Results from my sleep studies. Aaaaaagh! Help!
Question:
I finally got hard copies of my sleep study results from January and February. Here’s the basics (full results at end of post): ——————— Initial sleep study: AHI: 51 Arousal index: 63 Apneas: 104 (100% central) Hypopneas: 85 (100% obstructive) SatO2: 93% average, 85% minimum. Sleep efficiency: 50% Sleep time: 221 minutes Stage III/IV sleep: 3% REM: 13.3% ——————— Titration Study: AHI: 41 Arousals index: 77.3 (!!!) Apneas: 77 (100% central) Hypopneas: 48 (100% obstructive) Sleep efficiency: 40% Sleep time: 184 minutes Stage III/IV sleep: 0.5% (!!!) REM: 0% (!!!) ——————— I’d love to know what you think. I have a few particular concerns: 1) All hypopneas (~50%) are shown as obstructive in nature. All apneas (~50%) are shown as central in nature. Can this be right? I’m really concerned about the central apneas. 2) Lowest AHI achieved was 18 during the titration. It appears they tested me at 2, 3, and 4cm and finally prescribed 6cm. 3) Doctor prescribed Klonopin for RLS and "improved sleep density". When I expressed concern that might make the apnea worse he told me the CPAP would protect me from that. I tried the Klonopin and while at full dosage it improved my sleep density I would be wiped out and dizzy the next day and literally could barely function. Tried dropping dose down to 0.25mg and finally stopped taking it. 4) Apneas were reduced by 2/3 during REM sleep. Isn’t this backwards? Studies in PDF format at http://www.geocities.com/mikecccccc/sleepstudy.pdf (500kb) Initial Sleep Study ————————– Total sleep time: 221 minutes (damn lab setting!) Sleep Efficiency: 50% Sleep Onset: 137 minutes REM Latency: 251 minutes Stage I: 9 minutes 4% Stage II: 175 minutes 7% Stage III/IV: 7 minutes 3% REM: 30 minutes 13% Arousals: 231 Awakenings: 0 (???) Arousals Index: 63 Apneas, Total: 104 Index 28.2 Hypopneas, Total: 85 Index 23.1 Events (A+H): 189 Index 51.3 AI NREM: 33 AI REM: 0 (!) AI Total: 28 (How is this less than AI NREM?) HI NREM: 25 HI REM: 8 HI Total: 23 (Again… huh?) AHI NREM: 58 AHI REM: 8 AHI Total: 51 Movement Summary (PLMS/Total) —————————— Jerks: 16/38 Jerks w/ Arousal: 8/20 Jerks w/ Awake: 0 Jerks, no Arousal: 8/18 Jerks, Non REM: 16/36 Jerks, REM 0/2 EKG Summary (no idea what any of this means) —————————— 30-59 60-79 80-99 100-119 126 283 32 1 Various Graphs —————————— Sa02 graph which shows an average of 93% saturation with a few dips down to as low as 85%. Heart-rate which shows between 60-110 beats per minute with prolonged stretches above 90 (which seems a bit high to me) and closer to 60 during stage II sleep. Arousals chart which shows a vertical line for every arousal. Areas are nearly solid black most places during sleep. Obstructive apnea chart shows two OAs at the onset of sleep and two in the middle for 4 total. Obstructive hypopnea with ticks throughout the night accounting for about 50% of the total arousals. MA and MH charts which I assume are mixed apneas and hypopneas totally blank. Central Apnea chart which ticks through the night accounting for about half the total arousals. Central Hypopneas chart totally blank. Isolated leg movement chart showing about 26 events scattered but mostly in the second half of my sleep. PLMS chart showing intense PLMS activity from about 3:58 to 4:12am Titration Sleep Study —————————— Physician’s interpretation: 31 yo male with OSA and insomnia The PSG of 1/16/04 showed OSA RDI- 51 #189 with nadir desat to 85% with PLMS and fragmented sleep. This PSG with CPAP was little different with poor sleep and restless ness but O2 protection and reduced OSA Best cpap was not achieved but he tolerated CPAP 5cm PLM acted at a rate of 18/hour but REM was eliminated during titration RECOMMEND NasalCPAP at 6cm Klonopin 1mg at HS for PLMs regularly to improve sleep density and improve CPAP tolerance OSA 780.53-0 PLMs 780.52-4 Hypoxia 799.0 Chart —————————— Shows apneas and hypopneas for each pressure attempted cmH20 | Time | Apn | AI | Hyp | HI | AHI | Ar+Aw Ar+AwI ——-+——-+—–+—-+—–+—-+—–+——-+—– 2 30.5 22 43.3 8 15.7 59.0 48 94.4 3 49.5 32 38.8 21 25.5 64.2 62 75.2 4 104.0 23 13.3 19 11.0 24.2 127 73.3 Sleep Summary —————————— Total sleep time: 184 minutes Recording time: 458 minutes Sleep Efficiency: 40% Sleep Onset: 45 minutes Stage I: 22 minutes 12% Stage II: 161 minutes 88% Stage III/IV: 0 minutes REM: 0 minutes Arousals: 237 – 77.3 index Awakenings: 0 Apneas, total: 77 – 25.1 index Hypopneas, total: 48 – 15.7 index Events (A+H): 125 – 40.8 index Apnea index NREM: 25 Apnea index REM: 0 (duh, no REM) Hypopnea index: 16 SaO2 98% @ 89-100% O2 2% @ 80-89% O2
Response:
On 22 Apr 2004 20:24:01 -0700, EtherGnat pontificated at length: >I finally got hard copies of my sleep study results from January and >February. Here’s the basics (full results at end of post): >4) Apneas were reduced by 2/3 during REM sleep. Isn’t this backwards?
Typically but there’s always exceptions to the rules. >EKG Summary (no idea what any of this means) >—————————— >30-59 60-79 80-99 100-119 > 126 283 32 1
They recorded your heart rate as you slept and divided it into N samples… then did a summarization of the rates. You had very little tachycardia (rate >100). OTOH, I was swinging from 40 bpm to 150 bpm. — "So many sneakers, not enough feet." http://sneakers.pair.com/
Response:
Have been treated for PLMS for 7 years. Just had another study. Mild apnea. I jerked violently for quite some time midmorning but in my semisleep state they called it being awake so did not consider the movements PLMS or note them on report. Was not being taped so can’t prove what I know to be fact. But from my experience, your formal results may not be a true reflection of PLMs. Before being diagnosed for this, I was being tested for rheumatoid arthritis and various neuro muscular problems due to chronic pain, and finally given label of "fibromyalgia". Treatment for PLMS cured my muscle & joint pain – so much for fibromyalgia! Unfortunately, medications still have a ways to go for long-term effective treatment.
