Results Intrepretation

[GrahamSA]

Hi

I am a new member and would appreciate any help that anyone can offer. I have recently been for another polysomnogram and have been told that I do need to use my cpap machine anymore as my sleep apnea is now rated as Mild. I am not convinced of this assessment and would like your thoughts on the results please.

These are extracts from the original results:

Subject slept for 6.3 hours
Sleep maintenance efficiency was 96.9%
Sleep onset latency was 121.5 minutes
Oxygen saturations ranged from 89% to 96% and averaged 94%

ECG ranged from 52 bpm to 95 bpm and averaged around 68 bpm

NREM / REM

Stage 1: 6%
Stage 2: 75%
Stage 3: 0%
Stage 4: 0%

REM: 19%

Positional Predominance

Back: 6.3 hrs
Front: 0 hrs
Right: 0 hrs
Left: 0 hrs

Events

RD Events: 7.68
Arousals: 165
Snoring events: 101
Desaturations: 25

Assessment

No slow wave sleep
Significant snoring
50 hypopneas recorded, 49 were obstructive
Mild obstructive sleep apnea syndrome A+HI of 7.68
Moderate daytime sleepiness with Epworth Sleepiness scale 9/12

RECOMMENDATION
Weight reduction.
Upper airway assessment
Note that a number of medications the patient is taking may also contribute to daytime sleepiness.

Thank you

[Sleeprider]

I get an AHI of 7.9, but still in that range. Your sleep study points to a sufficient level of sleep disturbance that you may still benefit from CPAP, even if it is marginally not "medically necessary" as the insurance company may see it. You may be able to use your subjective Epworth sleepiness score along with the assessment your sleep is disturbed, as indicated by the lack of state 3 and 4 sleep, to recommend CPAP. This is confirmed by looking at the definition of "clinically significant OSA"

Clinically Significant Obstructive Sleep Apnea Syndrome (OSA)

Clinically significant obstructive sleep apnea syndrome (OSA) is defined as one of the following:

An apneic-hypopneic index (AHI) of 20. (AHI is also referred to as respiratory distress index (RDI); or

An AHI of between 5 and 20 with associated well-documented, excessive daytime sleepiness OR with associated hypertension.

Note: Individuals with an AHI greater than 20 have increased mortality associated with this degree of obstruction. Milder forms of obstruction with AHI between 5 and 20 are considered clinically significant only if associated with a significant history of daytime sleepiness or hypertension.

So in addition to the quantitative AHI, a medical professional should be considering co-morbidities, the way you feel (sleepyness, fatigue), treatment history (the fact you already use and accept CPAP) and any other conditions that might be worsened if CPAP is withdrawn. Your sleep apnea is not in the moderate range (>15), which is all that is required to recommend CPAP. On the other hand, with consideration of other factors, which are part and parcel to the definition, you have respiratory sleep disturbance that may be deemed medically necessary to treat by CPAP, among other options.

Conclusion: You have the right to a second opinion. I encourage you to discuss this with your regular doctor who can consider the entire scope of your health, conditions and medications, along with the data provided by sleep specialists to make a better more holistic recommendation. If you want CPAP, there is no reason it cannot be deemed "medically necessary" within the context of the definition.

[trish6hundred]

Hi GrahamSA,
WELCOME! to the forum.!
You should talk to your doc about this to get his assessment.
Hang in there for more responses to your post and good luck to you.

[Beej]

If you would be comfortable sharing the meds, I can look them up for effects/interactions, etc., unless you already know.

Once upon a time, I worked on a drug hotline, so I'm pretty good at interpreting, plus I've had my own issues with side effects and did some motivated reading after experiencing a seizure and hallucinations from interactions.

[GrahamSA]

Hi Beej

Thank you for reply and the other members that had replied as well.

I suffer from generalized anxiety disorder, and as a result I am on Epitec 100mg twice daily. I do however think that it is not necessarily this drug that is impeding my sleep, but the anxiety that breaks my sleep. This normally happens at 1-2am and then I have broken sleep thereafter. I have done some research and apparently the stress hormone cortisol may be the culprit.

Thank you again

[Beej]

...I do however think that it is not necessarily this drug that is impeding my sleep, but the anxiety that breaks my sleep. ...

I did a web search on the Epitec (lamotrigine). There was a research study in epilepsy patients (https://www.ncbi.nlm.nih.gov/pubmed/10080513), which found that 6.4% "had a sleep disturbance of a severity to required a change in therapy."
Also "the LTG-induced insomnia appeared to be dose dependent."

Depending on how you are doing, and the effectiveness and experiences you've had with this med and others, you may wish to discuss with you doctor adjusting the dose, or considering an alternative. (And if you've tried numerous options and this is the most optimal so far, I understand - I had to go through about 5 different anti-depressants before I found one where I could stay awake and wasn't allergic or intolerant of it!)

Also, there are a variety of stress management/relaxation tools which one may learn and for some, these may be very helpful. They may not fix the GAD; they may, however, help you cope with and survive it.

• relax
  
• progressive muscle relaxation
  
• positive visualization
  
• yoga
  
• self hypnosis
  
• biofeedback exercise - especially helpful if you notice muscle tightness anywhere
  
• massage
  

One of the recommendations is to take a good 20-30 minutes halfway through the day and employ one of these sufficiently to bring down the stress enough that it doesn't build too high by the end of day and make it difficult to relax and then go to sleep.

I was able to use the relaxation breathing on a crisis hotline with a caller who had panic attacks and successfully talk her down enough to be able to help her on a couple of calls. I've also used it myself to get my hands to warm up (Raynaud's)