Please help me interpret this in-lab study

[gaydolphinorgy]

My doctor basically told me I have insomnia and that these results are inconclusive because I had somewhat elevated RDI in REM but only got 28 minutes of REM sleep, and because this is not representative of how I normally sleep (which is sleeping throughout the night without waking up for 3 hours as I did in this study).

Please help me interpret this. I am wondering if this indicates UARS? What are "spontaneous microarousals" (page 3 Microarousal Analysis)?

They also said other measures would be included but it's not in the report. I've asked them to send me the raw data but they haven't responded. This is my second test, with my first one (a home-based one) a complete distaster - only 2 hours of sleep.

I have had unrefreshing sleep for years and have chronic fatigue and TMJ.

Thank you.

[Sleeprider]

The study summary lacks any respiratory flow details that would enable interpretation of of UARS. Your long period of wakefulness in the middle of the night is not indicative of insomnia, but may simply be an intolerance of the clinical sleep environment. From personal experience this is not unusual. The flow events chart show that flow restrictions are not correlated to PLM and flow events, mainly hypopnea, are highly clustered. We often see the same pattern in the flow charts of individuals using CPAP therapy and have associated these clusters with positional apnea or chin-tucking where episodes of obstruction occur due to "chin-tucking" or similar physical obstruction of the airway. These obstructions cause arousals which in turn result in movement to a position where freer respiratory flow occurs. If we saw persistent, low-level obstruction or airway resistance then UARS is more likely, however we prefer to see the detailed flow charts to draw better conclusions. Take a look at our wiki on "positional apnea" and follow links to the Soft Cervical collar wiki if you are interested in how we often treat the problem. http://www.apneaboard.com/wiki/index.php...onal_Apnea

If you suspect UARS but don't qualify for NHS issuance of a CPAP or bilevel machine, this article describes how bilevel positive air pressure helps with mitigating UARS http://www.apneaboard.com/wiki/index.php..._and_BiPAP

[gaydolphinorgy]

Thank you for your response. I have another study with flow information. Please could you help me interpret this?

[Sleeprider]

Overall mild obstructive sleep apnea with clustered hypopnea events. These results fall within normal parameters and would not be classified as sleep disordered breathing for the purposes of medical necessity of CPAP treatment. There is a persistent flow limitation which is defined as inspiratory flattening index greater than 0.15, and this would be an indication of grater respiratory effort and potential for respiratory effort arousal. Your worst desaturation occurred while on your right side at 07:00, and I would bet this was in a position with the chin deeply tucked.

Elective CPAP may help with obstructive events and flow limitation, however in my experience, the Philips CPAP algorithm will be much less effective than Resmed with EPR and Easybreathe™, or bilevel therapy to directly treat flow limitation. Improvement could be expected in AHI and flow limitation by use of a soft cervical collar that prevents cervical flexing and associated events, desaturation and flow limits.

[gaydolphinorgy]

Thank you. So you’re saying that despite not meeting the medical criteria for needing a PAP machine I should get one anyway? Like the Resmed BIPAP? What about ASV? Do you think the cervical collar without PAP could be sufficient and where can you find it?

[Sleeprider]

Your need for PAP of any kind depends on how your feel and whether you think opening up your airway and possibly assisting inspiration is something you want to invest in at your own cost. You do not have clinical sleep apnea and insurance is a long-shot option. If you are looking for a solution to inspiratory flow limitation and the resulting relatively low level of arousals, and hypopnea, then a device with some bilevel pressure is preferred. You do not need, and would not likely benefit from ASV as it can be more disruptive than the problems you experience. The ideal machine may be the Resmed Aircurve 10 Vauto, and the Resmed Airsense 10/11 Autoset would be a very close second with up to 3-cm of pressure support (EPR). Your condition will likely increase as you age, and especially if you gain weight. Lifestyle and fitness are the best short-term options, however bilevel PAP may improve sleep quality and alertness.

[gaydolphinorgy]

Alright thanks. So if I get the BIPAP on my own without a doctor, how would I know how to titrate it? And im guessing the cervical collar would not be enough?

The ENT surgeon told me that a PAP would be useless for UARS because of the anatomical feature that distinguishes it from regular apnea…

Also is it true that if you have congestion then PAP is useless? I’ve always had bad congestion of nose and sinuses.

[gaydolphinorgy]

Also, why would ASV be more disruptive? I was reading that ASV is preferable to BIPAP: https://sleepbreathe.org/response-to-sle...krakow-md/

(Sorry, there is no option to edit my previous post)