Hi y'all,

Just picked up the results of my study. This was a PSG to check for apnea and did not check for UARS, which is what I suspect that I have (because apnea has been ruled out and I have mild craniofacial deformity [retrognathia] which tends to accompany UARS).

I'm a 45 YO female, about 5'6" and weigh about 140 lb., with a BMI of 23.4. I never feel refreshed after sleeping, am always tired, and had an Epworth Sleepiness Scale score of 13 (elevated). Rare alcohol and 1 cuppa Joe every morning.

Here are the IMPRESSION(S) and some of my notes in brackets, with the DATA to follow. Interestingly, there is no mention in the report of the parasomnias I suffered that night, including 1 episode of sleepwalking and several episodes of sleeptalking. What do you guys think -- could this be UARS?

1) Sleep architecture was only mildly impaired, with a normal sleep onset of 12.6 minutes, but a slightly decreased sleep efficiency of 85 percent due to several awakenings, the longest of which lasted almost 1/2 hour [27.8 minutes to be exact]. Otherwise, sleep continuity was reasonably good. Sleep stage distribution was notable for slightly decreased and delayed REM sleep, the cause for which was not evident.

2) A brief period of sleep-disordered breathing was seen, with a few hypopneas and obstructive apneas. However, the overall Apnea Hypopnea Index (AHI) and Respiratory Disturbance Index (RDI) were normal at 2.5 and 3.3, respectively.

The rest of the IMPRESSIONS just state that oxygenation and heart rhythm were normal and that I slept supine throughout the study and had no PLMs or other abnormal motor activity.

Now for the good stuff:

DATA

Total sleep time was 384.5 minutes, with 14 awakenings.
Sleep efficiency 84.7
Latency to sleep onset 12.6 minutes
Number of stage shifts: 50
Number of awakenings 14
Latency to REM: 207 minutes (normal 90-120 minutes)
Wake time after sleep onset 56.8 minutes

SLEEP STAGES
Stage 1 8 min. or 2.1% TST (normal 5%)
Stage 2 256 min. or 66.6% TST (normal 50%)
Stages 3 & 4 68.5 min. or 17.8% TST (normal 15-20%)
REM 52.0 min. or 13.5% TST (normal 20-25%)

AROUSALS
Apnea + Hypopnea arousals 2 or 0.3 events/hour
RERAs 5 or 0.8 events/hour
Limb movement arousals 0
Spontaneous EEG arousals 24 or 3.7 events/hour

During the recording MILD TO MODERATE SNORING was noted. The AHI was 2.5 events/hour and the RDI was 3.3 events/hour based on the following:

RESPIRATION
Central apneas 0
Obstructive apneas 6, mean duration 16.2 secs, longest 19.3 secs, index 0.9
Mixed apneas 0
Hypopneas 10, mean duration 23.5 secs, longest 35.5 secs, index 1.6
Aps & Hypops 16, mean duration 20.7 secs, longest 35.5 secs, index 2.5
RERAs 5, mean duration 21.2 secs, longest 25.1 secs, index 0.8
(RERAs include snore arousals)

REM sleep time 52.0 min., AHI 3.5, Min. SaO2% 92.5
Non-REM sleep time 332.5 min., AHI 2.3, Min. SaO2% 86.0

OXIMETRY
Mean SaO2% Wake 97.9 NREM 97.3 REM 97.2
Min. SaO2% Wake 92.5 NREM 86.0 REM 92.5
Max. SaO2% Wake 100.0 NREM 100.0 REM 100.0

No muscle movements recorded.

During the study, pulse ranged from 69.9 BPM to 113.2 BPM.

Does this look like a UARS picture to you guys?

Thanks!!!

A quick followup:  One of the top sleep docs in country agreed to take a look at my sleep study. He said that picture looks like mild apnea to him rather than UARS picture. He thinks that my study was misinterpreted and that they are underestimating the severity of my problem so suggested that I have a second study. I am going to do this at a different facility, as I wasn't impressed with the one where the first study was done.

