Hello everyone.  I am new here and I am sure glad I found this site and forum.

Brief Bio: 40yrs old, married, no kids, I generally wake up several times a night gasping for air. Dont know what refreshing sleep is, but would like to experience it someday...
 
My initial study revealed the following impression:
Study demonstrates the presence of severe sleep-disordered breathing which is manifested as cyclically occurring obstructive apneas and hypopneas in addition to loud snoring (my wife and probably my neighbors can attest to that).  These respritory irregularities induce moderate hypoxemia and significant distruption of sleep.  Application of nasal CPAP at a level of 8cm H2O abolished most of the sleep related abnormalities and normalization of breathing patterns during sleep.  This study also demonstrated moderate periodic limb movements in sleep.  These movements frequently resulted in microarousals, but were often associated with the respiratory events.  (these movements might explain why I surprisingly wake up with 5 & 10K running race trophies and blue ribbons on my nightstand for no apparent reason).

This Saturday I am going for (Part II ?) of the sleep study. (RWJ Sleep Disorder Clinic, NB NJ)  Based on the information on this forum this may be a  titration test or study?  I was wondering is someone can tell me what to expect and what questions I should ask.  

The subject of sleep apnea is fairly new to me but would explain other ailments I am dealing with such as major depression, RLS, heart palpitations and blood pressure issues, cognitive problems and a general feeling of fatigue all of the time.  (I basically crash when I come home from work)

Initial Study Results: (can somone tell me what this info means?  to me it does not look to good)

Disordered Breathing Events:
Apneas: 1 Central, 9 Obstuctive 1 Mixed
Hypopneas: 162 over 178 minutes
Moderate changes to arterial O2 saturation
Apnea Index: 54.6 events per hr of sleep calculated
Leg Movement Index of 28.3 per hr (associated with repiratory events)

CPAP trial was performed during 1st study due to respiratory irregularities:

Wake After Sleep Onset/Wake     DX: 36min        CPAP: 47.5min
Stage 1 non REM Sleep               DX: 18.0min     CPAP: 11.0min
Stage 2 non REM Sleep               DX: 151.0min   CPAP: 98.5min
Stage3-4 non REM Sleep             DX: 0.0min       CPAP: 46.0min
REM Sleep                                 DX: 9.0min       CPAP: 44.5min

Sleep Efficiency :72.7%

Thanks for your time and any info you could pass along.  
Sleepless Solidarity!!!

Hey there,

Haha, funny about the running trophies and blue ribbons.  Hope you weren't kicking your wife!  

Was the first study recently?  It looks like you were tested with cpap already, so I'm confused why you are going back.  Was this an older study you had?  Or maybe they need to do a re-titration.  Normally the first study is without cpap and the second is with cpap.  

I'm guessing the "Apnea Index" is really AHI (apnea/hypopnea index).  And it's definitely in the severe range.  Apneas are defined as total cessation of breathing (no air is getting through your throat).  Hypopneas are almost, darn close to being full apneas (some air is getting through but not much), and they are generally thought of as equivalent as apneas in terms of significance.  You stop breathing (or partially) nearly once a minute.   Severity is generally defined as an AHI of 5-15 as mild; 15-30 as moderate; and 30 or more as severe.  The report doesn't give the numbers, but apparently your oxygen levels aren't significantly low.  Your leg movements are respiratory-related.  It's due to arousals which are occuring to jumpstart your breathing.  Your body is stopping breathing, and your brain is saying "Oh, no you're not!" and sends signals to muscles to jumpstart the breathing.  Apparently some of those signals found their way to your legs!  

I'm guessing cpap will sure help you!


Linda


_________________
Click here for link to FAQ and topics
Click here for link to section on machines and masks

My first sleep study was performed on 3/5/08.

The report does say that "because of the patient's sleep-relatd repiritory abnormalities a nasal CPAP trial was begun at 1:23am and I was monitored for another 247.5 minutes of which 155.5 minutes were spent in non-REM sleep and 44.5min in REM sleep.  As a result sleep was generally uninterrupted without frequent microarousals or sustained arousals.  Thus application of nasal CPAP resulted in significant improvement in sleep quality"  

So I am assuming this is a re-titration study.

