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First Sleep Study...finally! - rested gal
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Post First Sleep Study...finally! - rested gal 
By October 2005, I had chalked up two years of having self-diagnosed and self-treated myself with autopap, software, and the help of the apnea message boards.  My background story is here: Aug 16, 2005  "sleep or lack thereof"

Two years of "treatment" and I had never had a formal PSG study -- not even an at-home study, except some simple ones I devised for myself:

1. trying an occasional night with machine pressure set as low as possible (4 cm H20) to see what my AHI would be at a virtually non-therapeutic pressure.  Every autopap I used generally came up with an AHI of 7-9 at the minimum pressure tests.

2. trying several nights with a borrowed recording pulse oximeter, both with and without my autopap -- coming up with:
No cpap for a 6 hour session:  brief dip to 83%, average 93%
With cpap for an 8 hour session: lowest dip 93%, average 96%

Ever since I embarked on treating myself for what I felt sure was mild OSA, I've wanted to have a real sleep study.  Got my wish when none other than sleepydave himself told me the hospital based accredited sleep lab he manages would be moving into a new wing of the hospital and would be testing their equipment for several days immediately after the move before patients would be scheduled again.  If I could be there Oct 17 - 19, I could be the lab rat wired-up for verification of equipment.  Could I be there?  Took me about one second to decide.  Yes!!!  Thank you, thank you, Dave!

The PSG study was fun!  Yeah, I know...."fun" is not a word often used to describe going through a sleep study.  I had the advantage of two years worth of reading the apnea message boards about people's experiences with sleep studies, plus already had my own mask and my own equipment comfort issues fully resolved.  There'd be no tight-strapped leaky mask or chin strap on this gal!  LOL!!

I'd read that most people take their PJ's, slippers, a robe, a few toiletry items and maybe their pillow to a study.

Hah!  With all my supplies in tow, I looked like I was moving in for a month rather than three nights of PSG studies!

1. my own mask - Aeiomed's "Headrest" nasal pillows interface, formerly called the "Aura".

2. my own headgear for said mask. (Hint...the homemade straps were red and green.)
Picture of my mask/headgear.

3. Adhesive tape/scissors.  Yes, indeedy.  I taped my mouth for the titration night, just as I usually do...to control mouth air air leaks. Probably the only person who will ever be videotaped in that lab with mouth taped securely shut.  LOL!!

4. my PAPillow.

5. my Aussie heated hose.

6. ponytail scrunchy for hanging the airhose - had to tape it to the brandnew headboard (shhh, don't tell Dave... maybe he thought the gummy adhesive residue was left from a price sticker on the new headboards! lol)   I'd have taped the box the wires go into up there, too, if I hadn't been afraid it might fall on me.  

7. my 420E autopap -- for use on the third night to see how it compared with simultaneous PSG data.  Dave and I still have a few minor (lol) differences of opinion on autopap performance. I think sabotage was involved!  Wink

8. several 10 mg Ambien - even though I've never had difficulty going to sleep or going back to sleep if I happen to wake up... and, I've never taken a sleep aid in my life, not even a Tylenol PM, Benadryl or melatonin, I knew I'd be like a kid at Christmas! The excitement of finally getting a real sleep study.  I sure didn't want to botch my big chance, so I went prepared "just in case."  As you'll see on the titration night report, I did have some difficulty maintaining sleep during the last half of the night.  Kid at Christmas!!

Man, were those brand new full size beds comfy.  I slept well.  Smile   Tried out almost all of them before the visit was over.  Like Goldilocks, I slept in a different room each of the three nights.   Each beautifully decorated room had a big tiled private bathroom.  Individual temperature control in each room.  It was a four bed lab.  State of the art. If a person can't sleep there, they realllllly have a problem.

All the techs who were working while I was there were wonderful -- made me feel very welcome and answered every question I had.  They also had great personalities...fun people who obviously love their work.  Despite still being in the midst of a complicated equipment move and having to drop everything for several hours each evening to play host/hostesses to a steady parade of VIP's (doctors and donors visiting the newly opened wings) Dave and the techs never seemed harried.  Nor the least bit perturbed that here was this extra person adding to the workload in the middle of the move.  I noticed they were beginning to get dark circles under their eyes as the week days went on, but they were professionals all the way - doing their jobs perfectly.

I thoroughly enjoyed being wired up three nights in a row and getting to see the full results the very next day.  Dave is a great teacher. Sleep is fascinating stuff.  It still all looks like squiggles to me, but when someone who is top notch at this is explaining it to you right there on the screen, it becomes more interesting...especially when it's your own squiggles.  Wink

Speaking of squiggles -- something the PSG turned up that no machine (cpap, autopap, bi-level) could have ever told me is that I have PLMs (periodic limb movement.)  I'll leave that to Dave to explain better than I can.  Those ornery things can disrupt sleep, and apparently do for me quite a bit of the time without my being aware of them happening.  Since I feel very well rested every morning, however, (and don't have medical insurance to pay for prescription meds) I'll ignore them for the time being.  However, I'm very glad to have had the study which is the only way the PLM problem would have been discovered.  If ever I start feeling less than well rested in the future, I'll know that there's a possibility it might be due to the PLMs; not simply a failure of cpap treatment, and can address the PLMs then.

