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Sleep Study results - need help
I'm new to this forum, referred by a Daily Strength friend.
I had a sleep study done a couple of months ago and then the titrate, picked up my machine two weeks ago today. From the onset, I woke feeling extremely horrible - not just as bad or a little worse, but significantly worse. I woke in what felt like a stupor (like I was drunk or blood sugar severe drop); I was nauseated, and the fatigue was 10 times worse than it had been prior to trying to use the machine. I used the machine six days - and wasn't getting anywhere with getting the technician out to Rockford (from Chicago) to bring a chin strap, although I told her I am a mouth breather and was this why I was feeling so ill? And, she'd told me twice the machine 'probably' needed more pressure and to do it myself - but I told her there were NO instructions how to do that - so I was waiting for her to come from Chicago and I couldn't go through any more days after using that machine - in the shape I was in. By Friday night, my bp was 189/104 - I was almost on the way to the ER, but I got it to come down with some calming techniques. Now, I am not claustrophobic - that is not the issue here. I WELCOMED that machine, anticipating it would help lower my bp, help alleviate the insidious fatigue - I didn't care what I looked like! I didn't have trouble 'sleeping' - I just woke feeling so very, very ill, every single day I used it.
If someone could help me understand this report, I sure would appreciate it. I'm going to send this post by itself, because earlier, when I tried to send the attachment, it never went thru. Will send the report attachment in a different post. Here's a brief synopsis from the first page -
I don't have a copy of the titration, but I did look at it and it went up to 11.
Axis A: OSA/Hypopnea Syndrome - Mild (327.23)
Axis B: Polysomnogram (89.17)
Axis C: Obesity
Recommendations:
1. Mild OSA/HS, associated with mild oxygen desaturations and significant sleep fragmentation.
a. PAP tritration
b. Oral appliance or ENT surgical procedures, altho likely less sucessful given the degree of sleep disordered breathing
c. weightloss
No Central or Mixed Apnea indicated; OSA 25 (4.4); Hypopnea 9 (1.6) AHI (RDI) 6.8
Baseline Sao2 96; Desaturation Index while sleeping 13 (2.6); Lowest Desaturation 57
Arousals: N1 1 Apnea; 2 Hypopnea; Spontaneous 25 (36.6)
N2 3 (.08); 1 (0.3); Spontaneous 15 (4.)
N3 (none)
N4 (none
REM (none)
Views: 1108
Replies to This Discussion
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Permalink Reply by Daleen Palmer on
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sleep study report pdf attached
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SSR.pdf, 359 KB
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Permalink Reply by RockRpsgt on
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Please ask specicific questions about the report and I will answer them.
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RockRpsgt,
The biggest thing that I'm searching for an answer on is how did the CPap make me feel so, so ill? What could have happened? ResMed's website said mouthbreathing can cause flu like symptoms but I talked to a clinician at ResMed, and what they're calling flu like symptoms doesn't even come close to how bad I felt.
Then, when I read the report, I see an AHI score of 6.8. It appears to me the problem is the fragmented sleep. A marriage ending in dom violence surfaced PTSD and I'm working EMDR with a psychologist. And, just an FYI, the night I took this test, I took two xanax (I think they were .25's) and herbal sleep supplements - and I felt, that night, I slept well - but not according to the report. When I did the titration study, I took the same regime of meds, and that night I did the very common coming awake over and over and over and over, with night sweats. I had thought, with a CPap mask, I would have relief and not do this.
Last week, with the machine, I defenitely narrowed that waking over and over and over with sweats to sleeping on my back. However, when I slept on my side, with the mask, I still woke with that horrific stupor, elevated bp, nausea, and debilitating fatigue.
Without the machine, I wake fatigued - but nothing like what I experienced with the machine. What could have been happening?
So, per the test, is an AHI of 6.8 really the cause of my fatigue? Is that score indicative of needing a CPap?
My MD referred me to a sleep specialist here in Rockford and they've already called me. They didn't have any consult openings until the end of May, but when I told her what was going on and that I could email her the report, she wanted me to do so and thinks the sleep dr might be able to get me in sooner.
What are your thoughts?
RockRpsgt said:Please ask specicific questions about the report and I will answer them.
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The doctors look at treating any AHI above 5. Do you feel bloated or full of air, or is it an actual sickness when you wake up? Would your doc mind if you tried it without the sleep aids? It's hard to give an answer without actually being the one that saw your sleep. It sounds to me that some of your other issues may be compounding the situation.
