Hello,
Just got my split study results back.  Doc told me i have severe apnea....no idea what to think....still absorbing the shock of what he told me.
I am 30, fit, and thin.  I dont "feel" abnormally tired in the daytime, but fall asleep early and when i do get tired, its overwhelming.  Went to the study because my wife told me she heard me stop breathing at night and it worried her.  Based on others results here, these numbers dont look good at all....

228 minutes
sleep efficiency 44.9% (took a while to fall asleep.....does this reflect that?)
Obstructive events: 0
Mixed events: 0
Centeral: 0
Hypopneas with 4% desaturation: 16
Apneas+hypopneas: 146
My AHI is 85.5
Supine AHI: 125.2
Right: 52.5
Mean oxygen was 95% and minimum was 91%.  

How bad is this????  It seems pretty bad considering I am almost 3X the AHI thats considered severe....is it a blessing in disguise that the frequency of my interruptions don't allow my oxygen levels to drop much?  From what i've read many of the long term health problems seem centered around the fluctuations in oxygen.  I also read someplace that "severe" apnea usually also corresponds to o2 levels way lower than mine....hmmm

When i was on my back, i was being pulled out of sleep nearly once every 25-30 seconds.

I guess my bigger question is how can all this be true and me not be falling asleep at work, driving etc etc?  Am i just young and spunky?  Can i expect this to degrade my quality of life as i get older and I cant tolerate the lack of sleep as well?

I guess I am just a bit confused on how to react.  I go back in a week for a machine.  I know it will have an effect as the second half of my study I wore a CPAP and while I hated it, the graphs and charts do not lie...it was the only time dring the entire night I was asleep for more than 3 minutes.

Hi Tiktock and Welcome to the Hosehead club!  (Love that screen name)

Tiktock wrote:

I am 30, fit, and thin.

That is a common unfortunate misconception among the public and even medical professionals.  There is no typical Obstructive Sleep Apnea (OSA) patient.  We have old and young (see our pediatric forum), thick and thin, male and female.  I do triathlons.  And around 37% of OSA patients do not even snore.  The erroneous stereotype of an OSA patient being an overweight, middle-aged, male keeps thousands of people, including myself, from being properly diagnosed.

Tiktock wrote:

I dont "feel" abnormally tired in the daytime, but fall asleep early and when i do get tired, its overwhelming.

You will realize how sick you are once you have been treated for awhile and you discover what you have been missing.  This is a common statement from untreated OSA patients.

Mild OSA can be just as debilitating as severe so I don't pay much attention to the AHI (mine is 114 BTW).  What matters is that a CPAP will take care of all levels of OSA.  Where your AHI matters is when you get your CPAP.  Make sure it is fully data-capable, in other words, you have to be able to track and see your AHI so that you can make sure your therapy is working properly.  With a CPAP, your AHI should be less than 5.

Sleep disruption causes a lot of issues as does the repetitive hypoxia.  It is very difficult to know what effects what except that the repetitive hypoxia does do quite a number on the cardiovascular system.

Your wife is a keeper.  Your health would have gotten progressively worse.  I first had a suspicion I had OSA when I was in graduate school and around 30 years old.  For reasons I'll skip in this post (except that my ignorant docs said I couldn’t possibly have OSA because I didn’t fit the stereotype), I wasn't diagnosed until 12 years later when my health had completely deteriorated.  What follows is a short list of the effects of untreated OSA.

The effects of untreated sleep apnea are severe and systemic.  Some of them are; increased blood pressure, increased risk of heart attack and stroke (from the constant cycling in and out of hypoxia and increased blood pressure), heart arrhythmias, nocturia (because the increased pressure in the right heart ventricle makes the body think there is too much blood volume so urine is produced), headaches (probably from the hypoxia), fatigue (duh), memory and concentration problems, weight gain (sleep deprivation causes weight gain for several physiological reasons, one being the alteration of the hormones leptin and ghrelin), apnea induced seizures, there is a link to diabetes, there is a link to GERD, night sweats, depression, anxiety (each apneic event is a true suffocation and elicits the "Fight or Flight" adrenalin response), Fibromyalgia-like symptoms, impotence, relationship and job issues, car accidents, etc.

