SleepyDave:

I met Linda in the chatroom this evening and we had a nice chat. She suggested posting here to ask you if the Sleep Study Center would release results to me now that I have been to see my doctor.  My doctor did give me the report the Sleep Center sent over, but it does not contain nearly the information I see others posting here. Being a curious coyote, I would like to know more about this problem I seem to have.  I have dropped the study center an email as they provided their email for questions after my study.  And I will be going back for the CPAP titration.  They were not able to complete that the first night.

Thanks for your help,

CoyoteLady
aka Laramie

I was pretty tired last night when I first posted so I did not include the results I received.  Here is the report:

Medications:  Aerohist, Combivent, eye drops (zatador), and Nasonex.

Sleep HX: Usual bedtime is 10:30 PM and wakes up at 6:30 AM

Procedure:  The pt underwent the standard montage for clinical polysomnography

Results:  The pt had normal resting arterial oxygen SAT of 97% in the supine position.  The pt experienced the onset of sleep only 8 mins after the lights were turned which is decreased and does suggest excessive daytime sleepiness.  The pt had a normal sleep efficiency of 80% w/ a normal REM latency of 2 hours after sleep onset w/90% REM sleep and 25% slow wave sleep.

The pt had very loud snoring during this study. There were no obstructive apneas. There were 80 hypopneas for an apnea/hypopneas index of 16 events per hour of sleep. These events were associated, however, w/severe arterial oxygen desaturations as low as 79%. These events were not body-position dependant. Looking at the sleep histogram, these events were more common during the second half of the night; there, nasal CPAP was not begun.  These events were somewhat more prominent during REM sleep.

There was no significant periodic limb movements and no EKG abnormality was noted.

Summary:
1. Significant obstructive sleep apnea w/ an apnea/hypopnea index of 16 events per hour of sleep associated with severe arterial oxygen desaturations as low as 74%. [One paragraph said 79%, this one said 74%.] As stated, these events were more severe during REM sleep which occured during the second half of the night, therefore nasal CPAP was not b egun.  
2. Abnormal sleep architecutre with decreased sleep latency suggesting excessive daytime sleepiness, probably on the basis of obstructive sleep apnea.

Recommendations:
Would discuss w/ pt aggressive treatment for obstructive sleep apnea, such as nasal CPAP.

That is the exact format and sum extent of the report provided my ENT doctor.  He is sending me back for the CPAP titration.  

Why does my report look so much different from the others I have read here??  My sleep study was done at a Sleep Center within a hospital and the "The Lake Hospital System Sleep Center is the only sleep center in Lake County accredited by the American Academy of Sleep Medicine."   I assume they are qualified personnel.

Thanking you in advance for your input SleepyDave. (And whoever else comments)

Laramie

Hi Laramie:
Many of the reports that you see here are from the complete reports, yours is a summary of that.

No problem tho, other that the REM 90%, which is a typo I would assume, looks pretty cut and dry to me.

Have a Happy CPAP!
sleepydave

SleepyDave:

The 90% REM is not my typo to be certain.  That is what they had on the report.  Are you thinking that is a typo on their part?

Laramie

Yeah, there's no such thing as 90% REM, even 35% on a titration would be a ton of rebound.  Besides, you've already got 25% SWS so it can't add up.
sleepydave

Do you think if I ask the hospital for the long version of the summary they sent to the doctor.. would they give it to me?

Laramie

Hi Coyote,

I was a little worried about asking for my results before my doctor had reviewed them.
(I still have yet to talk to any doctor or expert since my study on 22 Dec)
(okay, except sleepydave... who is my hero

They gave me no problem (I just had to go and pick them up)

My mother is an RN and says we all have a right to see our medical results. Don't think they can say no.

Good luck!

Thank you Jenny!  I'll ask for them.  

Happy New Year All

I must say that the folks at the Sleep Center were very cooperative and quite happy to explain their testing.  They made arrangements for me to go over the initial test completely with the tech when I went in for my titration.

I now have the copy of the results from the titration.  Onset of sleep was now 13 minutes after lights were turned out, which is normal.  Sleep efficiency was normal at 84% (was 80% in my initial test).  There was normal REM latency of 95 minutes after sleep onset with 20% REM sleep and 2% slow wave sleep.  Those figures seem quite different from the initial test.

