I had a sleep study earlier this year, and it went terrible. I was having a lot of insomnia issues at the time, which my doctor never addressed, so I barely slept.

Total Recording time: 485.1 mins
Total Sleep time: 179.5 mins
Sleep efficiency 37.6%

First question: is it possible to get an accurate measurement with only 2.2% rem time, and less than 3 hours sleep?

Part of the problem is that the tech. made me sleep on my back- which I've never been able to do in my entire life. Not once. I was only able to doze off for about 18 minutes during the hours that they kept me on my back.

The results came back, and the doctor gave me a CPAP machine to use, but I'm not really sure how much I need it.

I had respitory events

4.9 times an hour when I wasn't on my back (non-supine)
and 40 times an hour when I was supine

Is 5 events an hour enough to be using a CPAP? I understand that I would need it if I slept on my back, because 40 per hour is a lot, but I never do!

I've tried calling my doctor, but the only people that I was allowed to talk to (since the very first time I went in to the office!) are techs, secretaries, and once a nurse practitioner who couldn't tell me anything, just relay the message that the doctor had sent- that I should use a CPAP, based on the high number of times I had respitory events while ON MY BACK!

HELP! What should I do? What do you think of my study? Should I be using the CPAP? It's a long term and difficult commitment that I'm not sure I'm willing to do unless it really is absolutely necessary.

An AHI of less than 5 means no apnea and an AHI of greater than 30 is severe apnea.  A sleep time of 3 hours would be enough to diagnose sleep apnea.  How was the CPAP pressure titrated?  

IF the numbers are correct and your AHI really is less than 5 while you sleep on your side, AND if you can guarantee that you will not sleep on your your back, you might be able get by without CPAP.  

An overriding factor is that you need to consider is that you were sent for a sleep study for some reason; if that reason is caused by sleep apnea, it would seem that you really DO need to use a CPAP.

Hi, and Welcome-we are so glad you found us! Oh my goodness!  First YOU ARE ABSOLUTELY ENTITLED TO MEET WITH THE SLEEP DOCTOR/PRACTITIONER TO GET YOUR RESULTS!

I went to my first sleep study and never really slept-I failed as a false negative (which happens in 50% of the cases).  My second study confirmed positive after just 2 hours! I was on the mask!  They gave to me a sleeping pill to help me fall asleep for the study.

In response to your first question-I am not the authority on this, but I would think you should have had a split study, which is testing a full 8 hours.  

Although, they need to see how you sleep in all positions, I am not sure why the tech would make you sleep on your back.  Did you tell them how you typically sleep?

I would insist that you need to speak with the SLEEP DOCTOR to discuss your results.  Sleep apnea is serious, and requires careful follow-up and a plan of care.  

What machine and set-up did they give to you-is it a mask or nasal pillows?  
What is your pressure setting?
Did you get a copy of your records? you can and need to request a copy of your records.

Keep us posted-we want to help you and support you. Lantern4life

My machine is a Sleepstyle600- it has a heater/humidifier, and I got a full face mask (mirage Quattro) because I always end up sleeping with my mouth open. The setting is 7. It was a tough experience to try to get used to sleeping with it- in fact, I abandoned trying after about two weeks of pulling it off in after a couple of hours each night... always because I was too worried about sacrificing the sleep I could get and ruining the next day.

I know I could get myself used to it with time, support, and commitment, but I just really want to know that it's necessary and will be good for me. Its really hard to commit yourself to something difficult if you're not sure of the benefits.

heydello,
I am not sure about the reasoning for making you sleep on your back during your study but I was told to do that, too. After lying there for what seemed like forever, I just rolled over onto my side and went to sleep.  My apneas were severe on my side so I guess I might have set off some alarms if I had been able to sleep on my back!  Actually, when I had my hips replaced (six weeks apart) before I was diagnosed I had to sleep on my back and I woke myself up snoring all the time.   I am wondering why you did the sleep study if you were not willing to follow through with the treatment prescribed after you were diagnosed?  I agree with Bearded One in that you must have been referred for the study for symptoms that you had. Anyway, if you can't get your doctor to talk to you, you need to get a copy of the study, the whole thing, not just the summary, and see another doctor. Sleep apnea is serious and you do need to get some answers to your questions from the doctor who diagnosed you. If he or she isn't willing to meet with you, then find a doctor who will.  I hope things work out for you.
Grandma


_________________
ResMed Quattro Full Face Mask
ResMed S8 Escape with heated humidifier
Pressure set at 11

Grandma, it's not that I'm not willing to use my CPAP to rid my life of fatigue. Maybe getting used to sleep with the machine is easier for some people, but it's pretty tough for me, and I think I have a right to know if it will actually help if I have only a few episodes an hour.

I was just hoping that some of the knowledgable people here would be able to tell me what they know about my study results.

I think understanding is really important finding out what I need to improve my quality of life.

heydello wrote:

Grandma, it's not that I'm not willing to use my CPAP to rid my life of fatigue. Maybe getting used to sleep with the machine is easier for some people, but it's pretty tough for me, and I think I have a right to know if it will actually help if I have only a few episodes an hour.

I was just hoping that some of the knowledgable people here would be able to tell me what they know about my study results.

I think understanding is really important finding out what I need to improve my quality of life.

Replying to this and your first message.

Normally, the lab wants a total of 30 respiratory events in a matter of 2 hours SLEEP time. Some labs are getting away for the 2 hour sleep time criteria because it appears that Medicare has abolished that in some states. The new protocol, if it hasnt changed yet in your area, will be 2 hours of bed time. The minute you hit 30 events, the lab can go ahead and begin titrating (so long as you have the 2+ hours spent in bed).

