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[Diagnosis] Finally had my first Sleep Study! How bad am I?
#11
Mine was 114 for my sleep study. 30 days into the journey and the average is now around 1.5. XPAP will be your best friend for how you can feel after.Sleep-well
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#12
@MCaswell: The biPap is new to me... what was your reason for getting one? Are they superior to a CPAP in some cases? If so, which ones? Thanks! :-)
-Ailu
Reformed CPAP Outlaw
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#13
Diagnostic 70% oxygen desat is very bad. Be concerned.

Have you had an in-lab CPAP titration performed?

If so, they should be able to titrate you to a pressure where your lowest Sp02/Sa02 is >90% and RDI is <5.0 in REM sleep while supine. Supplemental oxygen may or may not be required.

According to the Clinical Guidelines, if that titrated pressure exceeds 15cm they might've switched to a BPAP.

RDI is the number they go by to determine severity of condition. If your overall RDI is 16 you don't have severe apnea (except, of course, while supine). RDI is AHI + RERAs (if applicable). My understanding is that you are averaging only 16 events an hour.

Suggest that you not only get a copy of the study but also a copy of the Sleep Doctor's REPORT on that very study- should be a separate doctor's (not technologist's) report.

Following chart contains my titration in the split-night study where 12cm was determined to be the optimal pressure. My Sa02 minimum did not exceed 90% until at that level of 12cm, though RDI/AHI was perfect at 9cm and above:

[Image: 8932ffad-1373-4835-8e9e-005ab489b133_zpscula7hy8.jpg]



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#14
(06-08-2015, 11:02 PM)Sleepster Wrote: What does your doctor want you to do next?

Sorry i missed this question earlier, Sleepster! My answer below....

(06-09-2015, 12:20 PM)tedburnsIII Wrote: Diagnostic 70% oxygen desat is very bad. Be concerned.

Have you had an in-lab CPAP titration performed?

This is my first study. They did not end up doing a split study because everything did not break lose until I went into REM late into the night. My non-REM index was only 11.2, but my REM index was 47.2! And I only went into REM 14% of the sleep time. So it really brought down my overall number.

But because of the drastic apnea and oxygen desaturation experienced during REM, my sleep doctor recommended a follow up Titration study. Already got the appt booked! And I'm on their cancellation waiting list in hopes I can get in even sooner!

But the low oxygen during REM explains why I am always having dreams about water & drowning! Shock-2

What do you guys make of the extremely low oxygen? Both times when I got down to 70%, I was lying supine, and was in REM. Apparently I went over 114 seconds without taking a breath. Also I have had neurological issues in the past...
-Ailu
Reformed CPAP Outlaw
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#15
(06-09-2015, 02:14 PM)Ailu Wrote: What do you guys make of the extremely low oxygen? Both times when I got down to 70%, I was lying supine, and was in REM. Apparently I went over 114 seconds without taking a breath. Also I have had neurological issues in the past...

At this point? Don't worry about it, just react to the situation -- which you are doing. You will be fine.

Do take some preliminary steps to help with that "fine-ness" in between now and when you actually start using a machine:

1. Do not sleep on your back. Or, if you're going to do that, raise the head of the bed substantially. How much? At least to the point where you can look down and count the little piggies on your foot. Too much? When it gets to a point that you plummet off the end of the bed in the middle of the night landing unceremoniously on top of the cat, which takes great offense to the event, and expresses her displeasure awakening everyone in the house if not the entire neighborhood.

2. If you can't fix your bed as described in number 1 (above) then find a nice comfy chair where you can sleep.

All will be fine, but you can do quite a lot to help it become fine by just working a little with your sleep positions.
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#16
(06-09-2015, 02:43 PM)retired_guy Wrote:
(06-09-2015, 02:14 PM)Ailu Wrote: What do you guys make of the extremely low oxygen? Both times when I got down to 70%, I was lying supine, and was in REM. Apparently I went over 114 seconds without taking a breath. Also I have had neurological issues in the past...

At this point? Don't worry about it, just react to the situation -- which you are doing. You will be fine.

Do take some preliminary steps to help with that "fine-ness" in between now and when you actually start using a machine:

1. Do not sleep on your back. Or, if you're going to do that, raise the head of the bed substantially. How much? At least to the point where you can look down and count the little piggies on your foot. Too much? When it gets to a point that you plummet off the end of the bed in the middle of the night landing unceremoniously on top of the cat, which takes great offense to the event, and expresses her displeasure awakening everyone in the house if not the entire neighborhood.

2. If you can't fix your bed as described in number 1 (above) then find a nice comfy chair where you can sleep.

All will be fine, but you can do quite a lot to help it become fine by just working a little with your sleep positions.

Agree with above.

Ailu- you seem intelligent and on top of your situation and I am confident that you will get a handle on everything that ails you.

Glad to hear that you'll be going in for a separate titration study. If they follow the Clinical Guidelines, you will be placed on your back and hopefully they'll titrate you in REM. This accounts for worst-case scenario.