Thanks to everyone who took the time to review my results.

I am certainly not a leading expert, but this looks normal to me. There are certainly not enough RERAs to interpret this as UARS. I will be interested to see what data he uses to get insurance to pay for CPAP treatment for a normal study. Please share everything you can about what he says. As a leading expert, he must know a lot of things that others do not!

Thanks for posting.

Will this second study be done in this top sleep doctor's lab? Or at a sleep lab he has recommended?


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

RAM_Sleep wrote:

I am certainly not a leading expert, but this looks normal to me. There are certainly not enough RERAs to interpret this as UARS. I will be interested to see what data he uses to get insurance to pay for CPAP treatment for a normal study. Please share everything you can about what he says. As a leading expert, he must know a lot of things that others do not!

Thanks for posting.

Hi RAM_Sleep,

[Your sarcasm noted. :) ]

Well he said that he did not think that I had UARS but rather a case of mild apnea.

Okay, you asked, so this is what he said (paraphrased):

*Many times these studies are misinterpreted. You sleepwalked, you snored, you had witnessed apneas and hypopneas, and you had a three clumps of time (looking at the graph on the final page, I suppose) where your oxygen levels fell. This suggests to me that you may have mild apnea. I think they are underestimating the severity of your problem.*

We then discussed my having a second study (in my city, not his), which I brought up because I already intended to do this. (There is another facility here which reportedly has better monitoring, etc.) He said that that would be a good idea and said that I could also try CPAP and see if that helps.

At any rate, I was impressed that he called me personally and so quickly after faxing it over, and I appreciated that he gave his time.

Meanwhile, I had to discuss something else with the sleep study center and during that conversation mentioned this doc's comments, so they are having another doc there review  my study. Can't hurt.

Thanks for your feedback.
Ciao.

NoCPAPPleez wrote:

RAM_Sleep wrote:

I am certainly not a leading expert, but this looks normal to me. There are certainly not enough RERAs to interpret this as UARS. I will be interested to see what data he uses to get insurance to pay for CPAP treatment for a normal study. Please share everything you can about what he says. As a leading expert, he must know a lot of things that others do not!

Thanks for posting.

Hi RAM_Sleep,

[Your sarcasm noted. :) ]

Well he said that he did not think that I had UARS but rather a case of mild apnea.

Okay, you asked, so this is what he said (paraphrased):

*Many times these studies are misinterpreted. You sleepwalked, you snored, you had witnessed apneas and hypopneas, and you had a three clumps of time (looking at the graph on the final page, I suppose) where your oxygen levels fell. This suggests to me that you may have mild apnea. I think they are underestimating the severity of your problem.*

We then discussed my having a second study (in my city, not his), which I brought up because I already intended to do this. (There is another facility here which reportedly has better monitoring, etc.) He said that that would be a good idea and said that I could also try CPAP and see if that helps.

At any rate, I was impressed that he called me personally and so quickly after faxing it over, and I appreciated that he gave his time.

Meanwhile, I had to discuss something else with the sleep study center and during that conversation mentioned this doc's comments, so they are having another doc there review  my study. Can't hurt.

Thanks for your feedback.
Ciao.

I'm sorry, I didnt mean to make it sound like I was being sarcastic. I was suggesting that I really wanted to get the details of this case. There are patients on this board that have been refused for CPAP treatment due to a low AHI, regardless of the RDI (or RERA index). I was curious as to how you would get treated because all of your indexes are within normal limits.

My first though on your report was hypoventilation syndrome. Again, im a nobody, so its not worth much, but that was my first thought. That may explain the drops in O2. Did the lab measure ETCO2 values? If not, then you may want to find a lab that will. Just a thought.

This may all come down to tech error. I hope that your new study is more conclusive.

Quote:

I never feel refreshed after sleeping, am always tired, and had an Epworth Sleepiness Scale score of 13

Out of curiosity...how many hours do you normally sleep everynight?  Are you out like a light and out for the entire night or do you wake frequently?  Do you take day time naps?  If so, do you find them refreshing at all?  Do you have Automatic Behavior...Sleep Drunkenness...Confusional Arousals?  Do you sometimes feel paralyzed upon waking?


