Hi all - I'm so glad I found this site.  I've been reading information since my sleep study in late August, and now I have a copy of my results.  I'm scheduled for a follow-up titration study on September 30.

I have to say, I'm dreading it.  I felt like I got little sleep at the first one, although they said I slept almost 6 hours.  I felt like I was "hungover" for 2 days afterward.  Plus, I normally sleep in on Saturday mornings to "catchup" and they woke me at 5 AM!!  I ended up sleeping on my back most of the time, and some on my right side.  I'm wondering how accurate my results really are, as I never sleep on my back at home.  I couldn't lay on my left side, because the wires wouldn't allow it.  On my right side, I had trouble getting comfortable.  I had 52 hypopneas in 212.6 minutes on my back, versus 13 in 131.4 minutes on my side.

I am tired all the time, wake often with headaches.  I don't really snore, but I understand many women don't have that symptom.  My doc says to lose weight - which I have been working at diligently with NO success after my initial few months.  I lost 32 pounds in 6 months, and 0 in the last 6 months, despite exercising 4 -5 times/week.  So, I have some of the symptoms and I would love to feel rested for a change - just not looking forward to the cure.

I would love any advice on how to discuss with my doctor, what questions to ask, etc. to ensure we come up with the right treatment plan vs. automatically spending money on CPAP.

Here's some notes from the study:
   OSA was scored in this record.  (RDI = 11.3)
   OSA was more prominent and dramatic in REM state (REM RDI = 34.8)
   Some of these events resulted in arousals.  (Respiratory Arousals Index = 6.6)
                                                                  (REM Respiratory Arousals Index = 14.5)

Respiratory Summary:
  Apneas + Hypopneas:  Total 65, Index 11.3
  Respiratory Events (non-REM):  Total 34, Index 7.0
  Respiratory Events (REM):   Total 31, Index 34.8

Respiratory Arousals:
  Total Sleep Time:  38, Index 6.6
  Non-REM:             25, Index 5.2
  REM:                    13, Index 14.6

No PLM activity (finally figured out this was my leg movement!)

Lights Out 10:01 pm
Lights On 5:01 am

Time in Bed: 420.7 minutes
Total Sleep Time: 344.0 minutes
Sleep Efficiency:  81.8%

Sleep Onset:  11.6 minutes  (but felt like hours!)
REM Onset:  216.5 minutes
REM periods: 2
Awakenings after sleep onset:  55

Stage Distribution:
  WASO:  65.2 (WHAT IS THIS????)
  Stage 1:  15.0
  Stage 2:  253.5
  SWS:  22.0   (Is this the same as stages 3 & 4????)
  REM:  53.5

Latency from sleep onset:
  Stage 1:  0 min
  Stage 2:  2 min
  SWS:      51 min
  REM:      216.5 min


Central, Obstructive, Mixed Apneas:  0
Hypopneas:  65; 31 in REM, 34 in non-REM
Mean duration 23.8 seconds, longest 46.9 seconds

  What exactly is a Hypopnea?  I've found all kinds of information on the others, which I'm not having - so is this another type of sleep apnea?  HELP!

Arousals:

Respiratory - Total 38, Non-REM 25, REM 13
Snore - 0
Spontaneous - 459 total for index of 80.1; 429 non-REM for index of 88.6; REM 30 for index of 33.6

  (What's the difference between respiratory & spontaneous?  Another part of the report said awakenings 55 - what do all these mean?)

Pulse results:
                           Wake                  non-REM                    REM                   TST                      TIB
Max Pulse (bpm)    109.0                  109.0                        109.0                  109.0                   109.0
Mean Pulse             91.6                    86.2                           93.3                  87.3                     88.0
Min Pulse                77.0                    68.0                           80.0                  68.0                     68.0

Oxygen Desaturation:
Total Sleep Time:                45, index of 7.8
Wake (after sleep onset)       0
Non-REM:                            25, index of 5.2
REM:                                   20, index of 22.4

I know the oxygen stuff is important, but I'm still struggling with what it really means.

The report was written by a sleep doctor, but it's my internal medicine doctor that is sending me for the study and diagnosing sleep apnea/titration study.  She's a good doctor, but not a sleep expert.  Should I schedule a meeting with the actual sleep doctor?  

Thanks for your help!