The mask they put on was a full face mask which covered my nose and mouth since, well I breathe through my mouth at night serenading my lovely wife with the various snoring sonatas.

I am getting a bit impatient because I assume it will be another 3 weeks before this report is read and then some more time before I actually have a CPAP machine in hand and finally get some relief.  In the meantime my wife worries, sometimes cries and checks me many times during the night to see if I am breathing.  She is now incorporating the Dorothy/Sophia Petrillo mirror method of testing my breathing.  If there is fog on the mirror in the morning, she starts the coffee.  (obscure Golden Girls reference)

Thanks for your response.

Hahahaha!
Loved that show!

Well, at least it's this weekend.  If the second study was scheduled a week or more from now, I'd be tempted to call the sleep study center and ask why you need to come back.  But since it's scheduled, go for it.  Plus, it really is preferable to have a full night for titration.  That gets in as much sleep time as possible to test enough pressures and different masks, if necessary.  

Besides, it will be another night when your wife won't have mirror duty, and she'll get a good night's sleep!  


Linda


_________________
Click here for link to FAQ and topics
Click here for link to section on machines and masks

did you have a spilt sleep study? which is the 1st few hrs with out the mask and they came in and put the mask on for the 2nd part? because if you didnt you have to go back for another sleep study with the CAPA

I guess it was a split sleep study then.  Well it is 8:25pm and I am off.  Will report back tomorrow sometime.  Actually my wife is not looking forward to my absence, but my aunt is coming to spend the night with her.  I hope she gets a good nights sleep.
 
Sophia:  "My husband Sal was in the Army"
Rose: "Really?, Where was he stationed?"  
Sophia:  "In the attic"

Well, JoisyMike, we're waiting! How did this new titration study go? Did you sleep much? Did you sleep well? Did you have much trouble finding a comfortable mask?

Have you given any thought to what options you would like w/your CPAP machine? Are you just satisfied if it will work for you? Or are you gonna wanna know HOW WELL it is working for you?

NOW would be a good time to call your insurance company and ask them what local DME CPAP suppliers they are contracted with. HOPEFULLY MORE than just ONE. (DME=durable medical equipment). Not all DME suppliers provide CPAP equipment I was surprised to find out tho your sleep lab will know which ones do. If you live in a large metropolitan area your insurance may give you a long list some of which might not supply CPAP which is why I added CPAP to the DME above.

You might also ask just WHAT your DME CPAP benefits are. Rental? For how long? Outright purchase? How soon? CoPay? Deductable? How often for equipment replacement (i.e. mask, hose, etc.).

IF you want MORE than just a bare-bones, compliance data only, CPAP then it would be wise to start checking out the various Resmed and Respironics CPAPs now. I say Resmed and Respironics because they are the two leading CPAP manufacturers and the only ones to provide fully data capable CPAPs.

IF you get a phone call from a DME supplier to make arrangements to deliver or have you come pick up your CPAP equipment BEFORE you get the results of your titration study from the doctor or sleep lab BE SURE TO ASK WHICH SPECIFIC BRAND AND MODEL they are providing. IF it isn't a fully data capable CPAP (and DME's are often "less than truthful" about full data capability) REFUSE it. Unless you don't care and aren't interested in the data from your nightly therapy. I doubt that since you were interested enough to find this forum. You are paying for the equipment, you have a right to refuse anything less than what you want.

The only fully data capable CPAPs are:

1] Resmed S8 Elite w/EPR
2] Respironics M Series Pro w/C-Flex

IF you want or your doctor suggests an AutoPAP:

1] Resmed S8 AutoSet Vantage (w/EPR in CPAP mode)
2] Respironics M Series Auto w/C-Flex (in auto and CPAP mode)
3] Respironics M Series Auto w/A-Flex (in both modes)
4] Puritan Bennett GoodKnight 420E (no expiration pressure relief in either mode - but easy to purchase software)

All of the above xPAPs will provide EXCELLENT therapy. All are good name brands and excellent products. The Resmeds EXCELL in data access via their easy to read LED screen w/a simple button press combination. The Respironics data access via the LED screen is a bit of a PITA, it requires unplugging, plugging back in plus button press. I don't believe the Puritan Bennett provides data via the LED screen.

