I have been through 2 sleep study cycles. The first diagnosis, 5 years ago, was mild/mod OAS. The CPAP titration study that followed was a disaster..couldnt sleep at all. I never heard from the Dr after any of this so I chalked it up to sleep studies being a good revenue source for Dr's in need of a patient. Daytime sleepiness and other symptoms were never too bad. Age 55, BMI 26, neck size14.5, father diagnosed with OAS

My GP recommended another try at a different sleep center though symptoms remain fairly modest (modest daytime sleepiness, snoring & gasping at night etc). Results are back and I am trying harder to understand the implications & results this time.

Sleep Architecture:
Sleep efficiency 63% (241min TST/385min TBT)
Sleep latency 23Min
REM latency 111 min
Arousal index 16.6 –( 13.1 spontaneous, 2.5 RERA, 1 Resp event related)
25 awakenings
Sleep Stage
N1 17.2%
N2  56.5%
N3 .4%
REM 25.9%

Respiratory
AHI index 12.7/hr – (14 CA’s. 0 MA’s,8 OA’s, 29 hypop’s)
AH (45 REM/1.3 non REM, 15.8 Supine/0 non supine , 45.1 Supine REM

Oximetry  - desaturations were cyclic and associate with respiratory events
Wake 94%
Nrem 92%
REM 91%
Min 86%
<88% - 2.7%

EKG Normal sinus rhythm, EEG OK, Limb movement Index -0

Given 1 experience with CPAP I doubt my motivation to work through the transition and have started to use positional therapy given the lack of issues in non supine sleep. So far this seems to be somewhat successful; (as least as fare as I can tell). Is there anything in the test results that would invalidate my approach to try the least disruptive solutions first before going to the universal CPAP solution which this new Dr is recommending? Though study samples are small, mild apnea & small neck size appear to respond well to positional therapy. However, if long term health absolutely requires it…Ill figure out how to deal with CPAP

This is a complex mosaic of information and I would ceratinly appreciate your time, knowlege, insight & perspective.

Thanks

Quote:

I have been through 2 sleep study cycles. The first diagnosis, 5 years ago, was mild/mod OAS. The CPAP titration study that followed was a disaster..couldnt sleep at all. I never heard from the Dr after any of this so I chalked it up to sleep studies being a good revenue source for Dr's in need of a patient. Daytime sleepiness and other symptoms were never too bad. Age 55, BMI 26, neck size14.5, father diagnosed with OAS

Your statement 'Daytime sleepiness and other symptoms were never too bad.' is a common enough one.............then why on earth did you have the sleep study ? There must have been something going on ? Don't take this the wrong way.........it is a common statement from OSA sufferers who are not convinced that they have a problem. I know that I have said similar things in the past.

Quote:

My GP recommended another try at a different sleep center though symptoms remain fairly modest (modest daytime sleepiness, snoring & gasping at night etc). Results are back and I am trying harder to understand the implications & results this time.

Again, your GP recommended a study for some reason or other.........5 years down the line.
What is 'modest daytime sleepiness' ?..........At age 55 you should not have any daytime sleepiness (under normal work conditions), unless of course you have a problem.
Snoring and gasping can be translated to 'suffocating'.
It is good that you are now starting to look sderiously at the condition.

Quote:

Sleep Architecture:
Sleep efficiency 63% (241min TST/385min TBT)
Sleep latency 23Min
REM latency 111 min

Sleep efficiency is not good, but that is often the case during a sleep study. Sleeping with glued wires and sensors can be difficult.
Your REM latency is slightly extended, but not too bad. It's usually about 90 minutes. Nothing too serious.

Quote:

Arousal index 16.6 –( 13.1 spontaneous, 2.5 RERA, 1 Resp event related)
25 awakenings
Sleep Stage
N1 17.2%
N2  56.5%
N3 .4%
REM 25.9%

N1 is usually 5%
N2 is usually 55%
N3 is usually 20%
REM is usually 20%
These are average percentages, in a perfect world......always room for a little difference.

Your N3 sleep is very poor, and this alone would account for your Daytime Sleepiness. With the exception of Stage N1, the remainder are close enough (REM is a little extended).

Quote:

Respiratory
AHI index 12.7/hr – (14 CA’s. 0 MA’s,8 OA’s, 29 hypop’s)
AH (45 REM/1.3 non REM, 15.8 Supine/0 non supine , 45.1 Supine REM

Predominately in the supine position.

Quote:

Oximetry  - desaturations were cyclic and associate with respiratory events
Wake 94%
Nrem 92%
REM 91%
Min 86%
<88% - 2.7%

Your desats at awake are quite low...........do you have any other respiratory or cardiac conditions ?
Relative to your AHI, IMHO your desats are not great, particularly for any time spent below 90%.

Quote:

EKG Normal sinus rhythm, EEG OK, Limb movement Index -0
Given 1 experience with CPAP I doubt my motivation to work through the transition and have started to use positional therapy given the lack of issues in non supine sleep. So far this seems to be somewhat successful; (as least as fare as I can tell). Is there anything in the test results that would invalidate my approach to try the least disruptive solutions first before going to the universal CPAP solution which this new Dr is recommending? Though study samples are small, mild apnea & small neck size appear to respond well to positional therapy. However, if long term health absolutely requires it…Ill figure out how to deal with CPAP

 
I would be concerned about your lack of Stage N3 (Delta Wave) Sleep. I have little doubt that this is the cause of your Daytime Sleepiness.
Taking your age and low cO2 sats into consideration I think it more important to get the condition under control ASAP and get your sleep architecture sorted, than to experiment with positional therapy. Granted, as your events occur predominately in the supine position it may help, but what about sleep architecture and O2 sats.

I appreciate you have had difficulties with cpap in the past, but it is the most effective way to control things.
Once under control, it is easier to look at alternatives.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)

Thanks for your thoughts on this. To adress your question:

Quote:

Your statement 'Daytime sleepiness and other symptoms were never too bad.' is a common enough one.............then why on earth did you have the sleep study

Your response suggests all "OSA sufferers" are in denial of their symptoms. As I said my symptoms did not seem sufficient to warrant this testing however my GP included hypertension, heart failure, stroke etc as possible long term consequences. So it was the implications of the potential consequences not the severity of symptoms that prompted me to have the study. [/quote]

fastgreen wrote:

Thanks for your thoughts on this. To adress your question:

Quote:

Your statement 'Daytime sleepiness and other symptoms were never too bad.' is a common enough one.............then why on earth did you have the sleep study

Your response suggests all "OSA sufferers" are in denial of their symptoms. As I said my symptoms did not seem sufficient to warrant this testing however my GP included hypertension, heart failure, stroke etc as possible long term consequences. So it was the implications of the potential consequences not the severity of symptoms that prompted me to have the study.

[/quote]

No not all sufferers, but a good number. Usually when posters mention daytime sleepiness, whether significant or not, it calls for a question........how does it really effect you ? Many sufferers suspect that tiredness is an age factor, wheras it is often down to the untreated condition.

The fact that you had symptoms is sufficient reason to have them investigated. Your GP was obviously sifficiently concerned to suggest the sleep study and threw in some of the potential consequences as leverage to persuade you. High fives to your GP, he seems to be a good one.

Daniel.


_________________
The untreated Sleep Apnoea sufferer died quietly in his sleep.......
Unlike his three passengers who died screaming !!!!!!

(Anon)