My pressure was increased from 4 cm water pressure to 9 cm which controlled all but the rare respiratory eventeven during a period of REM sleep which kept arterial oxygen saturations mostly grater than 90%, however there were 2 areterial oxygen desaturations as low as 84% during REM sleep.

This tests noted mild sinus bradycardia with heart rate as low as 52 beats per minute.  My initial test showed no EKG abnormality.  Why the difference???  

The recommendations were to 1) rule out hypothyroidism if not already done. 2) Clinical trial of nasal CPAP at 9 cm water pressure with 2 liters of oxygen bled into the system.  Mirage Swift mask with medium pillows, heated humidifer were used.  I did ask to have the heat turned down however as the warm air was most uncomfortable for me.

I didn't post after my titration and waited to get results from the doctor.  Though I wasn't all that rested feeling, I had to admit that for 1-1/2 days, my breathing was markedly improved. I had no congestion whatever.  (I have alot of allergies and usually suffer from some degree of congestion.)  I am looking forward to that feeling again.

The tech explained to me in the morning that I slept much better (according to their monitoring devices) than I had the first study. I had nice REM periods.  

My question is what is with the low oxygen desaturations and I'd like to know about the oxygen bleed.  Is there something going on I should be more concerned about?    My doctor wrote the prescription for the Cflex 9cm H20 with 2 liter oxygen bleedin, heated humidity, mirage swift medium pillows.  

I was claustrophobic with the nasal mask. I'm good with the pillows.  He also sent me in for some bloodwork.  
I guess this kind of scares me.

Looking forward to your comments, SleepyDave.

Laramie

Hi Laramie:
The use of supplemental oxygen, assuming it was a normal, successful titration, may imply that there's something else underfoot.  What other blood tests are you talking about?

Get the complete graphs, that may give a clue.  Also any other underlying significant medical conditions.  How about height/weight?  The complete results wouldn't hurt, either.

Yet, strange to have a resting wake O2 sat of 97% while supine.  That suggests that there AREN'T any underlying additional issues that might have a bearing on the O2.

Let's see what the other info shows.
sleepydave

While these graphs may  make sense to you, the look like gooblygook to me!  I did get the graph from my first study.  I asked the guy who reviews first to send me the results, but I guess he forgot. I'll get ahold of the hospital and ask that they be sent to me.

The blood tests were for the hypothyroidism the results has indicated be ruled out.  He also checked the standard electrolytes.  

Hgt  5'4#  Weight 260 lbs.   I had lost 50 pounds but that attached itself again after returning to work.  My regular doc thinks it's not what I eat as much as lack of exercise.  However... I'll be the first to admit that by the time I work all day (9 hours there including lunch) and drive (another 1-1/2 to 2 hours as we live in a rural area and must commute).. the last thing I feel like doing is exercise. The family joke has always been, turn on the tv and turn mom off.  Knowing I had sleep apnea at least explained that. I just don't sleep well at night!  

I do have alot of allergies and am bordering on asthma.  I had pneumonia last year. Since then, I've been using an inhaler way more than I ever did before and have my own breathing treatment machine.  I've been on Xopenex several times to keep me breathing okay.  That spirometer test... I do pretty bad on.  It was like 330 which isn't even on the chart for someone my age, height and weight.  I've been doing lots of reading on the COPD and its relation to sleep apnea.  COPD patients often have the REM type apneas and low oxygen desaturation so it appears.

I had concerns since this second time for titration I had the sinus bradycardia.  I've been reading about that and it seems that sleep apnea can cause that as can hypothrodism and other factors.  So I guess I can see where they want to rule out the hypothrodism.  

I've actually found the whole relation between COPD and sleep apnea of great interest.  I want to discuss my results with my regular allergist actually.    My increased need for inhaler, breathing treatments and such make a fairly convincing case for COPD.  Oh why did I ever smoke??  I've been smokefree for probably 15 years now, but that COPD still sneaks up and kicks you in the butt it seems.  Mind you, I'm not a medical professional.  But after all this reading.. and following one link to another... it all seems to make some sense to me.  