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

Quote:

I'm sorry, I didnt mean to make it sound like I was being sarcastic. I was suggesting that I really wanted to get the details of this case. There are patients on this board that have been refused for CPAP treatment due to a low AHI, regardless of the RDI (or RERA index). I was curious as to how you would get treated because all of your indexes are within normal limits.

My first though on your report was hypoventilation syndrome. Again, im a nobody, so its not worth much, but that was my first thought. That may explain the drops in O2. Did the lab measure ETCO2 values? If not, then you may want to find a lab that will. Just a thought.

This may all come down to tech error. I hope that your new study is more conclusive.

Hi RAM,

No apology necessary. Sorry for the misinterpretation.

Hypoventilation syndrome?  That'a a new one on me. What can you tell me about it -- wait, never mind, I'll start Googling.....

*Okay, found this:

People with OHS are usually very overweight. Symptoms of OHS include:

Bluish color in the lips, fingers, toes, or skin (cyanosis)
Signs of right-side heart failure (cor pulmonale), such as swollen legs or feet, shortness of breath, or feeling tired after little effort
Reddish complexion
A short, thick neck and small airway passage in the mouth *

Well I'm certainly not overweight -- my weight is moderate/average. None of these apply except maybe the small airway passage.


No, the lab did not measure ECTO2 values. Thanks for the tip -- I will make sure that the next study includes this parameter. I want Pes monitored as well, just for good measure.

I won't enumerate all the inadequacies and committed errors that I have noticed by the facility -- suffice it to say that I am not one bit impressed with them. :)    So "tech error" certainly would fit.  

Thanks again for the info.  



Last edited by NoCPAPPleez on Sat Jul 19, 2008 12:21 am; edited 1 time in total

Mrs Rip Van Winkle wrote:

Quote:

I never feel refreshed after sleeping, am always tired, and had an Epworth Sleepiness Scale score of 13

Out of curiosity...how many hours do you normally sleep everynight?  Are you out like a light and out for the entire night or do you wake frequently?  Do you take day time naps?  If so, do you find them refreshing at all?  Do you have Automatic Behavior...Sleep Drunkenness...Confusional Arousals?  Do you sometimes feel paralyzed upon waking?

Hi Mrs. RVW,

Usually I sleep about 7 hours, 8 if I'm lucky. But I always yearn for about 12.

I zonk out and then wake up a few times that I remember -- the night of my study I remembered waking up thrice (once to the bathroom, once with the "sleepwalking," and once talking loudly) but the report says 14 awakenings. Twice in the last week I woke up with what felt like apneas (hypopneas?), then quickly went back to sleep. Never am I out for the entire night.

Naps -- Every day I am sleepy so nap if I can, always after lunch. Sometimes they are refreshing, sometimes not. (sorry -- I'm not being vague intentionally; that is the honest truth)  Many days I am so tired that I cannot function well at all -- I feel like total !@#!. "Hit by a truck" is the oft-used descriptor.

Automatic behavior -- Negative, but when severely tired I can perform necessary tasks on autopilot, and I also have moderate to severe ADD which can have an "spacey" (scatterbrained/forgetful) component
Sleep Drunkeness  -- Negative but positive in remote past
Confusional arousals -- Occasionally

Also I am plagued by strange, vivid dreams. Sometimes I wake up crying, other times yelling, sometimes hitting myself ("swatting a bee"). Lots of talking too.

The night of the study, I woke up standing at the door to the room. After a few seconds of staring at the door and the handle, I realized/remembered where I was, and I climbed back into bed. In walks the tech, and I apologized for "ripping those puppies [electrode connectors] right outta the wall." (I was supposed to ring the call bell to be disconnected before making a restroom trip, etc.)  Later when I said something about my sleepwalking, he said, "Oh but you were awake."  Technically that may have been true, but as far as I was concerned it was sleepwalking because it was not a conscious act:  (1)  The light was still off.   (2)  I'm blind as a bat and in a strange place, and my glasses were not on.   (3)  There was no destination (restroom), etc.   (4) I had no recollection of getting out of bed and walking to the door.   (5)  It was stressed to me repeatedly about the electrodes, and there is no way I would have gotten up without being disconnected first unless there was no presence of mind.

