I'm so glad I found this great forum.  I just had my first overnight study, and would love to get an opinion:

Me: 41 yo Male, Height 172 cm, Weight 78kg, BMI 26.4

Total Recording Time (TRT) 432.7 min
Total Sleep Period (TSP) 421.5 min
Total Sleep Time (TST) 342.5 min

Sleep Efficiency (SE) 79.1
Respiratory Disturbance Index 31.4
Periodic Limb Movement Index with arousals 5.6

Sleep Onset Latency (SOL) 11.2 min  (NOTE: This was after being given 10mg Ambien)
Number of Stage 1 shifts 64
Number of Stage Shifts 159
Number of Awakenings 45

Number of REM periods 2
REM Latency 197.5 min

Sleep Stages / TST(%)
Stage 1 / 17.4%
Stage 2 / 75.5%
Stage 3 / 0.3%
Stage 4 / 0.0%
REM / 6.9%

Apnea Events
Central or Mixed 0
Obstrutive 17
Mean Duration 16.5
Longest Duration 26.7
Occur in REM 1
Occur in NREM 16

Hypopnea Events
Central 0
Obstructive 124
Mean Duration 20.1
Longest Duration 43.2
Occur in REM 7
Occur in NREM 117

Respiratiory Events
Apneas and Hypopneas 141
Apneas and Hypopneas and Rera's 179
Supine Events 111
Non-Supine Events 47

Rera Events
Number 38
Mean Duration 21.4
Longest Duration 35.8
REM 0
NREM 38

SaO2 %
Awake: Mean 94.4 (87 - 98)
NREM: Mean 94.5 (84 - 98)
REM: Mean 94.7 (91 - 97)

PLM
With Arousal 32 (NREM 30, REM 2)
W/O Arousal 235 (NREM 219, REM 16)

Comments from Tech: Slept mainly supine and left lateral; Snoring evident

I'll also see if I can upload the graph.  Thanks for taking a look!!!

Still no thoughts on this?  Anyone?  

Hi physio:
There should also be a physician assessment and plan, can you post that?
sleepydave

Hi,

The Physician "Impression" is listed as: This recording is consistent with obstructive sleep apnea syndrome and periodic limb movement events with and without arousals.  The "recommendations" are: The patient should follow-up to discuss treatment options.

I have subsequently spoken with the physician, and they basically told me that the disturbance index of 31.4 is consistent with severe apnea (anything over 30 is severe), and she was a little surprised that my O2 dropped to 84%.

I will need to go back in for my CPAP titration.

So that's basically all I got from them.  Any other thoughts?

Thanks!

Hi physio:

Quote:

she was a little surprised that my O2 dropped to 84%.

Yeah, me too, since your supine REM is basically event-free, where the OSA should be at it's worst.  Oh, well, I've seen stranger things.

Speaking of REM, that looks pretty displaced.  Lot of fragmentation, too.  Any other medications?

Got the arousal table?  Especially spontaneous arousals, I just see the PLMAI.

If symptoms don't improve (assuming there are symptoms?) the PLMS, and/or at least one other issue (gotta wonder about that fragmentation) will need to be addressed.
sleepydave

I don't take any medicine regularly.  The only thing that was in my system during the study was the 10mg Ambien that I was given at lights out.

Would the arousal table be called something else?   I don't see anything that just lists spontaneous arousals.

I was wondering about the sleep fragmentation as well.  I thought it especially strange that I had no Stage 4 sleep at all, and only 1 minute of Stage 3.  I wonder how much of this is the effect of being in a new place, with wires hooked up to me, and how much is my normal sleep pattern.

My symptoms (for at least the last year or so) have been daytime sleepeness.  Most days I struggle to stay alert during afternoon meetings, etc.

In that software, the arousal table should be called "Arousal Analysis."  There should (could) also be a graph showing arousals.  It's gotta be somewhere.  Spontaneous arousals is (are) important.

How about medication(s) taken irregularly?

I like parentheses.  I like these things too [] but they sometimes mess up the page if you say the wrong thing in them.

Or this thing: ~

I mean, when you see somebody use that, don't you just say, "wow, that must be real important!"

And what time zone are you in that you're up at 2AM?  Unless you're getting ~7.5 hours of sleep (did you see the thing?) you're in the same boat as a wrecked sleep architecture.

Which also leads me to ask, how did you end up prepped with 10 mg of Ambien?

There is something to be said about lab effect, but it's not the automatic catch-all.  You can't say, "Oh look, missed REM, no SWS, 500 arousals, hour and a half WAS, must be lab effect" without thinking about it a little.
sleepydave

Hi Dave,

Nope, no arousal analysis in either the lab report or the graph.  I can't imagine they would collect this and not share it, but maybe?

No medications taken, either regularly or irregularly.

I'm not sure what you were getting at with the parentheses...Did I miss use them somehow?

