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[Diagnosis] Sleep test interpretation help (Questioning my diagnosis...)
#11
RE: Sleep test interpretation help (Questioning my diagnosis...)
---EDIT---
Finally got to add the images (pls see attachments)

Hello all, 

I'm new here, hoping to gain more insight into my sleep apnea and overall condition. Thank you in advance!!  [Image: smile.gif]

I was diagnosed with Moderate Obstructive Sleep Apnea last year after an at-home sleep analysis test.  However, I question this, as I feel like I may actually have "Central Sleep Apnea", or OSAHS.  

Very brief summary of my condition: 
  • Chronic Fatigue Syndrome (including post-exertional malaise PEM)
  • Moderate OSA - CPAP didn't improve symptoms at all
  • Autonomic Dysfunction - Major sympathetic dominance during sleep (symptoms pointing to Pure Autonomic Failure, not yet officially tested/diagnosed)
  • Multiple Chronic Infections - EBV, Coxsackie B 2-5, Echovirus 11
  • Orthostatic Hypotension
  • Autoimmune - Hashimoto's and hypothyroidism; also had acute Guttate Psoriasis  
  • Sleep 12hrs/night
  • Unrefreshing Sleep - still tired during day
  • 36yrs old - Very good health (aside from the above of course)
Sleep Test Analysis

Here's my overall, at 24.2 events - "Moderate"

One thing I don't understand is that I have way more Hypopneas than Apneas.  But it looks like they only used the Apnea events to score for "Obstructive" or "Central".  Shouldn't the Hypopneas be classified as well? 

I also found it odd that this test done end of 2019 appears to be using the 2012 guidelines.  Is that just me or does that seem like a really really long time ago.  I am wondering if scoring has changed much since then. 

Here is my sleep test in full.  Would very much appreciate any expert insight on this.


I believe that my sleep issues are related to autoimmunity and autonomic dysfunction.  


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#12
RE: Sleep test interpretation help (Questioning my diagnosis...)
OK your AHI places you in the moderate range, and a PAP is the suggested treatment. They are going to script pressures on a CPAP at 5-20 which is basically a default. I'm sure we can help edit that pressure to be better rather quickly with you using OSCAR to report therapy data.

I would suggest you state that you'd want a ResMed AirSense 10 AutoSet with patient choice for mask and heated hose, and ask doc to include DAW/dispense as written to help prevent PAP machine substitutions.

Note that you had obstructive but you did record a low level of central apnea. Just keep that in mind that the CA needs watched to see how they respond to PAP therapy. I will also suggest if on an AutoSet, you modify pressure settings to 6-20 and add EPR either 1 or 2 not 3 because of the bit of CA. You can choose whatever type mask you prefer, but if you consider pillows then nasal first, they may be more comfortable assuming you don't mouth breathe. If you do then you may need to consider the full face mask. I have a new personal preference to Fisher & Paykel masks, but most any will do as long as you find it comfortable and easy to adjust to have minimal leaks.
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: Sleep test interpretation help (Questioning my diagnosis...)
Cpapnea, do you have any charts from OSCAR? That would be very helpful

Your sleep study appears to be a home study recording airflow, respiratory effort, snore, SpO2, pulse, and sleep position. you had about 12 CA, and about twice as many OA. The hypopnea were extremely numerous at 19.5/hour and there is no way to determine obstructive or central. I'm not familiar with autoimmune or autonomic dysfunction, but it's an interesting theory. I think the snoring points to upper airway resistance and primarily obstruction. Once we see what Oscar is telling us, I bet we will know more than this study tells us.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#14
RE: Sleep test interpretation help (Questioning my diagnosis...)
@SarcasticDave94

Thank you for the response. I do appreciate the recommendations.  Unfortunately, my condition is not a simple one. My sleep issues are just a small part of my overall condition.  

The CPAP machine I don't use anymore, as it does not help.  My sleep apnea and unrefreshing sleep stem from major autonomic nervous system dysfunction with sympathetic dominance.  

I believe I have something called Pure Autonomic Failure.  And that it is due to my multiple autoimmune conditions.  Right now, my money is on having auto-antibodies to Acetylcholine Receptors, possibly Ganglionic (alpha 3) acetylcholine receptors (gAChRs), which would point to me having something called Autoimmune Autonomic Ganglionopathy.  

I will be getting my auto-antibodies results back soon though. Two other types of auto-antibodies I could have include Oxidized LDL (low-density lipoprotein, OxLDL) antibodies, and Anti-IgLON5 antibodies. Both of which can cause major sleep problems. 

Hopefully, I can learn more about the Sleep Apnea aspect to further along my research, and get me closer to curing my Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 

@Sleeprider
Thank you. I do not know this Oscar, but I do like free charts.  Jk... so what, does that connect with my CPAP machine?  I'm definitely down to gather more data. 

I am quite shocked that this forum is unaware of autonomic dysfunction, and the autoimmune aspects of sleep disorders.  Also shocked that there isn't a single mention of "IgLON5" (after searching).
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#15
RE: Sleep test interpretation help (Questioning my diagnosis...)
OSCAR is the free software most of us use to interpret efficacy. It allows you to scan data as well as get up close and personal, like a breath by breath basis. You load it on your computer or laptop, and use the SD card from your machine to see the data. Every Resmed but the CPAP writes efficacy data that is converted to easy to read charts. The information in there, will probably tell us why your machine did not work for you. Frankly, I don't see a path for you to get the answers you are looking for without it.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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