Thanks everyone for posting your sleep study results and thank you to those who have taken your time to comment and answer questions. I have found them to be very helpful in understanding this affliction and hoped I could get some input on my situation from you.
I was diagnosed with severe OSA in 1996 after being told I snored and stopped breathing for very long periods while sleeping. The sore throats were horrible then (felt like a blowtorch had been in my throat) but I had no other SA symptoms that I was aware of. I didn’t even know what SA was. The ENT did a septoplasty and turbinectomy for sinus problems and then I had a split night sleep study. I don’t know what the test results were but he diagnosed severe OSA and prescribed a ResMed Sullivan V Elite CPAP set at 6cwp. Over the years I found if I didn’t use the CPAP, the next day I had the burning sore throat back with skull splitting headaches that took days to get over.
In June 2008 when I finally realized that SA might be the reason I was having great difficulty functioning again even with the CPAP, I had another sleep study done.
Here are the results without CPAP:
Male age 51 5’10” 260lbs Neck 18”.
Sleep Time Statistics:
TIB = 416 min TST = 284 min
Sleep Disruption Event:
Arousals = 100 Awakenings = 10 Sleep Efficiency 68.3% No PLM’s
Sleep Stage Statistics:
Stage 1 = 4.2 Stage 2 = 72.5 Stage 3 = 9.0 Stage 4 = 0 REM = 14.3 (% to TST)
Latency to: Stage 1 = 40 Stage 2 = 2 Stage 3 = 285 Stage 4 N/A REM = 78 (mins)
Respiratory Events:
Obstructive Apneas = 44 Hypopneas = 105 Centrals = 0 Mixed = 0 RERAs = 0
Longest Event = 62.3 sec
AHI = 31 RDI = 31 REM/AHI = 31 REM/RDI = 31
EKG Summary:
AVG Heart Rate: Wake = 77.4 BPM Sleep = 84.3 BPM
Heart Rate: Sleep Min = 66.0 BPM Sleep Max = 90 BPM
Oximetry Statistics:
Mean SAO2: Wake = 96% Sleep = 95% Min SAO2 Sleep = 87%
SAO2 Intervals:
>89%    Wake = 88.5% Non-REM = 99.6% REM = 98.8%
80-89% Wake = 0.1% Non-REM = 0.4% REM = 1.2%
Interpretation:
Severe OSA, mild oxygen desaturation, severe snoring, Impairment in sleep architecture.
Disposition:
Recommend CPAP, Other options should include ENT surgery, somnoplasty and dental devices.
Impairment in sleep architecture is related to the first night effect and to the sleep apnea and should improve with treatment.
In July 2008 I had a Sleep Study with Titration with the following results:
Sleep Time Statistics:
TIB = 400 min TST = 357 min
Sleep Disruption Event:
Arousals = 30 Awakenings = 7 Sleep Efficiency 89.2% No PLM’s
Sleep Stage Statistics:
Stage 1 = 5.3 Stage 2 = 75.6 Stage 3 = 0 Stage 4 = 0 REM = 18.9 (% to TST)
Latency to: Stage 1 = 8 Stage 2 = 14 Stage 3 = N/A Stage 4 N/A REM = 124 (mins)
Respiratory Events:
Obstructive Apneas = 3 Hypopneas = 31 Centrals = 0 Mixed = 0 RERAs = 0
Longest Event = 29.9 sec
AHI = 6 RDI = 6 REM/AHI = 12 REM/RDI = 12
EKG Summary:
AVG Heart Rate: Wake = 73.4 BPM Sleep = 72.1 BPM
Heart Rate: Sleep Min = 66.0 BPM Sleep Max = 80 BPM
Oximetry Statistics:
Mean SAO2: Wake = 95% Sleep = 93% Min SAO2 Sleep = 83%
SAO2 Intervals:
>89%    Wake = 99.5% Non-REM = 99.5% REM = 97.1%
80-89% Wake = 0.5% Non-REM = 0.5% REM = 2.9%
Titration Interval Statistics:
CPAP6 TST 0:43 Apnea Index = 3 AHI = 18 RDI = 18 SAO2 Min = 84%
CPAP7 TST 0:31 Apnea Index = 0 AHI = 10 RDI = 10 SAO2 Min = 90%
CPAP8 TST 2:54 Apnea Index = 0 AHI = 5 RDI = 5 SAO2 Min = 83%
CPAP10 TST 1:33 Apnea Index = 0 AHI = 0 RDI = 0 SAO2 Min = 93%
CPAP11 TST 0:14 Apnea Index = 0 AHI = 0 RDI = 0 SAO2 Min = 91%
Interpretation:
An excellent response of sleep apnea and snoring to CPAP at 10cwp
Impairment in sleep architecture with complete absence of delta sleep, otherwise everything else is normal.
Disposition:
Recommend CPAP at 10cwp
Impairment in sleep architecture is related to the first night effect and to the initiation of CPAP and should improve with stabilization of treatment.
After reading the reports, my hypoxia was much worse at 6cwp than without CPAP and the complete absence of delta sleep with CPAP has me concerned. I don’t think first night effect explains everything.  How will I know if the delta sleep improves or if there are other causes?
Can the years of hypoxia caused damage that started the tinnitus among all the other SA symptoms?
I would appreciate any comments on my sleep studies
I have an appointment with an ENT who also treats SA to diagnose the tinnitus and review the sleep studies to see if there is a connection.
Any opinions you have will be appreciated. Thanks!