The Puritan Bennett software is the least expensive and doesn't require a cable reader but does require carrying your autoPAP to your 'puter and a cable for connection to your 'puter.
The Respironics EncoreViewer software and cable reader are more expensive but that software is a patient version of their professional software.
The Resmed AutoScan 5.7 or ResScan software and cable reader are also more expensive and is the professional version and thus a little more difficult to purchase but not all that difficult.

Back to the DME supplier: just tell them you prefer to wait to talk to your sleep lab or sleep doctor before accepting any equipment. Then contact your sleep lab or sleep doctor and tell them you won't accept any equipment until you and they have discussed your various options and come to a mutual agreement on just what equipment you will receive.

Back to the xPAPs:

I assume that you will need and want a heated humidifier. If you travel by air often you will DEFINITELY want the integrated humidifier for the brand and model xPAP you get. The Respironics M Series' integrated humidifier is a bit of a PITA, it is notorious for leak problems, some of the problem having been taken care of via a Recall, but still a very poor design and requires CAREFUL attachment and filling to prevent leaks even now. If you don't travel a lot and want an M Series xPAP I would strongly suggest the Fisher & Paykel HC 150 stand alone heated humidifier. Its the best on the market and has more capacity than any of the integrated humidifiers. It does take  up a little more room on your nightstand than having the integrated humidifier.

The Resmed Humidaire 3i for the S8 models is trouble free, easy to attach and detach, the tank is easy to remove for cleaning, its easy to fill.

I've heard of NO complaints about the Puritan Bennett.

Now, obviously the various CPAPs above have various prices. The fully data capable CPAPs mentioned above are more expensive than the bare-bones, compliance data only CPAPs the DME suppliers would prefer to provide. The autoPAPs for insurance purposes are considered CPAPs. The bare-bones, compliance data only CPAPs, the fully data capable CPAPs and the autoPAPs are ALL considered CPAPs AND ARE REIMBURSED BY INSURANCES AT THE SAME AMOUNT AND THE SAME HCPCS (insurance) CODE!!!! Meaning the DME gets paid one amount, the exact same amount, whether they provide a bare-bones, compliance data only CPAP or a fully data capable autoPAP. Obviously they have a greater profit margin (and motive) to try to pawn off a bare-bones, compliance data only CPAP on unsuspecting clients. By the way, that HCPCS code for all CPAP is E0601. (The bi-levels, etc. are NOT covered under this code).

When it comes to your mask:
Hopefully, you got a really good, comfortable fit with the mask you used during your titration study and if so its a wise idea to get that mask w/your equipment from your local DME supplier. HOWEVER, as you shop the various DME suppliers contracted w/your insurance company BE SURE to find out just how lenient their mask exchange policy is - just in case. It would be a wise idea to have your sleep doctor write your script for: "Full face, nasal cushion or nasal pillows mask OF PATIENT'S CHOICE". AND for you to know the NAME of the mask you used during your titration study. Some local DME's will require that you get a new script for a full face mask if you start out w/a nasal cushion or nasal pillows or if you want to try one of the "hybrids" (nasal pillows and mouth combined). Thus the wisdom of the "of patient's choice" on your script.

And when it comes to mask exchange: be aware that Resmed, Respironics and Fisher & Paykel will all replace most of their masks that clients have tried and not been successful with to the local DME supplier FREE IF they fill out a form and return them WITHIN 30 DAYS. It usually takes 10 days to 2 weeks to be really sure that a promisng mask is comfortable w/a good fit and few leaks. Often after a few days of use the inside of the nostrils will get sore from nasal pillows (Ayr Saline Nasal Gel or any NON-PETROLEUM BASED gel often takes care of that) or the bridge of the nose are will feel bruised or develop a sore spot w/the nasal cushions and full face masks (Padacheeks often helps w/that).


_________________
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.

I hate for Apnea to be real but I'm glad it is, at first I thought I was losing my mind when I first started feeling these symptoms Anyone have any idea or knowledge of why it occurs in more males then females? Like the previous post I feel the heart palpitation kinda feels like its going to pack up and leave
I have a lot of depression and mood swings from it as well. Tuesday I'll be going for Part two the Titration Study , can't wait BUt I hear I may actually sleep this night