Hi All~ I have just received the results of my 2nd sleep study (titration). I was on the CPAP and mask all night. As I have been comparing both the studies, it seems that some of the results from the second study (with the mask) are worse than the first study (without the mask) is this possible?

                                      First Study                             Second Study
Total Sleep time                357.5                                     333.3
Sleep Latency S1                 1.8                                      215.0
Sleep Latency S2                 2.8                                          9.0
Rem Latency                      71.8                                        93.0
Sleep Efficiency                   98%                                        92%

Stage 1 sleep                      26.0                                            6.5
Stage 2                             175.0                                         139.5
Stage 3                              53.0                                          110.0
Stage 4                              12.5                                              0
REM Sleep                          91.0                                            77.3
WASO                                  7.1                                            20.0

Oxygen Saturation                76%                                            85%


Apneas       NREM       REM     TOTAL                            NREM   REM    TOTAL                
Obstructive  1               4         5                                    5         1         6
Central        0               0         0                                   13        0        16
Mixed          0               0         0                                     9         0         9
Hypopneas   47            64       112                                  53       35       88
Total #         48            68      117                                   80       36      119
Resp Index 10.8           44.8   19.5                                         No Totals

Supine AHI           19.5                                                           20.9

 Hypopnea mean duration 23.1 sec                                       16.5 sec
Obstructive Apnea Mean   12.7 sec                                       14.0 sec
Mixed Mean                     0                                                 12.2 Sec
Central Mean                   0                                                 13.3 sec

Arousal Sumary          Number   Index                          number    Index
Respiratory                  54           8.8                              123          20.4


They have perscribed my setting at 14 even though during the study they only got to 12. They also reported that my EEG showed increased sleep spindle and mild Alpha/Delta sleep. My DR is an idiot and I had to tell him what to do next!!! He has ordered me a cpap machine with a heated humidifier and  with a full face mask and my setting at 14.

Any help would be appreciated. I have contacte and considering going to a specialist because my primary does not have a clue!!!

Thanks,
Shannon

Hmmm, yeah, a few strange things here.
That "S1" sleep latency at 215 minutes?  Is that number right?
Also odd that you've got mostly hypopneas, but they don't respond.
Then you've got some centrals in the CPAP study.
O2 saturation low, so there must be the obstructive component.
Refractory events make you think complex sleep disrdered breathing.  But again, they're hypopneas, not apneas.
Sleep spindles increase in some medications.
Alpha delta pattern appears in a few medical conditions (and no, we're not going to say anything yet).
How about any medications you're on, additional pertinent medical conditions, and the CPAP titration table.
And graphs.  Gotta have graphs.
In answer to your question, it may be for the total night it's worse, but there could be an "ideal pressure" where the AHI is good.
sleepydave

Thanks Dave, Here are some answers to your questions...

Yes the sleep latency S1 # is correct at 215.0

Only med I am on is Nexium and I have not taken it for a month!

Med conditions are GERD, Acid Reflux Disease, IBD, High Cholestrol, Depression (but not on meds for it), over weight by about 120 lbs.

CPAP Stats:

Interval Pressure     Sleep Time (Min)    Rem Sleep Time   Interval RID   Avg SpO2
           0                         0.0                           -                      -                  -
           4                        37.1                          0.2                  17.2              92.6
           5                        16.3                          0.0                  42.7              94.1
           6                          6.2                         0.0                 108.5              93.9
           7                        31.5                         13.0                 31.9              93.7
           8                        69.5                         0.0                     -                 93.9
           9                        58.0                         22.5                  23.2             95.8
         10                        65.7                         17.6                  12.6             95.9
         11                        30.4                           5.9                  9.4               97.0
         12                        18.3                          17.8                 5.2               96.3

Details: Follow up CPAP titration with the pressures titrated between 4 and 12 cm H2O. at the pressure of 12 cm H2O, there was residual obstruction. Patient may have benefitted from slightly higher pressure perhaps in vicinity of 14. THe heart rate ranged from 46 to 108 bpm. Arrhythmia was absent PLMs associated with arousals was 0.0/hr. EEG showed increased sleep spindle and mild alpha/delta sleep. Sleep architecture is affected by the process of CPAP titration with low normal sleep efficiency at 92%. Position remained exclusively in supine and rated sleep in the lab better, wide awake and alert.

