I finally got my sleep test results and while they were summarized for me, as I look at them I am confused and wondering if I should be concerned, especially by the oxygen levels.
It also is intimidating to look at 20 pages of medical lingo, charts and numbers.  I will make an attempt to put down what I think are pertinant descriptions and numbers.  I have been told I have severe sleep apnea and low enough wake oxygen level that my EENT wants a pulmonary evalutaion and we are trying to get this now.  Can anyone tell me which parts are really bad and which are not?   In the summary I can say that my pre CPAP problems were resolved at baseline saturation on CPAP of 13 with stabilization above 90%.   CPAP Bi-Level info was "Ultra Mirage, standard size.  Spit night study done taking "ambien"

Here goes:

Pre CPAP

    Apnea/Hpopnea    
                                        A or                                          (Mean)         Longest
Respiration      No.   %       H/h           Supine   Non Sup.       Secnds         Seconds
  Apnea          10     14.5     2.9            10          0                 16.4               20.6
      Obstruc.     8     11.6     2.3              8                            16.6               18.6
      Centrl         0      0          0              0          0                  0                    0
       Mxd           2     2.9       .6               2          0                 15.5               20.6
   Hypopnea     59     85.5    16.9          58           1                 18.7               35.0

TOTALS          69                 19.8          68           1                 18.3               35

Respiration         No. in REM      REM Index      No In NREM        NREM Index
  Apnea                 3                   25.7                  7                     2.1
     Obstruc            1                    8.6                   7                     2.1
     Central            0                       0                   0                        0
     Mixed               2                     17.1                0                        0
  Hypopnea            4                     34.3                55                     16.3
 
TOTALS                 7                     60.0                62                     18.4

Sp02 pre CPAP
    Av. O2 sat         87.5
    Low 02 sat         72
    Av Desat           9.8

Av o2/sat during Wake            87.8
Av 02 sat during REM              83.7
Av O2 sat during NREM            87.6

SUMMARY OF PRE CPAP PERIOD  (START TIME 8:02 pm ANALYSIS sTOP TIME 12:02
  Analyzed time       240.5 min.
  Index time            209.0 min
  A & H                      69.0
  Supine A/H              68.0 min
  Av O2 SAt               87.5%
Mild soft snoring and one loud snore presented.
Respiratory arrousals       21        
LM Arousals                      3
Spontaneous Arr                1
Time Analyzed             490.6 min
Sleep Period                479.8 min
Wake Time during
   Sleep Period               86.8 min
Total Sleep Time          393.0
Sleep Onset                 16.9 min
Sleep Efficiency            81.9%
No. of awakenings         11.0
Sleep Latency to S1       16.9 min
Sleep latency to S2        41.9 min
Sleep  Latency to SWS
 (S3 or S4)                       -min.
REM Latency from
  Sleep Onset                216.0

LM                                 145           22.1      2.8   .6    10.2
LM in PLM Sequence        117           17.9      2.8   .6    7.5
PLM Sequence                   8             1.2   498.4  121.2     1655.8

My EENT says the sleep apnea is severe but at this point is concerned by the awake o2 level of 89.   If the norm is 90 - 95 would just a point or two difference be that much to be concerned about?   As to the sleep apnea what or which is severe?  I am not computer literate and although I have several graphs I wouldn't know how to post them.  they also advised against driving until such a time as my syptoms are relieved and I feel better.  That kind of frightened me...not because I can't drive but because of what could have happened all those times I did drive through the years.

   Hoping for some input.
    Diane

I know little about sleep studies, I'm a newbie myself, so will let others answer those questions.

I would be very concerned about the O2 saturation though.  I have never heard normal is 90-95.  I would say more normal is 95-100.  It can drop down into the low 90s with exercise.  Below 90 is not good.  Generally if there are lung problems the saturation goes down with exercise.  (Maybe everyone's does, I have never gotten a straight answer on this).  So, if you are registering 87.5 (I didn't see the 89) pretty much at rest, that is quite low.  I'm not real positive about how good the low sat is, but that is extremely low and if awake you would be able to feel it I am quite sure.  Do you notice getting very short of breath?

