My diagonstic spontaneous arousal was 108, my titration was 339.  Arousals from respiratory events was 53 and 38 respectively.   Leg movements 25 and 5.

So even if my apnea is corrected, will I continue to have spontaneous arousals?  Are mine exceptionally high?  I only slept 158 min out of 392 min for diagnostic and 267 min out of total 503 min in titration.

In asking my sleep clinic questions about the study, I am told that the information is skewed because of my short sleep time.  So how valid is my sleep study?  Why do I have so many spontaneous arousals... is this simply because I was uncomfortable in my surroundings and would not normally have these spontaneous events at home?

I realize that focusing on my spontaneous numbers may be insignificant to my sleep problem, but it is listed.  Why is it there?  What does it tell me?

Thank you.

Hi LFA:
That number of spontaneous arousals certainly qualifies as exceptionally high.  Need to see the rest of the data from both studies, as well as any pertinent medical conditions and medications in order to try to make some sense out of it.
sleepydave

Okay, Dave, here are the numbers on the page I am referencing.

Diagonstic       Therapeutic
158                 267.5          Total sleep time
41.2                54.9            S efficiency
117.5              29.5            S latency
224.5              0                 REM latency

19.3                6.9              Stage 1
79.4                91.8            S2
0                     1.3             S3
0                     0                S4
1.3                  0                REM

50.9                9.6             Total AHI                
42.9                9                Supine AHI
30                   0                REM AHI
51.2                9.6             NREM AHI

53                   38              Arousal with Resp events
25                   5                A leg movements
108                 339             A spontaneous
244                 328             Total (there is also an index with these last four, but I question      numbers since they don't add up to the total -- example shown here, the total for the diagnostic is 186 not 244???)

snoring percent was 2.5 and 0

heart rate NREM 59.3 and 54.3

lowest O2sat 81 and 95

limb movements 64 and 39

I am in excellent heath, not overweight, take nothing at all but calcium (no sleep aids for the titration obviously).  Thought I was a very good sleeper, but my husband insisted I had apnea.  I did well with the mask, my problem and reason for questioning results etc is because I have severe stomach bloating with the pap.  I have not been wearing mask because of bloating (tried different pressures and Cflex).  Don't know what to do.  I have read and posted messages about bloating, but no one has a solution.  Seeing an ENT next week.

One of my questions to my sleep professionals is 84% (50-42) and 94% (9.6-9), as shown in AHI, of my respiratory events are on my back???  Is this the way you read it?  This is when he told me the numbers are skewed because of short actual sleep time.  I began not sleeping on my back (without pap) with some success (less tired and less frequent night urination).  If you want more numbers, I'll send them.

So will Cpap cure spontaneous arousals?  What is going on?

Thanks from LFA

Hi LFA:
Say, were those nights typical of how you sleep?  Cause a sleep efficiency of poor starts with 74%, so right off the bat you'd have to darn near double your sleep to get something worthwhile.

Putting that aside for a minute though, you've got no REM in either study (1.3% almost 4 hours into the study on the diagnostic is like nil), so it's not skewed, it's inadequate.

Yeah, the arousal numbers don't add up, I don't know why that is.  That should be part of the computer analysis, I can't see how the mistake was made.

Get the CPAP titration table, and if you can, scan and post the sleep architecture graphs.

Quote:

One of my questions to my sleep professionals is 84% (50-42) and 94% (9.6-9), as shown in AHI, of my respiratory events are on my back??? Is this the way you read it? This is when he told me the numbers are skewed because of short actual sleep time. I began not sleeping on my back (without pap) with some success (less tired and less frequent night urination).

No that's OK, those are AHIs.  That means, in the first, for example, that they occur 51 times an hour during sleep in total, and 42 times per hour on your back. So oddly, there are less events on your back.  Course, with that efficiency anything's possible.

Get those things, we'll try to get a plan.
sleepydave

I don't remember ever being so tired as I was the day after titration.  I slept all day.

All my life I thought I got excellent sleep.  I fall asleep the minute my head hits the pillow, typically go to bed about 10:30, wake about 7 am.  Used to always feel great in the morning and thought age (57) was slowing me down.  Never wake in the night except once or twice to urinate (thought that was age too, until I read that physiological reaction to apnea is the cause) and then easily fall asleep again.  I never would have guessed that I had a sleep problem.  It was my husband who listened to my snoring and gasping.

So, the hypnogram shows that a large group of my respiratory events were on my stomach, another reason for the earlier question which you have already clearly explained.

