I can’t thank you all enough for the wonderful words of encouragement and ideas that I have read from this community helping each other out.  I was so nervous to get this study done, ‘afraid’ of the results and saying to myself the all time favorite ‘let me lose weight and see what happens’.  From being now an educated apnea-er from this site, and the readings I have done, I scheduled my sleep study test.  

I was nervous, but ok with the experience.  The tech made me feel comfortable,  but overall I couldn’t get all that the study was going on.  Well, I think it showed in my results.  I welcome all who have their own take on the results of my study.   I’m also concerned that while I think my doctor is wonderful, I don’t know how experienced he is with sleep study data, and that is where I need to get the script from for the CPAP machine.   From reading here, I feel I can go a lot more informed.
I can’t imagine doing this again, and thinking of a titration study makes me feel sick to my stomach.  I like the reading physician’s recommendation of starting therapy ASAP if it ‘immediately’ has to be done ;  I really really want to get started on this machine.  Is the titration study so needing to be done first?  Does it dictate exactly what kind of machine I would get, or does that not matter.  Can I get the machine and see how I feel at the recommended setting of 11cm.  I felt so much better for the brief hours that it was on during the study and I hate sleeping now knowing there is help out there.

I underlined a few parts that I thought where especially interesting and curious to know what this means.  Anyways, here it is, and again, I appreciate in advance your own desires to help someone who is new to all this and feels like a deer caught in the headlights.

Split Night CPAP Study

Polysomnogram Summary:

Sleep architecture:  Sleep efficiency is 65%.  
Sleep onset occurred at 68.5min and REM onset began at (o.ooh).
 The patient spent 1% total sleep time in Stage 1, 99% total sleep time in Stage II
0% in Stages ¾ and 0% in Stage REM
Arousal rate is 33.8 per hour.  Total sleep time was 4.4hrs.

Respiratory Data:
101 obstructive apeans, 53 hypopneas, 0 mixed apneas, 0 central.
AHI before treatment is 97.4 per  hour (normal is less than 5)
Supine rate is 8.0 per hour with a non-supine rate of 77.3 per hour.
Non-REM rate was 36.5 per hour and the REM rate was 0 per hour.
Minimum oxygen saturation with events is 77%, Stage 2.
Total supine time is 2.6 hours with a non-supine time of 1.8 hours.

Periodic Limb Movement:  PLMS rate is 0.

Polysomnogram Impression: This overnight sleep study reveals the following:
1.    During a baseline recording of 216 minutes, 85 minutes of sleep was recorded.  During this interval, the patient showed 138 respiratory events consisting of 106 obstructive apneas and 32 hypopneas.  The resulting respiratory disturbance index was 97.4 events per hour of sleep.  This is consistent with a diagnosis of severe obstructive sleep apnea.
2.    Due to the severity of the patient’s sleep apnea, emergency application of positive airway pressure per protocol was instituted.  Pressure was initiated at 4cm H20 and titrated upwards in response to           snoring and obstructive respiratory events.  Pressures between 4cm and 11cm were utilized.  Pressure of 11cm was found to be therapeutic with the patient supine.
3.    However, no stage REM sleep was recorded during the entire study.  
4.    During sleep, heart rate ranged from 62 to 101 beats per minute.
5.    Sleep efficiency was moderately reduced to 65%.  Sleep onset latency was markedly prolonged at 68.5 minutes.  Only stage 1 and Stage II sleep were recorded.

Clinical Recommendations:
1.     Positive airway pressure at 11cm H20 was therapeutic and maintained arterial oxygen saturation within the normal range during stage II sleep.  However, no deeper stage of sleep was seen and therefore is unknown whether this pressure would be therapeutic in deeper stages of sleep.
2.    Suggest full night of positive airway pressure titration for this patient with severe obstructive sleep apnea.  If this study cannot be done fairly rapidly, institution of positive airway pressure at 11cm H20 with a Respironics ComfortGel medium mask would be recommended.

Welcome to the forum, Lotus. And congratulations on accomplishing your split night sleep evaluation and titration.

So what's the problem w/going for a full night titration study? You obviously survived the split night w/no trauma! So what was so bad that you get sick to your stomach at the thought of doing anothe in-lab study? Come on, you survived. You weren't injured or harmed in any way. What's the problem? Don't be bashful.

I can sure see WHY they opted for the split night w/the data you produced during the evaluation segment!!! Sheesh, girl! Your sleep is phershtunga!! How the devil have you been managing?

