hi all -
i just received my study results and have mixed feelings.  my doc had told me that i had severe apnea & some desaturation so based on things i've been reading online i thought my numbers would be higher/lower than they are.  ends up that my "severe" apnea is only during REM sleep and it's mostly hypopnias and my sats never drop below the 90s.  lots of the numbers are good from what i can see. i see the sleep doc tomorrow but my big question is could this still be causing me lots of problems with fatigue, etc?  obviously it's good that things aren't as bad as i thought, but b/c i have so many health problems part of me was hoping that fixing this would be a big help & now i don't know if that's the case.

here's the results:
Sleep Architecture
Sleep Time: 462 minutes
Efficiency: 92%
Awakenings: 18
Total Time Awake after Onset: 41 minutes
Latency: 16 minutes
REM Latency: 87 minutes
Supine position: 45.9%
Stage 1: 5.1%
Stage 2: 45.1%
Stages 3&4: 26.7%
REM: 15%
Arousals: 103
Arousal index: 13.4
Stage shifts: 128

Respiratory Data
No snoring
53 respiratory events
3 apneas (0 obstructive, 1 central, 2 mixed)
50 hypopneas
AHI: 6.9
REM index: 35
non-REM index: 1.4
mean O2 sat: 96%
min O2 sat: 92%

no PLMs

ECG Data
Average HR: 71
HR Range: 47-87

ICSD Diagnosis: Obstructive Sleep Apnea Syndrome

Impression:
1. Severe REM related obstructive sleep apnea, worse in supine position.  Respiratory events associated with mild O2 desaturation.  The overall AHI was in mild range (6.9) and non-REM AHI was normal.
2. Abnormal sleep architecture likely due to respiratory events and first night effect.


i know what the specific things mean but not really what the "big picture" means, i.e. an overall mild score but severe during REM....also, are all hypopnias necessarily obstructive?? (just wondering b/c of "obstructive" diagnosis when the 3 apneas were central or mixed).  and what to make of the arousals/arousal index?  does this mean anything? one of my major complaints has been frequent awakenings during the night. i'm SO confused!  is this going to be CPAP territory or is the doc going to tell me to use tennis balls on my PJs and lose the 5 pounds that i don't really have to lose?

any info/input would be appreciated.
thanks much,
melissa


_________________
"I get up, I walk, I fall down. Meanwhile I keep dancing." HILLEL

www.dinet.org
www.ndrf.org

Melissa:
It would be nice to get the sleep architecture graph, especially, since the MD called it "abnormal."  Could be lab effect, as he noted-  was the lab night worse than your "normal" night?

1 central, 2 mixed? Barely worth even mentioning.

Read your other post.  Gad, is there anything you don't have?  Maybe a review of the meds in re: sleep effects could be helpful.

The tennis ball thing will only work if most, if not all of the REM events are supine (get the REM supine AHI) and that's not absolutely stated there.
Good luck!
sleepydave

dave -
thanks for your input.  they were intrigued with me to say the least.  i also got copies of graphs, etc. and more detailed breakdown of info and hypopnias on my back were only slightly worse than on side so position isn't really a big factor.  my awakenings & arousals corresond pretty well with respiratory events and i'm aware of waking up a lot throughout the night so i'm hoping that treatment may help me stay asleep.

we discussed the possibility of meds to try to reduce REM sleep time since that's really my "only" problem but with all the meds i'm already on & with my issues absorbing things normally new meds are always quite a venture for me.  so essentially - since i'm willing to give it a go - we're going to give CPAP a shot. i got fitted for my mask already and should hear from the DME folks next week about the machine itself.  then after a few weeks i go back for a titration study.  i was SO far ahead of the game since i'd already been reading up on this and other sites, chatting etc...i actually knew what they were talking about and whatnot.  i think they thought as a 26 yr old i'd go running with the thought of a CPAP nightly but it takes a lot more than that to phase me.  and i'll try whatever (almost) to feel better.

in terms of my meds i don't think i'm on anything that could be directly affecting things, or if it "could" i've been on much of the combo long before i had sleep issues (that i was aware of) or started things long after.  my regular/daily meds are mestinon, midodrine, inderal, protonix, zelnorm, cortef, DDAVP, K-Dur, clarinex, seasonale, & flonase.  mesalamine & reglan and various topical "stuff" as needed.  i hate being such a druggie but i'm bedridden without a lot of them so i'm thankful for at least the level of functioning i do have.  i do know that steriods & beta-blockers can affect sleep but don't know the details of "how" & know that for me my sleep didn't change in any way i could tell when starting them; i take both in pretty tiny doses.