Suggestion: 14 cm H2O CPAP with remed full face mask and heated humidification.

As soon as I figure out how to get the scan of my Summary Graph into this message board I will do it!

Thanks again for your help SleepyDave!!!!! I don't know what I would do without this forum!!!

Shannon

Shannon, you're in far better hands with sleepydave looking at your study, but I'll stick my masked snoot in, anyway.    My layperson's take on just this part:

"Details: Follow up CPAP titration with the pressures titrated between 4 and 12 cm H2O. at the pressure of 12 cm H2O, there was residual obstruction. Patient may have benefitted from slightly higher pressure perhaps in vicinity of 14."  (emphasis added)

Wonder of wonders,  that guess "perhaps" became a suggestion that became a prescribed pressure:
"Suggestion: 14 cm H2O CPAP"

Hahhah...easy for someone who probably doesn't have to use CPAP himself/herself to guesstimate, "Oh, let's just give Shannon 14 even though we didn't try it during the titration."  Easy for someone else to say that, when they are not the one who is going to have to deal with the increased mask leaks that each cm of higher pressure can cause!   Not to mention that higher pressures can make aerophagia (gas/bloating, often painful) more likely, be more difficult to breathe out against, be more drying ESPECIALLY if one does much mouthbreathing using a full face mask.

If the doctor is going to go with a guessed-at suggestion, I'd ask for a trial at home on an autopap - specifically the Respironics REMstar Auto with C-Flex, a heated humidifier, and the pressure range set at 8 - 14.   Let the autopap gather some more information to look at before making a final guess.

I'm betting that 10 or 11 will take care of you fine most of the time.   But I'm not a doctor...so...it's easy for me to throw out my own guesstimate, too.  

I'd definitely go to work on controlling the GERD if I were you.    

This is a rather extreme example of how GERD was very possibly the culprit in messing up how two different autopaps were struggling to read one fellow:

Nov 05, 2005   subject: SUCCESS AT LAST-GERD,420E, PRILOSEC AND BENADRYL

Good luck, Shannon!

Hey Dave,

How do I get the Graph into the post? I have scaned it into the my computer, but I don't know how to get it into the posts. I have it saved as both a .jpg file and a word document.

Hopefully, once I get that info to you, it will help with some of the explanations.

Thanks again,
Shannon

And like magic....

OK, overall I think they did a pretty good job here.
And your sleep architecture looks quite good.
Your first epoch of sleep was a stage 2, which is extremely unusual, but given the increased spindle activity (which is one of the 2 hallmarks of stage 2) that's fine, just to close that point.
There's a big chunk of continuous delta sleep there with the pressure at 8, if I'm counting right.
So it looks like 8 will take care of all your non-REM sleep.
However, OSA is almost always worse in REM.
And that pressure is not enough when REM appears.  It was advanced to try to address all the events, maybe not quite fast enough, but the remaining events seem to be somewhat subtle and I can easily see where the amount of REM didn't allow a lot of titration.  I usually yell when people run the pressure up too fast, and I think they did a good job here, just ran out of time.
All of your arousals appear to be from the respiratory events (119 out of 123) so there does not appear to be other noxious stimuli to deal with.
Soooo....the AutoCPAP might be a good idea, might as well set the low at 8, but start the high a little more than RG suggests maybe 16 even 18, just to see what happens.  Or if you do start at 14, just be ready to push it up a bit.
Look for the AutoCPAP response at 90 minute intervals, when REM appears and you'll be needing more pressure.
sleepydave

  Thank you so much SleepDave for all your help!!! One final question? What is the alpha/delta sleep?

Thanks again,
Shannon

Hi Shannon:
Oh yeah, that.
In the EEG pattern of the deep, restorative sleep (stage 3 and 4) are the large delta waves, from which this type of sleep gets another of its names.  Superimposed on the delta waves may be an alpha wave pattern.  Now, you can get an alpha EEG pattern by closing your eyes and resting quietly.  Some folks with the alpha-delta pattern may still feel unrefreshed even after a night of "normal" sleep.  Then again, others do not, so this finding may be non-specific.
Some entities that may have an alpha delta pattern include some psychiatric disorders, fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, deep coma and some medications.
But since it also appears in normal subjects, don't think that it means you have to have something.
sleepydave

Thanks again!!! I don't know what I would have done with out you or this forum!!!!