Medicare pays for oxygen if your sats are 88 after a 6 minute walk.  I took a friend in who has oxygen problems and he uses O2 at home, but didn't take it with him to the doctor.  He measured at 86, and the doctor wouldn't even talk to him until the nurse brought in an oxygen tank.  So, that's just a few points too -- I think you see where I am going with this.

Well, before I sound really dire I'll stop.  You can email me if you want to chat about it out of this forum.  I just wanted you to know that they might have found something that you should also see to ASAP.

Judy

Hi Judy,
   Thanks for your input.  I was told that the 95 range was considered normal but that 87-89 while at rest and awake was low.   I don't understand how my problems were resolved at
13cm h20 and resulting greater than 90%  is than considered okay.   Guess I will have to wait to see what all that means.  We are still trying to get an insurance approval for a referal to a pulmonary person.   I am now getting very concerned and anxious about this.  My EENT
faxed my primary care last WED asking for help to get that referal referencing the 89% at rest and awake and asking for baseline O2 testing.  If I don't hear anything by WED I will call both places to see what is going on.   To add to the stress I picked up my CPAP machine today and will probably try it tonight.  My problem is going to be a stable enough place to set it on.  Our bed set has a raised arch over the tope and two pyramids (one at each side) attach to the bed. This gives us a closed unit with three shelves at the top of the pyramid,
and a space like an open faced cabinet next and on the bottom two drawers.  It is a beautiful
set...but it is going to be hard to find a place to set the CPAP.  I might have to get another piece of hose because the unit will have to be placed aways away from the bed.   If it isn't one thing it is another!
   Thanks again...I can be reached at NV_CRACKER@yahoo.com
    Diane

Hi Diane:
By your AHI (19.8, if I'm reading the columns correctly), your OSA is more like moderate.  Your saturations appear to be the issue.
Can you get the CPAP titration table that lists all the pressures tried and the results?
Although there's no real good way to predict how much CPAP anyone will need, 13 cmH2O seems like a lot given the severity of your OSA.  Based on the results of the CPAP numbers and the PFTs and blood work from the pulmonologist, it may be more appropriate to use supplemental oxygen to raise you oxygen level rather than CPAP.  Why this way?  It could allow you to use a much lower CPAP pressure and be a little more tolerable.
For that matter, daytime oxygen might be good idea too, given those oxygen levels, could significantly increase your exercise tolerance and overall well-being.  You really need your oxygen level over 90%.
sleepydave

Hi Sleepy Dave,
    I said these numbers were confusing...there are 19 pages of numbers and graphs...I found another page that siaid the RDI was 19.8/hour and that the REM RDI as 29/Hour.  Another page shows a summary for Pre CPAP as
               Index time                         209.0 minutes
               Apnea & Hypopnea               69                               19.8/h
               Supine A&H                          68                              112.6/h
               Avg O2 Sat.                          87%
Question do these still indicate moderate apnea?  If so I wonder why the EENT says severe and that I also need to see a pulomary specialist which we are still trying to get a referal too.
I am not being stubborn just trying to educate myself so I can make good decisions.  I am getting upset over the delay in getting a referal to a pulmonary person as I am so TIRED.  I started my CPAP on Monday and the first night was horrible.  Tossed and turned all night, mask broke the seal every time I turned. nocked the hose off three times but I kept at it for 8.7 hrs.  Last night was better and kept the mask on for seven hours.   I will keep this up until I give this mask a fair trial.  I have a small face and it seems even thought this mask was the smallest they had on hand at the time, it seems that it is wide on the nose piece and a smidgeon to long in the nose piece.  The seal starts right below by eyelids and ends just a hair above my lip and extends to the center of each cheek.   Sorry to be such a bother but I am not feeling real good right now and tomorrow I will start calling my primary and the EENT docs again to see what the status is of that pulmonary referal request.
   Thanks for your input ...you are much appreciated.  I look forward to seeing your comments on this.
  