Last edited by FoggyinMD on Sun Aug 03, 2008 10:34 am; edited 2 times in total

Hi there,

Mostly I wanted to say hello to a fellow Marylander (if your username is any indication).  Welcome to the forum!

I am no expert on the titration studies, so I'm sure others will chime in.  I work in only the office a sleep study center and I get confused by the titration reports, and my boss tells me that parts are averaged differently by the program.  So it may be that the sleep stage information is indicative of how you were prior to or at the beginning of them testing you with cpap pressure, similar to the first study situation.  They start you out at zero pressure or a low pressure and increase it gradually.  I'm guessing this is the situation, based on the report comments, but it's only a guess.

I'm not surprised that you need a higher pressure, however.  Hopefully that increase will help you to feel better again.


Linda

Well, first off, I'm not a medical professional, just a patient like yourself. Second, despite one night for evaluation and one night for titration we are still talking ONE night of results w/and ONE night of results w/o CPAP. We really just do NOT sleep the same every night. Stress we went thru that day, what we ate, what we drank, how well we slept the night before, what we anticipate will be going on tomorrow, the weather ......

Delta sleep is stages 3 and 4. Hell's belles, you had no stage 4 and only 9 minutes of stage 3 during your sleep evaluation!!! So what is the big deal about no stage 3 or 4 w/CPAP? You virtually had none during your evaluation. 9 minutes out of almost 5 hours of sleep? Whoop dee doo!

I would agree I don't think that first night affect had much influence on the evaluation or the titration but sleeping in a sleep lab w/all the extra wires, etc. and wanting some answers and hoping these studies will provide them is NOT the same as sleeping in a hotel w/a CPAP at a steady pressure. There is an "anticipation" w/these in-lab studies that isn't in effect in a hotel room whilst away on business or pleasure.

You know, in rare cases, CPAP can aggravate or even cause tinnitis. Something to keep in mind w/o obsessing about it. That ENT appointment for the tinnitis is a good step. It isn't surprising that your 02 desaturations were worse at 6 cms of CPAP pressure than w/o CPAP. For two reasons: the different night effect but even more likely 6 cms of pressure w/a CPAP mask on often is a bare minimum, if that, for most of us to be able to breathe comfortably and sufficiently.

Frankly, I would be MORE concerned about the Central Apneas. That was one h*ll of a whole lot of them during the evaluation and still a lot of them w/the CPAP therapy. But CPAP therapy did drastically reduce them.

