Here's what it says:

RE: Joseph Redding
Sex: Male
DOB: **/**/****
Age: 25
Height: 5-11
Weight: 240

Admitting Diagnosis: Obstructive Sleep Apnea Syndrome (OSAS) 327.3

Past Sleep History: Morning Cephalgia, Non Restorative Sleep, Snoring and Witnessed Apnea.

Medical History: Rhinitis

Mr. Redding slept 349.00 minutes out of 422.8 minutes in bed for a decreased sleep efficiency of 82.5%. The sleep latency was increased at 21.8 minutes. 6.6% of the total sleep time was spent in the supine position. Stage 1 sleep was normal at 4.4%. Stage 2 sleep was increased at 73.9%. Slow wave sleep total was absent at 0%, with stage 3 sleep absent at 0% and Stage 4 sleep absent at 0%. There were 3 REM sleep periods. REM sleep was normal at 21.6%. REM onset occurred 115.0 minutes into the study.

The overall apnea hypopnea index was moderate at 16.8 events/hr. The REM specific index was 3.2 events/hr. The supine index was 67.6 events/hr. The obstructive apnea index was 3.3 events/hr. There were 19 obstructive apneas with a mean duration of 16.6 seconds. There were 79 obstructive hypopneas with a mean duration of 25.1 seconds. Mean saturation was 96.3 with a nadir in non-REM sleep of 91.7% and in REM sleep of 94.2%. 96.7% of the study time was spent with a saturation in the 90-100% range. 0% of the study time was spent with a saturation below 90%. There were 95 arousals related to respiratory events with an index of 16.3 arousals/hour. There were 116 Spontaneous arousals noted with an index of 19.9 arousals/hour. The etiology of some of these was unclear. Snoring was mild. Mean heart rate was 69.1 bpm. Heart rate changed from 56.1 bpm
*
So that's that...I really didn't think my situation was that severe, as I really wasn't experiencing some of the severe effects of OSA that i've seen people experience on these forums. Apparently i'm pretty severe though?

I was sent to the sleep study by an ENT when I went to him about the snoring problem that my girlfriend noticed when we moved in together. When he first examined he me he remarked about how big my tonsils were. His exact words were: "OH MY GOD Your tonsils are huge!" I really thought this was going to end up being the problem, since I know alot of people with tonsil problems end up with very similar situations.

So my ENT is telling me to try a CPAP and already gave me the script for it. I'm not thrilled about it, but I know I have to try whatever I can. He told me to stick with it for a few months and if I hated it, he would talk to me about other options which I'm guessing is a UPPP.

Any thoughts? Thank you in advance.

Welcome to the forum.

If you have not already done so, I would encoourage you to review the sticky post on Sleep Study Terms in this section of the forum.

I am not a medical professional but I will try to explain the major things in htis study as best I can. Your summary indicates that you slept for roughly 5 3/4 hours and that it took you a bit longer than average to fall asleep. In evaluating sleep overall, several measures are used. One is sleep efficiency-how much time you spend sleeping once you first fall asleep. Normal is I believe around 85% or so. Your efficiency is a little low. Another measure is your sleep architecture which is the amount of time you spend in each stage of sleep. The stages are stage 1, stage 2, stage 3 & 4 (sometimes reported separately, sometimes referred to as slow wave sleep, delta sleep or deep sleep), and REM sleep. REM sleep is known to be quite important and most sources suggest that this should comprise 20 to 25% of your total sleep. This looks fine for you. Stage 3 & 4 sleep is the other area that most sources I am familiar with suggest is quitet important and these same sources seem to suggest that this is the stage of sleep when the body does most of its physical recuperation. These sources generally suggest that stage 3 & 4 sleep should make up about 20% of your total sleep. By this standard, you were short on stage 3 & 4 sleep. I will mention, however, that I know of at least 2 people who had no stage 3/4 sleep in their studies whose doctors told them that stage 3/4 sleep is not important in adults. I am not familiar with any research that supports this statement but again I am not an expert in this field so I am interested in seeing whether there is any data to support this position or not.

Another area that is looked at during a sleep study is what are called respiratory events. These are broken down into apneas (events lasting 10 seconds or longer where there is no intake of air into the lungs), hypopneas (events lasting 10 seconds or longer where there is a significant reduction of air into the lungs), and respiratory effort related arousals (usually referred to as RERAs, these are events lasting 10 seconds or longer of educed breathing-not meeting the standards for hypopnea or apnea-that lead to an arousal). Apneas and hypopneas may be classified as obstructive (meaning that there is a normal effort to breath but airflow is either blocked or restricted), central (meaning that the normal effort to breath is absent or reduced), or mixed (meaning that the event combines features of both obstructive and central events).

Overall, in evaluating respiratory events, sleep apnea is measured by the Apnea-Hypopnea Index (AHI). This is simply the number of episodes of apnea and the number of episodes of hypopnea recorded during a sleep study divided by the number of hours of recorded sleep. An AHI of under 5 is considered normal. An AHI of 5 to 15 is usually considered to represent mild sleep apnea. An AHI of 15 to 30 is considered to represent moderate sleep apnea and an AHI of 30 or more is usually considered to represent severe sleep apnea. The RDI (respiratory disturbance index is another measure similar to the AHI. The difference is that the RDI includes the number of RERAs recorded during your study (as well as the number of apneas and hypopneas, all divided by the number of hours of sleep during the study).