thanks again.
:-)melissa


_________________
"I get up, I walk, I fall down. Meanwhile I keep dancing." HILLEL

www.dinet.org
www.ndrf.org

p.s. forgot to answer your question re: my sleep the night of the study...if anything i'd say my sleep was better during the study.  more like i have maybe one "better" night a week (on average, correlates with nothing that i can figure out)....


p.p.s. i'm not sure how to post my graphs within a post?? i have them scanned on my computer but then am lost.  cut & paste isn't working.  anyone??


_________________
"I get up, I walk, I fall down. Meanwhile I keep dancing." HILLEL

www.dinet.org
www.ndrf.org

Hi Melissa:
Those meds make a whole meal!

To post graphs, scans, vacation pix, etc. upload them to some third party server that takes photo uploads and gives you an http address.  Then stick the address in between the image buttons like [img}http://xxx[/img]

(One bracket changed to a } so you can see the format)

Make 'em about 800 pixel wide, that seems to fit pretty good.

sleepydave

okey dokey...here goes with the attempt to post the image.....



okay, it worked, but sorry about the size.  i'll try to play with it later but initially i don't know how to do so quickly.
:-)melissa


_________________
"I get up, I walk, I fall down. Meanwhile I keep dancing." HILLEL

www.dinet.org
www.ndrf.org

Hi Melissa:
In your photo editor, get that width down a bit and it'll fit better.  Although, bigger scans offer more detail, so it's more functional-- hey, I'm a guy, do you want it to look better or be better?

Anyway, that's actually quite a good overall sleep architecture, even for "lab effect".  OK, 15 awakenings is a lot, should be more like 2, but all the stages look well placed and sufficient.  Good heap of SWS (stage 3/4).  Almost too much.

The REM events, independent of position as you noted, are clearly defined.

An AutoPAP MIGHT be beneficial here if it turns out you need a lot of pressure to control the REM respiratory events.  You probably won't tho, but just to keep in mind.

Taking drugs to control REM?  Probably not a good way.  It means taking a drug (probably an antidepressant) taking enough so it works (not everybody gets effectively suppressed), hoping it lasts all night (we'll often see a bunch of REM in the late study as the drug wears off, or the REM overrides drug effect)(I don't know if that second part happens, I just made that up)(but that sounds good, don't it?), and you don't develop a tolerance to it (eventually it won't suppress REM any more).

You will get some benefit from CPAP, if it works well, you'll at least cut that arousal index in half (you'll get rid if 6.9 per hour out of the 13.4).  Is that enough to make a noticeable difference in the EDS?  I don't know, just have to see, but I would think every little bit helps.

In re: blood pressure, CPAP can, as least theoretically, reduce BP by reducing venous return.  So if your baseline systolic pressure is like 80 you might want to monitor that during titration periodically.  And don't jump out of bed first thing in the morning.
sleepydave

Wouldn't Mestinon, Midodrine, Zelnorm, & Reglan make a great name for a law firm?
s.d.

lol...i love the law firm name!  am going to have to share that with my buds on the dysautonomia forum i frequent (if you don't mind..i'll give you credit as my new sleep study guru/consultant).

i tried playing with my photo editor a wee bit and allegedly got it narrower but then when i uploaded it it looked the same.  and then i was annoyed and stopped trying.  pleased i got it to work at all.  i think it may have been an issue with cookies so that it didn't "really" upload the new version.  anyhoo....

based on reading on this & other forums i had thought my overall sleep architecture seemed fairly okay too.  and the docs yesterday agreed.  so not too sure why that was specified on the report.  more odd - and perhaps what was being referenced - was the number of stage shifts. knowing there's no foer sure yeas or neighs, is this something that could potentially add to fatigue or not really?