Keep asking questions and keep us posted on your progress!

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Vos Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

Vicki wrote:

Tiktock wrote:

I am 30, fit, and thin.

That is a common unfortunate misconception among the public and even medical professionals.  There is no typical Obstructive Sleep Apnea (OSA) patient.  We have old and young (see our pediatric forum), thick and thin, male and female.  I do triathlons.  And around 37% of OSA patients do not even snore.  The erroneous stereotype of an OSA patient being an overweight, middle-aged, male keeps thousands of people, including myself, from being properly diagnosed.

Vicki wrote:

For reasons I'll skip in this post (except that my ignorant docs said I couldn’t possibly have OSA because I didn’t fit the stereotype), I wasn't diagnosed until 12 years later when my health had completely deteriorated.
Vicki

Thanks for your response, so much!  

These two lines ring so true for me!  I had to literally tell my doctor to refer me for the study as he didn't seem to think it was necessary.  He initially sluffed me off and said something to the effect of "You don't fit the profile."

That made me mad...this in response to me telling him my wife stays up at night afraid i wont start breathing again?  It also set me up for a shock, since I half expected the sleep doctor to say "tell your wife you're fine...you just snore a little....have a great day."

The most amazing thing?  When i told my father, he said "That doesnt surprise me.  Youv'e always sputtered and choked, even as a baby."

Its quite a shock learning that I am completely inept at an important part of being a healthy human being...and it took 30 years and for someone to say "hey, you don't just snore...you stop breathing for a long time" for me to react.

Crazy.

(By the way, I got the screen name while on a 370 mile thru-hike.  Apparently my clock ticked pretty loud and bothered a few fellow hikers, and the next day people called me tiktock.  Its stuck ever since.)

Well, I wouldn't get too upset about your results. For one thing split-night studies aren't the ideal altho sometimes necessary.

Tiktock wrote:

... the graphs and charts do not lie...

Welllllllll ... I wouldn't go so far as to say they COULD lie - but - MUCH depends on the skill of the sleep tech conducting the study, AND the RPSGT who scores the sleep study - AND the expertise of the sleep doctor who also SUPPOSEDLY re-scores the sleep study him/her self before initialing the scoring and dictating the results.

In addition, we are asked to sleep in strange surroundings w/all those wires, etc., w/a camera watching, whilst anticipating what the results might reveal - and then when a split night study having a mask fitted to our face and the CPAP pressure experience fluctuating thru out what's left of the night.

I'm not saying that its likely that you DON'T have OSA by ANY means! All I'm saying is don't get into a twit about how dire these reported results are. You didn't sleep phershtunga and you obviously had enough events the first part of the night to justify spending the rest of the night being titrated for CPAP.

The info you've posted isn't even all that clear. 228 minutes was your TOTAL sleep time for the entire night? Yeah, 44% is lousy sleep efficiency but "first night effect" can have a lot of influence on that. I'm sure there must be some typos since you are reporting 0 obstructive events, 0 mixed events, 0 central events and only 16 hypopneas - and then report 146 apneas plus hypopneas.

Tiktock wrote:

... Can i expect this to degrade my quality of life as i get older and I cant tolerate the lack of sleep as well?

That depends on you. If you go into this CPAP therapy bit w/a determined, can-do attitude, a POSITIVE attitude, then NO, it shouldn't degrade your quality of life at all. If you give CPAP therapy a half-hearted try, decide it isn't for you, and continue to sleep w/o CPAP, then YEAH, you can expect this to degrade your quality of life. And shorten it too.