I'm in California, so PDT.  For example, the local time is now 12:00 midnight, and I'm heading for bed.

As for the Ambien, this came from the doctor.  When I was setting up the appointment for the sleep study, and she was explaining the wires that would be hooked up to me, I must have said something like "How do you sleep with all that?"  She replied that some people request a sleeping pill, and in fact she suggested I just go ahead and ask for one right away once I was ready for bed.  On the night of the sleep study, I asked the tech if I should take a sleeping pill, and he said that some people toss and turn for awhile and then ask for one, but he suggested taking one right away.  So I asked, and they brought me one.  At home, I never use them.

Is this unusual?

Thanks!

By the way...I just went into my profile and adjusted my timezone to GMT - 7 hrs.  So maybe the time will show correctly now!

Quote:

Nope, no arousal analysis in either the lab report or the graph.  I can't imagine they would collect this and not share it, but maybe?

Spontaneous arousal summary is critical to the sleep report.  If that's the complete report and it's not in there, that's a big issue.

Quote:

No medications taken, either regularly or irregularly.

That's a lot of sleep fragmentation.  It's always easier if someone says they drink 4 cans of caffeinated Coke or take a Lexapro before bedtime.  But let's wait and see what happens after the CPAP, maybe those PLMs are the culprit.

Quote:

I'm not sure what you were getting at with the parentheses...Did I miss use them somehow?

You're too serious, but I'll attribute that to the sleep fragmentation.

Quote:

As for the Ambien, this came from the doctor.  When I was setting up the appointment for the sleep study, and she was explaining the wires that would be hooked up to me, I must have said something like "How do you sleep with all that?"  She replied that some people request a sleeping pill, and in fact she suggested I just go ahead and ask for one right away once I was ready for bed.  On the night of the sleep study, I asked the tech if I should take a sleeping pill, and he said that some people toss and turn for awhile and then ask for one, but he suggested taking one right away.  So I asked, and they brought me one.  At home, I never use them.  Is this unusual?

Yes it is.  There's about 80 other sleep disorders besides OSA, and in evaluating symptoms, there are plenty of patients that have an issue other than, or in addition to, OSA.  Advocating the blanket use of Ambien will mask the underlying problems of a few of those patients.  If they are automatically giving everybody Ambien to "get through" the study, that's another issue.
sleepydave

I read the definition of spontaneous arousals but I can't grasp why they are critical to the sleep report.

In my sleep study report, there is one spontaneous arousal and it was caused by a noise in the hall outside my room.  In other words, someone was careless and woke me up.  Is there some significance to this?  Is one arousal significant?  What would be the significance of some other reason for an arousal?

In other words, I don't understand.

Quote:

Spontaneous arousal summary is critical to the sleep report.  If that's the complete report and it's not in there, that's a big issue.

I looked at the report again, and I do see one section I forgot to list above.  It's called "Respiratory Events with Arousals."  There were 179 total events, 171 in NREM and 8 in REM.  There's also something called "RERA Events and Body Position."  This shows 19 supine events and 10 non-supine events.

Is this what you were looking for?

Quote:

That's a lot of sleep fragmentation.  It's always easier if someone says they drink 4 cans of caffeinated Coke or take a Lexapro before bedtime.  But let's wait and see what happens after the CPAP, maybe those PLMs are the culprit.

I don't drink lots of caffinated things.  Almost never have coffee, and maybe only one caffinated soft drink a day at lunch or dinner.  Sorry!

Quote:

You're too serious, but I'll attribute that to the sleep fragmentation.

It's possible!  But that's what way too many years of schooling well get you...Some folks do say I have a "dry" sense of humor.  I'm just worried that I might be less funny with more sleep...

Quote:

Yes it is.  There's about 80 other sleep disorders besides OSA, and in evaluating symptoms, there are plenty of patients that have an issue other than, or in addition to, OSA.  Advocating the blanket use of Ambien will mask the underlying problems of a few of those patients.  If they are automatically giving everybody Ambien to "get through" the study, that's another issue.

It did seem sort of strange to me as well.  Bu the doctor said that Ambien has no effect on sleep pattern (ie. stages of sleep), only in helping one fall asleep.  I'm sure it did help me sleep that night.

I was supposed to have the CPAP titration this week, but my work schedule has gotten a bit busy.  I'll call the clinic tomorrow to set up a new appointment, and I'll certainly keep everyone posted.

Thanks for the support!

Frances wrote:

I read the definition of spontaneous arousals but I can't grasp why they are critical to the sleep report.

In my sleep study report, there is one spontaneous arousal and it was caused by a noise in the hall outside my room.  In other words, someone was careless and woke me up.  Is there some significance to this?  Is one arousal significant?  What would be the significance of some other reason for an arousal?

In other words, I don't understand.

Spontaneous Arousals:

Clinical Significance of Spontaneous Arousals