that you can perhaps learn the lessons that I had to learn the hard way without doing it the hard way: If I had it all to do over again, I would have started listening to the PA the first time she started mentioning that I needed to get more serious about figuring out what I wanted to do with the insomnia, which was about a month into therapy. Had I started doing the CBT for insomnia then I might have saved myself a lot of grief and misery. But I wasn't ready to listen at that point.
Best of luck with your follow ups with the doctor and getting started on some kind of therapy for this---be it CPAP of some sort or something else.