So - where do you start? First off, call your insurance company and ask them what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than one as that gives you more bargaining/negotiating room to be sure to get a fully data capable CPAP and a local DME supplier with a lenient mask exchange policy and an RRT (registered respiratory therapist) you like and are able to work comfortable with who ALSO knows how to do a proper mask fitting and knows and UNDERSTANDS the equipment they are providing beyond just the Quick SetUp Guide.

Given you had a split night study I'd be inclined to suggest that you INSIST and REFUSE TO ACCEPT anyhing less than a fully data capable CPAP, that you TRY to get a fully data cpable APAP (auto adjusting CPAP). I don't usually recommend trying too hard for an APAP but when there was actually very little titration time during an in-lab PSG often the pressure needs can be "off" and will need adjusting.

Most all insurances pay for this equipment by an insurance (HCPCS) code and NOT by brand and model. They contract at one set price for ANY HCPCS code e0601 and both straight CPAPs and auto adjusting CPAPs (APAPs) are e0601. Now the APAPs the DME supplier more than the fully data capable CPAPs which cost the supplier more than the bare bone compliance data only capable CPAPs - so since they are only getting paid one set fee regardless which CPAP they provide you with MOST will PREFER to provide and try to pawn off a bare bone, compliance data only capable CPAP on their new clients who don't know any better.

If you start off asking for a fully data capable APAP if the local DME supplier tries to pawn a bare bone CPAP off on you that gives both you AND the local DME supplier the ability to negotiate down to a fully data capable CPAP and make both of you happy. If the local DME supplier isn't willing to negotiate and you have the option of more than one supplier you can move on to the next one before accepting any equipment. And maybe your first encounter will be w/a good local DME supplier willing to provide the equipment you want (w/in reason, of course), have a good RRT and a lenient mask exchange policy.

Keep in mind, just because a CPAP has a data card does NOT mean it is fully data capable!!! The fully data capable APAPs are:

1] Resmed S8 AutoSet Vantage
2] Resmed S8 AutoSet II w/EPR
3] Respironics REMStar Auto w/C-Flex (the beloved pre-M Series "tank")
4] Respironics M Series Auto w/C-Flex
5] Respironics M Series Auot w/A-Flex
6] Puritan Bennett GoodKnight 420E (the "E" is the key identifier)
7] Covidien (Puritan Bennett) Sandman Auto
8] DeVilBiss IntelliPAP AutoAdjust
9] Fisher and Paykel SleepStyle 200 Auto (the "Auto" is the key identifier)

Fully data capable CPAPs that I am aware of as of April 2009:

1] Resmed S8 Elite w/EPR
2] Resmed S8 Elite II w/EPR
3] Respironics REMStar Pro II w/C-Flex
4] Respironics M Series Pro w/C-Flex
5] Covidien (Puritan Bennett) Sandman Info (not to be confused w/the Intro)
6] Fisher and Paykel SleepStyle 244 (the 244 is the key identifier)
7] Puritan Bennett GoodKnight 420S
8] Puritan Bennett GoodKnight 420SP

Its your job to explore information on the above xPAPs, some of them are older models that most local DME suppliers will no longer have in stock.


_________________
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, ProBasics Zzz-Mask full face, ResScan 3.7, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

The info you've posted isn't even all that clear. 228 minutes was your TOTAL sleep time for the entire night? Yeah, 44% is lousy sleep efficiency but "first night effect" can have a lot of influence on that. I'm sure there must be some typos since you are reporting 0 obstructive events, 0 mixed events, 0 central events and only 16 hypopneas - and then report 146 apneas plus hypopneas.

Thanks for all the info on the machines.  I'll certainly be doing my homework.

The 228 minutes was the non-CPAP time, I believe.  I need to re-read the report to figure out what portion of that time was just me trying to initially get to sleep because math-wise, the 146 Hypopneas dont divide out to an AHI of 85.5 when using 228 minutes.

The numbers were:
0 Obstructive
0 Mixed
16 Hypopneas with 4% or greater desaturation
146 Hypopneas

I will type out the full results tonight, as I may be skipping some key components that I am not aware are important in reading the results.