Couldn't copy/paste, so sending charts via this URL: [http://photos.yahoo.com/lfa_66]

You comments are much appreciated.

Hi LFA!
OK, got the graphs.
That is one (two) terrible looking pieces of sleep architecture.
That's a tremendous amount of arousals that are independent of anything.
You've absolutely got another issue besides OSA, I just can't see chalking both nights up to the lab effect and CPAP.
BTW, if you were going to use CPAP with CFlex, just turn the CFlex up to 3.  It will be far more comfortable, and has no bearing on the actual CPAP you will receive at the critical moment of inhalation.
Yet, without solving the underlying arousal and bloating issues, CPAP's a tough sell right now.
Ambien might help you to get to sleep, but staying asleep might be a big problem.  There is a timed-released form of Ambien, tho.
Almost had something there when I saw all those leg movements on the first study, thought you could have PLMs or RLS.  But then they disappeared pretty much in the CPAP.  Any feelings of leg discomfort in the evening?
No drugs, huh, and that includes no caffeine?
Menopausal insomnia can be a very viable explanation (yeah, it's a real thing), ever consider HRT?
In the absence of any other medical issues, this is a definite see the Board-Certified Sleep Specialist kinda problem.  If neither night represents anything close to your normal sleep pattern, you really need somebody to give you the once over and say, "OK, that's lab effect, don't worry about it."  But right now the data is screaming that something else is underfoot.
Stay in touch.
sleepydave

Dave, no one here seems alarmed by my spontaneous, even though I pointed it out to them.  I had no caffiene the days of the study as instructed.  I don't drink coffee, my only source would be coke and chocolate, but I don't have these every day and ususally not in excess...  and not the days of the study.  I did do HRT for awhile, but I feel like I am past the problems there.  I do not wake with night sweats.  I have no problem with RLS.

I ususally feel comfortable in strange places like motels and sleep like a rock, but that sleep study was a real ordeal.  It seemed to me I was consciously awake all night.  I mean, I expected my wake line to be straight across the top and that I barely nodded off.  For some reason, is was a stressful event for me.  There have been aggravations associated with the whole 9 month process.  Maybe I was just tense.  Does it ususally take 9 months to get where I am at?  

Thank you again for helping with the charts.  Is there anyway to do at least a partial sleep study in your own bed?

LFA

Hi LFA!
Sure, you could get a home study, just make sure they do the EEG signals, and tell them you're interested in sleep staging and arousals.  Quality in home studies can be marginal at best, so you have to be careful there.  Perhaps this would be a good exception to the "Lab Only" rule.

But see, when you're having a "miserable" night, like you might get in a lab effect, it will typically have a lot of awakenings (greater than 15 seconds) and time spent wake (minutes to hours).  An arousal occurs when you are jostled from sleep in little 3 to 14 second bursts, then you fall back to sleep.  And even "spontaneous" arousals have a cause.

But could you have a night that bad and chalk it up to lab effect?  Sure.  But textbook normal the next night?  Probably not.  And it's just that leaving 300+ arousals on the table is real tough to just walk away from.
sleepydave

So, Dave, "even spontaneous arousals have a cause."  What might that cause be?  

I gather from your responses that a high number of spontaneous arousals is uncommon in sleep apnea studies???  I also gather that you would expect some underlying health problem.

I guess I am just saying, if this has been documented, what caused it before?

LFA

Hi LFA:

Quote:

What might that cause be?

Well, that's the million dollar question.

And I sure wish I had the answer.

GERD?  Hyperthyroid?  CPAP intolerance?  Technician scoring error?

Again, another opinion might not be a bad idea.  I think 300 arousals ARE a concern.  If it was lab effect, fine.  But somebody has to really call that.
sleepydave

Your suggestions have been a great help.  Nothing is worse than getting brushed aside by the people who are there to help you.  I will certainly follow up on all of the things I am learning.  

I saw the ENT.  He does not recommend surgery (a relief to me) or oral appliance.  He told me that the air pressure would not damage my esophagus, a concern of mine.  I've gotten a few ideas I can try on my own as far as my original problem with pap and extreme bloating.  I have not been using the Cpap, but will begin again and document each night.  

I will consult with my family practice doctor about my sleep study results.  The only thing I can think about your spontaneous comment of being jostled from sleep in many short bursts is that it may be the opposite...  that  I am fighting to stay awake and nodding off hundreds of times in short bursts.  Crazy maybe, but for reasons beyond my control, I was obviously fighting sleep at the clinic.  As you said, we need to sort that all out.  I hope I will have some solutions to report in the near future.  

Best wishes and many thanks, LFA