How long did it take before you knew cpap worked?

robysue wrote:lorraineg57,

How long before I could tell CPAP was working?

In terms of data: Immediately.

In terms of how I felt (during the daytime OR when going to sleep OR immediately upon waking): Four or five months. And the first three months were a living hell of growing insomnia and growing daytime dysfunctionality---as in fatigue, sleepiness, and general non-alertness during the daytime and what felt like a complete inability to get to sleep with the mask on anywhere near a reasonable, normal bedtime.

The first sign that CPAP was doing me some good was extremely subtle---to the point where I would have missed it had I not been keeping a sleep log as part of my War on Insomnia. About four months after starting therapy I began to notice the phrase "Woke up with no hand or foot pain today" was appearing in my sleep log notices several times a week. By month five, I was noticing that the hand and foot pain had disappeared completely.

I'd also like to bring up a couple of ideas regarding your sleep study information:

lorraineg57 wrote: Hypopnea is defined as a 30-80% reduction in airflow from
baseline. Hypopneas must be associated with a 4% desaturation to be counted as part of the apnea +
hypopnea index (AHI). . (emphasis added)

So your sleep study was done using the Medicare standard for scoring Hypopneas instead of the so-called Alternative standard for scoring Hypopneas. In other words, a hypopnea was only scored if there was a 4% drop in O2 saturation; if your airflow dropped by 50-80% and there was an associated EEG arousal, but the O2 did not drop by at least 4%, the arousal was apparently NOT counted as respiratory related. This is significant because:

Sleep fragmentation: There was moderate sleep fragmentation with 126 arousals and 5 awakenings greater
than one minute to yield an arousal +awakening index of 22.8 events per hour.
Respiratory parameters: The oxygen saturation on room air was 98 %. There were 6 apneas and 30
hypopneas yielding an apnea + hypopnea index (AHI) of 6.3 events per hour. Of the 6 apneas counted, 1 of
these apneas was a central event.

So there are some 90-95 arousals that were not counted towards the AHI because they did NOT involve an oxygen desaturation of 4% or more. The pertinent questions are: How many of those 90-95 arousals would have been scored as "hypopneas with arousal under the Alternative standard? How many of those 90-95 arousals would have been labeled as RERAs if the lab were looking for RERAs?

While the "definition of hypopnea" doesn't lead to drastically different diagnoses for most people tested for OSA, it can and does affect a small number of those tested. In my case, had the lab only been testing for hypopneas under the Medicare (Recommended) standard, I would have been sent on my way with a "You don't have OSA because your overall AHI = 3.5; your REM AHI = 0.0, and your supine AHI = 4.0." (Supine sleep was only about 30 minutes out of a four-hour sleep window; and I seldom sleep on my back at home.) But with the Alternative standard hypopneas, my overall AHI jumps from the acceptable 3.5 to the unacceptable 23.1 (with REM and supine AHI being less than that.)

So given that your pre-diagnostic Epworth Sleepiness Scale score is 14, something is going on. You've got lots of arousals that were scored in the sleep study. The parts of the sleep test report you quoted seem to imply that these arousals were not counted towards the AHI and, indeed that they were essentially ignored because they did not meet the Medicare standard. Did the lab count Alternative hypopneas or RERAs at all? We don't know. But if there is no so-called RDI listed on your report, then it's a fair bet that they did not attempt to score these two types of sleep disordered breathing at all.

So given the fact that you've had lots of other diagnostic stuff done, the fact that HRT didn't help, and the fact that your pre-sleep test Epworth Sleepiness score is excessively high, I think it's a reasonable hypothesis that you do have some sleep disordered breathing going on, but it has not yet deteriorated to the point of having the vast majority of your events count as hypopneas under the Medicare guidelines. In other words, I think your OSA-type events lead to arousals before the expected O2 desaturation occurs---in other words, you're "waking yourself up" or "arousing" before the desat gets bad enough to make the event count as a hypopnea under the standard used by your lab.

lorraineg57 wrote:I just downloaded my data, now all I have to do is find a tutorial as to what all the spikeys and pretty colors mean! The help section isn't very in depth?