The supine trial. Well, this isnt mandatory at all labs, but it is important. The supine position is the position, generally, that will yield the most respiratory events (apneas, hypopneas). The physicians usually are under the mindset that if the CPAP can aide breathing in the supine position, then all of the other positions are covered. Plus, many patients state that they do not sleep on their backs, but at some point during the night they slide over onto their back. Most times they will have an event, which wakes them up long enough to get back over on their side. Some of those people arent sleeping on their back because they cant breathe, not because they arent used to it.

So, looking over your study:

You probably didnt have enough sleep time for the tech to split your study. 180 minutes over the course of a night is markedly low, but not out of the ordinary. Insomnia sufferers are used to this.

Does it appear that you need Cpap? Yes, however if you refuse then it is very important to sleep in the non-supine position. You are borderline OSA overall, but the physicians in my office would send you back due to your REM AHI alone. Plus you had little REM in the first place, so your stats are padded, somewhat.

When the physician ordered a CPAP machine, what pressure did he set you up on? It doesnt sound like you were titrated, so is he taking a guess at what pressure you needed?

Heydello, you need to get a copy of your sleep study, including the consolidated graphs.

Frances wrote:

Heydello, you need to get a copy of your sleep study, including the consolidated graphs.

I dont agree. While it would be more informative, you have the bare bones data listed above. In addition, the physician recommended that you use a CPAP machine, so he must feel that you are in need. I would continue trying to get him to sit down with you and go over the data.

40 events per hour (supine) and 5 events per hour (lateral)

3 hours sleep time.

Again, 30 events is the magic number with 2+ hours of sleep. Enough said. There are alot of details that will indicate the true severity, but diagnosis can be made that quickly.

Finally, you had all of those events without many minutes of REM. Add REM in there and your AHI is likely to grow.

I do have a copy of all of the records of that first study- everything they had in my file, which only accounts for three pages, one of them graphs.

Would any of the stats help you understand my study better?

RAM- I actually did have a second study when I was on the CPAP all night, and they evaluated me as best using a level 7.
I understand the importance of not sleeping in a supine position, and trust me, i couldn't sleep on my back if I wanted.

From what I understand , 5 events per hour is really very borderline... do you think its just a matter of the doctors opinion of whether or not I should use the machine (once he reevaluates the study knowing that supine sleep is impossible for me)?

heydello wrote:

I do have a copy of all of the records of that first study- everything they had in my file, which only accounts for three pages, one of them graphs.

Would any of the stats help you understand my study better?

RAM- I actually did have a second study when I was on the CPAP all night, and they evaluated me as best using a level 7.
I understand the importance of not sleeping in a supine position, and trust me, i couldn't sleep on my back if I wanted.

From what I understand , 5 events per hour is really very borderline... do you think its just a matter of the doctors opinion of whether or not I should use the machine (once he reevaluates the study knowing that supine sleep is impossible for me)?

Did you post the results of the CPAP titration study, where 7cm h20 was indicated? Were you on your back for the second study? If not, then we may be getting somewhere.

Yes, an AHI of 5 is very borderline, so long as you arent having long apneas (either central or obstructive) all night long. If the tech noted that supine trial was not tolerated by patient, he may have not written you a script for CPAP. Its tough. All physicians are different and they all have their own way of doing things. I cant speak for him, but if my feet were to the fire and I HAD to guess: Id say that clinically, based on the data that he was shown, you need to have CPAP.

5 is borderline for your first study, but consider that you only displayed 2.2% REM. Had you had the normal 20%, then your AHI may have been higher, further into the MILD classification, possibly higher. At an AHI of 5 he was covered to get you back for a titration and seeing that they bumped you to 7 leads me to believe that CPAP can certainly help you.

The first study is wacky because of the little REM sleep, so its not a good indication, however thats all that we have. If I can ask, what was your low O2 for the first study?

Yes, I was on my back for the first half of the night on the second study, but they let me move onto my side earlier than they had for the first study. They kept waking me to move onto my back- I'm assuming because they wanted to test the CPAP's effect at different levels on supine sleep.

And I can't be sure that my doctor was ever told that I couldn't sleep on my back. Although I complained to techs and secretaries, I never thought to ask if the doctor was ever informed.
My mean SaO2 was 96.9%
it ranged from 91.0% to 99%
lowest desaturation 91.5%
% sleep time > 90%= 98.8%

heydello wrote:

Yes, I was on my back for the first half of the night on the second study, but they let me move onto my side earlier than they had for the first study. They kept waking me to move onto my back- I'm assuming because they wanted to test the CPAP's effect at different levels on supine sleep.

And I can't be sure that my doctor was ever told that I couldn't sleep on my back. Although I complained to techs and secretaries, I never thought to ask if the doctor was ever informed.
My mean SaO2 was 96.9%
it ranged from 91.0% to 99%
lowest desaturation 91.5%
% sleep time > 90%= 98.8%

Your lowest desat from the first study was 91.5%? Probably due to the low time spent in REM, but its just a guess.

Talk with your doctor, if you possibly can. The problem might be that you wont be able to speak to the doctor who read the study, only the doctor that you normally see. Hopefully, its the same guy.

There should be a note in your report that says that supine trial was not well tolerated, or something to that effect. If not, then you may have to assume that there was no notation.

You just might be one of those individuals who can just sleep on their side. Im NOT telling you to do that. It has to be your choice. Keep trying to get a hold of someone who wants to take the responsibility in telling you to stick on your side. If that makes sense.

well, I was able to leave a message for my doctor's MA, hoping that she'll be able to get him to look at my files again. The secretary sounded optimistic that this would work, so here goes nothing!

I'll keep you posted when I hear back from them.