Paralyzed upon awakening -- I had this a lot in my younger years but can't remember the last time that I had this.

So there you have it. You asked some pointed questions, so my guess is that the wheels are turning.

Some additional info:  It's 0215 hours here, and I've been awake since 0150 so thought I would post.  :)

Lately I have been waking up with sore leg muscles (around the knees and at top of the thigh), and since I don't do calisthenics before bedtime I have to assume that there must be some thrashing/kicking going on. Sometimes I wake up with a vague feeling of being hot --since I'm awakening from a dead sleep and back to sleep shortly thereafter I don't even know if there is perspiration -- (no daytime hot flashes, and my doc says estrogen levels are fine) with one leg flexed at the knee (while in the supine position). In fact, this occurred the night of my sleep study, though according to their report I laid there like a statue and never moved at all.

On the same mornings I awaken with sore legs, I also have orofacial achiness in front of the ears (classic TMD site). So I have to assume that maybe there is some concomitant clenching or something going on (I do have a history of bruxism but that was about 10 to 15 years ago, and to my knowledge I'm not a grinder now). I do have diagnosed TMD (temporomandibular disorder) with anterior subluxation of the TMJ disk bilaterally as a sequela of my jaw situation (retrognathia).

During a conversation with a lady at the more professional sleep facility here in town, after describing some of this to her, the woman (who seemed very knowledgable regarding clinical stuff, although I did not inquire as to her position) said that it sounded to her as though I had more than one thing going on.

The initial study was performed at a center that only checks for apnea (they don't even perform any kind of check for UARS), and the second facility checks for all kinds of sleeping disorders (they check for UARS with temperature monitoring but do not do Pes [to revise my previous post] so that will not be an option there).

Thanks again, guys.

Even labs that are not checking specifically for UARS can still suggest it as a diagnosis. Instead of totaling up RERAs (which would be absent from the report), they would be mark the "events" as spontaneous arousals. In UARS patients, they would be showing a hundred (or more) of spontaneous arousals in many cases.

RAM_Sleep wrote:

Even labs that are not checking specifically for UARS can still suggest it as a diagnosis. Instead of totaling up RERAs (which would be absent from the report), they would be mark the "events" as spontaneous arousals. In UARS patients, they would be showing a hundred (or more) of spontaneous arousals in many cases.

I had read that an experienced doc can detect UARS without the special monitoring. But when I inquired, I was told by that facility that they had no way of checking for it. They really seem to be fixated on apnea.

Thanks for the info.

RAM_Sleep wrote:

Even labs that are not checking specifically for UARS can still suggest it as a diagnosis. Instead of totaling up RERAs (which would be absent from the report), they would be mark the "events" as spontaneous arousals. In UARS patients, they would be showing a hundred (or more) of spontaneous arousals in many cases.

Hi there...that tidbit of info is very helpfull!!  do you mean 100+ actual arousals, or per hour?......I'm glad I eavesdropped....new sleep study scheduled for next week..

embryopathy wrote:

RAM_Sleep wrote:

Even labs that are not checking specifically for UARS can still suggest it as a diagnosis. Instead of totaling up RERAs (which would be absent from the report), they would be mark the "events" as spontaneous arousals. In UARS patients, they would be showing a hundred (or more) of spontaneous arousals in many cases.

Hi there...that tidbit of info is very helpfull!!  do you mean 100+ actual arousals, or per hour?......I'm glad I eavesdropped....new sleep study scheduled for next week..

Well, if you look at the UARS research, some of it suggests that UARS candidates have 50+ arousals (albeit RERAs, or labs scoring them as spontaneous) per hour.

I found a nice graph at work last night, which I will try to find again tonight. I will post it here.