In your study you had 97 respiratory events (19 obstructive apneas and 79 hypopneas, RERAs are not mentionned) recorded during your full study for an overall AHI of 16.8. Your results show frankly normal sleep during REM sleep but moderate apnea during non-REM (or NREM, meaning stages 1, 2 and 3/4) sleep. This is somewhat unusual as apnea is often worse during REM and it is not usual for apnea to be a lot better during REM. It does looks your sleeping position has a big effect on your apnea as your AHI was 67.6 events an hour during the time you were sleeping on your back. It is common for apnea to be worse when you are sleeping on your back but this degree of difference is more significant than it is for most of the studies I've seen posted here.

Associated with your respiratory events you had some drop in your blood oxygen level. Your average blood oxygen level was a little over 96% which is perhaps a little on the low side but your oxygen level did drop as low as 91.7%. I suspect it really should not be below 95% in a normal healthy person. These results are a little low now but if your apnea is left untreated this should get worse over time.

Where your sleep is really messed up however is seen in the data about arousals. Arousals are abrupt transitions from a deeper stage of sleep to a shallower stage of sleep. You are having a lot of arousals and it is these arousals that are likely contributing to your lack of stage 3 & 4 sleep. It is interesting to note that you also have a significant number of spontaneous arousals (arousals not connected to respiratory events or to periodic limb movements). Some of this might be related to the sleep lab situation. I would suggest you takl a bit more with your doctor about this.

Now those are your results. You are only 25 and are probably in good health in most other ways, but both your symptoms and your health will likely continue to get worse if you leave apnea untreated. The effects of apnea on the body accumulate over time. CPAP treatment is usually considered to be the most effective treatment for moderate to severe sleep apnea. Surgery has a less reliable track record and it sounds like your ENT doctor is in agreement about CPAP being best for your individual case.

Anyway, I hope this addresses most of what you are wondering about. If you have other questions, please feel free to ask. Do keep us posted on further developments.

Best wishes,
Bill

Thanks JPB,

My girlfriend and I found out shortly before my study that my apnea is extremely side specific. She noticed that my snoring is literally non-existant if not extremely mild when i'm on my RIGHT side. It's when I'm on my LEFT side, or when I end up on my back that it's at it's worst. I fully understand why it would be worse on my back, since it seems that the supine position is generally the worst position for apnea, but the side-specific......ness is confusing    I'm basically in good health. I'm not a lightweight, but I'm not carrying excessive weight either. I'm concerned more about my tonsils since he isn't the only dr to have remarked about how "huge" they are. That's why i'm curious about the surgery option, as far as UPPP goes, but I'm aware that this isn't a place to find medical opinions.

The problem with talking more to my ENT about it is, quite frankly I'm not too fond of the guy. He's been really condescending and arrogant to me and anytime I've ever tried to talk to him about anything he kind of just rushes me through. Again, this isn't about me not complying with the CPAP method, since I know how important treating sleep apnea is. It's just that I'm noticing some vast differences between my situation and the ones I've seen since I discovered this forum, posted here and I don't really feel confident that this Dr. is giving me the proper attention. As much as i'd like to find someone else to talk to about it though, I go through stages of sleeping really horribly and really good. When I sleep horribly is when my girlfriend sleeps horribly because it's usually when I'm snoring pretty badly, so I want to get it treated asap.

Thanks again for the reply.

Joe

nimr0d44 wrote:

The problem with talking more to my ENT about it is, quite frankly I'm not too fond of the guy. He's been really condescending and arrogant to me and anytime I've ever tried to talk to him about anything he kind of just rushes me through.

DUMP HIM...and tell him why (in a letter if you are non-confrontational).   You are a customer, he is providing a service and working for you.  There are plenty of others who would love to have your business and I would let him know that.  You wouldn't let your mechanic or contractor talk to you like that, don't let him either.

Medical Arrogance is a hot button for me if you can't tell.  

Joe-
However good a doctor your ENT is, if you can't talk to him/her and/or (s)he can't listen to you then that is a doctor who cannot provide the level of care we each want, need and deserve. So even though I have a bias in favor of ENTs who recommend CPAP over surgery (as opposed to a reported fair number of ENTs who appear to recommend surgery for just about everyone), I would tend to agree with Barry. If you need help trying to find a certified sleep doctor in your area, you can try this link here: http://www.absm.org/

I do believe that the results you posted are from a summary of your sleep study and that there may be some more data in your full study that might prove to be very helpful and I would suggest that you may want to request a copy of your full sleep study (which should run 5-6 pages with charts and graphs) from your sleep doctor, ENT, or primary care doctor.

The full sleep study will show if you spent any time sleeping on your left side. I am also in the dark as to whether you have had a titration study (a study with the CPAP machine, done either as the second part of a one-night split study or as a separate study, done to determine the best pressure for your CPAP treatment). If you have had this study, it would be important to request and review these results as well.

I do think that the issue of your sleep being much worse on your left side and much better on your right warrants further discussion/follow-up.

Do keep us posted.

Best wishes,
Bill