If you are concerned about not sleeping through the titration suggest that you take a mild sedative- I doubled up, though. I sedated myself and many others have as well- no regrets. I would do it again- not a masochist and I want my titration to work out splendidly as it did previously. My double-dosage amounted to only 2.5mg diazepam and 10mg Zolpidem. Just be careful, though- consult with your doctor if necessary.

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#17
@Ailu - welcome. Those are some pretty normal numbers. But some abnormalities stick out. Before we talk about these, let's be clear - you are OK, need therapy, and will benefit from it. If any of the remaining discussion scares you, calm down, because you are over-reacting.

The things that are a little abnormal, and suggest you may be in store for harder transition that many of us, are:

1. You had central apnea (CSA) (in addition to OSA). registering CSA without any pressure therapy is an indication that you may have a CNS (central nervous system) disorder. In short, there is no obstruction, you/brain/body just decides not to breathe. Standard CPAP is not an effective treatment for CSA, but there are other machines that can treat this (like ASV)

2. You had apneas in much greater number during REM, and possibly in REM transition typical of SUS (startled-upon-start). This can (and sounds like it does) corrupt your REM sleep and effectiveness. It can be caused by CNS issues or the OSA (obstructive sleep apnea). If OSA is causing this, then the standard CPAP should restore you to a normal REM sleep period.

3. You had neurological disorder. This could influence your CNS (central nervous system) and it's control mechanisms for breathing.

A lot of information will come from the titration study.

retired_guy is right on with what you can do in the interim to reduce the onset of apneas due to sleep position. Side sleeping and elevation of head may partly resolve your shattered REM sleep.

Good Luck - you ARE on the right course!

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#18
QAL, thank you so much for your reply! You really helped me understand what is going on. And I really do believe, from the way I wake up gasping for air sometimes, that my nervous system is not telling my body to breathe.

BTW - I scanned my sleep study and uploaded it on another post:
May 2015 Sleep Study

Titration scheduled for tomorrow night! Can't hardly wait! Banana

(06-11-2015, 02:59 PM)quiescence at last Wrote: @Ailu - welcome. Those are some pretty normal numbers. But some abnormalities stick out. Before we talk about these, let's be clear - you are OK, need therapy, and will benefit from it. If any of the remaining discussion scares you, calm down, because you are over-reacting.

The things that are a little abnormal, and suggest you may be in store for harder transition that many of us, are:

1. You had central apnea (CSA) (in addition to OSA). registering CSA without any pressure therapy is an indication that you may have a CNS (central nervous system) disorder. In short, there is no obstruction, you/brain/body just decides not to breathe. Standard CPAP is not an effective treatment for CSA, but there are other machines that can treat this (like ASV)

2. You had apneas in much greater number during REM, and possibly in REM transition typical of SUS (startled-upon-start). This can (and sounds like it does) corrupt your REM sleep and effectiveness. It can be caused by CNS issues or the OSA (obstructive sleep apnea). If OSA is causing this, then the standard CPAP should restore you to a normal REM sleep period.

3. You had neurological disorder. This could influence your CNS (central nervous system) and it's control mechanisms for breathing.

A lot of information will come from the titration study.

retired_guy is right on with what you can do in the interim to reduce the onset of apneas due to sleep position. Side sleeping and elevation of head may partly resolve your shattered REM sleep.

Good Luck - you ARE on the right course!

QAL

-Ailu
Reformed CPAP Outlaw
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#19
Ailu-

I think it's great that you are having a lab CPAP titration done, inasmuch as you suffer from hypoxia.

For that reason, I don't see where a CPAP machine titration on one's own would be of benefit due to your hypoxic condition, unless a pulse oximeter were attached.

Don't be surprised if your RDI is <5 at lower pressures- sleep lab should titrate you up from there to get to minimum Sa02/Sp02 of 90% to the OPTIMAL pressure, in accordance with Clinical Guidelines.

I sedated myself throughout the split-night study. Here you will have a full night of titration. You might want to consider doing such sedation because lying awake with the mask on will not be beneficial, and you might find the mask to be foreign and uncomfortable at first.

Best wishes!
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#20
Thanks Teddy! Because of previously reading this advice on the forum (probably a post by you) I decided to take lorazepam with me on my initial sleep study. At first, I tried to sleep without it. But after 30 minutes, I realized resistance was futile, and caved in. Eight minutes after taking the pill, I was out cold. So for the titration study today, which will certainly be even more stressful, I am going to take it right from the get-go! Sleep-on-pillow

(06-11-2015, 04:12 PM)tedburnsIII Wrote: Ailu-

I think it's great that you are having a lab CPAP titration done, inasmuch as you suffer from hypoxia.

For that reason, I don't see where a CPAP machine titration on one's own would be of benefit due to your hypoxic condition, unless a pulse oximeter were attached.

Don't be surprised if your RDI is <5 at lower pressures- sleep lab should titrate you up from there to get to minimum Sa02/Sp02 of 90% to the OPTIMAL pressure, in accordance with Clinical Guidelines.

I sedated myself throughout the split-night study. Here you will have a full night of titration. You might want to consider doing such sedation because lying awake with the mask on will not be beneficial, and you might find the mask to be foreign and uncomfortable at first.

Best wishes!
-Ailu
Reformed CPAP Outlaw
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