Kikisue:

I too am in the process of evaluating my test scores.  My limited research discloses that there is more to this than just your test scores.  I have put a good deal of time into understanding the scores.  It appears the main score is the Apnea-Hypopnea Index.

One of the medicare standards for CPAP is an Apnea-Hypopnea Index of greater than 5 (yours greater than 11) AND documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia or documented hypertension, ischemic heart disease, or history of stroke.

The other standard ia an Apnea-Hypopnea Index of greater than 15.

I have noticed that most insurance companies have the same standard as Medicare.

I strongly recommend that you ignore the diagnosis of Joseph AKA Mike and even what I have written and consult your Doctor.

Frank

During my sleep study I didnt have a great amount of obstructive apneas.  But I was loaded with hypopneas which my sleep doctor has said are just as critical as the obstructive apneas and treated the same.  The biggest concern of course are the oxygen desaturations.  During low oxygen levels you are at risk for a stroke.

Linda (roseinpa57)

Joseph aka Mike

[color=darkblue][b]Respiratory Summary:
  Apneas + Hypopneas:  Total 65, Index 11.3

The above is what I read.  I understand those to be the AHI.[/b][/color]

Frank

Joseph wrote:

Frank,

Did you look at her scores?

Her combined apneas for Obstructive, Central and Mixed was ZERO - O

She doesn't have sleep apnea.


Michael

You are incorrect.  She had partial events, Hypopnea's.  Please stop giving medical advice.  You are not qualified to do so.  KikiSue,  from the report it sounds like mild sleep apnea or UARS,  SleepyDave should be chiming in here and giving you an expert opinion...

I do not know what Medical School Michael/Joseph went to but they should be proud of him for diagnosing your condition. He sounds like a GENIUS!  My suggestion is to go to a sleep specialist and stop wasting your time on the internet.


Bob

jimmyjayjay wrote:

I do not know what Medical School Michael/Joseph went to but they should be proud of him for diagnosing your condition. He sounds like a GENIUS!  My suggestion is to go to a sleep specialist and stop wasting your time on the internet.


Bob

SleepyDave is a sleep specialist  

I’m very new to this forum and problem.  However, I am over 65 and am covered by Medicare.  The following is from Medicare National Coverage Determinations Manual Chapter 1, Part 4 (Sections 200 – 310.1) When I am googling and find an insurance company definition, they generally quote the exact same standards as follows:

“The use of CPAP is covered under Medicare when used in adult patients with moderate or severe OSA for whom surgery is a likely alternative to CPAP. The use of CPAP devices must be ordered and prescribed by the licensed treating physician to be used in adult patients with moderate to severe OSA if either of the following criterion using the Apnea-Hypopnea Index (AHI) are met:

• AHI greater than or equal to 15 events per hour, or

• AHI greater than or equal to 5 and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

The AHI is equal to the average number of episodes of apnea and hypopnea per hour and must be based on a minimum of 2 hours of sleep recorded by polysomnography using actual recorded hours of sleep (i.e., the AHI may not be extrapolated or projected).

Apnea is defined as a cessation of airflow for at least 10 seconds.

Hypopnea is defined as an abnormal respiratory event lasting at least 10 seconds with at least a 30 percent reduction in thoracoabdominal movement or airflow as compared to baseline, and with at least a 4 percent oxygen desaturation. “

I am aware that some tests show events that do not meet the definition of Hypopnea.  In fact my own test has events that do not meet that definition.  However, these events are labeled Respiratory Effort Related Arousals.  These are defined as “Hypopnea with arousal without 4% desaturationâ€�

I have also run across something called Respiratory Distress Index.(RDI)  Unfortunately for me, some places use RDI and AHI interchangeably and other places seem to indicate that they are different.  My own test results include the Respiratory Effort Related Arousals in the definition of my RDI.  Needless to say without a generally accepted definition, the RDI is useless to me and I accept the AHI standard and my AHI.

Like I have repeatedly said, I’m new and am studying very hard to understand this problem.  My simple minded understanding of the problem is that I have a breathing obstruction which reduces the oxygen to my body.  This seems to be measured as SaO2.  The severity of this problem is generally defined as the Apnea-Hypopnea Index (AHI) as outlined above.  Seems to me if you meet either criterion you should have treatment of some sort and CPAP seems to be the thing.