What pressure are you on? What mask are you using? Dry mouth in the morning?
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I only felt bloated the morning I had slept on my side. The nauseau felt very familiar as to how I felt when my bp was very, very high three years ago. I think the machine was making my bp worse - I just don't understand. I wondered if the stupor feeling was actually oxygen deprivation. She had my machine set at a 4, although the dr indicated it could go to 11. I had only a nasal mask - she never once asked me if I was a mouth breather. I made it clear to her when I woke with my mouth wide open and did some research, that I am definitely a mouth breather and that's when I asked for the chin strap - that I never got. I can't remember if my mouth was dry but who bronchial tube felt dry. And, I significantly noticed a horrible taste in my mouth - when I would wake in the night, I would get up and brush my teeth it was so bad. By the time I said screw the machine, my tongue had that white coating all over it, like a sick person does. When I slept on my back, I repeatedly woke feeling like I wasn't getting air and would have to lift the mask from my face to see that it actually had pressure. I didn't get this feeling at all on my side.
RockRpsgt said:The doctors look at treating any AHI above 5. Do you feel bloated or full of air, or is it an actual sickness when you wake up? Would your doc mind if you tried it without the sleep aids? It's hard to give an answer without actually being the one that saw your sleep. It sounds to me that some of your other issues may be compounding the situation.
What pressure are you on? What mask are you using? Dry mouth in the morning?
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Why would they not follow the docs orders? That does not make sense. I would call the doc. Let the person that makes the decisions do the job.
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I'm sorry, RockR - this is all a mess.
The clinic owner, my dr, contract the sleep doctor and sleep specialist tech to come from Chicago. The dr never comes and this sleep tech is very trained and has been doing this for 20 years. Why she did not bring a chin strap, or a full face mask, or recalibrate the machine as the clinic dr told me she would, I have no idea. For one, I think she did not like me asking her the question 'what happens when you're using a cpap with a nasal mask and mouth breathing'? I don't think she could answer the question. I have no idea what she's told the sleep dr. I sent an email, so he could read my words. But she told my clinic dr that I said I was having chest pains and he called me from a seminar in Florida! I had to tell him I was not, had never had, nor ever said I was having chest pains! What really frustrates me is that she took the machine - had I known that, I would have removed that memory card so we could see what happened last week. Now, I have to start all over - which still has me perplexed, because if I get a machine from a local vendor, who's going to read the card? That dr in Chicago? My clinic dr told me not to even deal with the sleep specialist tech at all. So, I don't know how this is supposed to work.
Anyways, Rock - those aren't my questions. I'm hoping someone on here can give me a professional interpretation of the report. That is the purpose of my post.
RockRpsgt said:Why would they not follow the docs orders? That does not make sense. I would call the doc. Let the person that makes the decisions do the job.
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You have mild sleep apnea associated with severe arousals and low o2 desaturations. You reached REM which is a good thing. You need a chinstrap. Im not sure what more you are asking. Ask specific questions about the report and I will try to answer.
Daleen Palmer said:I'm sorry, RockR - this is all a mess.
The clinic owner, my dr, contract the sleep doctor and sleep specialist tech to come from Chicago. The dr never comes and this sleep tech is very trained and has been doing this for 20 years. Why she did not bring a chin strap, or a full face mask, or recalibrate the machine as the clinic dr told me she would, I have no idea. For one, I think she did not like me asking her the question 'what happens when you're using a cpap with a nasal mask and mouth breathing'? I don't think she could answer the question. I have no idea what she's told the sleep dr. I sent an email, so he could read my words. But she told my clinic dr that I said I was having chest pains and he called me from a seminar in Florida! I had to tell him I was not, had never had, nor ever said I was having chest pains! What really frustrates me is that she took the machine - had I known that, I would have removed that memory card so we could see what happened last week. Now, I have to start all over - which still has me perplexed, because if I get a machine from a local vendor, who's going to read the card? That dr in Chicago? My clinic dr told me not to even deal with the sleep specialist tech at all. So, I don't know how this is supposed to work.
Anyways, Rock - those aren't my questions. I'm hoping someone on here can give me a professional interpretation of the report. That is the purpose of my post.
