I have a great Sleep Disorder Doctor (probably not the right title for this very nice man), and my company is changing insurance companies.  I need to advocate for myself, as I just got my CPAP a couple weeks ago, and my current insurance is renting it for 2 months before agreeing to purchase it.  The doctor is submitting a medical necessity form,  to help me get the machine before my insurance changes to a HMO that doesn't work with the current CPAP supply company.   Hopefully that works.  I asked for the full copy of my Sleep Study Report to give to my new doctor.  I would like some help in understanding it, my current sleep doc says that I have very severe apnea and NEED to keep on top of it.  I'd like some feedback on the numbers, because I see that I have normal REM and that is the stage that I need, right?  How bad is it, really??  I'm sticking with the CPAP, but I would like to know....

I fell asleep for about 3 hours, then was put on a CPAP.  "Very frequent but brief burst of loud snoring between apneic events prior to use of CPAP.  Lowest Oxygen: 63, average:  91, AHI highly elevated at 94, total of 72 apneas, 171 hypopneas, AHI 33 for whole night, total arousal index 34.5, Sleep effectiency normal at 88.5, Sleep latency 7 minutes, REM latency 191.5, WASO 10.7, stage one normal 7.7, slow wave absent, REM 22.1 (normal).

Hi there,

Your doc was right in saying that your sleep apnea is in the severe category.  Severity is generally defined as AHI (apnea/hypopnea index) which is how many apneas and hypopneas you experienced per hour during the study.  Mild is 5-15; moderate is 15-30; severe is 30 or more.... although I've seen scales that placed 25 in the severe category.  AHI gives one view, but the doc looks at the big picture as well, by looking at the other information.

It looks like you had no deep sleep.  Healthy sleep is when we go through a specific cycle of sleep, from stages one through four and also REM.  REM is the dreaming stage.  But stages 3 and 4 are considered to be more restorative stages, called Delta sleep.  All of the stages are needed.  You seen to lack much of the much needed sleep stages.

Normal sleep% are:
Stage 1 - 5%
Stage 2 - 55%
Stage 3/4 - 20%
REM - 20%

Your blood oxygen levels averaged 91% (normal is about 97% or higher).  That's not too bad, but you had at one point your oxygen level dipped to a very dangerous 63%.  You weren't there long, no doubt, but it's still low.

Your doc was right to say you need to keep on top of it.  I don't know your symptoms, but I would imagine that you're plenty tired.  Plus, untreated sleep apnea places your health and your life at risk.  You stop breathing 33 times an hour during sleep.  That's once every two minutes.  You should definitly be concerned.  But we've seen much worse.  We've seen people with AHI of over 100.  That's nearly twice a minute.  And how long you stop breathing is a factor as well, how many seconds.  By definition, apneas are at least 10 seconds, I think, but some folks stop breathing for a lot longer.  For someone who stops breathing once a minute, for example, and if they stop breathing up to about 40 seconds, you can see  how hard that could be on one's system and oxygen levels.  Try holding your breath for say 20 seconds once every two minutes, all night long, and you can see how exhausted and worn out you'd get.


Linda


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What you had was called a split study. WASO is wakefulness after sleep onset.
I am a little confused because some of the results here seem to reflect just the first part of the study and some are for the full night, and full night statistics are not all that useful.
What I would feel safe in saying is that your have some very serious problems. The primary means of determining is the apnea-hypopnea index (or AHI). This is the number of apneas (episodes where breathing ceases for 10 seconds or longer) and hypopneas (episodes where breathing is significantly reduced for 10 seconds or longer) divided by the number of hours of sleep. An AHI under 5 is considered normal. An AHI over 30 is considered severe. Your AHI for the first part of your study is 3 times this. Associated with this, you had drops in your blood oxygen level with drops to as low as 63% (normal low readings should be at least 30% higher). Your average 0xygen level is also lower than it should be (which migt reflect only your apnea but might reflect other physical problems). You also have a fairly high number of arousals (abrupt transitions from deeper stages of sleep to less deep stages of sleep).
What is not clear to me is whether the information regarding your sleep stages is for the whole night or just for one part or the other. This is fairly critical since some people might get much more REM on CPAP. So your REM figure of 22% is normal but we don't know whether this is for the initial part of your study (in which case it is a reflection of your untreated apnea) or not. If it is for the full night, then we really need to get the figures for the first part of your study to see what your untreated sleep really looks like.
Your absence of slow wave sleep could well be significant, although there is some dispute regarding the importance of slow wave sleep in adults. Generally most descriptions of slow wave sleep indicate that this is the most physically restorative stage of sleep but there are people who have been told by sleep specialists that slow wave sleep is not important in adults. I do not believe that this is a mainstream position and I am not sure what data would support this statement.
Your full sleep study provides far more information and detail than you have reported here. If what you have reported is the bulk of the information you were given, then you were given a written summary and I would suggest that you request a copy of the full report (which should likely run to 5 pages or so and include some charts and graphs).

Hope this is of some help.

Best wishes,
Bill