    Diane

Hi Diane:
When you rate the severity of sleep apnea, you're talking about a number of factors, so different parameters can have different severities:

Quote:

Mild:  An apnea-hypopnea index from 5 to 14.  An oxygen saturation of at least 86%.  Unwanted sleepiness or involuntary sleep episodes occur during activities that require little attention.  Examples include sleepiness that is likely to occur while watching television, reading, or traveling as a passenger.  Symptoms produce only minor impairment of social or occupational function.
Moderate:  An index from 15 to 30.  An oxygen saturation of 80% to 85%.  Unwanted sleepiness or involuntary sleep episodes occur during activities that require some attention.  Examples include uncontrollable sleepiness that is likely to occur while attending activities such as concerts, meetings or presentations.  Symptoms produce moderate impairment of social or occupational function.
Severe:  An index greater than 30.  An oxygen saturation of 79% or less.  Unwanted sleepiness or involuntary sleep episodes occur during activities that require more active attention.  Examples include uncontrollable sleepiness while eating, during conversation, walking, or driving.  Symptoms produce marked impairment in social or occupational function.

AHI and EDS references from:
Flemons WW. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22(5):667-89.

So, your overall AHI is moderate, but your O2 desaturation is severe, as is your supine and REM AHI.  And your level of sleepiness sounds like it could be a little more in the severe category.
Anyway, don't get too tied up by the severity category, in your case, one word to decscribe everything doesn't do it justice.

Can you get your non-supine AHI? (or if it's listed as RDI, that's fine).  Or the time that you spent on each, supine and non-supine.  You had only 1 respiratory event while you were non-supine, so there may be an opportunity there.

Try to get the CPAP titration table.  It looks like this:



Based on those results, there might be another something that can be done there, too.

Say, can you scan and post graphs?  Those can sometimes be very helpful.  If not, we'll figure it out.
sleepydave

Sorry for the delay in response to your kind reply.  No I can't post my test results on this forum, I am not computer literate enough.  Sorry!  Right now I am very discouraged by the health care systems present in this country today.  It seems the insurance companies deliberately set up roadblocks hoping you will just go away and thus not cost them any $.   My insurance demands pre author for almost everything.  My primary referred me to EENT and when the EENT wanted to send me to pulmonary, the insurance gave him the pre author. to do so but neglected to tell him that they required a chest xray and a spirometer test.  Lost time there.  Finally the EENT faxed my primary that he needed a baseline oxy level test to help facilitate getting me to pulmonary.  I stood there and watched them fax it and got a copy.  After not hearing anything for 8 days I called the primary to find out the status of that fax.  They said they never got it.  I took all my paper work over there and saw the office manager.  All he could say was that it shouldn't have happened and got his head of referrals to take care of it right away.  I had my chest xray that afternoon and my spiromter test the next day.  One place was 20 miles to the west and the other was 30 miles to the north west.  Now I have to wait at least 7 days for the chest exray results.   When they have both the primary can fax them to the EENT and then the EENT can fax them to the pulmonary place.  When pulmonary has them I can call and make an appointment.  I managed one to 3 person small offices for over 40 years and I can tell you that no documents were ever lost on my watch.  In todays litigious atmosphere, I would think that business especially the medical ones would be very careful to document everything properly but to do so that would cost them a fraction more.  In this instance I am referring to attaching a faxing confirmation to all faxes.
Ironic that the primary office manager said that just that morning he had a 2 hour meeting on just that topic.
Enough of my rant and I apologize!  But they cost me a lot of unnecessary delay,

I have had my CPAP a week today and have averaged just a little over 6 hours a night.  I feel the mask is somewhat uncomfortable as it shifts when I turn and the seal momentarily breaks and than reseals. Also I am a side and tummy sleeper but since the seal breaks I find that I try not to move at all and this is making my shoulders somewhat achy.  I will continue to use the CPAP at least until I get an answer to why my oxy levels are so low...87-89 at rest while awake.  I don't have asthma or emphysema so what else could it be?
  