Hi kikisue!
Looks like a lot of the problems have been cleared up, so let me see if I can shed some light on the remaining questions.

You do have over 2 hours of sleep on your side, so let's say that's OK for now.  If you have completely positional dependent OSA, you can try positional therapy (sleeping only on your side), but the fact that you came in with all these symptoms means whatever you're doing on a "normal" night still has a problem, and if you say you always sleep on your side at home, well, even that low "side" AHI may be causing a problem.

WASO is wake after sleep onset, how much time you spent being awake after you first fell asleep.
SWS, delta sleep and Stage 3/4 are synonyms.
A hypopnea is a 50-80% reduction in air flow (in a breath) PLUS a drop in oxygen level and/or an arousal (a disturbance in sleep continuity  for 3 seconds or more).  Those are some loooonnnngggg hypopneas.  Maybe we'll come back to that.

A spontaneous arousal is an arousal with no apparent cause.  A awakening is a break in sleep continuity for 16 seconds or more.  You will not be aware of arousals, you may remember awakenings.

Is the lowest oxygen level noted?

Your overall sleep architecture is a wreck.  Normally, you may have about 2 awakenings per night, so 55 is like tons.  
Your REM periods are very late and reduced.  459 spontaneous arousal is about 450 more than normal.

You may have subtle respiratory changes that cause the arousals, a syndrome called UARS, but the lack of snoring is somewhat atypical.

How about any medications?  Particularly REM-suppressants, like anti-depressants?
Other sleep hygiene issues like too much caffeine?

Go see a sleep specialist?  Sure, that's an excellent suggestion.

Hope that's a start.
sleepydave

PS- Actually I'm an RPSGT

Thank you all so much for the help - I appreciate all the insights.  I know I have an issue and really want to fix it.  You have all given me hope, through this and other posts I have read, that the CPAP can make a difference if I end up with one.

I've been researching sleep doctors in my area, and the one that read my report was not in the diplomate list.  There is one in my town, however, so if he's on my insurance I may try to get an appointment for after my titration study on the 30th.

Any pointers on particular questions to ask when I go in?  If I don't prepare ahead, I always wish I had asked something after an appointment with my doc, so want to be ready with my questions/concerns.

As to sleepydave's questions - here is my oxygen info:
                              Wake         Non-REM            REM          TST          TIB
Max SaO2%             99.0            100.0                99.0         100.0        100.0
Mean SaO2%           95.0              94.5                94.0          94.4          94.5
Min SaO2%              61.0              90.0                87.0          87.0          61.0

As to my medications - I'm on 25 mcg of Levoxyl for thyroid.  I don't take any other prescription medicines, just the occasional tylenol or aspirin for headache, etc.

I drink 2 cups of coffee in the early morning, but no other caffeine generally.  I drink a lot of water - used to drink sodas but as part of my weight loss program I gave them up over a year ago.  I do love chocolate, which has caffeine and sugar, so I limit it but do indulge occasionally.

I go to bed generally about the same time during the week and get up the same time to exercise before work.  Weekends I sleep in on Saturday - I know they say not to, but it's my "catch-up" day.  Sundays I get up about 1-2 hours later than during the week, to exercise and go to church.  I do notice days that I skip my exercise are rougher, even though I've had a little extra sleep.  I do have a hard time getting up each morning - just very tired all the time, which is why my doc sent me for the study.  

Anyway, thanks for the info and support, and I'll let y'all know how the titration study goes.

kikisue

Hi all!
A fair question.
There is a hypopnea index (HI), an apnea index (AI), and an apnea-hypopnea index (AHI).
In the AHI, either value can be zero.

The oxygen desaturation of 61% would ordinarily be scary-low, but since it occurred during wake, it's probably artifact.  Nonetheless, ask about that, if it's artifact, it shouldn't have been left in the report.

Levoxyl, huh?  When you see the sleep specialist, make sure you tell him you're on that, and include the 55 awakenings and 459 spontaneous arousals all in the same sentence.  While pharmacy is out of the field of my expertise, seeing the sleep specialist has suddenly gone from an excellent idea to a superior idea.

This isn't a black and white case, so I wouldn't rule out the effect of either component yet, stay in the information-gathering mode.
Stay in touch.
sleepydave