Hey, if you want this CPAP therapy to work you NEED to KNOW what the best pressure setting for you is. You NEED to KNOW if a CPAP is going to be adequate therapy or if maybe what you really need is a bi-level PAP. The more sleep time they have to titrate your pressure and evaluate your sleep whilst on PAP the more adequate the pressure recommendation should be.

Look, my Sleep Efficiency was rated at 83% and that was considered "el !@#!" for sleep.
It took you a full hour to get to sleep so there was an hour of evaluation lost.
You had NO REM sleep and that is the sleep stage wherein our brain does most of its processing and filing of the day's events.
You had NO Stage 3 & 4 sleep and that is where we get most of our rest and rejuvenation for the next day, where our muscles repair the minute rips and tears that occur thru out the day, where our mind really gets to REST.
Stage 1 sleep isn't really true sleep at all, it is the transistion between wake and sleep and we are easily aroused during Stage 1, its that dozing in and out that we so often experience as we proceed to sleep.
Stage 2 sleep is the first real stage of sleep. It isn't the deep restful sleep of Stages 3 and 4. You spent almost your entire sleep time in Stage 2.
Your arousal rate was more than once every 2 minutes meaning your sleep was disturbed more than one every 2 minutes.

Most of us experience most of our sleep disordered breathing events whilst supine (on our back) and during REM sleep (you didn't even get into REM sleep).
Your 02 desaturation at 77% is disturbing. In the hospital if your 02 saturations fall below 90% for any length of time they put you on 02 supplementation.

In the final analysis you experienced 97.4 events per hour of sleep. good golly, girl, that is more than one arousal per minute!!!!!

Many insurances won't even pay for CPAP therapy if you slept less than 2 hours out of 6 hours bed time. So your insurance may well refuse to even pay for a CPAP machine and accessories w/o another night at the sleep lab for more titration time.

Think it over. It really is in your best interest to go thru w/that in lab overnight titration study.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

While I do concur with everything CrohnieToo posted, I also know that if you can't really go to sleep in the lab then they may again not get the results needed.  I have severe insomnia and don't sleep very well or much under the best of circumstances (my home), let alone in a lab, it was nearly impossible to come up with anything useful on me at my titration.

If you think you can sleep, especially if you use a prescription sleep aid such as Ambien, Lunesta, Sonata, then go for the in-lab titration.  (NOTE: If you do not already use these sleep aids, get some samples or small prescriptions from your doc.  Try them a couple of weeks ahead of the titration to see which one works best for you.  Not all the sleep aids work well in all cases, and some may actually promote wakefulness.  So be familiar ahead of time with how you react.)

If you do not think you can sleep at the in-lab titration under any circumstances, please check with your doctor and insurance about the rental of an Auto CPAP for a few weeks to a month or more.  

The APAP is no substitute for the lab, its data recording capabilities are limited to certain aspects of breathing only.  However, in my opinion (and I am not a doctor!) your sleep study summary figures you posted, suggest that you have relatively uncomplicated OSA.  Using an APAP at home for weeks or months and having your doctor review the numbers every week or two and fine tune the machine's pressures, may work out quite well for you.  You might well be renting an oximeter from time to time, to check your O2 levels as your xPAP pressures are adjusted.

As I mentioned, it was just not possible to get a reasonable titration on me due to my insomnia.  So an APAP at home is what we ended up doing in my case.  Except that I kept my APAP (my insurance did not have any issue with purchase of the APAP as opposed to a straight CPAP.  They can be set to straight CPAP mode so nothing lost).  My doctor reviewed the data collected by the APAP every couple of weeks and slowly fine-tuned my therapy.  We started with my "best guess" titration from the lab -- 10 cmH2O.  I have uncomplicated OSA and UARS and NO real desats.  Pressure 10 did achieve decent control for me.  Howver, over many months my doctor increased my pressure based on the data collected by the machine.  Today my pressure is 14 cmH2O and it seems to do a superb job for me.  I could have gotten by on 10 but it seems that having found 14, it is the 'magic number' for me.

Again, concur with CrohnieToo, go for the in-lab titration (with a sleep aid, if required) if you think you can do it.  Otherwise ask your doctor about whether you are a good candidate for a trial of an Auto CPAP at home, probably with oximeter.

Blessings,
--pseudonym

After reading this thread, I know I had a harder time than usual getting to sleep at the sleep lab.  I think when I go to my titration on 6/24, I will stay up as late as I can the night before without jeopardizing my work the next day, and then go in tired to the lab.  I want to leave that place with the magic number for them to put on a script.  I managed to get 12 minutes of REM sleep out of the 4.5 hrs they had me sleeping.  Now I can't wait to get a restful night's sleep.

I am already addicted to the chat room on cpaptalk.com so I should have no problem doing that