Getting discouraged but sticking to it.
   Diane

Sorry for the delay in response to your kind reply.  No I can't post my test results on this forum, I am not computer literate enough.  Sorry!  Right now I am very discouraged by the health care systems present in this country today.  It seems the insurance companies deliberately set up roadblocks hoping you will just go away and thus not cost them any $.   My insurance demands pre author for almost everything.  My primary referred me to EENT and when the EENT wanted to send me to pulmonary, the insurance gave him the pre author. to do so but neglected to tell him that they required a chest xray and a spirometer test.  Lost time there.  Finally the EENT faxed my primary that he needed a baseline oxy level test to help facilitate getting me to pulmonary.  I stood there and watched them fax it and got a copy.  After not hearing anything for 8 days I called the primary to find out the status of that fax.  They said they never got it.  I took all my paper work over there and saw the office manager.  All he could say was that it shouldn't have happened and got his head of referrals to take care of it right away.  I had my chest xray that afternoon and my spiromter test the next day.  One place was 20 miles to the west and the other was 30 miles to the north west.  Now I have to wait at least 7 days for the chest exray results.   When they have both the primary can fax them to the EENT and then the EENT can fax them to the pulmonary place.  When pulmonary has them I can call and make an appointment.  I managed one to 3 person small offices for over 40 years and I can tell you that no documents were ever lost on my watch.  In todays litigious atmosphere, I would think that business especially the medical ones would be very careful to document everything properly but to do so that would cost them a fraction more.  In this instance I am referring to attaching a faxing confirmation to all faxes.
Ironic that the primary office manager said that just that morning he had a 2 hour meeting on just that topic.
Enough of my rant and I apologize!  But they cost me a lot of unnecessary delay,

I have had my CPAP a week today and have averaged just a little over 6 hours a night.  I feel the mask is somewhat uncomfortable as it shifts when I turn and the seal momentarily breaks and than reseals. Also I am a side and tummy sleeper but since the seal breaks I find that I try not to move at all and this is making my shoulders somewhat achy.  I will continue to use the CPAP at least until I get an answer to why my oxy levels are so low...87-89 at rest while awake.  I don't have asthma or emphysema so what else could it be?
  
Getting discouraged but sticking to it.
   Diane

Hi Diane:
Yeah, I'm sure that's how some insurers operate, so just be persistent and keep on them.  Don't get aggravated, that's what they want to happen.  Just nice them to death-  "Hi. I'm Diane, I know you're busy, but have there been any developments since I called an hour ago?"  Don't forget too, it's isn't the idea of the person who you're talking to on the phone, he/she has kids to feed too.
Don't know about the O2 level, gotta get those PFTs.
sleepydave



Last edited by sleepydave on Thu Oct 20, 2005 8:50 pm; edited 1 time in total

Hi All,
  Thanks to you all for replying.  I had my chest XRAY last Thurs and my and sprirometer test on last FRI.
I don't have the XRAY report yet but the spirometer test results said I do not have asthma or emphysema.
So now when my primary gets those two results he can fax them to EENT and they can fax them to the pulmonary place and THAN I can make an appointment.  At this point all I know is that my sleep study says my oxy levels were 87-89 at rest while awake.  So now I am wondering and fearful that the problem is related to the heart.  No I don't get short of breath while I am walking unless I try to hustle...but I get exhausted just from everyday activities.  I am sleeping a little better on the CPAP but not as much as I would like...about 6-7 hours a night.   Although the test came back and said I don't have asthma, I always have post nasal drip, feel exhuasted, and sometimes when I breathe I feel as if I am breathing through a cloud of fine powdery dust.  Sometimes I also will be talking and my throat will suddengly go dry to the point I am choking and gasping trying to get relief.   What a conundrum.  I wonder if this could all be just
allergies and apnea?
   Comments are always appreciated.  Thank you all so much for being here!
   God Bless!
   Diane

Hi Diane:
Hmm, that you mention spirometry means you only had "flow rates" done.  Oxygen function needs to be analyzed using "diffusion", so if you didn't get part of the test done, it might be coming.  Although the things that cause diffusional impairment might show up on the X-ray.  Stay in touch.
sleepydave