I'd suggest your replacing that old Sullivan w/a new Resmed S8 II Elite w/EPR or even better yet if you can swing it w/a new Resmed S8 II Autoset. You're gonna need some time w/one of these newer fully data capable CPAPs and then, tho I'm sure you don't wanna hear this, I would want another evaluation w/my CPAP to see if it does eliminate the Centrals or reduce them to less than 5 in 6 hours of sleep. If it doesn't than you are likely a candidate for one of the bi-levels developed to treat Centrals. Usually you have to "fail" CPAP therapy before insurances will approve a bi-level or RAD.

Good luck!


_________________
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.

Ummm, you may notice that ChrohnieToo is kinda partial to the Resmed auto machines.    
Having an auto is often a good idea, though.  But regardless, it's good you had a restudy.

Yup, Linda has my number! I'm a died in the wool Resmed fan. But in all fairness, Foggy did say his current CPAP is an old Sullivan Elite which was the earlier Resmed model.

Actually, after having owned two autos, a Resmed AND a Respironics, I'm not that great a "pusher" of their benefits. Most of us w/autos end up using them in straight CPAP mode anyway. BUT, I have read where sometimes the auto can have a beneficial effect on centrals, tho its not as "proven" as w/the more technical devices.

I believe there is a PubMed abstract by Mayo Clinic on Complex Sleep Apnea .... some people refer to PubMed as MedLine. Six of one, half dozen of the other. A search there should bring up the abstract.


_________________
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.

Wow! Thank You Linda and Chronie Too for the quick  and informative responses.
Yes Linda, I live in Maryland and thanks for your well-wishes.
Chronie Too, I actually didn’t have any centrals at all. I can see that the way I wrote it can make it look that way.
Hypopneas = 31 / Centrals = 0 etc.
Since I read just about everything on the forum to date, it is my understanding that the
delta stages or slow-wave sleep, (stage 3 & 4) is when the body does the bulk of the physical repairs. That’s why I am concerned that I am not getting much of that and none with CPAP.
Normal values should be Stage 1= 5% / Stage 2 = 50-55% / Stage 3 = 10% / Stage 4 = 10% / Stage REM = 20-25%
That and the long-term hypoxia effects certainly could explain why I feel like $&*! and my “Foggy” brain. Thanks for the tip about the new CPAP. That is in the works. And I did not know that CPAP could, in rare cases cause or instigate tinnitus. I’ll be sure to tell the Doc.
I am very fortunate that they were able to reduce my AHI and RDI to 0 and keep the O2 levels up. That’s got to be a good thing.
I am curious if the new CPAP will, in time, restore the sleep architecture. What are the chances?

That I can't say. But - lessening the number of arousals should definitely improve sleep. How much .. who can say for sure? You don't know 'til you try it.

Ooops. Yeah, I see where I mis-read the Centrals during the evaluation. Moi bad. Duh. You know, what your data doesn't tell us is sleep position, neither during the evaluation nor during the titration. Most, but not all, people experience the majority of their events when supine and/or when in REM.

Yup, that's always been my understanding, Stages 3 & 4 are where we get the most restful, restorative sleep - BUT - its also been established that as we age we get less Stage 3 & 4 sleep. Of course, that does NOT mean NO Stages 3 & 4.

I really wish that RAM-Sleep would jump in here and help you out w/a more learned reading of your data! Darn it! You COULD try PMing him w/your data as you presented it above. Just copy and paste it to a PM to him. He's an RT and RPSGT and adminsters sleep evaluations and titrations in a sleep lab. Of course he's not a sleep doctor and he can't and won't Dx your problem but he can help explain your results much better than we can.


_________________
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.

Here is the position information:
Sleep Study w/o CPAP
Respiratory Events:
Total = 149 / REM = 21 / Non-Rem = 128 / Supine = 46 / Non-Supine = 103

Sleep Study Titration with CPAP
Respiratory Events:Total = 34 / REM = 13 / Non-Rem = 21 / Supine = 27 / Non-Supine = 7

Well, you certainly went against the positional sleep apnea statistics during your sleep evaluation, didn't you?


_________________
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.