RockRpsgt said:Why would they not follow the docs orders? That does not make sense. I would call the doc. Let the person that makes the decisions do the job.
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Thanks, Rock! What causes severe arousals? And, what causes desaturations?
Also, looks to me like REM was only achieved once . . . why? because of the arousals?
Many spontaneous arousals- more than apnea incidences.
It sure looks to me like the significant fragmented sleep is much more the issue than the AHI of 6.8 .
RockRpsgt said:You have mild sleep apnea associated with severe arousals and low o2 desaturations. You reached REM which is a good thing. You need a chinstrap. Im not sure what more you are asking. Ask specific questions about the report and I will try to answer.
Daleen Palmer said:I'm sorry, RockR - this is all a mess.
The clinic owner, my dr, contract the sleep doctor and sleep specialist tech to come from Chicago. The dr never comes and this sleep tech is very trained and has been doing this for 20 years. Why she did not bring a chin strap, or a full face mask, or recalibrate the machine as the clinic dr told me she would, I have no idea. For one, I think she did not like me asking her the question 'what happens when you're using a cpap with a nasal mask and mouth breathing'? I don't think she could answer the question. I have no idea what she's told the sleep dr. I sent an email, so he could read my words. But she told my clinic dr that I said I was having chest pains and he called me from a seminar in Florida! I had to tell him I was not, had never had, nor ever said I was having chest pains! What really frustrates me is that she took the machine - had I known that, I would have removed that memory card so we could see what happened last week. Now, I have to start all over - which still has me perplexed, because if I get a machine from a local vendor, who's going to read the card? That dr in Chicago? My clinic dr told me not to even deal with the sleep specialist tech at all. So, I don't know how this is supposed to work.
Anyways, Rock - those aren't my questions. I'm hoping someone on here can give me a professional interpretation of the report. That is the purpose of my post.
RockRpsgt said:Why would they not follow the docs orders? That does not make sense. I would call the doc. Let the person that makes the decisions do the job.
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The desaturations are caused by breathing events. These events are caused by a muscle atonia(loss of tone). Atonia is a safety mechanism brought on by years and years of evolution that keeps us from acting out our dreams. Atonia is progressive starting at onset and peaking in stage REM when we are parylized from the loss of tone. Right now reading this your airway is like a plastic straw, solid on all sides allowing air to move through freely. As soon as you fall asleep your airway goes from the plastic straw to an old wet paper straw. Remember how they made noise when you blew through them? That's snoring. As you breathe through a flacid airway the sides vibrate and come together at times causing snoring,flow limitations, and/or apneas. Cpap increases the atmospheric pressure in your airway and has a ballooning effect allowing it to combat the loss of tone.
Many things can cause arousals, including breathing events. It is also very possible that your body is reacting to prevent events due to the nature of your o2 levels and desaturations. Both PTSD and the meedicines to help this disorder can cause sleep fragmentation or a disruption in your sleep architecture.
With desats as severe as yours reaching REM once is a good start.
My interpretation of your report(which isn't much as I am no doctor) is much the same as yours. The arousals and the sleep fragmentation seems to be the bigger problem. Sometimes these along with the breathing events are cured with PAP treatment. With those types of o2 desats and heart issues I would not come off of PAP without medical advice. This could be tragic in your case. The most important thing you can do at this time IMHO is find a doc or team that is more available and willing to listen to your needs.
Did you have an in lab titration study?
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Permalink Reply by mollete on
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RockRpsgt said:
You have associated with severe arousals and low o2 desaturations.
Daleen Palmer's report said:Mild OSA/HS, associated with mild desaturations and significant fragmentation.
Mollete asks:
Now I'm confused. Which is it?
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It is also noted in your report that:
Low Heart Rate was 32
High Heart Rate 193
Low Heart Rate was 57Clearly, all these events represent Critical Values which would have required the technician to immediately intervene. Since they did not, and certainly appear to be spurious data relative to the rest of study, they are probably artifact and should have been discarded.
However, they were not, and instead submitted in the report signed by the physician, which now makes them "valid". So what this tells me is that overall this is one sloppy piece of work and makes everything suspect.
So what you need to do is call up Singh and say "Hey Singh, you reported all these horrible events in my study but didn't do anything about it. Either clean it up using crisp interpretation of AASM 2008 or send me the raw data on a disk so I can bring it to a third party expert to do some Interscorer Reliability QA."
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