The PSG also revealed the arousals that fragment sleep.  It provided a look at the sleep architecture.   Toted up an RDI.   Gave detailed  information no cpap machine can give.  Gotta have all  those wires attached to see the big picture.  And gotta have people who know what they're doing collecting the data, scoring it, interpreting it.    

The reports from all three nights (and some pictures) are here:

study-Oct2005 Laura (rested gal)

sleepydave, you're a "good'un!" Thank you again for such a wonderful opportunity to find out what a well run sleep study and a well equipped sleep lab are all about.  Not to mention learning more about my own sleep from a genuine expert.



Last edited by rested gal on Sat Nov 19, 2005 1:22 am; edited 1 time in total

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Awesome Laura...thanks for sharing.  The pictures and documents were a great touch.  It's always nice to see the people that you talk to online.


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Dave

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Laura,

Thanks for sharing your experience. Looks like you got a great study and had fun doing it. Wish we could clone sleepydave.   Smile

SnoozeHunter


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I'll 2nd that.  A sleepydave in every sleep lab in the country!  Imagine that.  Applause

Laura, glad to hear you had such a great experience!

Linda (roseinpa57)


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Post Re:First Sleep Study...finally! - rested gal 
Very interesting post, RG.
I had my sleep study in December of 2004 and didn't know all that went on in the background.

I praticularly like the Auburn University avatars you included.
As you some of and the others may know, I'm an Auburn fan !!!!!

WAR EAGLE !!!!!!!!!1


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Harold

Until later, stay safe, be nice, sleep well and keep on papin'

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Wow, r.g.!!!!!  Such great information!  I never thought I'd enjoy pouring over 3 nights worth of sleep study results.  Then again, you probably never thought you'd be as excited as a kid at Christmas being wired up for 3 nights either!

This confirms my belief in the accuracy of APAPs (ignoring the inexplicable 420e anomaly), but also serves as a reminder that nothing can take the place of a PSG when done by competent staff for getting the WHOLE picture.  If only everyone could be guaranteed their study would be conducted by such a competent staff....

Good stuff!!!  Thanks for sharing!


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neversleeps wrote:

This confirms my belief in the accuracy of APAPs (ignoring the inexplicable 420e anomoly), but also serves as a reminder that nothing can take the place of a PSG when done by competent staff for getting the WHOLE picture.  If only everyone could be guaranteed their study would be conducted by such a competent staff....


You summed up my feelings exactly, neversleeps.   Incidentally, there are two things I can think of that might account for my 420E's behavior at the lab.  One is the possibility that the make-shift Argyle "sensor tube" was kinked or pinched in the main air hose that night.  After getting home, I pulled the Argyle hose completely out of the main air hose,  intending to discard the Argyle.  Later decided to try it one more time, so crammed the Argyle back down through the main air hose and had my usual good results at home from then on.  Perhaps it went through straighter the second time.  I'm still using the Argyle tube as the sensor line with no problem.  

Also,  I have to run my 420E with IFL1 turned off.  Normally people use that autopap with both defaults "on" (IFL1 and IFL2 both on.)  My keeping IFL1  "off" blinds my autopap to some things.
Another poster (-SWS) wrote once, on page 2 of this thread on the TAS board Apr 10 2005  subject: A question (or two if I can remember) about the PBG 420E:

IFL1 is the trigger for flow runs without amplitude decrease
IFL2 is the trigger for flow runs with amplitude decrease

"Amplitude decrease" is synonymous with "hypopnea"

IFL1 is thus the trigger for runs or sequences of isolated flow limitations
IFL2 is the trigger for flow runs that occur simultaneously with hypopneas
(with the above each having a dedicated algorithmic pressure response routine)


Possibly sleepydave will post some PSG graphs from that third night, showing my machine's lack of response to some of the airflow changes.

SnoozeHunter said:  "Wish we could clone sleepydave.  Smile  "
I agree!  Absolutely!

roseinpa57 said: "I'll 2nd that. A sleepydave in every sleep lab in the country! Imagine that.  Applause  "
I'll 3rd that!

KurryKid, yes, it was great fun getting to meet sleepydave and share (with his modestly reluctant permission) pictures from the trip.

Tenpin,  getting to see some of the behind-the-scenes activity was a wonderful experience.  I keep using the word "fun"... 'cuz that's what it was, as well as being a professionally run study.


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So you got to see what all the fun is about! Its not too bad to be hooked up to all the wires when you realize how much information they generate that helps them figure out what is really going on in our sleep. I didn't look too close at your results, but did being on CPAP help the PLMD any?


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christine wrote:
I didn't look too close at your results, but did being on CPAP help the PLMD any?


Nope.

PLM Events With Arousals Index
1st night (no cpap) -  6.4
2nd night (lab titration) - 9.1
3rd night (autopap) - 8.3

If more nights had been done, I'd guess those numbers could have kept changing around, depending on the sleep architecture of any particular night, machine or no machine.

Luckily, the PLMs with arousals don't seem to interfere with my overall sleep...don't leave me feeling tired or sleepy the next day.  Had it not been for this sleep study, I'd never have known there was any potential sleep-fragmenter going on at all.  Good to know for future reference if I ever have daytime sleepiness problems even though the OSA is being well treated.

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