feeling so bad, need help to interpret sleep study

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feeling so bad, need help to interpret sleep study

Postby sleepyjean » Tue Dec 06, 2005 1:46 pm

I had my second sleep study done last Thursday and felt better the next day than I have in a very long time. However I will have to wait for probably a month now before I get my CPAP and in the meantime I am feeling so horrible that I can barely function. Restless all night long, having many vivid dreams, and absolutely cannot wake up in the morning. I feel drugged, foggy, whatever other words there are to explain, such as brain fog. I've been diagnosed with moderate sleep apnea, however I'm wondering if the number of arousals has anything to do with the way I am feeling. Any help from anyone who can interpret the following info would be greatly appreciated.

My first report read:

Findings: Polysomnography was performed on the night of Nov. 9, 2005. The sleep period time is 382.5 minutes with a total sleep time of 354.5 minutes, essentially normal sleep efficiency of 93%.

SLEEP LATENCY: The sleep latency to stage I sleep was normal at 14 minutes and latency to REM was prolonged at 349.5 minutes.

SLEEP ARCHITECTURE: The painent had reduced REM sleep.

BODY POSITION: Patient spent the majority of the time in the supine position and slept 126 minutes in the supine position.

SLEEP FRAGMENTATION: There were 312 arousals from sleep leading to severe sleep fragmentation with an arousal index of 53 events per hour.

RESPIRATORY EVENTS: THERE WERE 97 RESPIRATORY EVENTS DURING THE NIGHT. fIFTEEN WERE OBSTRUCTIVE APNEAS. 82 WERE OBSTRUCTIVE HYPOPNEAS.
This lead to an overall apnea-hypopnea index of 16 events per hour, which is moderately elevated. This is slightly worse in the supine position. Additionally there were 170 respiratory event related arousals with a central respiratory disturbance index that was also moderately elevated at 29 events per hour. When the patient was awake and breathing in the room air, the total oxygen saturation was 98%. During sleep it was 87%.

LEG MOVEMENTS: There were 117 periodic leg movements during the night, only 12 were associated with an arousal.



Thank you in advance for any insight anyone might be able to give me. Sleepyjean
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Re: feeling so bad, need help to interpret sleep study

Postby sleepydave » Sat Dec 10, 2005 7:10 am

sleepyjean wrote:SLEEP LATENCY: ...latency to REM was prolonged at 349.5 minutes... The patient had reduced REM sleep.

SLEEP FRAGMENTATION: There were 312 arousals from sleep leading to severe sleep fragmentation with an arousal index of 53 events per hour.

RESPIRATORY EVENTS: This lead to an overall apnea-hypopnea index of 16 events per hour... Additionally there were 170 respiratory event related arousals with a central respiratory disturbance index that was also moderately elevated at 29 events per hour.

LEG MOVEMENTS: There were 117 periodic leg movements during the night, only 12 were associated with an arousal.


Hi SJ:
It's probably best to see how these results fare in the CPAP report, especially since you say you felt so much better after the titration. However, stuff to look for:

While OSA can delay and reduce REM, so can a lot of medications.
The 170 respiratory event related arousals (RERAs) should disappear with CPAP.
That should make almost all the arousals disappear.
The 117 leg movements may "disappear" with CPAP. If so, they were never really "official" leg movements, or PLMs.
The "central RDI" of 29. Now this you kinda hafta watch. Central events can be a RESULT of arousals, in which case they're probably harmless, really be OBSTRUCTIVE in nature, and they'll also be successfully treated with CPAP, or may truly be CENTRAL in nature, in which case they may (probably) not respond to CPAP, and there may be another issue underfoot.

See if you in fact have 170 central events, otherwise that "central RDI" is a confusing misnomer.
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Postby sleepyjean » Sat Dec 10, 2005 10:50 pm

Hi Sleepydave.

Thanks so much for your explanation. I will take your advice and see what the second study shows. I have kind of been on my own trying to figure things out as the doctor who read my study sent the results to my g.p. who called me and said "you have sleep apnea and another study with a cpap is recommended." That was the extent of the information that I received! I did call my g.p. back to request a copy of the report, but of course the terminology used is not familiar to me, thus my request for help! Just one more question, what else might cause central respiratory disturbances? I'm so glad to have found this forum and I'm grateful to those of you offering your help to those of us who have just been diagnosed. Thanks again. I will post again once I know the results of my last study.

Jean
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Centrals

Postby sleepydave » Sun Dec 11, 2005 9:35 pm

Hi Sleepyjean:
Just one more question, what else might cause central respiratory disturbances?