Hi
   Well I had my appointment with the pulmonary specialist and he was also a sleep doctor. The end result is he said my sleep apnea was between moderate and severe, that I had severe restless leg syndrome, that my chest xrays and spriometer test ruled out any problems with the lungs and ashtma or emphysema.  He gave me meds to take for my legs
(never knew I had that problem) and told me to be sure that I use the machine every night.
Because despite my body size I have a small face and nose the face mask wasn't working for me.  Every time I moved my lips or wiggled my nose the seals would break and I would have air blasting me in the eyes or face.  So I switched to Mirage Swift Nasal Pillows and have had no problems.  I can even sleep on my stomach!!!   He did say that my problem was probably long standing and that it would take some time before I felt a differance in energy levels.  Right now it has been only 8 days or so and I am sleeping throught the night sometimes almost 8 hours.  Mostly about 7 hours, but when I first wake up I don't want to get up...I just want to lay there and realize I have actually slept without waking!

   Is it true that if the problem has been long standing that it could take some time before I feel my energy level rising again?

   Also since using the CPAP machine my oxy levels are coming back up...1st check it was 91 and last it was 96...normal.   Hope it stays that way.  If I ever get to feeling that bad again you can bet I wll ask them to check those oxy levels.!!!

   Dave thanks so much for your input and encouragement....God Bless!
    Diane

Hi
   Well I had my appointment with the pulmonary specialist and he was also a sleep doctor. The end result is he said my sleep apnea was between moderate and severe, that I had severe restless leg syndrome, that my chest xrays and spriometer test ruled out any problems with the lungs and ashtma or emphysema.  He gave me meds to take for my legs
(never knew I had that problem) and told me to be sure that I use the machine every night.
Because despite my body size I have a small face and nose the face mask wasn't working for me.  Every time I moved my lips or wiggled my nose the seals would break and I would have air blasting me in the eyes or face.  So I switched to Mirage Swift Nasal Pillows and have had no problems.  I can even sleep on my stomach!!!   He did say that my problem was probably long standing and that it would take some time before I felt a differance in energy levels.  Right now it has been only 8 days or so and I am sleeping throught the night sometimes almost 8 hours.  Mostly about 7 hours, but when I first wake up I don't want to get up...I just want to lay there and realize I have actually slept without waking!

   Is it true that if the problem has been long standing that it could take some time before I feel my energy level rising again?

   Also since using the CPAP machine my oxy levels are coming back up...1st check it was 91 and last it was 96...normal.   Hope it stays that way.  If I ever get to feeling that bad again you can bet I wll ask them to check those oxy levels.!!!

   Dave thanks so much for your input and encouragement....God Bless!
    Diane

Hi
   Well I had my appointment with the pulmonary specialist and he was also a sleep doctor. The end result is he said my sleep apnea was between moderate and severe, that I had severe restless leg syndrome, that my chest xrays and spriometer test ruled out any problems with the lungs and ashtma or emphysema.  He gave me meds to take for my legs
(never knew I had that problem) and told me to be sure that I use the machine every night.
Because despite my body size I have a small face and nose the face mask wasn't working for me.  Every time I moved my lips or wiggled my nose the seals would break and I would have air blasting me in the eyes or face.  So I switched to Mirage Swift Nasal Pillows and have had no problems.  I can even sleep on my stomach!!!   He did say that my problem was probably long standing and that it would take some time before I felt a differance in energy levels.  Right now it has been only 8 days or so and I am sleeping throught the night sometimes almost 8 hours.  Mostly about 7 hours, but when I first wake up I don't want to get up...I just want to lay there and realize I have actually slept without waking!

   Is it true that if the problem has been long standing that it could take some time before I feel my energy level rising again?

   Also since using the CPAP machine my oxy levels are coming back up...1st check it was 91 and last it was 96...normal.   Hope it stays that way.  If I ever get to feeling that bad again you can bet I wll ask them to check those oxy levels.!!!

   Dave thanks so much for your input and encouragement....God Bless!
    Diane