re: the meds, uneducated (about sleep stuff at least) me totally agrees with you.  and i don't think the doc disagrees.  the two that were mentioned were lexapro/celexa (virtually the same med...i've been on it in the past as it's used off label for autonomic & GI issues but it wasn't doing squat for me) or neurontin (which i don't know tons about). i think it was more that he was anticipating me to be more resistent about trying a machine.  he told me that the few other under-thirty set he's worked with haven't been too pleased with the idea &/or flat-out refused when they found out it would be more than a short-term treatment plan.  so he was pleased when i was okay with it.  and your additional thoughts about meds not really being of much help make sense.  although the issue of wearing off through the night probably wouldn't be the case as generally all SSRIs (that i'm aware of) have long half-lives so that they take at least a few days to build up & then also to leave your body.  when used for autonomic issues (and i think for depression), barring any untolerable side effects at least a month is given before deciding on effectiveness.  and i know when i went of the lexapro last year i actually had a withdrawal effect of sorts that was NOT pleasant.  and i'd been on a super low dose.  the issue of REM actually overriding a drug effect is really intriguing to me though.  i know you said you made it up, but it does sound good.  and makes me wonder about the physiology/pharmacology of that.  for instance....b/c with body essentially paralyzed during REM, less muscle activity, etc...then that means less processes like digestion at that time, no?  so if i'm taking meds that facilitate/speed digestion what do they do/ not do during REM?  hmmmmm.....very interesting.  i'll have to pick which one of my lucky docs is going to get to hear that question from me at some point

unlike the doc's previous experience with us young'uns i actually had a stronger aversion reaction when the resident brought up the weight loss possibility.  i was like, "look, i almost ended up on a feeding tube last spring b/c i couldn't eat or drink much of anything. my GI tract hardly works without drugs.  i still have days where i'm on liquids-only, i work out as much as my messed-up body allows, have lost and gained ten pounds in the past month solely from med changes and a moody tummy, was more than 30 llbs lighter and looked like death warmed over when my sleep started wigging out, and my blood pressure drops lower & i thus pass out more with any weight i lose, etc. etc.....so i REALLY don't think i should be trying to lose weight here." the resident was a bit taken aback i think by my, um, strong reaction, but the attending/main doc agreed that the weight loss route wouldn't likely help and might hurt over all so unless something happens wherein i start gaining tons its probably a non-issue.  but enough of my never-ending soapbox about that.

like you said, i'm of the opinion that any/every little bit of better rest helps...or at least can't hurt....so am at least hopeful that some noticable improvement may come to pass once the CPAP happens.  and if not at least i'll know i gave it a shot and can scratch if off the list of possible contributing factors.

thanks for the more specific explanation of why CPAP can reduce BP.  i hadn't thought through the mechanics of it and it's helpful to know.  i'll definitely ask about BP monitoring during the titration though with the plan for me to try the machine on my own first for a few weeks i'll just have to stay aware of it.  i have my own cuff so can measure in the AM and whatnot but obviously not while sleeping.  and i definitely don't jump out of bed first thing in the morning as is so that won't be changing.  haven't been able to do that in years.....i have to take my BP upping meds at least 30-45 min before i can get out of med so usually have a first wake up then a second wake-up/get up time in the AM.  not the best in the sleep hygeine world but better than the alternative of my ending up on the floor.

geesh.. i wrote another book.  i promise that it won't be a regular occurance.  at least not until i get going with the machine itself

again...thanks for all your input/info/advice.  much appreciated.
  melissa


_________________
"I get up, I walk, I fall down. Meanwhile I keep dancing." HILLEL

www.dinet.org
www.ndrf.org

Hi Melissa:
There may also be some long term effects to BP with CPAP, like reduction, if in fact, there is something to reduce.  I guess it's not that clear cut in your case, but obviously getting through the the night without unecessary untoward incident is utmost, hence the mechanical effects of CPAP blurb.

Yeah, the stage shift thing.  It's probably better to look at arousals and awakenings, and the sleep architecture.  There's times where you can have a lot of stage changes, and not be of concern.  And actually, in your case, you do have a bunch.  See those several areas where you go from 2 to 3, a whole bunch of times, but there's really few or no arousals or respiratory events?  You're just fluctuating between 2 and 3, based on scoring criteria, and probably sleeping like a log.  Every one of those adds 2 stage changes, so the number gets padded a little.

It's a little more important if you're doing a lot of Wake to 1 or 1 to 2 and back.  That'll really wreck your architecture.  Here's some examples of the good, the bad-  I don't have a real ugly:

Sleep Architecture

sleepydave