Well, central events area generally are of a neurological origin, be it directly or indirectly. Examples might be underlying cardiac issues of or an unstable breathing control system as you might see in a "Complex" Sleep Disordered Breathing situation. But wait till you get the word as to what they specifically mean in the report.
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CPAP report - more questions

Postby sleepyjean » Sun Jan 08, 2006 12:20 am

Sleepydave,

I am attempting to interpret the CPAP report as no one went over it with me and it was not summarized in the same way that the first test was. I'm hoping you can help me figure it all out. If not, I may have to take a drive south :-)

Here goes:

Respiration Summary

Central Mixed Obstructive
Apneas, NREM Count 3, Mean Dur 15 Count 4, Mean Dur 18 Count 5, Mean Dur 17
Apneas, REM Count 1, Mean Dur 13 Count 1, Mean Dur 13 Count 0
Apneas, Total 4 5 5

There were no hypopneas. If you recall from my first post, there were a lot more centrals noted. Am I right in thinking that they were not really centrals at all?

I was prescribed a CPAP machine having a setting of 6cm. Should I have asked for a BIPAP? The last time my dr (gp who ordered the sleep study) spoke with me was after he got the report on my first test. He has not contacted me at all since the second one...the only reason I have a copy of the report is that I asked for it...but that's another story.

I have had some good nights and days, but also a couple of extremely bad mornings, awakening with a drugged feeling, headache, unable to get out of bed. Just the way I felt before starting CPAP. I also have been experiencing a tightening feeling in my throat, most notably in the evening before bedtime.

If you need more information, I probably can scan the results, including the chart. It's so frustrating to try to figure out all of this on my own so I sure would appreciate any help that you can give me.

Thanks so much.

sleepyjean
"Don't be dismayed at good-byes. A farewell is necessary before you can meet again. And meeting again, after moments or lifetimes, is certain for those who truly love."


Beckham
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CPAP report - more questions

Postby sleepyjean » Sun Jan 08, 2006 12:30 am

Sleepydave,

I am attempting to interpret the CPAP report as no one went over it with me and it was not summarized in the same way that the first test was. I'm hoping you can help me figure it all out. If not, I may have to take a drive south :-)

Here goes:

Respiration Summary

Central Mixed Obstructive
Apneas, NREM Count 3, Mean Dur 15 Count 4, Mean Dur 18 Count 5, Mean Dur 17
Apneas, REM Count 1, Mean Dur 13 Count 1, Mean Dur 13 Count 0
Apneas, Total 4 5 5

There were no hypopneas. If you recall from my first post, there were a lot more centrals noted. Am I right in thinking that they were not really centrals at all?

I was prescribed a CPAP machine having a setting of 6cm. Should I have asked for a BIPAP? The last time my dr (gp who ordered the sleep study) spoke with me was after he got the report on my first test. He has not contacted me at all since the second one...the only reason I have a copy of the report is that I asked for it...but that's another story.

I have had some good nights and days, but also a couple of extremely bad mornings, awakening with a drugged feeling, headache, unable to get out of bed. Just the way I felt before starting CPAP. I also have been experiencing a tightening feeling in my throat, most notably in the evening before bedtime.

If you need more information, I probably can scan the results, including the chart. It's so frustrating to try to figure out all of this on my own so I sure would appreciate any help that you can give me.

Thanks so much.

sleepyjean
"Don't be dismayed at good-byes. A farewell is necessary before you can meet again. And meeting again, after moments or lifetimes, is certain for those who truly love."


Beckham
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hang in there sleepyjean

Postby Jenny33 » Sun Jan 08, 2006 1:10 am

Hi sleepyjean,

Just wanted to commiserate with you on your problems with your regular doctor, and being on your own
to figure it all out. I can totally relate. PM me if you ever want to just vent :-)

I called Friday to tell my PCP I had concerns with the diagnosis from the sleep lab. (sleep study on Dec 22)
(My diagnosis was severe OSA...but I only had two obstructive apneas all night.)
So I get a message on my machine on Friday 5:00 (just as they were closing probably) from his NURSE
asking what my issue was with CPAP. (I guess they assume my concern is that I'm worried about it, instead of questioning the diagnosis.)

My doctor never called me to even tell me the diagnosis, so I assume he won't be talking to me unless I call.
Or cough up a copay and go in to talk to him.

Hang in there! I hope we both feel better soon. It's exhausting feeling like you're
not only fighting a battle with the symptoms, but also with the doctors!
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Really Need the Report

Postby sleepydave » Sun Jan 08, 2006 6:55 am

Hi SJ:
Yeah, we really need the entire report, probably both studies.