Who knows just how long I've actually had sleep apnea.  Hubby says I've snored since we got married 13 years ago.  BUT... after I had pneumonia last year, my snoring did change. And that is why he was concerned enough to send me packing to the doctor.  He said I sounded like I was drowning.  

I find it so infuriating that they reduce those hours of observation and monitoring into just a few paragraphs. Course.. when presented with the graphs, I can't understand those so I suppose the few paragraphs are of some meaning!  

Now that we have me getting treatment, we are getting hubby looked at.  He's been reading my books and decided that perhaps he should be tested as well.  The tech told that it is rather common for couples come in, and even have apnea.  The woman usually comes first, followed by the man (usually begrudgingly).   A fascinating field you have, sleepy dave!

So... once I get these graphs, just what am I looking for anyhow???  And I sure wish you had some reasssuring thought as to why I had no abnormal EKG in the first study and this silly slow heart rate in the titration.  

Laramie

coyotelady wrote:

The blood tests were for the hypothyroidism the results has indicated be ruled out.  He also checked the standard electrolytes.

Those could be interesting, especially the -HCO3.

Quote:

Hgt  5'4#  Weight 260 lbs. My regular doc thinks it's not what I eat as much as lack of exercise.  However... I'll be the first to admit that by the time I work all day (9 hours there including lunch) and drive (another 1-1/2 to 2 hours as we live in a rural area and must commute). the last thing I feel like doing is exercise.

One of my other "hobbies" is basal and stress metabolic testing.  Trust me, it's the food.
The second thing I think of when you need supplemental oxygen is the problems created by excessive weight.
There are no acceptable excuses for improper diet and lack of exercise.  If they don't fit on your priority list, then you need a new priority list.

Quote:

I do have alot of allergies and am bordering on asthma.  I had pneumonia last year. Since then, I've been using an inhaler way more than I ever did before and have my own breathing treatment machine.  I've been on Xopenex several times to keep me breathing okay.  That spirometer test... I do pretty bad on.  It was like 330 which isn't even on the chart for someone my age, height and weight.

The first thing I think of when you need supplemental oxygen is COPD.  The Pulmonary Function Test has about 30 values on it.  If you got a "complete" PFT, why not grab that while you're at it.  330 could be anything.

Quote:

I had concerns since this second time for titration I had the sinus bradycardia.  I've been reading about that and it seems that sleep apnea can cause that as can hypothrodism and other factors.  So I guess I can see where they want to rule out the hypothrodism.

We are (did) have a brief discussion about bradycardia:

Bradycardia

Generally, if it's a sinus bradycardia, due to apneas, and is corrected by CPAP, then it's not a big deal.
But the heart rhythm in the sleep study is a very rudimentary 2-lead strip and should not be used to assess overall cardiac status.  So I'd be listening to my MD about heart health and not crazydave from the internet.

Quote:

once I get these graphs, just what am I looking for anyhow???  And I sure wish you had some reasssuring thought as to why I had no abnormal EKG in the first study and this silly slow heart rate in the titration.  

We'll be looking for unresponsive baseline drops versus desaturations per se.  And if you've had at least a real EKG, maybe a Holter monitor, that reassurance should come from your MD.

sleepydave

I have an appointment Tuesday with my gp/allergist. I was planning on taking my sleep study results in and talking with him about it further.  I really would like to pursue the more complete pulmonary function test.  We held off even doing the spirometer test until I was doing better from the pneumonia.  I think it's time to do a complete one though myself. Glad you agreed.  

They said it would be 5 7 days to get blood test results back.  I'll follow up then on those.  

I don't think you're so crazy.  

As for priority lists, working happens to be a big one.  One of the reasons I'm looking forward to cpap is in the hopes it renews some of my energy so I can do things OTHER than work.   I do not fear being a hose head.  

Thanks for the input.  I'll let you know how things are going!

Laramie

Although I do not have the actual copy yet, the office called to let me know that the results were all normal for my blood tests.   Saw my regular doctor Tuesday and spoke with him.  He agrees to proceed with a complete Pulmonary Function Test and said the doctor that wrote my sleep study and titration results is a lung specialist and to just call him.

Hubby goes for his sleep study on Feb 14.