First Study:

TRT: 398
TIB: 385
awakenings: 24
TST: 313
WASO: 44.5
Sleep Efficiency: 81.3%
Sleep Oncet Latency: 24.5
REM Latency: 257.5

Awake: 72min
Stage 1: 18 min / 5.8%
Stage 2: 259.5 min / 82.9%
Stage 3: 2 min / .6%
Stage 4: 0 / 0%
REM: 33.5 min / 10.7%

Arousal Index:  25.1/hr
Apneas:  3 in REM
Hyponeas: 23 in REM, 3 in Non-REM, total 26
RERAs: 3 in REM, 22 in Non-REM, total 25
AHI: Non-REM - .6, REM - 46.6, Sleep - 5.6
RDI:  Non-REM - 5.37, REM - 51.94, SLeep 10.35

Second Study with Titration:

TRT: ?
TIB: 379.5
Awakenings: ?
TST: 251.5
WASO: 128min
Sleep Efficiency: 66.3%
Sleep Onset Latency:  27.5
REM Latency:  198

Awake: ?
Stage 1: 10.5%
Stage 2: 46.5%
Stage 3: 23.9%
REM: 19.1%

Arousal index: 6.2hr
Apneas: 0
Hyponeas: 23
RERAs: 6
AHI:  5.6, except 46 during REM

These were done by 2 different labs, so their reports are different.  So I couldn't make a complete comparison.

I am not sure I am reading it right, but it doesn't look like the CPAP did much other than help me have more REM sleep.  I guess that is helpful, but what about the hyponeas, etc?

On the first study the doc said I had severe apnea.
The second study they said mild.
2 different doctors, 2 different labs, 2 different results.

I am confused.  Please help me understand.

Thanks!

Well, we do NOT sleep the same every night. How much time elapsed between the two sleep evaluations?

During your first sleep study you got very little Stage 3 and 4 (delta or slow wave sleep) which are the sleep stages wherein we get our most restful, restorative sleep. You got very little of this restful sleep. As is usual for most of us you experienced most of your "events" in REM. Those RERAs (respiratory event related arousals) were slowed/impaired breathing not quite qualifying as hypopneas but causing light arousals nonetheless.

Its interesting that your sleep efficiency was so much lower during your second study. Its not clear, you say it was done at another sleep lab but was it a second sleep evaulation or was it a titration study w/CPAP? You were still spending too much time in Stage 2 sleep which is a light sleep from which we are easily aroused. But you did get more more Stage 3 and some labs tend to combine Stage 3 and 4 sleep. Since there is no mention of Stage 4 sleep I'll assume it is a combinantion of Stage 3 and 4.

An AHI <5 is considered normal sleep for those w/o sleep problems. An AHI of 5 to 15 is considered mild sleep apnea, 15 to 30 is considered moderate sleep apnea and over 30 is considered severe sleep apnea.



Last edited by CrohnieToo on Thu Jul 17, 2008 7:12 am; edited 1 time in total
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One of the studies was on 5/23 and the other was on 7/2, so 5-6weeks apart.  

The first one was one a sleep study without any CPAP.  The second one was titration with CPAP.

Why did the first doctor diagnose me with severe sleep apnea and the second one mild?

The first one has a diagnosis of "severe snoring with severe sleep apnea during REM sleep, but minimal problems during light sleep.  No PLMS.  And moderate hypoxemia of 88%.

The second one says "mild obstructive sleep apnea with an index of 5.6 but and AHI of 46 during REM.  The patient should wear a nasal CPAP at 10cmH2O every night and during naps.

I am worried that my insurance will see the MILD and not let me have the CPAP.

It seems to me both diagnoses say the same thing, they just put it in different order.  The first one that says severe specifies that it was only during REM and otherwise was mild.  The second one says it was mild but with high during REM....same thing.

The second study was done WITH cpap as you say.  So what is shown is that you went from severe with no treatment to mild with treatment.  Thus, the insurance will see that the treatment - cpap - is working for you.

However, I would wonder why you are still having such a high amount of trouble in REM sleep.  Why didn't they use enough pressure to keep those apneas from occuring if it was a titration study and not the diagnostic study?

crossfit wrote:

The second study was done WITH cpap as you say.  So what is shown is that you went from severe with no treatment to mild with treatment.  Thus, the insurance will see that the treatment - cpap - is working for you.

However, I would wonder why you are still having such a high amount of trouble in REM sleep.  Why didn't they use enough pressure to keep those apneas from occuring if it was a titration study and not the diagnostic study?

There isnt enough information posted, regarding the titration study. The original poster should have a printout showing a breakdown of pressure settings. That sheet will indicate how many events occurred on each pressure setting. For instance, at 9cm h20, the patient may have had 10 events with 40% REM. The tech could have titrated to 10 cm h20, the breathing normalized, the events were reduced to a single event, with 20% REM and a total sleep time of 130 minutes.

Settings 5cmh20 - 9 cmh20 could have had a REM AHI of 60, whereas on 10 cmh20 it may have been under 5. We have no idea of knowing.

Overall AHIs on titration studies are worthless, IMO, unless the majority of the night is spent on one pressure setting. REM and NREM AHIs on titration studies can give a false impression of the treatment.

I will have to call and get the report from the sleep lab, because the one I got from my regular doc. didn't have it broken down...The regular doctor gave me everything that he had, so the didn't send it to him either.  

Thanks for the help.  I will post more when I have the rest of the report.