In re: the centrals, we're not really sure what they were really talking about
central respiratory disturbance index


That terminology is a little off-center and the events didn't show a lot of central anything. It seems more like it was just an inappropriate use of the term. The respiratory disturbance index (RDI) includes apneas, hypopneas and RERAs, and the only "central" event that really is scored is apneas, so there's really no such thing as a "central RDI."

Get all the arousal info, that was quite important. Graphs are always VERY helpful.

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how to scan to forum?

Postby sleepyjean » Sun Jan 08, 2006 8:47 pm

i've scanned my graphs to my computer, but can't seem to copy them to here. Help please!

thanks.

sleepyjean
"Don't be dismayed at good-byes. A farewell is necessary before you can meet again. And meeting again, after moments or lifetimes, is certain for those who truly love."


Beckham
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PSG Scans

Postby sleepydave » Tue Jan 10, 2006 7:04 am

Here they are, somebody had put them in the sock drawer:

Diagnostic Study
Image

Titration Study
Image[/b]
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For Starters...

Postby sleepydave » Tue Jan 10, 2006 7:43 am

OK SJ, there's a ton of info here, but let's toss out a couple things just to get started.

There's still a ton of arousals and the REM remains significantly reduced and delayed. Any other underlying medical conditions or medications?

There is very little supine sleep in either study (although if "S" means supine, then what the heck is "B"- back?). I know that some of the CPAP report was spent explaining how supine REM may not be very important here. Certainly, reading between the lines, you can tell it is, so we'll keep that in the back of our minds.

There's a bunch of PLMs, but not enough to explain all the arousals.

OK, this one looks like it could be a little GERDY.

All of the arousals could be due to the previously-mentioned RERAs, if so, the pressure is sub-optimal. I'll go back and try to find out if higher pressures were tried and if the arousals did not change. If, in the meanwhile, you talk to your MD, ask what's up with the continued high number of arousals.

Despite that, you can see that there's significant improvement in the sleep architecture, and the oxygen saturation graph has come up nicely.
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Where's the Titration Table?

Postby sleepydave » Tue Jan 10, 2006 7:53 am

Yo SJ:

I can't find the titration graph, or at least the table, if you talk to them try to get that.

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titration graph

Postby sleepyjean » Tue Jan 10, 2006 10:03 am

sleepydave,

thanks so much for all of the information thus far.

isn't the 2nd graph the titration one? i'm confused (although probably no more than usual). If this isn't what you can't find, let me know what you need.

In the morning after breakfast I take 75mg. Effexor, .05mg Xanax, multivitamin, calcium, glucosamine condroitin, 1 baby aspirin.

what is GERDY?

I am still feeling pretty bad.

Thanks.

Jean
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setting during titration

Postby sleepyjean » Tue Jan 10, 2006 10:43 am

hi again.

the tech told me that the only setting used during the study was 6cm. she said that's what she set it at and i didn't seem to require any more during the night, so that's where it stayed.

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Re: titration graph

Postby sleepydave » Tue Jan 10, 2006 9:25 pm

sleepyjean wrote:isn't the 2nd graph the titration one? In the morning after breakfast I take 75mg. Effexor, .05mg Xanax..what is GERDY?


Hey again:
I was looking to see if there was a specific graph or table of all the CPAP pressures tried, but if you were on 6 cmH2O all night, that answers that.

A normal arousal index (events per hour) is probably less than 5, assuming that even that does not cause any symptoms.

The delayed REM onset is undoubtedly due to the Effexor. Antidepressants and long-term use of benzodiazepines (like Xanax, and I assume that a 0.5 mg dose) can create sleep problems like insomnia and arousals. Don't throw 'em out yet, you could also make it worse, check with the MD before you go that route.

You've got PLMs, that might be the cause of all the arousals. Treating them might help. That wouldn't be my first choice, however.

With that single pressure, all those arousals could be from RERAs (respiratory events a little more subtle than apneas or hypopneas). They really should've turned up the pressure a bit to see how they respond. Trying an AutoCPAP might help identify if that's the issue. Get one that identifies flow limitations however, just in case. Or be ready to kick up the low limit a little if you don't feel better.

GERD is gastro-esophageal reflux disease. Heartburn, give or take. Something caused by GERD is GERDY. OK, I made that up. If you have symptoms of GERD, treatment may also include a medication, so again, check with the MD. Long term use of PPIs and H2 blockers are not without concerns either. That pile of arousals showing up at 4:30 AM looks a little curious, tho.

The way you tell for sure if it's GERD is do a pH probe. If your sleep is that bad, and it's GERD-related, a pH probe would be well worth it before you went on 10 years of PPIs.

I don't think your basic architecture looks too bad otherwise, my guess it's one (or more) of those four things.
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